BACKGROUND Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. METHODS The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. RESULTS Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. CONCLUSION Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

中文翻译：

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通过服务提供者的眼光：在尼日利亚东南部的Enugu州，卫生系统因素影响结核病控制的实施。

背景技术运转良好的卫生系统对于实现全球和国家结核病（TB）控制目标至关重要。这项研究从服务提供商的角度研究了影响结核病控制计划实施的卫生系统因素。方法该研究在尼日利亚东南部的Enugu州进行，采用定性的横断面设计，涉及23位TB服务提供者（13位地区TB主管和10位设施TB负责人）。使用卫生系统动态框架通过深入的半结构化访谈收集数据，并进行专题分析。结果国家结核病控制规划（NTP）的管理改善了结核病控制的治理，但地方政府的管理却薄弱。政府在结核病控制方面的支出不足，而捐助者为结核病控制提供资金。人力资源管理不善的做法阻碍了结核病服务的提供。结核病服务提供者的数据管理能力很差，因为记录和报告工具的变更与服务提供者的培训不匹配。尽管使用了后勤机构，但向结核病治疗中心提供的药品和其他用品仍被中断。结核病与普通卫生服务的整合不善，实验室能力薄弱，对社区志愿者和专利药品供应商的补贴撤消，患者追踪系统资金不足以及结核病/艾滋病毒/艾滋病合作无效，导致结核病服务提供的组织薄弱。结论加强结核病控制服务的卫生系统必须注重对NTP和当地卫生系统的有效监督。通过预算和社会健康保险调动可预测的国内资源；培训和激励措施，以吸引和留住结核病服务提供者；有效的供应和结核病药物管理；以及改进服务交付的组织。