Background Of Programme
Tuberculosis in Ghana started way back in the pre-independence era when the then colonial government recognized the need to combat the disease due to the threat it posed to the larger society. In July 1954, the Ghana Society for the Prevention of Tuberculosis was established to support and supplement government’s efforts at combating the disease. In the early 1960’s, the Government of Ghana sponsored nurses to train in Israel in the area of TB Management (they were then known as TB nurses). It also came to light that, during that same period, Mobile X-Ray Vans were used to carry out mass screening for TB.
Dr. Moses Adibo, former Director of Medical Services who was instrumental in the setting up of the National TB Control Program developed interest in TB during his work at the Winneba Government Hospital between July 1965 and April 1968, through the commitment and dedication demonstrated towards TB patients by one Dr. Shamar, a TB specialist during his regular visits to the Winneba Hospital to examine TB patients and see how the disease was being managed at the hospital. His enthusiasm in TB further deepened when he started seeing TB patients at Nsawkaw in the Western Region. Over there, he observed that TB patients when asked to go for X-Ray at Wenchi or Sunyani Government Hospital did not show up and only resurfaced after sometime. News that they were seeking treatment at a sanatorium in La Cote d’Ivoire prompted Dr. Adibo and his team of nurses to pay a fact finding visit to the Bontoukou TB sanatorium in La Cote d’Ivoire.
There, they discovered that the patients go to Bontoukou due to financial difficulties since over there, diagnosis and treatment was free; they were however forced to return to the Nsawkaw Government Hospital after some time due to the need for social support from their relatives back home. According to Dr. Adibo, this revelation further deepened his interest in TB. According to Dr. Adibo, in June 1986, when he became the Director of Medical Services, he took a critical look at TB statistics (over a period of 10 years) across the country and realized that there was a rise in TB cases in every region.
This prompted him to put the issue across at the Regional Directors conference held at Ho in 1992. It was at this conference that consensus was reached on the need for a TB control program followed by the drafting of a TB Control Program document for Ghana. To facilitate the setting up of the program, Dr. Eugene Nyarko undertook a six-month WHO fellowship to study TB in Wales and Masters in Public Health program in London and became the first Program Manager of the TB Control Program in 1993.
In 1991, the Director of Medical Services recognized the poor situation of TB in the country and concluded that important measures were required to rectify it. In 1992, new initiatives were started to design the NTP and DANIDA was approached for financial support. In November 1993, an agreement between DANIDA and the Government of Ghana was signed on the basis of a Project Document. The Document reflected the mainstream policy of the IUATLD (International Union Against TB and Lung Diseases) at that time.
The implementation of the program started in 1994 with training sessions in three regions. In the same year, Ghana adopted the WHO DOTS Strategy, based on the five pillars of political commitment; diagnosis by sputum smear microscopy, standardized supervised treatment, uninterrupted drug supply and recording and reporting system. DOTS (Directly Observed Treatment Short course) was implemented countrywide within the 5 tier health system in the public sector.
The NTP is currently implementing the DOTS Strategy for TB control. The strategies involve ensuring regular drug supply, surveillance, building capacity for TB treatment and control, and directly supervising treatment among others. By W.H.O. definition Ghana achieved 100% DOTS coverage in 2000. Presently, Ghana is in the maintenance phase of DOTS expansion.
Tuberculosis is a contagious bacterial disease caused by Mycobacterium tuberculosis. TB mostly attacks the lungs (pulmonary TB) but it can affect any organ in the body (extra Pulmonary TB). TB that affects other parts of the body is not as infectious as TB of the lungs.
Pulmonary TB is transmitted from a sick TB patient as a droplet infection through coughing, singing and sneezing. Inhalation of these droplets by an uninfected person may cause infection. The risk of contracting TB increases with the frequency and duration of contact with people who have the disease.
The cardinal symptom of pulmonary TB is a cough lasting 2weeks or more and for people living with HIV (PLHIV) a cough of 24hours is significant along with other constitutional symptoms. Other symptoms are weight loss, tiredness, night sweats, chest pain and cough with blood-stained sputum
Tuberculosis (TB) is the most common opportunistic infection with a high mortality rate among HIV-infected individuals. The risk of TB in HIV-infected persons continues to increase as HIV disease progresses and immunity decreases. There are persons who are HIV negative but are at risk of developing TB disease by virtue of having immunosuppression from medications or disease. It has been found that a vast majority of people infected with TB do not have no signs or symptoms of TB but are at high risk of active TB disease when the immune system becomes compromised. This state is known as Latent TB infection (LTBI) and is defined as ‘a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB (1).
TB Preventive Therapy (TPT) is the administration of one or more anti-tuberculous drugs to individuals with latent TB infection to prevent progression to active disease. WHO recommends the use of Isoniazid for 6 months in resource-limited settings for the prevention of TB in at risk populations living in high TB incidence, prevalence and transmission settings. The use of Isoniazid is one of the ways in which active TB disease is prevented among at-risk populations in high TB incidence settings others include Rifampicin and Isoniazid taken daily for 3 months and Rifapentine plus Isoniazid weekly for 3 months.
Programme Implementation Unit
The Programme Manager is the overall manager of both technical and support functions of the NTP. He is an experienced senior public health specialist responsible for developing capacities and providing strategic direction for programme implementation.
Core Functions and Responsibilities:
1. Directs and coordinates day to day administration and management of programme in accordance with Ghana Health Service policies to obtained optimum efficient operation and maximizing good results
2. Plans the programme and monitoring its overall progress, resolving issues and initiating corrective action as appropriate
3. Ensures the establishment and submission of relevant reports on the operations of the programme to the higher authorities and stakeholders
4. Develop and maintain a culture that will foster co-operation, commitment, efficiency, accountability and productivity within the NTP at all levels
5. Develops and implement systems and methods of effective monitoring and control of activities of the programme
6. Builds, manages and motivates programme team members.
The Programme Manager has a Deputy who assists in the performance of the above tasks. The Deputy Programme Manager is also a public health specialist who supports the Programme Manager in day-to-day programme management but directly supervises programme implementation.
Core Functions and Responsibilities
As the Head of Programme Implementation Unit She directly supervises and oversees the implementation of programme interventions across the country
The Deputy Programme Manager links the programme with the national health system through the Deputy Directors of Public Health. She is responsible for coordinating MDR, TPT, HIV implementation in the region
Research, Monitoring & Evaluation Unit
They Monitor and evaluates the implementation of programme interventions. An experienced M & E Specialist, heads the unit which consists of 13 programme officers and 10 regional M & E officers.
• Supervise and monitor the implementation of programme interventions at Regional Level
• Collate, validate, analyze and report NTP Data for necessary action
• Monitor and Evaluate NTP activities at all levels (National, Regional, District & Sub-District) and submit relevant report to management
• Undertake technical support visits to programme implementing sites and submit written report to management and provide feedback to all sites visited
• Offer on-the-job training (skills training) when necessary to implementers at lower levels
• Advice on M&E and other programme implementation issues arising from programme execution to NTP and other stakeholders
• If assigned a region for parenting, will perform the activities listed below, among others
• Ensure the submission of all programme data, activity report and other relevant information
• Ensure that all logistics required for TB service delivery are available and in adequate quantities e.g. laboratory reagents, surveillance tools, TB Medicines etc.
• Identify key problem areas for operational research at levels of implementation and undertake and complete with report at least one (1) operational research study per year to influence programme policy and implementation
• Represent the NTP at various fora, within and outside the health sector, to pursue Programme goals and objectives and provide written feedback to management to ensure follow through of decisions and directives from these fora
Laboratory & Logistics Management Unit
The programme logistics and medicines is managed by a senior Pharmacist with the following core duties:
Core Duties and Responsibilities
• Ensure regular supply of TB Drugs and other logistics to all the Regional Medical stores and Teaching Hospitals through proper quantification and monitoring of commodities
• Ensure safe, good quality storage and handling of TB Drugs at all levels of TB Management
• Review stock level of all TB Medicines and commodities and inform the authorities/stakeholders accordingly.
• Liaise with the Procurement Division of Ghana Health Service to procure all commodities i.e. medicines, Laboratory reagents, blended and other logistics needed by the programme
• Build capacity of health workers for proper storage and security of all commodities especially Multi-drug resistant TB medicines
• Provide advice on issues arising on Purchasing, storage and distribution of TB Drugs
• Performs other related activities from time to time that fall within the NTP’s organizational culture.
This unit directly supervises laboratory services and a senior laboratory scientist manages this unit. The laboratory scientist ensures delivery of quality laboratory services to meet international standards.
Administration & Human Resource Unit
This unit manages the administrative business of the programme and human resources. An administrator manages daily activities and a human resource focal person coordinates human resource-related issues
• Ensure transactions are properly recorded and entered into the computerized accounting system
• Establish and maintain supplier accounts
• Implement financial policies and procedures
• Be punctual and ready to listen and attend to staff of all categories
• Arrange to convey staff meetings, informs members of the venue, time, date etc., at the most appropriate time
• Manage the NTP Office on issues related to staff welfare, procurement and management of office logistics, vehicles and other assets
• Assist with the annual audit and maintain financial files and records
• Provide advice on human resource and office management issues arising out of the programme execution to NTP
• Perform other administrative duties from time to time that falls within the NTP’s organizational culture
This unit manages the finance of the programme. A chartered accountant with health systems management experience heads the unit. The unit ensures prudent financial management of programme finances and reports to relevant authorities.
• Continues management of financial systems, preparation of budgets, Bank reconciliation statements and Claims payment in accordance with accounting procedures and guidelines in the Financial Management Manual (FMM)
• Preparation and regular submission of financial reports, including end of month and quarterly reports to NTP/Audit Department
• Ensure proper filling system of all accounting documents in an orderly and systematic manner to ensure quick reference and retrieval
• Providing advice on financial issues arising out of programme execution to the programme manager and other stakeholder
• Perform other financial related activities from time to time that falls within the NTP organizational culture
Technical Support Unit
Is made up of international partner agencies that provide technical support to the NTP. These include WHO and USAID. Currently the Programme has technical support from USAID
The Central TB Unit has five units implementing programme activities. These units do not operate independently but are coordinated and supported by the larger health system structures such as the Public Health Division and the Policy Planning Monitoring and Evaluation Division