TB KaSPar
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Countries may have DSD policies in place, but children, adolescents and people living with HIVassociated TB are often excluded. DSD has primarily focused on people living with HIV who are established on ART (79). It is therefore important that the NTP works closely with the national HIV programme to ensure children and adolescents are able to access these patient-centred approaches.
Engaging health care providers within the private sector aims to improve access to TB care and treatment for people who prefer to seek care within the private setting, including children and adolescents (174).
In most low- and middle-income countries, private providers are an important source of health care for the whole population. Typically, less poor people make more use of formal, qualified providers, while poor people often turn first to informal, unqualified providers. Private providers often account for 50–70% of care, especially outpatient primary care (175).
In many high TB burden countries, the majority of missing people with TB, including children, seek treatment from private providers or other care providers not linked to the public sector at least once (174). The private sector is also a common point of care for children presenting with common illnesses, such as cough, fever and diarrhoea, especially in countries with a large private sector (175).
Health care facilities that offer TB services should have access to supplies for sample collection such as nasogastric tubes, spatulas and specimen containers, and access to child-friendly formulations of TB medicines. Sample referral systems need to be established if access to mWRDs is not available on site (76).
Decentralization of health services requires decentralization of health information systems including capacity-building among staff responsible for data collection and analysis. The use of NTP recording tools (such as contact investigation, TPT and treatment registers) may need to be evaluated and enhanced, including through operational research.
The availability of regulatory frameworks and policies that support the implementation of decentralized and integrated TB services is key to bringing TB services closer to children, adolescents and families and to creating and sustaining ownership and accountability at the national and subnational levels. The NTP, in partnership with other programmes, needs to review the existing health care structures and identify opportunities for decentralization and integration of TB services, or components thereof.
The NTP could consider conducting stakeholder consultations (including relevant programmes such as maternal and child health, HIV and nutrition, national paediatric associations, other professional bodies and the national regulatory authority) to identify opportunities and strategies for decentralization and integration of services and to address health system challenges that might hamper implementation. This could be done through an existing child and adolescent TB technical working group or another relevant platform.