Health system readiness and diagnostic capacity for tuberculosis screening in primary health care facilities in Mbale city, eastern Uganda.
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Date
2026
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Busitema University
Abstract
Background: Tuberculosis (TB) continues to be one of the causes of morbidity and mortality in Uganda with an annual incidence of 196-200 new cases per 100,000 persons. While there have been commitments by the government and international community towards TB elimination, a significant gap exists in TB case detection which continues to hamper efforts to combat TB especially at the PHC level which is where initial contacts take place for TB patients. Health system readiness, which includes qualified staff, availability of diagnostic tests, supplies, and adequate supervision, is a key factor influencing TB screening and case detection. There has not been much research carried out in Eastern Uganda regarding TB screening readiness.
Objectives: The current study was intended to evaluate the readiness of the health system and the diagnostic capability of primary health care facilities in Mbale city, Eastern Uganda to conduct TB screening. Specific objectives included: (i) To establish the availability of TB screening equipment, materials and instruments; (ii) To assess human resources and their competencies in conducting TB screening and diagnosing cases; and (iii) To evaluate the efficiency of the TB samples' referral services and the time taken for diagnosis.
Methods: Cross-sectional study design using quantitative data collection technique was used among 11 public primary health care facilities within Mbale city that include Health Center II, III and IV level facilities. The study population consisted of two groups of participants including 69 health care workers involved in TB screening and 11 in-charges of various health centers. Questionnaires adapted from the SARA and Uganda NTLP readiness tools were used. A checklist tool was used to review health facility infrastructure, equipment, supply and documentation system.
Results: TB screening registers were present in 68/69 (98.6%) of service delivery points, while all 11 facilities (100%) documented TB symptoms routinely, suggesting adequate administrative preparedness. However, there were major operational gaps identified across all three study domains. On the matter of infrastructure and supplies, specimen transport items were not available in 6/11 (54.5%) of facilities, and stock-outs of GeneXpert cartridges, microscopy reagents, and sputum cups were noted in many facilities over the previous six months. On the other hand, only 5/11 (45.5%) of the facilities offered on-site GeneXpert testing, while 52/69 (75.4%) referred specimens for molecular testing. In regard to human resource capacity, only 32/69 (46.4%) of the healthcare providers had undergone TB screening training within the previous 24 months, and just 52/68 (76.5%) correctly described the national TB screening algorithm. Routine TB symptom screening of all patients attending the OPD services was conducted by only 34/69 (49.3%) of the workers. Finally, on the issue of referral system functionality, the mean diagnostic turn-around time was 8.41 days (SD ±8.96; range 1–30 days), which is far above the two-day WHO recommended threshold. Treatment initiation delays following a positive result were reported by 21/69 (30.4%) of workers, most commonly attributed to resource limitations (7/19, 36.8%) and prolonged turnaround times (5/19, 26.3%).
Conclusion: PHC centers within Mbale city are well equipped for documentation of tuberculosis screening processes yet exhibit several operational challenges such as weak supply chain management, low health worker training and ineffective referral services. Inability of the health care system to translate intentions into actions is demonstrated through extended periods of test turnaround time, inconsistent outpatient department screening practices and weak supply chain systems; thus, creating inefficiencies within the diagnostic process and causing pre-treatment dropouts. It is crucial for intervention measures including strengthening of the supply chain vi systems, provision of annual training for health workers, and rapid decentralization of GeneXpert testing centers to PHC III centers to be implemented.
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Undergraduate research report
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Citation
Kabahinda, N. (2026). Health system readiness and diagnostic capacity for tuberculosis screening in primary health care facilities in Mbale city, eastern Uganda. [Unpublished undergraduate research report]. Busitema University.