Dr. Odinoy Erkaeva credits training she received through the USAID-sponsored Quality Health Care Project with improving her ability to diagnose and treat her tuberculosis patients.
Tuberculosis is one of the most difficult diseases to cure because of its lengthy drug treatment regimen. The shortest TB treatment requires a daily dose of medication for at least six months. Patients with multi-drug resistant TB face the even more daunting task of taking medicine daily for up to two years.
Poor adherence to the TB treatment regimen is one of the main reasons that TB and multi-drug resistant TB have spread in Tajikistan and other Central Asian countries.
But Abt Associates and the government of Tajikistan are improving TB outcomes through the USAID-funded Quality Health Care Project. The project is a five-year effort to improve health in Central Asia by incorporating modern quality improvement techniques and evidence-based international care standards. The quality improvement activities began in Tajikistan in March 2011.
Abt, as part of the project, is increasing the pool of rural primary care doctors in Tajikistan by retraining specialists to become family physicians. Physicians spend part of their time during the six-month training focusing on TB treatment. This TB training emphasizes the importance of communicating effectively with TB patients and observing patients to ensure they take their medication.
“Through the course, we started to think about TB as we hadn’t before,” said Dr. Odinoy Erkaeva, one approximately 60 doctors to receive the training.
“The Abt Associates training also encourages physicians to take more responsibility for identifying and solving patient care problems through a process called continuous quality improvement,” said Marian Sheridan, Abt Associates senior analyst and Tajikistan Country Manager. “Instead of perpetuating the status quo by providing health care services that may not be effective, doctors are encouraged to devise their own solutions based on international best practices, track the outcomes, and adjust their treatment accordingly.”
Savlat Khotamova, a nurse from Dushanbe Health Center #1, observes a patient taking her tuberculosis medication.
TB testing rates increase
The TB training is delivering results. For example, when the program began in July 2011, only 26.6% of patients at two health centers in Dushanbe were observed taking their TB medication. That improved to 87% six months later thanks to improvements in care devised by the centers’ staff. Forty-five patients benefited from the improved monitoring. Direct observation of TB treatment has also been strengthened in other pilot sites in Tajikistan.
“Now we have a lower number of patients who stop treatment and, most importantly, there have been no TB-related mortalities,” said Dr. Erkaeva, now the director of her rural health care center. “We have organized a treatment center in our facility so that patients who used to have to travel can now get treatment close to home.” She also provides TB education sessions to the community.
USAID and the government of Tajikistan plan to expand and institutionalize these changes to improve the lives and health of Tajik citizens.