Public private mix in tuberculosis control: is it really working in India?

Nautiyal, Ram Gopal; Singh, Rajesh Kumar

doi:10.18203/2394-6040.ijcmph20180258

Cited by 8 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It provides countrywide accessibility of free TB diagnostic and treatment services to the population. Despite this provision from the public health sector, 60 to 88% of Indian patients seek TB care from the private health sector, and around 90% of them prefer to buy anti-TB drugs from the private market irrespective of their financial status [3]. The TB diagnostic practices in the private sector differ from those in the public sector wherein the primary emphasis under RNTCP is on sputum and chest radiography examination.…”

Section: Introductionmentioning

confidence: 99%

Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?

Poornima¹,

Shruthi

Chingale

et al. 2020

Tuberculosis Research and Treatment

View full text Add to dashboard Cite

Background. TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A p value of <0.05 was taken as statistically significant. Results. Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%–52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; p<0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (p<0.05). Conclusion. The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.

show abstract

Section: Introductionmentioning

confidence: 99%

Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?

Poornima¹,

Shruthi

Chingale

et al. 2020

Tuberculosis Research and Treatment

View full text Add to dashboard Cite

show abstract

“…These efforts are laudable but there is room to grow. 45 Mandating the use of free drugs available through NTEP by PPM programs will reduce drug costs. Increasing awareness of NTEP services, continued decentralization of services, and dispelling negative attitudes about the NTEP may encourage impoverished Indians to avail of free care.…”

Section: Discussionmentioning

confidence: 99%

How much do Indians pay for tuberculosis treatment? A cost analysis

Sinha

Carwile

Bhargava

et al. 2020

public health action

View full text Add to dashboard Cite

Setting: India’s National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers).Objective: To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB.Design: We identified relevant articles using key search terms (‘tuberculosis,’ ‘India,’ ‘cost,’ ‘expenditures,’ ‘financing,’ ‘catastrophic’ and ‘out of pocket’) and calculated variance-weighted mean costs.Results: Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs.Conclusion: PLWTB in India face high direct and indirect costs. Priority interventions to realize India’s goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.

show abstract

“…Reasons for not using the intermittent regimen were evident in the study by Nautiyal et al, wherein almost 97% PPs did not perceive RNTCP as a successful strategy. 20 This suggests that PPs do not realize the scientific basis of intermittent TB treatment. However, the recent shift of RNTCP from intermittent to daily regimen in the State of Uttarakhand in year 2018, may help in establishing uniformity of TB care between the private and public health sector in the region.…”

Section: Discussionmentioning

confidence: 99%

Management of pulmonary tuberculosis in private health sector: is it according to revised national tuberculosis control programme guidelines?

Nautiyal

Singh

2019

Int J Community Med Public Health

Self Cite

View full text Add to dashboard Cite

INTRODUCTIONThe Revised National Tuberculosis Control Programme (RNTCP) of India is the world's largest TB control programme. Encouraged by its achievements, the programme in 12 th five year plan (2012-2017) had articulated National Strategic Plan with a vision of TB Free India. 1 Tuberculosis (TB) care in India is provided by both the public and the private health sector. 2 In order to realize this vision, TB management needs to be uniform between these two sectors. This means that the private health sector needs to adopt the World Health Organization (WHO) recommended RNTCP's TB management methodology.However, since the earliest documented report by Uplekar et al in 1991 to a systematic review by Satyanarayana et al on suboptimal TB management in private sector of India, TB care in private health sector has been reported to be substandard and erratic. 3,4 As almost half of Indian TB patients are managed by the private health sector, the substandard TB care in private sector has the potential to disrupt TB control efforts of RNTCP. [5][6][7] The RNTCP has been aware of this fact ABSTRACT Background: As private sector is dominant tuberculosis (TB) care provider in India, to realize the vision of TB free India, it is crucial that public and private sector follow uniform standard of TB care. This can be achieved when private health sector adopts TB management methodology of Revised National Tuberculosis Control Programme (RNTCP) of India. The present study was conducted to estimate whether or not TB management practices of allopathic private practitioners (PPs) conform to RNTCP guidelines by assessment of their knowledge and practice about new pulmonary TB (PTB). Methods: A cross-sectional study conducted using a semi-structured questionnaire among PPs practicing in urban areas of five of the six districts of Kumaon Division of Uttarakhand State of India between October 2013 to November 2014. Results: Of 71 PPs included in the study, almost 66% did not suspect pulmonary TB unless cough was associated with other symptoms. For diagnosis and follow up, sputum AFB microscopy alone was used by only 10% and 8.4% PPs respectively. Of the 71 PPs, 67 PPs who prescribed treatment for new PTB, used 20 diverse anti-TB regimens, and 10.5% of them included levofloxacin in the regimen. Conclusions: Majority PPs didn't follow the RNTCP's TB management guidelines for new PTB.

show abstract

Public private mix in tuberculosis control: is it really working in India?

Cited by 8 publications

References 3 publications

Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?

Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?

How much do Indians pay for tuberculosis treatment? A cost analysis

Management of pulmonary tuberculosis in private health sector: is it according to revised national tuberculosis control programme guidelines?

Contact Info

Product

Resources

About