For several years South Africa’s National Department of Health (NDoH), has been planning to conduct its first National TB Prevalence Survey. The Survey aims to determine the true burden of TB disease through bacteriological assessment among the population aged 15 years and older. It will be implemented in 110 randomly selected clusters across the country and will consist of a sample size of 55 000 subjects. In partnership with the NDOH, the survey is being implemented by the South African Medical Research Council (SAMRC), the Human Sciences Research Council (HSRC) and the National Institute for Communicable Diseases (NICD) over a period of 24 months.

The WHO country office (WCO), in collaboration with WHO Headquarters (WHO HQ) has played a key role in the preparatory stages and implementation of the survey. This includes protocol and SOP development, resource mobilization, training and mentorship, as well as the coordination of partners.

The first pilot took place in November 2016 where operational and data challenges were identified by WHO. Through intensified support, communication between all the stakeholders improved, the data system was refined, retraining for field activities took place, additional survey staff were recruited, and the NDOH took ownership of the survey. Following a second pilot in July 2017, the survey was officially launched in August 2017 in Kwa-Zulu Natal.

Challenges are inevitable

As with most surveys, implementation has not been without challenges. The main challenge experienced in this survey’s first 9 clusters has been the low participation rate which averaged at 35%; way below the survey target of 85%.

To support NDOH’s National TB Programme in addressing this situation, WHO immediately provided technical support and leadership to address the challenges being experienced in the field and identify causes leading to the survey’s poor performance. In collaboration with WHO HQ and the NTP, WCO conducted an urgent field support mission in October 2017. The following implementation bottlenecks were identified, namely; suboptimal coordination of implementing partners; inadequate community mobilization resulting in low community participation; lack of incentives to encourage participation; and a limited survey budget which didn’t fully cover all field activities.

For more information please visit WHO Africa website http://www.afro.who.int/