Role of Technical Assistance in the Establishment and Scale Up ofProgrammatic Management of Drug Resistant Tuberculosis (PMDT) inEthiopia

Abstract

Implementation and scale up of programmatic management of drug resistant tuberculosis (PMDT) has proven to be a challenge in many resource-constrained settings like in Ethiopia, despite the political commitment. A critical programmatic gap analysis was conducted by technical experts to develop feasible recommendations for incorporating multi drug resistant tuberculosis (MDR-TB) management in the national TB program following international guidelines and receiving continuous technical and financial support. The major achievement was building of technical capacity in the country at the level of a national MDR-TB technical working group (TWG) as well as at the level of the MDR-TB treatment hospitals among the MDR management teams. In addition, guideline development, improved access to second line drugs and renovation of health facilities in accordance with TB infection control standards contributed to optimize implementation. Between February 2009 and September 2012, 575 MDR-TB patients accessed treatment under the program. Building programmatic and clinical capacity at different levels of the health system in combination with strong political commitment and partner's engagement were key elements of the PMDT approach. Structured technical assistance combined with financial support during key steps was critical in the initiation and subsequent scale up of the program.