Views of health service providers on obstacles to tuberculosis control in Ghana

BACKGROUND: Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers. METHODS: In-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively. RESULTS: Respondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions. CONCLUSIONS: This paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients’ views on health service-related barriers to TB control.