Kavish Maharaj | From data to diagnosis: A TB victory
8 October 2025
Throughout my career in public health, I have been driven by a simple conviction: that data, when properly utilised, can transform health outcomes. Our work with South Africa’s National Tuberculosis Programme offered a powerful validation of this approach. What began as a technical challenge - chronically high sputum sample rejections undermining advanced diagnostics - became one of the most instructive experiences of my professional life.
The situation was both analytically interesting and deeply consequential. Sophisticated Nucleic Acid Amplification Testing (TB NAAT) was being compromised by operational gaps, with up to 20,000 samples rejected monthly between August and November 2024, and the national rejection rate reaching 6%. Each rejected sample not only delayed a diagnosis, but was the systemic nature of the problem that demanded a structured response. This was less a moral emergency than a compelling operational puzzle, one that required collaboration, not crusading.
Working alongside The National Health Laboratory Services (NHLS), our team focused on understanding the underlying causes. The data revealed a clear pattern: over 90% of rejections were due to clinical collection errors, and a concentrated number of facilities - primarily in KwaZulu-Natal, Gauteng, and the Western Cape - were contributing disproportionately.
The solution centred on enabling others rather than imposing fixes. We developed an electronic dashboard that provided real-time visibility into rejection trends, allowing local teams to monitor their performance against the national 3% target. This was paired with practical quality improvement tools that empowered frontline health workers to address issues within their own facilities. The approach was rooted in the belief that sustainable change comes from equipping people with the right information and authority.
The outcomes were both measurable and meaningful. Within six months, the national rejection rate fell from 6.30% to 3.94%, enabling 28,332 additional patients to receive timely diagnoses and treatment. For the National TB Programme, it marked a shift toward continuous quality improvement.
Of all my career highlights, this one stands apart for its impact. I have profound pride from knowing our work ensures more patients receive care - the only measure that truly matters.