The Malawi National Tuberculosis Programme: an Equity analysis

Abstract

Background: Until 2005, the Malawi National Tuberculosis Control Programme (NTP) has been implemented as a vertical programme. However, in the first half of 2005 the NTP reoriented its planning, approach and budgeting in line with the Sector Wide Approach (SWAp). Monitoring of equity performance of the programme requires synthesis of baseline information on TB programming, access and development of strategies to promote equity.
Methods: A consultation was undertaken with key stakeholders on critical equity issues in tuberculosis (TB). The results are situated within a synthesis of reports and studies on equity and access to services. An additional analysis of routine data enabled a national overview of access to TB services by socio-economic status to be created.

Results: TB cases have increased rapidly. This increase has been attributed to HIV/AIDS. Although there is no TB prevalence data, the WHO estimates that only 48 percent of TB cases are detected in Malawi. Equity analysis of routine data highlights a lower utilisation of TB services by populations with limited access to health facilities. The complexity of TB diagnosis requires repeated visits, long queues, and delays in sending results. This reduces the Poor\'s ability to access and adhere to services. The costs of seeking TB care are high for poor women and men - up to 240 percent of monthly income as compared to 126 percent of monthly income for the non-poor.

Conclusion: The NTP has attempted to be responsive to the needs of different social groups, for example through the development of interventions in prisons, decentralisation of treatment and piloting of community based activities to improve equitable access to services. The Programme of Work which is being delivered through the SWAp is a good opportunity to enhance equity and pro-poor health services. The major challenge is to increase case detection, especially amongst the poor, where we assume there are many ‘missing cases\'. In addition, the Programme needs a prevalence survey which will promote service access amongst ‘missing\' women, men, boys and girls.


Malawi Medical Journal Vol. 18 (1) 2006: pp. 13-18