article · Discover Public Health
Tuberculosis continues to be a major driver of illness and death globally, with a disproportionately heavy burden falling on resource-limited settings. Although funding for tuberculosis programmes has risen, critical weaknesses remain in how these initiatives are evaluated. A scoping review of 78 studies evaluated tuberculosis programme effectiveness, implementation, equity, and sustainability across these regions, with most research centred in Sub-Saharan Africa and South Asia. Quantitative approaches proved the most common, followed by mixed methods. Significant deficits were identified across multiple dimensions: only 21 percent of evaluations examined multidimensional equity, and merely 9 percent investigated long-term sustainability. Furthermore, whilst over 61 percent reported stakeholder engagement, true involvement of community members and policymakers was sparse. Addressing these limitations requires context-sensitive methodologies that embed equity metrics and facilitate broader stakeholder involvement.
Tuberculosis programmes receive substantial global funding, yet poor evaluation limits understanding of their true impact. Identifying shortcomings in current assessments ensures that future public health initiatives in lower-income areas are measured fairly. By focusing on sustainability, equity, and local community voices, health authorities can deploy resources more effectively and save lives.
The abstract does not indicate a commercial application pathway, as it focuses entirely on public health programme evaluation methodologies and gaps in existing research literature.
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Abstract Background Tuberculosis (TB) remains one of the leading causes of morbidity and mortality globally, disproportionately affecting resource-limited settings (RLSs). Despite increased investments in TB programs, significant gaps persist in the evaluation process. Objectives This scoping review aimed to: explore the types of evaluation frameworks and methods used, assess implementation level and evaluations, and identify gaps in TB program evaluation across RLSs. Methods Following the PRISMA-ScR guidelines, a structured search was conducted across five electronic data bases and grey literature sources. Studies evaluating TB programs effectiveness, implementation, equity, or sustainability in RLSs were included. Data was charted using a standard form and synthesized thematically. Results Of 78 included studies, most evaluations were conducted in Sub-Saharan Africa (41%) and South Asia (23%). Quantitative methods were the most employed (31%), followed by mixed methods (24%). Gaps emerged in three key areas: only 21% of studies applied a multidimensional equity lens, just 9% assessed sustainability while stakeholder engagement was reported in 61,5% of the studies, involvement of community members (35%) or policymakers (12%) was limited. Conclusion Evaluations in RLSs are limited in scope and methodology. Future evaluations should adopt context sensitive methodologies, that are embedded in equity metrics, and promote inclusive stakeholder participation to guide more effective and sustainable TB control strategies.
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DOI: 10.1186/s12982-025-00837-7
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