MOAE0202 | ENHANCING HEALTH SYSTEMS THROUGH PUBLIC-PRIVATE PARTNERSHIPS: LESSONS FROM TUBERCULOSIS CONTROL IN GHANA

Ernestina Sam¹, Nicholas Asare¹, Doris Dornor¹, Abraham Koyaara¹, Gideon Okyere¹, Felix Ayichuru¹, Nana Kofi Quakyi¹, Kafui Senya², Rita Patricia Frimpong³ | ¹The Aurum Institute Ghana, Accra, Ghana; ²World Health Organisation, Accra, Ghana; ³National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana

Since 2024, Aurum Institute Ghana and the National Tuberculosis Control Programme have worked together with private healthcare providers in 26 districts across the Ashanti, Greater Accra, Western, and Northern regions to improve TB services by building skills and upgrading facilities. The initiative involves 90 high-volume private health facilities and 80 private community pharmacies and over-the-counter medicine shops, which share 20 GeneXpert machines in a hub-and-spoke model and has trained 375 private-sector healthcare workers (HCWs) using a blended approach combining workshops, onsite mentorship, and supportive supervision. Additionally, 37 TB champions—individuals who have been successfully treated for TB—support active case finding, sputum transport, linkage to care, and preventive therapy. The intervention has significantly improved HCWs' capacity, evidenced by enhanced diagnostic accuracy and adherence to national treatment guidelines. Between April 2024 and March 2025, participating sites screened 253,947 clients, identifying 28,572 presumptive cases. Of these, 16,826 (59%) underwent testing, detecting 875 TB cases (739 bacteriologically confirmed, 128 clinically diagnosed, and 8 extrapulmonary), 5% (44) of which were TB/HIV coinfected. TB treatment initiation was 98.9%, and all TB/HIV coinfected were initiated on antiretrovirals. However, challenges persist: 41% of presumptive clients failed to produce sputum and access to free or affordable digital x-ray services in private facilities is limited. Intermittent GeneXpert cartridge shortages delayed testing and variable sample quality affected lab turnaround. Notably, high staff attrition disrupted service continuity, as many of the trained nurses were temporary staff on locum or awaiting postings to government facilities. Seconding public-sector staff to private facilities can mitigate attrition-related disruptions. Ensuring sustained cartridge availability, expanding affordable digital X-ray access, and strengthening sample collection through patient education are critical.