The prevalence of tuberculosis among population: The disease total estimations in Sudan were 200,000 cases with 200 new infections annually include 1.9% Multi-Drug-Resistant Mycobacterium tuberculosis and 20.0% of them were previous treated patients (Figure 1). Using World Health Organization Sample Size Calculator, the final sample size = 0.015 for all Eastern States (Appendix A 1,2).
Figure-1: National tuberculosis infections baseline
Management of mobile health intervention:
Management of mobile clinic: Clinic Management Systems to give complete end to end solutions to clinics that are looking for administrative support along with Record Management. The Clinic Management System is focused on bringing in efficiencies into the mobile clinics by streamlining Appointment management, Registration and follow up along with maintaining electronic records for all TB patients. The system was ensuring collection of appropriate data to be able to present dashboards to the key users with a focus on improving clinical and operational efficiencies and reducing costs.
B) Management of mobile laboratory: Simple laboratory tests such as microscopy, ICTs blood tests, hemoglobin estimation and urine examination are carried out at camps by regular moving of laboratory with its technicians. The clinics received referrals from the laboratory technicians for the management of medical and surgical emergencies and making etiological diagnosis quick and correct.
C) Management of mobile Pharmacy: Quick delivery of health services including treatment and vaccinations attuned to the needs of patients in different area. Monitoring of patients’ health and their outcomes: An important benefit of the project drug delivery is derived from observations that tuberculosis patients at the boarders are suffering from lack of medical services than others.
Management of communication network: include coordinate with others. Interagency and interpectoral coordination should be established to ensure comprehensive care for community.
Conduct orientation meetings with community leaders; include representatives of social and community services, protection, the police or legal justice system, and security. Depending on the services available in the particular setting, others may need to be included. As a multi-sectoral team, establish referral networks, communication systems, coordination mechanisms, and follow-up strategies as shown in (Table-1).
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Implementation of service delivery plan: Implement solutions determined in the Improve stage. Comprehend both technical as well as any business process related changes. Implement a comprehensive ‘Change Management’ plan to ensure that all stakeholders are appropriately trained.
Data Control Measurement: Verify at periodic intervals that the data is consistent with the business goals and the data rules specified in the Definition Step. Communicate the Data Quality metrics and current status to all stakeholders on a regular basis to ensure that Data Quality discipline is maintained on an ongoing basis across the organization as declared in (Table-2).
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* Data Quality is not a onetime project but a continuous process and requires the entire organization to be data-driven and data-focused. With appropriate focus from the top, Data Quality Management can reap rich dividends to organizations.
Implementation Research Outcomes: The conceptual framework for this project was informed by a combination of the general program logic model, the health system framework of the World Health Organization, the pillars of the Sudan health agenda, and the framework of the Strategic Elimination Plan. It is posited that the reduction of TB burden at the national level (long-term output or impact) is preceded by improved case-finding and case-holding practices (short-term output).
Figure-2 Innovative strategies for developing tuberculosis framework.
Medical intervention and quick response: These, in turn, require the following inputs and activities: (i) delivery of health services that are consistent with accepted standards, but are also attuned to the needs of the local population; (ii) availability of human, material and financial resources to support program implementation; (iii) evidence-informed decision making; (iv) exercise of administrative oversight, and presence of support from policy-makers and local stakeholders; and (v) effective partnerships that harness contribution from the other government agencies, private sector and civil society.
Acceptability: Perception of local policy-makers and decision-makers on their agreement to the TB prevention and control program as cascaded by the national government (and development partners, as applicable).
Appropriateness: Perception of local policy-makers and decision-makers on the relevance to their local context of the TB prevention and control program as cascaded by the national government (and development partners, as applicable).
Fidelity: The consistency and quality of the intervention’s implementation was implemented as intended due to major plan and conceptual framework (Figures-2, 3)
Feasibility: Perception of local policy-makers and decision-makers on the practicality of implementing the TB prevention and control program as cascaded by the national government (and development partners, as applicable). For purposes of the implementation research, the acceptability, appropriateness and feasibility of the package of interventions for TB prevention and control as provided by the national government from the local policy-makers shall be considered as among these potential driving or restraining forces.
Implementation research outcomes
Socio-(economic, politics, cultural) impact outcome: An important benefit of the project is derived from the observation that tuberculosis is much more common in boarders than center of Sudan where no clinical services. It is conceivable that, although outbreaks may occur periodically, the control of disease might be easier to overcome than direct medication.
Figure-3: Conceptual Diagram ©Elshayeb 2018
Direct health impact outcome
Changing the regular health policies and the prevention approach have great benefits in poor communities. Another obvious outcome is the increase of patient’s outreach, treatment and vaccination from 25% up to 75% in Dordabe locality Eastern Sudan
Beneficial impact outcome
Developing implementation strategy for elimination and eradication of Tuberculosis has stimulated funds from national and (expected international) relevant organizations and academia.
Future Prospects
- Development of future management systems could offer powerful tools for disease management within wider strategies of control
- The Project is an attempted a grand challenge to identify future risks from tuberculosis across Sudan and neighborhood.
- Implementation of a new research study and technology that might reduce such risks.
- Development of alternative therapeutics technology platform against MDR tuberculosis using novel methods for the targeted delivery of Bacteriophage Therapy