The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan

Barriers to accessing health services faced by poor and vulnerable populations are numerous in developing countries. These include; geography, income poverty, lack of trust in the quality of public health services, and lack of empowerment of women and adolescent girls (as patients and carers) to mobilize adequate and timely resources to access these services.

The project aims to test if TB case detection can be increased by engaging informal health care providers in active case finding. In one urban district of Khartoum, these providers will be trained to work as first point of entry to the health system using a comprehensive package that includes disease recognition, health communication, and patient referral. In a comparator urban district of Khartoum, no attempts will be made to engage informal providers.

By comparing data of TB patients and Lab registers between the intervention and comparator districts in Khartoum, this project aims to test if, and to what extent, these expected effects can be realized.

Overall this is a trial of a health policy so individual patients will not be recruited or randomized to one intervention or the other. Rather the policy is being applied in one district while the other district is being used as a comparator.

Inclusion criteria

• Access point for health seeking by the poor and vulnerable
• Active and well known in community
• Intervention activities can be confined to intervention area
• Based in community/locality
• Longevity; long standing
• Present in control and intervention areas
• Able and willing to complete the training to be Triage-Plus providers (ie giving formal consent)

Exclusion criteria

• Formal health providers, e.g. clinics, labs, hospitals (MOH, NGO or private)
• Internationally funded organizations, e.g. international NGOs
• Civil servants e.g. teachers