21 August 2017 - - US-based health and health care improvement group The Institute for Healthcare Improvement (IHI) has been awarded a USD 3m grant from the Bill and Melinda Gates Foundation to support a four-year quality improvement initiative to reduce deaths from tuberculosis in South Africa, the organisation said.

The initiative has been co-designed with the South Africa National Department of Health (NDoH) and other partners, and will be the first country-wide TB effort of its kind to utilize QI methodologies at both local and national levels.

According to the IHI, the goals are to find the missing TB cases, dramatically improve the care of patients with TB, reduce the incidence of the disease by nearly a third by 2022, and cut the rate of TB mortality in half by the same year.

Every year TB kills more than 30,000 people in South Africa, making it a leading cause of death in the country. Despite recent improvements in TB cure rates, the burden of TB in South Africa remains high, fueled by a HIV co-infection rate of approximately 57%.

The increasing number of drug-resistant forms of TB further worsens the situation, with more than 10,000 people diagnosed with RR/MDR-TB annually.

The main challenge faced by the NDoH is the high level of attrition among patients from screening to diagnosis, treatment initiation, and completion, known as the "TB Care Cascade."

The NDoH has prioritized strengthening the TB Care Cascade to reduce the number of patients who fall out of the process along the cascade.

Quality improvement methodology will be used to identify the gaps, develop and monitor plans to address them at facility level.

In November 2016, the NDoH convened IHI and partner organizations based in South Africa to undertake the design and implementation of a QI initiative to support the implementation of the National TB Strategic Plan.

This initiative will be implemented in all 52 health districts in South Africa to create innovative, local learning networks of primary health care clinics and community health centers.

Starting with an intense period of learning in ten sub-districts located in four provinces with the highest burden of TB in the country, local learning networks of primary health care clinics and community health centers will be established.

Health facilities will identify and test strategies that can then be rapidly scaled up to the rest of the district, province, and country.

The new efforts being announced follow the South African government's successful national application of QI methods to prevent mother-to-child transmission (PMTCT) of HIV eight years ago.

This programme leveraged local expertise and deep facility-level engagement in driving down PMTCT rates from 23.2% in 2003 to 2.4% in 2012.

IHI has been working for decades with national and regional governments to co-design QI-based strategic initiatives that have resulted in improved quality of national, regional, and district-level performance of health systems.

IHI is in health and health care improvement worldwide. For more than 25 years, IHI has partnered with visionaries, leaders, and frontline practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations.