USAID/Democratic Republic of Congo | Monitoring, Evaluation, and Coordination Contract Assessment of USAID/DRC Tuberculosis Portfolio

In response to this challenge, the United States Agency for International Development (USAID) requested a comprehensive examination of its TB portfolio to inform future programming and improve the extension of services at all levels of the health system. The assessment, conducted by International Business and Technical Consultants, Inc. (IBTCI), aimed to answer 12 questions related to the epidemiology and trends of TB in DRC, assess the effectiveness of and lessons to be drawn from various interventions supported by USAID and other donors, and provide recommendations to improve TB program performance. The assessment team reviewed project literature and conducted key informant interviews with representatives from USAID, implementing partners, and other donors. The assessment found that TB continues to be a major public health concern in DRC, with significant challenges in detection and treatment. The report highlights the need to extend current detection and treatment to those parts of the population currently left out, either due to lack of access to healthcare or ineffective integration of TB services into the health system. The assessment team explored various aspects of expanding access to TB services, including mobile clinics, targeting high-risk populations, and scaling up the use and functionality of GeneXpert machines. The report emphasizes the importance of integrating TB services into existing programming, including HIV, child survival, and other approaches. Collaboration with donor activities in other sectors, such as SGBV, the mining sector, and education, is also recommended. The assessment highlights the need for a cross-sector collaboration at different points in the program cycle, from activity design to monitoring and evaluation. USAID's field-level efforts in TB are primarily via its Challenge TB activity (CTB) and the Integrated Health Project Plus activity (IHP+). CTB implements activities through a vertical approach specifically focused on TB efforts, while IHP+ operates primarily at the provincial and health zone level and focuses on multi-disease, integrated primary health care. The assessment identifies several key trends and challenges in TB programming in DRC, including low detection rates, low coverage rates, and barriers to testing, including cost, distance, and stigma. The report also highlights the need for improved coordination within the National Program for the Fight Against Tuberculosis (PNLT) and regionally, as well as the importance of leveraging points, strategies, and tools to improve detection rates and respond to multi-drug resistant (MDR) and extremely drug-resistant (XDR) TB. The report provides a set of recommendations for the design and implementation of future programming, including opportunities to improve TB program performance at different levels of the DRC health system. The recommendations emphasize the need for a cost-effective approach to providing support to the central unit of the TB program, as well as the importance of leveraging points, strategies, and tools to increase case detection rates and respond to MDR and XDR TB. Overall, the assessment highlights the need for a comprehensive and integrated approach to TB control in DRC, one that addresses the challenges of detection and treatment and leverages opportunities for collaboration and cross-sector coordination.