ABSTRACT
There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment; social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals; 6 medical doctors and 18 nurses; working at the DH level and at the FLHC level; respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6(7/66) HIV cases. Up to the time of the survey; 5 TB (6.6) and 18 HIV+ patients (27.3) have been hospitalised for care at least once; 64 TB (85.3) had been declared cured and 38 HIV (54.5) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11; the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool; to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action