KNCV Tuberculosis Foundation has developed a benchmarking tool to help countries to align their policies with the latest WHO guidelines on childhood TB. Agnes Gebhard presented a first version of this benchmarking tool at the recent 17th Wolfheze Workshops. The first official version of the tool was presented by Connie Erkens and Huong Thien Nguyen on December 3, 2015, at the 46th Union Conference on Lung Health in Capetown.
Diagnosing tuberculosis in children is more difficult than in adults, and treatment for children needs to take into account that they differ from adults in their response to the disease. TB control interventions therefore need to address the specific vulnerabilities and needs of children and their families.
The World Health Organization (WHO) has developed guidance for countries on how to address childhood TB. KNCV Tuberculosis Foundation’s benchmarking tool was developed to help countries that are in the process of aligning their policies with these guidelines.
The benchmarking tool is designed for self-assessment. It is not intended for reporting to WHO, or ECDC or any other bodies: it for the country’s own use, in order to identify any gaps or areas that may need to be addressed.
The intended users are national (or subnational) working groups on childhood TB: importantly, this should consist of all partners who deal with child health and thus with childhood TB. Thus, the national immunization program should be included, as well as pediatricians, the Mother and Child Health (MCH) services, NGOs working in care of children and child wellbeing: there where it may be picked up that a child is failing to thrive or that it is not doing well. The Ministry of Health, the national TB programs (NTPs), HIV programs, the laboratory systems, and any country-specific stakeholders should also be included.
The tool consists of two parts: a summary of surveillance data and standards/benchmarks.
Indicators for assessing activities to address childhood TB
Part A of the tool is designed to provide an overview of the surveillance data. The tool asks some more specific questions than the routine country surveillance system does, in order to get insight in the completeness of the service delivery on childhood TB. Two examples of additional data collected are the acceptance rates for preventive therapy and the percentage of children with HIV that have started anti-retroviral therapy (ARV).
Standards and benchmarks for childhood TB
Part B of the tool consists of the standards and benchmarks for childhood TB. In total there are 12 standards.
It is easy to record that, for instance, “a national childhood TB working group is in place” but what does this mean? The tool helps to specify this by noting criteria (benchmarks) for such a working group. The answers are scored using three options: either 1. “met” or 2. “partially met” or 3. “not met”.
The idea is not to just stop there, after ticking the results boxes, but to write down a summary of the discussions on where the country stands at that moment, and to formulate what the group and what each partner will do in order to meet the standard, if the standard is not yet fully met.
Presentation of the results
Finally, the results of the exercise can be presented by pulling together the outcomes according to specific categories. The presentation is not only on what scores were given, but also on the action plans that have been agreed upon.
The tool makes provision for collectively presenting the information according to three main areas of insight:
- Political commitment and stakeholder coordination
- Technical strategies approaches
- Access to services
- The outlines of an action plan
Presentation “Introduction to KNCV benchmark tool for Childhood TB programme implementation” (English, Russian).
Document: (May 2015) KNCV benchmarking tool for Childhood TB policies and practice.
Latest version (December 2015) KNCV benchmarking tool for Childhood TB policies, practice and planning