Assessment of the health system to support tuberculosis and AIDS care. A study of three rural health districts of Burkina Faso

There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment, social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals, 6 medical doctors and 18 nurses, working at the DH level and at the FLHC level, respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6% (7/66) HIV cases. Up to the time of the survey, 5 TB (6.6%) and 18 HIV+ patients (27.3%) have been hospitalised for care at least once, 64 TB (85.3%) had been declared cured and 38 HIV (54.5%) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11, the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool, to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action.