The effect of health sector industrial actions on TB and TB/HIV case finding in Ogun State, Nigeria: Is Public-Private Mix a viable solution?

Abstract

Background: Though industrial disputes are a global phenomenon, there is a rising concern of its frequent occurrence in Sub-Saharan Africa.

Objective: To assess the effect of industrial actions embarked upon by the health workers during the year 2014 on Tuberculosis (TB) notification in Ogun State, Nigeria.

Methods: A retrospective review of TB notification in 2013 and 2014 was conducted. Quarterly TB case notification, the proportions of Human Immunodeficiency Virus (HIV) test, Co-trimoxazole (CPT) uptake and Antiretroviral Therapy (ART) uptake in the years 2013 and 2014 were compared using the Epi-info software.

Results: There was a decline in the proportion of TB cases reported  by the public sector health services and an increase in the proportion of TB cases reported by the private health facilities during the period of industrial disputes in the public health sector (doctors and non-doctors) (p = 0.001). Compared to the year 2013, the proportion of presumptive TB cases tested for HIV declined significantly during the period of the strike actions by the non-doctors but not during the strike actions by doctors in 2014. There was no difference in the uptake of Co-trimoxazole (p = 0.456 and 0.511) and Anti-retroviral Therapy (p = 0.192 and 0.544) by TB/HIV co-infected patients during the strike actions by the doctors and the non-doctors respectively.

Conclusion: This study demonstrated the importance of Public-Private–Mix for TB case finding efforts in the developing countries, where there are incessant strike actions by health workers in the public sector.