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Background Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012–17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. Methods and findings We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program’s budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. Conclusions As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable.

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One consistent theme within public debates on the problem of drug misuse is its association with minority ethnic groups (Pearson 1995b). It is, nevertheless, a peculiar feature of the British drug scene that members of black and other minority groups have been significantly underrepresented among known populations of problem drug users. This despite the fact that there has been clear evidence since the early 1980s of a concentration of the most serious drug-related problems in areas of high unemployment and social deprivation, and that ethnic minorities in Britain experience a high degree of social exclusion in terms of poverty, housing deprivation, educational disadvantage, and discrimination in the labor force (Jones 1996). It is entirely possible, of course, that drug users from Britain's black communities are more likely to remain unknown to service agencies—reflecting other aspects of disadvantage in access to health care (Awiah et al. 1992). In what continues to be a rapidly changing drug scene in Britain, this paper sets out to review this perplexing area of drugs, deprivation, and ethnic minority status, while also presenting evidence in Part II from an outreach project among Asian drug injectors in the city of Bradford in the north of England.

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It is considered that child health professionals should have sufficient knowledge of patterns of substance (mis)use in young people to enable them to respond appropriately if faced with a client who is, or is suspected of, (mis)using substances. Whilst there is an increasing amount of literature relating to young people's substance misuse in general, there is a paucity of knowledge relating to substance (mis)use amongst young people from an ethnic minority background. In this article the findings of qualitative studies carried out at two sites in Greater Manchester are presented, which suggest that whilst patterns of substance (mis)use amongst Asians may be similar in many ways to those for the general population, they occur within a different cultural context. It is suggested therefore, that there is a need for child health professionals to be culturally sensitive in working with young people who are, or are suspected of, (mis)using drugs - although unfortunately practical examples of such cultural sensitivity have yet to be provided.

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