Barriers for involvement of private doctors in RNTCP – Qualitative study from Kerala, India

Abstract

Introduction: Engaging the private sector effectively has been considered as the single most important intervention required for Revised National TB Control Program (RNTCP) to achieve the overall goal of universal access and early detection. This study attempts to identify the barriers and facilitators in the involvement of private practioners in signed schemes of RNTCP. Materials and Methods: Six focus group discussions - four among private sector doctors and two among RNTCP TB key workers and 10 key informant interviews were conducted. Themes were divided into private sector involvement in RNTCP, barriers for private sector involvement, facilitators for private sector involvement and suggestions for better PPP. Results: General feel was that private sector involvement in RNTCP was increasing. Public sector at ground level has not really understood the need to engage the private sector. Lack of capacity for public sector staff to understand and deal with private sector, power relations and not taking hospital managements to trust emerged as important barriers for engagement while private sector doctors expressed concerns over patient confidentiality and patient choices, apprehension of losing patients, inability of program to keep commitments and timely payments, poor recognition to private sector, bureaucratic hurdles and cumbersome formalities. Building locally customised partnership schemes, behaviour change for PPP, building managerial capacity of Public sector to deal with private sector, presence of an interphase agency and quality control through a participatory body were important suggestions for improvement of PPP. Conclusion: Strategies have to be formulated to customise partnership for private sector doctors using the flexibilities of the program. Strengthening PPP will be possible in presence of strong administrative will and the understanding that personal relationships are the best key to Public Private Partnerships.

Ensuring universal access to quality care for persons with presumed tuberculosis reaching the private sector: lessons from Kerala

“…In 2016, even after the NTEP implemented a daily anti-TB regimen—the absence of which was cited as the major reason by the private sector for not participating—there was not much improvement in the private sector participation in terms of contributions towards TB notification or partnering with NTEP on signed partnership schemes. Operations researches conducted through the NTEP mechanisms, revealed many challenges for sub-optimal private sector participation [ 32 , 33 ]. Efforts were also put in place to understand the real problems of patients reaching the private sector [ 34 ].…”

TB notification rates across parliamentary constituencies in India: a step towards data‐driven political engagement

“…In India, PC‐level information on private sector performance can help secure the support of elected representatives for scaling up successful experiences and ensuring the sustainability of private sector involvement. There is evidence to suggest that instead of a centrally administered uniform model, services may be decentralised to develop locally appropriate models of partnerships with private providers [ 25 ]. PCs with adequate private sector notification can serve as role models for neighbouring constituencies.…”

STEPS: A Solution for Ensuring Standards of TB Care for Patients Reaching Private Hospitals in India

“…Even after NTEP implemented a daily anti-TB regimenthe absence of which was the major reason the private sector cited not participating-there was not much improvement in the private sector participation. 17 Operations research identified several important barriers to engagement of the private sector in NTEP: absence of mutual trust between the public and private sector, concerns over patient confidentiality and patient choices, apprehension of losing patients, lack of consideration for hospital management, lack of time for doctors to document, inability of the program to keep commitments and timely payments, poor recognition of the private sector, and bureaucratic hurdles. 17 A recent study from Kerala of the prescribing pattern of practitioners reported that TB management in the private sector follows a reasonable standard of care in terms of treatment prescriptions.…”

“…17 Operations research identified several important barriers to engagement of the private sector in NTEP: absence of mutual trust between the public and private sector, concerns over patient confidentiality and patient choices, apprehension of losing patients, lack of consideration for hospital management, lack of time for doctors to document, inability of the program to keep commitments and timely payments, poor recognition of the private sector, and bureaucratic hurdles. 17 A recent study from Kerala of the prescribing pattern of practitioners reported that TB management in the private sector follows a reasonable standard of care in terms of treatment prescriptions. 18 A private tertiary care center in Kerala demonstrated that establishing a management system within the hospital ensured 100% TB notification with a 4-fold increase over 6 months.…”