Strategies for optimisation of the quality of tuberculosis care services in public health centres of Addis Ababa, Ethiopia

Abstract

Optimising the use of existing tools and improving the quality of care, which has been a missing ingredient in TB care services, could prevent half of all TB deaths (Pai & Temesgen 2019:12-13). The purpose of this study was to develop strategies for the optimisation of the quality of TB care services. A convergent parallel mixed-methods design based on pragmatism paradigm was employed. The research was done in two phases. The first phase of the study included quantitative and qualitative parts that described and explored the quality of TB care services from the perspectives of TB patients and healthcare providers respectively. The findings were used as evidence in the development of strategies. Sampling design was applied and aligned with the methods used within the mixed-methods design. Quantitative data were collected from 441 TB patients using a questionnaire. This represented a 97% response rate. Descriptive and logistic regression analysis were done using Epi Info and SPSS software. Qualitative data were obtained through in-depth interviews with 10 healthcare providers using an interview guide. Data were transcribed and thematic analysis was employed using Atlas ti software in the second part of phase one. The quantitative and qualitative findings were integrated and used as the basis for the development of strategies. Six major thematic areas were identified. It was possible to align the six thematic areas with the Donabedian model. Strategies, actions relevant to the strategies and rationale of the strategies were proposed under each identified theme. The interim strategies were validated by a purposively selected 13-member panel of experts in two rounds of Delphi technique and finally 11 strategies were approved. The study identified the need to provide integrated, comprehensive, competent, and patient-centred quality TB prevention, diagnostic and treatment services in the health centres.