Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review
The results show that National TB Programme (NTP) managers agree on the need for active case-finding scale-up, which was also reflected in the national TB strategies that we reviewed, while not all strategies included explicit aims and targets related to screening. At the same time, most of the NTP managers identified human and financial resource constraints as the main barriers to active case-finding implementation and scale-up – pointing to a gap between policy and practice. A few more interesting findings from our study were: 1) NTP managers acknowledged the risk that active case-finding may cause increased health system costs in the short-term, but also recognized the possibility of decreasing costs in the long-term. 2) Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence for advocacy. 3) Different types of evidence were used for developing and implementing active case-finding policies, while there was a particular demand for local evidence to inform local decisions. 4) Managers in districts and regions were seen as key stakeholders whose involvement could help improve active case-finding policy development, implementation and scale-up.