Table 2 Themes and quotes from participants on mechanism of collaboration

Increased support for communicable diseases compared to stagnant support for non-communicable diseases

"In some facilities, the NTP brought in task shifting officers because screening is a role the nurses are supposed to do, but they are saying it is another load, so we are shifting it. The aim is that they see it as their routine work". (Participant 1)

“The other policy is to have separate clinics for DM apart from the normal OPD [outpatient department], but because of human resource challenges, not all health facilities are able to do this”. (Participant 4)

The standard thing is to screen patients for DM, but it is expensive, so no hospital can do that because of the strips. It should have been part of the insurance package, especially if you are coming for the first time you are checked for DM. We should deliberately make it a policy that DM is checked, just as blood pressure”. (Participant 4)

“One of the initiatives is the wellness clinic [for NCDs]. We asked all hospitals to set up the wellness clinic. The challenge is how to fund it.” (Participant 4)

“The whole NCDCP itself is not even funded so what are you going to use to follow-up [TB-DM cases]?” (Participant 2)

Donor support

“Most support from partners go to maternal and child health, not NCD'S. Depending on what the partners prioritize, that is where the money goes ". (Participant 4)

“We [NCDCP] rely on partners because we don't have any direct source of funding for the program, these collaborations become essential. If you intend to get anything done, you need funding." (Participant 2)

Another challenge is funding. We get support from the WHO and the government of Ghana, but the main support is from the Global Fund.” (Participant 3)

Poor collaboration between TB and DM programs

“There is currently no collaboration between the NCDCP and TB programs. There are ongoing talks, now issues have come up because of the Malaria-HIV-TB funding structure. They are directly global funded, and the way their lines of funding are, most times, they are stuck on those activities and don't veer horizontally to other programs." (Participant 2)

“No, we do not have any collaboration with the TB unit, we have not had any meetings in that direction. I do not remember being invited to any TB workshop”. (Participant 7)

"We are not seeing collaboration from the diabetic side. We [NTP] say they should screen, but they should also know it is for the best management ". (Participant 1)

“It will be much smoother from the TB side to get things along than the DM side. A lot of hospitals have done that in-house usually based on personal initiatives. It’s not a nationwide thing”. (Participant 2)

Low TB-DM case detection

“We [NTP] have not really zoned into TB-DM screening, our challenge is case detection, but from where I am sitting, the screening among the DM [patients] is very poor and because most of the places do not have a specialized diabetic clinic, it's difficult to detect. Since they all pass through the OPD”. (Participant 3)

“In the few places where there are diabetic clinics, it’s easier to implement but, in most places, where they go through the OPD its likely to miss them [TB-DM] because not everyone is asked questions related to DM”. (Participant 2)

“We are interested in our TB cases, so we are asking the DM clinic to screen but the other way round we are not screening for DM, so we have no data. We always talk of looking for TB comorbidity but testing for DM is not captured in our register”. (Participant 1)

“We need to show more evidence of the TB-DM data and provide feedback to practitioners”. (Participant 3)

We know risk factors for TB is HIV and DM, so we have included screening at DM clinics.” (Participant 1)

“Because it is difficult to segregate the data it’s difficult to get TB-DM cases” (Participant3)

“There is no such tool for screening TB patients for DM (participant 4)

The success of policies is on engaging the people and making sure they have the capacity to do it, the large numbers and workload give the health workers stress”. (Participant 2)

The emphasis should be more on screening the TB cases for DM rather than DM for TB. When it's the other way around, we need more orientation. Most of the comorbidity cases have been picked up from the TB clinic. TB clinics are fairly well run in Ghana because of the HIV-TB structures. (Participant 2)