|dc.description.abstract||Background: The rising tuberculosis -diabetes mellitus co-epidemic is threatening the advances made
by global policy to reduce tuberculosis and diabetes mellitus prevalence. In 2011, the World Health
Organization (WHO) and International Union Against Lung Disease (Union) launched the Collaborative
Framework for Care and Control of Tuberculosis and Diabetes. The recommendations provided by the
framework have been adopted by many countries, globally.
The overall aim of this research was to explore the barriers and facilitators to the implementation of the
WHO-Union collaborative framework in Ghana, from the perspectives of the policymakers, program
managers, health facility managers, and front-line implementers (healthcare workers).
Methods: Using an explorative qualitative study design, data was generated by employing a scoping
review, documents review, in-depth interviews, and non-participant observation. In-depth interviews
were conducted with 27 participants from Accra and Tamale in Ghana. All interviews were audio
recorded (with participants’ permission) and transcribed verbatim, except for two interviews, whereby
participants requested the interview not to be audio-recorded. Non-participant observation was guided
by a checklist of sensitising concepts. Analysis was guided by the grounded theory to identify recurrent
ideas which were coded and further grouped to develop themes.
Results: This thesis presents key findings from research on the implementation of the framework in
Ghana. The major outputs of this study included: 1) a scoping review to map evidence on the
implementation of the framework, globally. 2) paper one examines the systems and structures in place
for implementing the collaboration of TB-DM management in the selected health facilities. 3) paper two
explores the mechanisms of collaboration between the National Tuberculosis Control Program and the
Non-Communicable Disease Control Program at the national, regional, and local (health facility) levels
of the health care system. 4) paper three addresses the experiences of frontline healthcare workers
through the lens of Lipsky’s theoretical framework of street-level bureaucracy.
Conclusion: The findings of this research support the implementation of the framework in Ghana. This
has been enhanced by the increased staff capacity and institutionalization of screening. However, gaps
still exist which require increased awareness about TB-DM comorbidity, and increased support for inservice
training to curb the rising TB-DM comorbidity.||en_US