Quality Mindset: The Missing Ingredient in Tuberculosis Care and Control in Togo

Abstract

Quality has been mentioned as the missing ingredient in TB care and control. In Togo, TB is a priority public health problem. We hypothesize that "quality mindset" is the missing ingredient for excellence in TB care and control in Togo. We used statistical process control (SPC) tools to analyze cohort data from the National Tuberculosis Control Program. There was an unstable quarterly variation in smear-positive pulmonary TB (TBP+) treatment success rate from 2017 to 2022. The general trend since the first instability was a quarterly variation around a success rate of 86%. Results showed stability in the quarterly variation of TBP+ case fatality rate at 7% since 2017. The root cause analysis of the low performance of the program revealed that TB management and DOTS strategy standards were not well adhered to. Based on the Pareto chart prioritizing the most affected health systems building blocks, health services delivery and health workforce building blocks accounted for 70% of all the dysfunctions. This study revealed that quality mindset is the missing ingredient for TB control program to be a center of excellence in Togo. It is therefore timely for a national project to verify the real contribution of total quality care to TB program performance in Togo.