How to improve access to TB care for the nomads? Review of barriers and enablers for Sahel nomadic populations

Tuberculosis (TB) control in nomadic populations represents a major public health problem in sub–Saharan Africa. Barriers and enablers of TB care for nomads were identified through a literature review and survey conducted among the National TB Programs (NTPs) of six Sahelian countries: Burkina Faso, Chad, Niger, Mali, Mauritania, and Senegal. A conceptual framework was developed. Data retrieved from twenty-eight peer-reviewed papers or collected through the survey were regrouped in 5 categories: health system related factors, socioeconomic factors, cultural, political and environmental factors. The large distance between nomadic camps and health care facilities and the absence of TB-specific programmatic interventions for nomads were the main barriers identified. The establishment of a multi-ministerial national committee in charge of nomadic populations, the mapping of nomadic transhumance roads, the identification of gaps in health service provision and community engagement for defining fit for purpose solutions are key elements to improve TB control in nomadic population. Some countries in the region successfully implemented interventions to overcome the barriers to TB care. These interventions should be more widely shared to inform other countries for the development of appropriate strategies for which community engagement is essential.