Challenges of Directly Observed Treatment Strategy implementation in eThekwini Municipality, South Africa

Abstract

EThekwini Municipality in Kwazulu-Natal, South Africa has a high prevalence of Tuberculosis (TB) and reported a defaulter rate of 18.9% in 2007, in spite of the Directly Observed Treatment Short Course (DOTS) which was adopted in 1996. While numerous quantitative studies have evaluated aspects of the DOTS programme in South Africa, there are limited qualitative data on this issue. The aim of this study was to determine the challenges associated with the implementation of the DOTS programme in the eThekwini Municipality. Five participants, who were all involved in TB management and control within the municipality, were interviewed. Textual data were content analysed. Three themes relating to healthcare personnels’ reports on the challenges associated with implementing DOTS in the municipality emerged from the inductive analysis of transcripts namely; inadequate follow up and tracing of patients, training of health care personnel and choice of DOTS supporters and DOTS sites. In spite of the eThekwini Municipality’s commitment to TB control and management, problems with implementation of DOTS persist. Communication, reporting and co-ordination between the different levels of the TB programme are essential to optimise patient benefit from both the TB programme and community or home based care.