Healthcare management strategies to improve Tuberculosis case notification and treatment success rates in Makueni County Referral Hospital

Abstract

Tuberculosis (TB) has remained a significant global public health challenge, particularly in low-and middle-income countries, where it continues to affect millions and contributes to high morbidity and mortality rates. Despite the disease being both preventable and curable, the World Health Organization (WHO) reported over 10 million new TB cases in 2022, with African and South-East Asian regions bearing the greatest burden. Kenya, as one of the high-burden TB countries, faces persistent challenges in achieving the WHO's End TB Strategy targets, which aim to reduce TB-related deaths by 75% by 2025. This study was conducted to assess the healthcare management strategies used to improve TB case notification and treatment success rates at Makueni County Referral Hospital. The study was anchored on three theoretical frameworks: the Management in Health Theory, the Evidence-Based Management (EBM) Theory, and the Utilisation Management (UM) Model. These frameworks provided a lens for evaluating how management practices, evidence-driven decision-making, and resource utilisation influence TB outcomes. A descriptive survey design was employed. The target population comprised hospital administrators and healthcare workers directly involved in TB care. A pilot study was conducted at Makindu Sub-County Hospital, while the main study involved a sample of 122 healthcare professionals drawn from Makueni County Referral Hospital. Data was collected using structured questionnaires and analysed using SPSS, focusing on both descriptive and inferential statistics. The findings revealed that healthcare management strategies had moderately improved TB case notification and treatment success rates. The findings suggested that training of healthcare workers, community-based active case finding, decentralised TB services, provision of adequate personal protective equipment, and the use of geo-coding for case tracking were perceived by respondents to be associated with improved TB case notification and treatment outcomes. However, given the cross-sectional nature of the study, these associations should be interpreted as indicative rather than conclusive, as the design does not permit causal inference. Collaboration with private healthcare providers also contributed positively to service delivery. However, several barriers hindered optimal implementation, including non-adherence to TB guidelines, low staff motivation, inadequate funding, bureaucratic delays, poor communication, and heavy workloads. The study concluded that while progress had been made, several systemic and management-related obstacles persisted. The hospital was recommended to strengthen adherence to TB guidelines through continuous training, decentralise decision-making processes, and enhance staff motivation through incentives and mental health support. Additionally, increased funding, improved communication protocols, digital record-keeping, and staff expansion were proposed to further improve TB case notification and treatment success rates.

Keywords: Healthcare Management Strategies; TB Case Detection, TB Case Treatment