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Involving private health care providers in TB control: strategic options

Involving private health care providers in TB control: strategic options. Mukund Uplekar, TB Strategy and Operations, Stop TB, World Health Organization IUATLD Annual Conference, Montreal, October 02. The context…. TB programs Public health system Private providers The disease

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Involving private health care providers in TB control: strategic options

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  1. Involving private health care providers in TB control: strategic options Mukund Uplekar, TB Strategy and Operations, Stop TB, World Health Organization IUATLD Annual Conference, Montreal, October 02.

  2. The context…. • TB programs • Public health system • Private providers • The disease • Clients

  3. The context…. • TB Programs • Strengthened programs • Low case notifications

  4. The context…. • Public health system • Weak • Changing role • Care provision Stewardship

  5. The context…. • Private providers • Inadequate practices • Alienated from TB programs

  6. The context…. • The disease • Low morbidity • Non-specific symptoms • Rapid response to treatment

  7. The context…. • Clients and their provider choice • Confidence • Convenience • Perceived quality of care

  8. The context…. • Major considerations • The state of general health services • The capacity and quality of NTP services • The size and reach of the private sector • People’s choices and preferences

  9. Strategic options…. • Public system • Exclude private providers • Parallel systems • Ignore / tolerate private providers • Collaborative system • Accept private providers

  10. Strategic options…. • Public system: • Exclude private providers from TB control • Mandate referrals or restrict sale of anti-TB drugs • Prerequisites for success: • NTP capacity to substitute for private sector provision • Services “acceptable” and “convenient” to patients • Political will to exclude private providers • Administrative capacity to enforce exclusion

  11. Strategic options…. • Parallel system: • Ignore private providers or tolerate them • Marginalise private sector by providing quality care • Prerequisites for success: • Strong and well functioning TB programme • Services good enough to attract all patients • General health services in good health • Private providers willingly referring cases • Private providers follow good management practices

  12. Strategic options…. • Public Private Collaboration: • Build a suitable public-private mix for care delivery • Share key service delivery tasks with other providers • Prerequisites for success: • Willingness to work together and “Give and Take” • Clear identification of mutual roles / responsibilities • Appropriate incentives and disincentives • Flexibility for setting-specific adaptations

  13. PPM DOTS: spectrum of options Tools and guidelines for routine use in practice Incentives for positive contribution Outlaw TB mgmt. by PPs Involvement in planning/training Mandatory internships Contractingout DOTS Regulation of practices In-practice education Designate “Best Practice” private clinics Postgraduate program postings Regular interaction

  14. Strategic options…. Key questions for choosing a strategy: Immediate: 1. Can the NTP achieve case detection targets working mainly through the public sector? 2. Can this be done in the next 2-3 years? Long term: 3. Can private providers be eliminated from any strategy to eliminate TB?

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