Revue externe du PNT

Background

LHL has had a long term partnership with the government of Senegal by the Ministry of Health. The plan was to phase out the rest of the program support after the end of the current 5 years contact period. Before doing so it was important to asses what has been achieved during this period. Additionally it has been established as a regular practice to perform every fifth year an in depth/external review of the program to monitor the over all performance of the program.

Purpose/objective

To evaluate the overall situation of the tuberculosis epidemic in Senegal - achievements and perspectives

Methodology

The evaluation was conducted as an external participatory review.
A group of representatives of the national TB program and others from the health sector in Senegal together with the WHO consultant Dr. Bah B Keita prepared the evaluation based on Terms of Reference from LHL. The evaluation was conducted by 36 local/national and international (external) consultants divided in 7 teams and visiting 5 of Senegal's 11 regions. LHL engaged two independent external experienced evaluators; one expert on laboratory services from Benin and one French expert on tuberculosis and health sector strengthening. The teams visited several of the health structure institutions in each region and conducted interviews with both health workers and patients. Representatives of the health sector administration were also visited in every district.

Key findings

On the positive side the key findings were first of all the fact that the authorities are dedicated to fighting tuberculosis by following the DOTS strategy through a national tuberculosis program in strengthening the health system and providing free medications. A steady increase of the performance of the program on the level of cases and treatment fulfillment was also recognized.
On the issues for improvement it was pointed out that the insufficient funding of medication. The program planned to introduce a new treatment regimen with a four drug combination tablet that was more costly than the previous regimen. This would imply an increase in the budget line set aside for Tb-drugs.

Sustainability of the funding for the program activities needs to be addressed. There is also a need for more human resources and a long time strategy need to be followed. There is a lack of follow up of the regional and district medical officers and likewise the regional to district level supervision. Collaboration with other NGOs in social mobilisation activities and collaboration with HIV program needs to be improved.

Recommendations

Main recommendation to the government is consequently to find ways to secure funding for the program and recruit new personnel to the central unit.
- To the health directorate the recommendation is to form an official collaborating body to follow up the TB/Hiv coinfection activities.
- For the central unit of the national tuberculosis programme the main follow up should be to make an action plan to follow up the long term plan 2007 - 2011, to strengthen the support to the regions and their follow up of supervision to districts and local health posts, strengthen the supervision activities on a general level and review the organogram of the program. There is also a need to improve the administration of medications.
- Recommendations were also made for the regional medical officers and the district as well as the Faculty of medicine at the University of Dakar.

Comments from the organisation

This evaluation document will serve as a background document for phasing out LHL support of the program in 2009.