Audit finds Sask. plan to address TB hasn’t been updated in decade

Provincial auditor of Saskatchewan Tara Clemett at the legislative building on Tuesday, December 6, 2022 in Regina. PHOTO BY TROY FLEECE /Regina Leader-Post

Alec Salloum

Regina Leader-Post

Saskatchewan’s rate of tuberculosis infections is twice the national average while the provincewide plan to address the disease has not been updated in a decade.

With that in mind, provincial auditor Tara Clemett delivered several recommendations to the Saskatchewan Health Authority (SHA), which are detailed in Volume 1 of her annual report released Wednesday. For one, her report states that a new plan is needed to better address the spread of tuberculosis, which is particularly acute in northern Indigenous communities.

“When it comes to active TB cases, we can see that a number of these cases end up being in northern Saskatchewan,” Clemett said Wednesday. “Forty-four per cent of the active cases are in those communities.”

Last year’s reporting period, ending in December, showed there were 138 patients in Saskatchewan with active tuberculosis. The province had 10.9 cases per 100,000 people in 2023, which is more than twice the national average of 5.1 cases.

Clemett’s report notes that Saskatchewan’s latest tuberculosis plan was updated in 2013 and expired in 2018. Since then, the province has been without a modernized strategy to guide the SHA in addressing the disease.

A report commissioned in 2018 and delivered in 2019 did make 30 recommendations, some of which have been implemented. But overall, Clemett found the SHA “and its partners have not updated the provincial TB strategy,” adding that work must be done to ensure the tuberculosis rate “trends downwards.”

Opposition MLA Erika Ritchie said the audit on tuberculosis rates in Saskatchewan “was one of the most disheartening things” she saw in the auditor’s report.

“The fact that there has been recommendations sitting on the ministry’s desks now since 2019 that haven’t been acted on … to me, it’s unacceptable,” she said.

Part of the rationale for why more of the initial 30 recommendations were not implemented was COVID-19, but Clemett remarked that the province has since emerged from the pandemic “so I do encourage them that they need to relook at things.” The SHA, federal partners and people on the ground in the community are needed to co-ordinate a new plan, according to the auditor.

Clemett said one barrier to reducing the rate of TB is the number of people who aren’t following through with doctor visits. About 45 per cent of scheduled appointments for diagnosis and treatment went unattended.

At the same time, with recent changes to health-care delivery, Clemett noted that lessons learned from the pandemic are applicable in addressing tuberculosis.

“This, to some degree, has a bit of a parallel to COVID,” she said. “You very much want to identify, isolate and then start to treat.”

The report also found the SHA does not track or assess timelines for when a person is exposed to the disease, and there is no clear instruction on how to notify the public when an outbreak occurs.

As part of updating the SHA’s strategy to address the spread of tuberculosis, the auditor’s recommendations include the following: 1. Assess timeliness of contact investigations for cases; 2. Establish and use criteria to determine appropriate treatment delivery method for patients with tuberculosis; 3. Evaluate the care models available to determine an efficient and effective model for tuberculosis patients; 4. Set clear expectations for making the public aware of tuberculosis outbreaks; 5. Analyze and report key information about tuberculosis to senior management and the public.

In an email sent late Wednesday afternoon, the Ministry of Health said it appreciated the recommendations. It intends to bring in “a robust system for tracking and assessing notification processes during contact investigations.”

That process includes timelines for patients.

“The SHA will also develop criteria to help determine the most appropriate treatment delivery and best care models to use,” the email said. “We look forward to reporting on our progress regarding these recommendations.”