From many deaths to some few cases of drug-resistant tuberculosis: travelling with the systems quality improvement model in XXXX Health District, Togo.

@entity1 @entity645 @entity19882 @entity378 @entity1907
The ultimate goal of every @entity378 ( @entity378 ) treatment program is a high treatment success rate. Treatment success is extremely important because, when the rate is high, it significantly contributes to declining numbers of new cases by reducing the number and period of infectious cases, @entity378 morbidity and mortality, and prevents the emergence of resistant strains. Our aim was to decrease @entity378 mortality by increasing @entity1907 @entity1 ' treatment success rate to at least 85 % in @entity19882 Health District by end of July 2014. A systems and dialogic analysis of the public health system related to @entity378 @entity1 ' treatment revealed that it was not performing well; we found weak coverage and quality of @entity378 services, a poorly-functioning @entity378 health information system, poor-performing health workforce, poor availability of @entity645 tests and antiretroviral for @entity378 @entity1 , and low degree of @entity1 ' participation in their care. We redesigned the system to correct those weaknesses. The effectiveness of these changes was monitored using plan, do, study, act (PDSA) cycles. We increased @entity378 @entity1 success rate from 80% to 95% between February 2012 and July 2014.The mortality rate dropped from 13% to 3% and the failure to follow-up rate dropped from 3% to 2%. In conclusion, district health systems performance depends on factors such as the closeness of services to population; skilled workforce; the ability to collect and analyze data and use information for action; population empowerment, and good management and improvement capabilities of management team especially the public health director. High @entity378 @entity1 ' success rate depends also on the availability of antiretroviral drugs. It is highly important that every district health management team member develops improvement capabilities.
