Regulatory framework and policy guidance

The availability of regulatory frameworks and policies that support the implementation of decentralized and integrated TB services is key to bringing TB services closer to children, adolescents and families and to creating and sustaining ownership and accountability at the national and subnational levels. The NTP, in partnership with other programmes, needs to review the existing health care structures and identify opportunities for decentralization and integration of TB services, or components thereof. Given the variation in country-specific settings, and the variety of settings within countries, the NTP should consider a flexible approach guided by the existing infrastructure, availability of resources and disease burden – for example, decentralization of a single component of TB services versus a
combination of components; phased implementation versus full-scale implementation; or operational research setting versus programmatic implementation. Some studies have shown that interventions delivered at the primary health facility and community levels (combined) have resulted in increased TB case notifications and TPT initiations compared with more centralized approaches (158–161, 165).

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