Assessment of Child and Adolescent TB Policy and Governance in Countries Participating in The Union’s Sub-Saharan Africa Child and Adolescent TB Centre of Excellence

Abstract

In August 2019, The Union in collaboration with GTB/CDC convened a regional stakeholder meeting in Kampala, Uganda to launch the COE and discuss the need to address the child and adolescent TB policy-practice gap, and share best practices and lessons learned in combatting child and adolescent TB among countries in sub-Saharan Africa. The meeting was attended by global TB stakeholders and representatives from nine NTPs: Eswatini, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe. These countries eventually became the founding members of the COE. The goal of the COE is to pursue the bold vision of the Childhood TB Roadmap by capacitating national leadership, bridging the policy-practice gap, and fostering partnerships across the region to improve and expand interventions to end child and adolescent TB. To optimize the quality and type of technical assistance provided to COE member countries, the COE team needed information on the landscape of policy, governance, financing, and training for child and adolescent TB in the COE member countries. This foundational information would then enable  COE staff to support the development of tools and other forms of technical assistance that address specific needs/requests by country teams. Further, this landscape assessment would serve as a baseline by which to measure the contributive impact of the COE’s activities on child and adolescent TB programming in member countries in the future.

In April 2021, all nine COE member countries were provided with a standardised survey tool to complete the landscape assessment. The analysis of survey results was performed with a focus on aggregated country results to identify variability in policy, governance, training and management processes, including prioritizing common technical assistance needs.

The NTPs of all COE member countries provide oversight of TB programming in the respective countries and are responsible for the inclusion of child and adolescent TB in the TB National Strategic Plan (NSP). Only 44% of member countries have specific interventions and targets for addressing adolescent TB in the TB NSPs that were in effect during the survey. While child TB was included in all NSPs, there were gaps in the integration of child TB into MOH/NTP guidelines. All member countries have dedicated child and adolescent TB focal points. The NTPs ensure the functionality of child and  adolescent TB Technical Working Groups (TWGs) (existing in 89% COE member countries), these however have a varying representation of relevant stakeholders. All COE member countries report having dedicated funding for child and adolescent TB but only half report such funding from their national MOH or government.

All COE countries have training programs informed by a curriculum. In addition, they have tools for supervision and mentorship. Not all COE member countries have training materials that comprehensively cover all relevant topics in the management of child and adolescent TB. In addition, adolescent TB management has been omitted in some of the member countries’ training materials, supervision and mentorship tools. Only four countries are capturing the WHO recommended age disaggregated data for child and adolescent TB. These findings will further guide the COE work plans and provision of technical assistance that addresses the specific needs of its member countries.