FeedbackDecentralization includes the provision of, access to or capacity for child and adolescent TB services at a lower level of the health system than the lowest level where it is currently routinely provided. In most settings, decentralization applies to the district hospital level (first referral level), PHC level or community level. Interventions to facilitate decentralization include capacity-building of various cadres of HCWs, access to diagnostic services, availability of TB medicines for children and adolescents, and follow-up of children and adolescents with TB or on TPT.
Since unwell children and adolescents commonly seek care at the PHC level, where TB services are not always available, decentralization and integration of such services using a family-centred approach has the potential to improve access to care, especially for children and adolescents who do not need referral to a higher-level facility. The objectives of decentralization are closely linked to the aspirations of universal health coverage (all people have access to the health services they need, when and where they need them, without financial hardship), which is a strategic priority for SDG target 3.8 (8).
Decentralization of care at the community level has the following advantages:
- increased equity via improved access to health services;
- provision of TB care at the same time and in the same place for all family members;
- savings in time and money when care is provided closer to home;
- continuity of care between the person’s home, community and local health centre;
- increased community support, which may lead to better adherence to treatment and can be instrumental in overcoming barriers to long-term care, including treatment adherence, transportation costs, missing school, and loss of wages during sickness and clinic visits.
Other potential benefits of decentralization in the context of TB include increased treatment coverage in children and adolescents, reduced time to diagnosis and time to treatment, improved treatment success among children and adolescents started on TB treatment and TPT initiation, and reduced transmission (158–161).