Service Availability and Health Care System Readiness in Integrating Dual Tuberculosis and Diabetes Mellitus Services in Tanzania: A Cross-Sectional Survey


Nyasatu G. Chamba
Kilimanjaro Christian Medical Centre
Kenneth C. Byashalira
Kibong’oto Infectious Disease Hospital
Paul Eliakimu
Kibong’oto Infectious Disease Hospital
Peter Daud
Kibong’oto Infectious Disease Hospital
Pendomartha J. Shayo
Kibong’oto Infectious Disease Hospital
Kaushik L. Ramaiya
Hindu Mandal Hospital
Rachel N. Manongi
Institute of Public Health, Kilimanjaro Christian Medical University College
Ib C. Bygbjerg
Section of Global Health, Department of Public Health, Copenhagen University
Ib C. Christensen
Section of Global Health, Department of Public Health, Copenhagen University
Stellah G. Mpagama
Kibong’oto Infectious Disease Hospital


Introduction: Tanzania endures a high burden of tuberculosis (TB) and a current emergence of diabetes mellitus (DM). Due to this double burden of disease, the management and care of TB and DM need to be integrated as DM can exacerbate the clinical manifestation of TB. Reducing the overall burden of TB and DM requires common platforms and approaches to maximize the detection and management of this comorbidity. The aim was to assess the current Tanzania health system practice on the readiness in integrating clinical management of dual TB and DM by using the WHO’s service availability and readiness assessment (SARA) manual.

Methods: A needs assessment survey was conducted in selected healthcare facilities (HFs). The SARA manual assessed the service delivery outcomes in terms of availability of guidelines, availability of medicines and diagnostic equipment, training of health care workers (HCWs) in providing TB and DM care, and review of patient records. Data were analyzed using Statistical Package for Social Science version 26.

Results: Of the 30 HFs, three were regional referral hospitals, eight were district hospitals, eighteen were health centers, and one was a dispensary. Among the guidelines observed, National TB case-management guidelines were in 27 HFs, disease management guidelines were in 24 HFs, DM guidelines were not followed, TB-IPC guidelines and TB-DM guidelines were observed in 18 and 10 HFs, respectively. The training and management system was weak, especially among DM. Implementation of screening TB patients for DM or screen DM patients for TB was not done in the HFs.

Conclusion: Integrative screening and management of TB-DM can be achieved if integration is initiated in healthcare facilities and policies in Tanzania. This can be achieved by strengthening the DM services through staff training and mentoring, capacity building, and integration of TB-DM services as a priority for implementation in Tanzania.

July 24, 2021