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Introduction : face aux faibles performances des systèmes de la prise en charge des cas de tuberculose dans les pays en développement, la recherche-action peut contribuer à améliorer l’offre de soins aux patients tuberculeux. Une expérience pilote d’amélioration des performances des services de santé par la recherche-action en réseau a mis à contribution des équipes multidisciplinaires dans six pays d’Afrique de l’Ouest en 2003. Méthodes : les équipes de recherche étaient composées de prestataires de soins, de responsables de programme de lutte contre la tuberculose, de socioanthropologues et de responsables sanitaires. Chaque équipe a mis en œuvre son protocole de recherche et évalué les résultats obtenus. Les équipes ont testé des solutions au faible dépistage des tuberculeux (Burkina Faso, Côte d’Ivoire et Niger), à la faible compliance des patients au traitement et aux taux élevés des malades perdus de vue (Bénin, Mali et Sénégal). Résultats : un an après, le niveau des résultats obtenus varie d’un pays à l’autre. Dans l’ensemble, les membres des équipes de recherche ont mieux compris l’étendue transnationale des problèmes de la prise en charge des patients tuberculeux et les avantages du travail en équipe pluridisciplinaire. Le processus recherche-action mené dans chaque pays leur a permis d’acquérir des notions théoriques suivies d’applications pratiques immédiates. Cependant, les multiples réunions ont souvent entraîné des absences répétées des prestataires à leurs postes de travail. Conclusion : l’identification et la prise en compte des attentes des patients et de leurs proches dans le domaine psychosocial auraient rendu plus efficace le processus d’amélioration de la prise en charge des patients tuberculeux. Une nouvelle dynamique de travail en équipe et en réseau mérite d’être poursuivie au regard des avantages que tous les participants ainsi que les systèmes de santé peuvent tirer., Background: Improvement in management systems for tuberculosis (TB) care is urgently needed in West Africa. In 2003, an experimental action research network began there, involving care providers, health system managers, and TB programme managers. Each project in all 6 countries used a “patient-centered” approach to improve tuberculosis case management. Methods: The research teams included care providers, district medical officers, anthropologists and TB programme managers. Each research team conducted its project for a one-year period and then assessed its results. The specific problems identified were low TB detection rates (Burkina Faso, Côte d’Ivoire and Niger) and poor compliance among patients receiving treatment, including their ensuing loss to follow-up (Benin, Mali and Senegal). Investigators concluded that these weaknesses were due to the lack of access to care (geographical, financial and cultural), the complexity of the care system and the low quality of care. Solutions for all 6 countries aimed at improving access to high-quality care. Results: One year after the experiment began, results varied from one country to another. In general, all participants understood the need to collaborate beyond national health systems because the problems from all 6 countries were quite similar. The research process led to better sharing of work between care providers and sometimes between care providers and TB patients. It provided participants with new concepts and a constant opportunity to implement them. These repeated meetings, however, keep care providers away from their offices. Conclusion: The research would have improved case management and care more effectively had the teams taken into account the psychological and sociological need of TB patients. A new regional dynamic has begun and must be pursued to help improve health care systems.

SETTING: In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment. OBJECTIVE: To improve the case management of TB in Burkina Faso. DESIGN: Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003. RESULTS: Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study. CONCLUSION: Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.