An Assessment on the Capacity of Health Facility Staff in Implementing Strategic Management Practices for Active TB Case Finding in Nairobi, Kenya

Abstract

Tuberculosis (TB) is a contagious disease caused by the bacteria Mycobacterium tuberculosis. This bacterium primarily targets the lungs but can also affect other body parts, including the kidneys, spine, and brain. TB spreads through airborne droplets when an infected person coughs, sneezes, or even breathes. Symptoms of TB include a persistent cough, fever, chest pain, fatigue, night sweats, and loss of appetite. TB remains one of the most widespread infections globally and continues to be a significant cause of illness and death. In 2019, the World Health Organization (WHO) reported that 10 million people contracted TB, resulting in approximately 1.2 million deaths. Additionally, the Centers for Disease Control and Prevention (CDC) highlighted that around 3.6 million people with TB go undetected annually, thus not receiving the necessary care. Effective TB management requires strategic planning, including setting clear goals based on comprehensive assessments, prioritizing TB screening and detection, focusing on high-risk groups, and implementing appropriate screening and diagnostic methods. Despite these efforts, active TB case finding faces several challenges. These include diagnosing extrapulmonary TB, executing healthcare plans, delivering healthcare, and addressing patient obstacles. Healthcare facilities also struggle with community delays in seeking care, insufficient awareness among healthcare professionals, financial barriers, inadequate training, staffing shortages, and community stigma. The study aimed to assess the capacity of health facility staff in Nairobi County to implement strategic management practices for active TB case finding. This study utilized both quantitative and qualitative methodologies. Structured questionnaires were used for quantitative data, while focus group discussions and open-ended questionnaires provided qualitative insights. The target population consisted of 3,290 individuals, including 2,604 healthcare workers and 686 non-health technical staff across healthcare facilities in Nairobi County. During the study period from April to June 2024, 406 respondents, representing an 81% response rate of the targeted 501 healthcare workers at 239 TB treatment sites in Nairobi, were reached. Most respondents (86%) reported receiving specialized training in TB case finding, indicating a proactive approach to skill development. However, 14% had not received such training due to various reasons like not having started training yet or staff shortages. Training modalities included Continuing Medical Education (CMEs), on-the-job training, virtual training, and didactic training. On-the-job training was rated the most effective (4.5 out of 5), followed by CMEs (4.4), with virtual and didactic trainings receiving lower ratings (3.7 and 3.5, respectively). Addressing skill gaps was a priority, with 94% of respondents relying on on-the-job training, 74% on specialized capacity-building training, and 69% on mentorship strategies. Regular training, often conducted quarterly, demonstrated a commitment to ongoing learning. Strategic management training covered various aspects from TB case finding protocols to leadership and project management, reflecting a comprehensive approach to workforce development. High self-rated skills in clinical assessment (4.6), communication with patients, and teamwork (both 4.5) validated the effectiveness of the training. However, logistical challenges and staffing shortages still hindered some training efforts. The study recommends developing and implementing structured mentorship and continuous professional development programs, utilizing both in-person and remote methods. Ensuring all health facility staff have ongoing access to specialized TB case management education will address logistical challenges and staffing shortages, enhancing clinical capacity and effectiveness in TB case finding and management