Curing tuberculosis with DOTS in Bolivia

A young woman at the San Luis
Health Center takes her TB
medication as a nurse watches
CHALLENGE In Santa Cruz, Bolivia, there is a high incidence of tuberculosis. The peri-urban health centers struggle to care for TB patients, who require 6-8 months of diligent monitoring and follow-up. In order to treat TB patients effectively, each health center must have a dedicated TB consultation room that is stocked with directly-observed treatment, short-term (DOTS) kits, educational materials, and tracking tools to avoid loss-to-follow-up of TB patients. Health staff must also be trained in DOTS program procedures and correct sample gathering for laboratory analysis. Records for TB patients must be well maintained to ensure that TB patients and their families are also monitored to prevent the spread of the disease.

In 2007, the Health Management and Quality Project (GCS) began an effort to strengthen the quality and success rate of treatment given to TB patients. The program provided six health centers in Santa Cruz with reusable monitoring banners to help health workers track patients and cure rates. GCS-donated purified water jugs and DOTS kits allowed staff to administer medications properly and observe treatment directly.

As a crucial part of the project, GCS taught health personnel at the six centers how to use the monitoring banners; correctly follow-up with patients and their family members; take proper laboratory samples for testing; educate patients on TB care and nutrition; and document patient progress. Although the work was time-consuming, health personnel learned the importance of monitoring all TB patients closely and ensuring that they complete treatment. The health centers worked with the municipal government to set catchment, treatment, and cure rate goals for their communities, which they track using tools provided by GCS.

Patients were tracked through health center visits, phone calls, and home visits. Each center used the monitoring banners to document progress toward goals. Health personnel, having seen improvement since the project was implemented, valued GCS’s contributions to their TB programs. By the end of the intervention, the cure rate for enrolled TB patients program at the six health centers was close to 100%, and almost none were lost to follow-up in the final six months.