Enhancing the role of private practitioners in tuberculosis prevention and care activities in India

Abstract

India accounts for the highest number of incident tuberculosis (TB) cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs) has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS) helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program.

Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India

“…The Government of India's NTEP has made several efforts to engage the formal private health care providers [ 11 , 12 ], but the efforts made to engage the informal providers have not been commensurate to the need. The main reason for hesitancy to engage informal providers is that these providers are technically unqualified and therefore illegal practitioners of medical care.…”

Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City, Viet Nam

“…Increased acceptance of Xpert testing has also been observed to result in a reduction of clinical diagnosis [40], so that increasing private-sector Xpert uptake could substantially reduce the rate of over-diagnosis and contribute to improved individual and public health outcomes. Efforts to optimize NAAT access have proven effective in several settings through the Initiative for Promoting Affordable, Quality TB tests [24,38,41].…”

“…One such scheme is the Private Provider Interface Agency (PPIA) model that has subsequently been scaled through the Joint Effort for Elimination of Tuberculosis (JEET) to 23 states of India [22,23]. This model employs intermediary agencies [15,24] that aim to offer a tangible value proposition with bottom-line impact rather than appeal to altruistic motivations [25,26]. This value proposition includes free or discounted access to nucleic acid amplification testing (NAAT) and medicines at pre-negotiated price-points for providers and patients and, perhaps most importantly, the option for private providers to retain their customers and thereby their livelihoods [27].…”

Ending tuberculosis in India: A political challenge & an opportunity

“…Third, engagement with the private sector needs to be scaled up. Over half of the TB patients in India first seek care in the private sector 19 . The care provided in the private sector, while being more easily accessible, is often unregulated and can be of substandard quality 20 .…”