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Implementing Joint TB and HIV Interventions in a Rural District of Malawi: Is There a Role for an International Non-Governmental Organisation?

By R Zachariah, R Teck, A D Harries and P Humblet


In a rural district in Malawi, poorly motivated health personnel, shortages of human and financial resources, weak dialogue between existing tuberculosis (TB) and human immunodeficiency virus (HIV) programmes and poor community involvement are constraints to establishing joint TB-HIV interventions. The presence of a non-governmental organisation (NGO), Médecins Sans Frontières (MSF), in the health care delivery system provided an opportunity to bridge some of these gaps. The main inputs provided by MSF included additional staff, supplementary drugs including antiretroviral drugs, technical assistance and infrastructure development. The introduction of a scheme of monthly performance-linked incentives for health personnel proved successful in improving their performance, as judged by attendance rates as well as the quality and quantity of activities. This initiative also provided the district management with a tool for exerting pressure on health staff to improve their performance. The availability of independent NGO funds and a logistics team for construction of new infrastructure allowed the rapid initiation of new interventions at the district level without having to wait for disbursements of funds from the central level. This introduced a new dynamic of decentralised operational flexibility at the district level which improved access to care and support for people with TB-HIV

Publisher: International Union Against TB and Lung Disease
Year: 2004
OAI identifier:
Provided by: MSF Field Research

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  1. (2001). 11 Ministry of Health and Population. Malawi National Health Accounts: a broader perspective of the Malawian Health Sector. Planning Department, evaluation report.
  2. (2003). 15 Inventory of operational research studies 2000–2003. National TB Control Programme. Lilongwe, Malawi: Ministry of Health and Population,
  3. (2003). 7 Ministry of Health and Population. Malawi Health Facility Survey report. Planning Unit.
  4. (2003). 9 Ministry of Health and Population. The status of human capacity development for an effective response to the HIV/AIDS epidemic in Malawi (evaluation report).
  5. (2002). Cotrimoxazole prophylaxis in HIV-infected individuals after completing anti-tuberculosis treatment in Thyolo,
  6. (2002). High death rates in health care workers and teachers in Malawi. Trans Roy Soc Trop Med Hyg
  7. (2002). Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early deaths. Trans Soc Trop Med Hyg
  8. (2003). sexual behaviour and risk factors associated with HIV in individuals seeking voluntary counselling and HIV testing in a rural district of Malawi. Trop Doct
  9. (2001). The journey towards TB diagnosis: preferences of the people of Mtsiliza, Lilongwe.
  10. (2003). Tuberc Lung Dis
  11. (2003). Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces

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