City-Assisted TB Project in Line for UN Award

An innovative project to combat tuberculosis in the Western Cape which is being jointly run by the City of Cape Town's Health Directorate, the Provincial Government of the Western Cape's Health Department and the NGO, the TB Care Association, has been selected as a finalist of the 2009 United Nations Public Service Award in the category of "Improving the delivery of services".

"The Administrative Support for TB Care Project" was nominated for the UN award by the Impumelelo Innovations Award Trust (http://www.impumelelo.org.za/) which rewards exceptional projects involving partnerships with the public sector that enhance the quality of life of poor communities in innovative ways.

Judy Caldwell, TB Project Manager, in the City of Cape Town's Specialised Health Department is in New York today as a possible recipient of the UN award. Dr Keith Cloete, Chief Director: Metro District Health Services from the Provincial Health Department is representing the province at the awards ceremony.

Motivating the nomination, Rhoda Kadalie, Executive Director of Impumelelo Trust, said: "This is a model of excellence, which, if implemented throughout the country, will effectively reduce the tuberculosis pandemic to manageable proportions. Since it was implemented, treatment default rates in the Western Cape have dropped dramatically and cure rates have significantly improved. The project won one of Impumelelo's Platinum Awards in 2008 and we subsequently recommended this exceptional service delivery model to the United Nations for a Public Service Award because of the outstanding service it delivers in reducing the TB rates in Cape Town."

Tuberculosis persists as a significant public health problem in South Africa. The TB burden is not equally distributed throughout the Western Cape Province, with Cape Town carrying 55% of the overall burden in the Province. There has been a 68% increase in the number of reported TB cases in the Cape Town region over the last 10 years, with 28,224 TB cases reported in 2008. The demographic make-up and socio-economic conditions of the sub-districts vary enormously and the increases have been disproportionately higher in geographic areas with poorer socio-economic conditions and high HIV prevalence rates.

This particular project is a partnership between City Health, the Provincial Department of Health and TB Care Association and it represents a creative response by health officials to two different forms of problems affecting poor urban communities in Cape Town.

The first problem faced is that the incidence of TB had been rising consistently over the last 10 years while cure rates remained static, some of the reasons being that diagnosed patients failed to complete the lengthy treatment or response to treatment was not adequately documented. TB treatment requires intensive monitoring and precise documentation if a cure is to be effected and recorded. Nursing staff in health clinics typically come under intense pressure to attend to waiting queues of patients with the result that they tend to overlook both monitoring and recording with the consequence that many patients are lost to follow up or response to treatment not adequately documented.

The second problem, though not directly a health issue is prevalent in poor urban communities, is the question of youth unemployment - especially of recently matriculated students who are unable to find a foothold in the formal economy.

The innovative step taken by health officials was to bring the two problems into a common focus and to conceptualize a new layer of health workers to be added to clinic staff. The concept, in brief, was to recruit the new staff from among unemployed school leavers and to employ them as TB Assistants and TB Clerks with responsibilities for the monitoring and recording of all TB treatment schedules, most specifically by monitoring all registered patients to check for compliance with the DOT medication programme.

The basic design of the project is that TB Care receives the funds for the project and employs the assistants and clerks and is responsible for their terms of service meeting all human resource requirements including disciplinary rules and procedures. At the same time City and Provincial Health provide the training and place the staff in 27 clinics where they fall under the line management system of the clinic.

Dr Ivan Bromfield, Executive Director: City Health, said that he was very proud of the achievement of being nominated for such an award and that it showed how a partnership between the City, the Provincial Health Department and the NGO, TB Care, could deliver an effective response in improving the TB control programme.

"Project results have been impressive. The levels of patients interrupting treatment have fallen and the levels of full cure have risen consistently on a quarter by quarter measure, from 69% in 2005 to 76% in 2006," Dr Bromfield said. "In Khayelitsha where the cure rate in Quarter 3 2004 was 26%, in Quarter 4 2006 it had risen to 72% and the point of change dates from the inception of the project."

The project was fortunate in being able to use extra funding made available by Provincial Health. It was equally fortunate in being able to use the long standing relationship with the TB Care Association, an NGO with a long record of stable service in community treatment of TB. The presence of TB Care made it possible to recruit potential staff speedily without having to pass through the long and complicated procedures of the public health system.

Dr Craig Househam, Director General of the Provincial Health Department in the Western Cape, said:" The award recognizes excellent work done by the City of Cape Town and the Western Cape Department of Health in addressing the challenge of tuberculosis in Cape Town. The award also acknowledges the positive working relationship between the two spheres of government in combating one of the most significant health challenges in the province."

After being submitted by Impumelelo Trust, the project passed the second round of selections and further supporting documentation had to be submitted to the United Nations adjudication committee. City Health was informed on 4 May that the project has been selected as a finalist of the 2009 United Nations Public Service Award in the category of "Improving the delivery of services" for "Administrative Support for TB Programme, City Health Cape Town".

Over 300 participants, including the President of the United Nations General Assembly, the Secretary-General of the United Nations and the Under-Secretary-General for Economic and Social Affairs are expected to attend. High-level government officials, international experts, representatives of NGOs and other worldwide organizations working in the field of governance are also invited to participate in this event.

During the Ceremony, high-level officials from a number of countries will deliver statements about the importance of celebrating and recognizing public service. The Ceremony will be followed by an Experts' Meeting on "Sharing Innovations in Governance and Public Administration" which will take place in the afternoon of 23 June and on 24 June 2009, the UNPSA winners and finalists are expected to make a presentation on their respective initiative.

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Issued by: Communication Department, City of Cape Town