Content
Part 1 – Why care for people affected by tuberculosis cannot be organised only through a universal set of standardised
activities
Chapter 1-1: Introduction: Justification, objectives and methodological approach……… 15 Chapter 1-2: “The need to consider the PATB care process as a complex process: “An exploration of the concept ‘Directly Observed Therapy (DOT)’ for tuberculosis patients:
From a uniform to a customised approach””……….. 24
Part 2 - Analysis of the process of care for People affected by tuberculosis in Nicaragua:
Chapter 2-1: Introduction to the process analysis of the care for people affected by TB in Nicaragua ……… 41 Chapter 2-2: An overview of Nicaragua’s health system………. 45 Chapter 2-3: Is routine information useful to identify the problems of people affected by TB?
A discussion based on TB control program of Nicaragua……… 48 Chapter 2-4: The cost of medical care and people’s health-seeking behaviour before being suspected of tuberculosis in three local health systems of Nicaragua.……… 66 Chapter 2-5: Informing TB suspects for sputum sample collection and communicating
laboratory results in Nicaragua: a neglected process in tuberculosis case finding……… 83
Chapter 2-6: An exploration of health care workers’ beliefs on precautions to prevent spread
of tuberculosis and tuberculosis patients’ social problems in Nicaragua.……… 95
Chapter 2-7: An exploration of the social stigma of tuberculosis in five “municipios” of
Nicaragua to reflect on possible local interventions ……… 109
Part 3- The intertwined process of local intervention to improve TB care management and development of a health system
research unit in Nicaragua
Chapter 3-1: Introduction ……… 133 Chapter 3-2: Setting of the study ……… 135 Chapter 3-3: Methodological issues ………... 140 Chapter 3-4: Analysis of four “micro processes” of implementation of intervention in
municipios of Nicaragua ……… 145 Chapter 3-5: Analysis of a macro-process - the development of a health system research unit in Nicaragua ……… 173 Chapter 3-6: Lessons from the analysis of processes of implementation of interventions 180
Part 4- General conclusions - towards a strategic approach for improving care for people affected by tuberculosis
Chapter 4-1: Introduction………. 189 Chapter 4-2: A systemic analytical framework to customise care for PATB in the local health systems ………... 190 Chapter 4-3: Reflections towards a strategic approach for the improvement of the care for people affected by tuberculosis………... 205
Final conclusion
