- TB case notification can be increased by involving a small number of Private Medical Practitioners (PMPs) in selected areas. This makes scale-up feasible, as training in using the Public-Private Mix (PPM) model does not have to in-clude all PMPs in the area.
- The PPM model should be scaled up in other urban areas in Bangladesh.
- Adequate human and financial resources should be provided for partnership activities.
- The roles and responsibilities of participating agencies and individuals must be defined in a Memorandum of Understanding to develop and sustain effective partnerships.
- Systematic implementation of the partnership leads to greater and more effective involvement of PMPs.
- PMPs need training to enhance their knowledge on the NTP guidelines.
- The involvement of PMPs substantially increased case finding of infectious TB cases.
- The PPM model is highly effective in improving access to and quality of TB care in urban settings.
- Appropriate protocols, tools and training materials have considerably improved the quality of TB reporting.
- The revised protocol for referrals gave PMPs confidence that they would not lose their patients, which greatly increased their motivation to remain in the partnership.
- Participatory development of the PPMs and maintenance of close links were crucial in gaining PMP’s willingness to be involved in the PPM.
- Joint ownership of decisions and collective responsibility for implementing the partnership contributed to success.
- insufficient infrastructure;
- shortage of appropriately trained health personnel;
- health facility opening times that are inconvenient for working people, which limits access to and acceptability of treatment; and
considerable stigma associated with TB.
- The case notification rate for new SS+ TB cases in the study areas increased steadily and was consistently higher than the national average (see Figure 1)
- 703 PMPs were trained in technical and operational aspects of TB care, and PPM/TB record-keeping
- 3,585 sputum smear positive (SS+) TB patients were registered across 5 TB centres;
- 647 of the 3,585 patients were referred by PMPs
- tools and guidelines needed to diagnose patients;
- national recording and reporting forms;
- registers to maintain records of the referrals from PMPs; and
- NTP’s TB treatment algorithm to incorporate a flexible referral mechanism.
- 703 participating PMPs referred almost 19,000 TB suspects and 3,959 SS+ TB cases to the designated TB diagnostic centres; and
- almost 36% of all SS+ TB cases were attributable to involvement of the private sector providers.
Zafar Ullah AN, Huque R, Husain A, et al. (2012)Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods. BMJ Open. 2(6). doi:10.1136/bmjopen-2012-001534
For more information email Dr Rumana Huque at firstname.lastname@example.org