PNLT : Fight against Tuberculosis

Tuberculosis (TB) remains one of the world’s leading infectious diseases, despite medical advances in recent decades. Every year, it affects millions of people, particularly in regions where health systems are weak. In Africa and the Indian Ocean region, TB remains a major public health issue, fuelled by socio-economic insecurity, high population density in certain urban areas and coexistence with other infections such as HIV.

Madagascar has a high prevalence of tuberculosis, with an incidence estimated to have remained stable for several years at 223 cases per 100,000 inhabitants and 73,000 cases reported in 2024. The country is far from meeting the WHO’s 2025 targets for reducing mortality, incidence and costs borne by patients. Some populations are also particularly at risk of contracting TB, particularly in connection with HIV-TB co-infection. People working in mining areas and injecting drug users (IDUs), among whom there has been a resurgence of HIV cases, are therefore also at risk of contracting tuberculosis. Similarly, for people in prison, a context where fundamental rights are often compromised, and where the majority are male, a recent study has highlighted an extremely high prevalence of active TB, reflecting the role of detention conditions and limited access to care. In addition, paediatric TB is a major issue in Madagascar, where children under the age of five who are exposed within the home remain insufficiently identified and diagnosed.

Several civil society organisations (CSOs) are contributing to the fight against tuberculosis, complementing the National Tuberculosis Control Programme (PNLT), and developing interventions focused on awareness-raising, community screening, improving access to care and supporting vulnerable populations. In a context marked by significant geographical disparities and limited access to health services, community health workers (CHWs) and local organisations play a crucial role in improving early detection, referral and follow-up of patients. They help to raise awareness in communities, identify symptomatic individuals and support treatment completion.

Finally, the TB care cascade, or therapeutic cascade, is a model for assessing patient retention through the various stages of care required to achieve a positive therapeutic outcome. In this perspective, the implementation of a Programme Quality & Efficiency (PQE) Plan is a relevant lever for strengthening the capacities of the NTP. Finally, the results and recommendations from the TB cascade analysis and the Programme Quality & Efficiency Improvement Plan will contribute to the development of the new National Strategic Plan (NSP) for TB for the period 2027-2031.

OVERALL OBJECTIVE

Improve the quality of tuberculosis care in Madagascar by strengthening the capacities of the National Tuberculosis Control Program (PNLT) and sub-recipients (SR).

SPECIFIC OBJECTIVES

1.  Analyze the TB cascade to identify challenges and obstacles hindering program performance.

2.  Propose a plan to improve the quality and efficiency of the TB program (PQE – Program Quality & Efficiency), incorporating indicators, tools, and an operational implementation strategy.

3. Support the implementation of the improvement plan by strengthening the capacities of the NLT team and SRs, and providing technical support to ensure ownership and adjustment of the tools.