Tuberculosis testing for healthcare workers in South Africa: A health service analysis using Porter's Five Forces Framework

Abstract

South Africa has one of the world's highest tuberculosis (TB) incidence rates. Healthcare workers (HCWs) are at particularly high risk of developing active TB compared to the general population, due to their occupational exposures. International guidelines support the routine screening of HCWs for active TB as an effective strategy to reduce the TB burden in high prevalence countries. However, it is estimated that only two-thirds of HCWs in South Africa will utilize available TB services at any point in their career. In this study, multiple data sources including semi-structured interviews, focus groups, observation, site visits, and secondary data analysis were synthesized and analyzed using Porter's Five Forces Framework of Competitive Position Analysis. The outcomes of this systematic evaluation found TB services available to HCWs in South Africa to be an industry with high rivalry, moderate -to -high bargaining power of the suppliers and a threat of substitutes, low bargaining power of buyers and a limited threat of new entrants. Value opportunities presented through these five forces can enhance the utilization of TB services, reducing TB-associated morbidity and mortality among this high risk, yet often neglected and under-researched population.

Keywords:

• Tuberculosis
• Screening
• Healthcare workers
• South Africa
• Five forces framework
• Testing
• Strategy
• Competition

Acknowledgements

Colleagues at Centre for Health Systems Research and Development at the University of the Free State South Africa were crucial in defining the context of the problem and enabling opportunities for data collection.

Disclaimer statements

Contributors NNO contributed to study planning, data collection, data analysis, and writing of the report. JMS contributed to study planning, data analysis and helped to write the report. LMO contributed to study planning, data collection, and writing of the report. LEN contributed to study planning, data collection, and writing of the report. CAM contributed to study planning, data analysis, and helped to write the report.

Funding None.

Conflicts of interest The authors have not conflicts to disclose.

Ethics approval Ethics approval was obtained at the University of British Columbia and from the Ethics Committee of the Faculty of Health Sciences at the University of the Free State. Participation was in the interviews and focus group was voluntary after informed consent. Participants were allowed to refuse participation or withdraw at anytime with no consequences.