Indigenous NGO involvement in TB treatment programmes in high-burden settings: experiences from the Northern Cape province, South Africa

Effective tuberculosis (TB) treatment delivery in high-burden countries increasingly requires a multisectoral approach. This paper examines the role two local non-governmental organisations (NGOs) play in TB care delivery in a high-burden setting, the Northern Cape province, South Africa. NGOs played a complementary role to the formal health sector in effecting TB treatment delivery by training facilitators and recruiting and training lay volunteers for directly observed treatment. One key challenge was the paucity of systematised information to enable rigorous evaluation of the effectiveness of NGO contribution, which led to inadequate funding, as potential donors were sceptical about supporting activities whose value they could not assess. In high disease burden settings, where auxiliary actors can play useful roles in effective service delivery, it is important for NGOs to document and self-evaluate their role. One way of building this capacity is through technical support by government and development partners.