Stop TB Partnership

Improving TB Diagnosis: USAID Performance Evaluation of the TB CARE Medical Specimen Transport System in Zimbabwe

25 March 2015 - Zimbabwe - Zimbabwe is among 22 countries worldwide designated as high burden countries (HBCs) for tuberculosis, with an estimated incidence of 552 per hundred thousand population. Case detection rates fall below international targets, estimated at about 45%. As part of efforts to improve TB diagnosis, the Zimbabwe National TB Control Programme (NTP) has identified a strategic need to strengthen referral networks and transport logistics between peripheral health facilities and laboratories.

In response to this need, the United States Agency for International Development (USAID) funded a medical specimen transport (ST) system as part of the $225m TB CARE I program. The TB CARE ST system was initiated in 2010 and is implemented by International Union against Tuberculosis and Lung Disease (The Union) through Riders for Health (RFH), in collaboration with the Zimbabwe Ministry of Health and Child Care (MOHCC) through the NTP. The ST system is aligned with NTP’s effort to increase timely access to laboratory TB diagnosis and results, which is expected to lead to faster initiation on treatment, better patient monitoring during the course of treatment and, ultimately, better TB patient outcomes and reduced TB transmission in the community.

The specimen transport system was first piloted in three urban districts and five rural districts, and the system now operates in 33 districts across the country. The mainstay of the TB CARE ST system is a cadre of motorcycle couriers who conduct specimen transport full-time, bringing sputum samples and other medical specimens from clinics to laboratories, and test results from laboratories back to clinics. The system has enabled a 24-hour test result turnaround in urban areas, and one-week turnaround in rural areas.

In 2014, an evaluation team from Social Impact Inc. conducted an external performance evaluation of the TB CARE ST system in Zimbabwe, on behalf of USAID, with the purpose of assessing the project’s implementation, effectiveness, integration, and sustainability. Using a mixed-methods approach, the evaluation team focused primarily on the process of implementing the specimen transport system.

The evaluation identifies factors that have led to successful implementation of the TB CARE ST system in both urban and rural districts in Zimbabwe - some of these factors include strong buy-in across the health system, reliable maintenance of the fleet, and accountability of the system through log-book documentation. The evaluation team also found that the ST system strengthened linkages between district and peripheral facilities, and in this way has helped decentralize diagnostic services, which reduces the burden of diagnosis on patients, empowers health workers at peripheral clinics, and reduces crowding at district facilities. The evaluation points to the centrality of the courier role, identifies ways that the ST system may benefit other health services, and describes factors that will influence sustainability.

The evaluation provides a set of actionable recommendations that will assist USAID, the Zimbabwe NTP, and their implementing partners, further improve ST and ultimately improve TB diagnosis in the country.

To read the full findings and recommendations of the evaluation, download the report from the USAID Development Exchange Clearinghouse (DEC): Zimbabwe TB CARE Medical Specimen Transport System Evaluation Report.