Summarybackground Public-private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries.objectives To evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America.methods We contacted the local Pharmacists' Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before-after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists.results The proportion of pharmacies selling TB drugs decreased (rifampicin: 23-11.5%; isoniazid: 16-3.1%; P < 0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22-58%; P < 0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB.conclusion The first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment.

Short delays to treatment are important for the control of tuberculosis (TB). National Tuberculosis Programmes provide free diagnosis and treatment for smear-positive patients, so that the patients' out-of-pocket medical expenditure could be almost nil. The factors associated with delays in starting treatment, and the pre-treatment out-of-pocket medical expenditure for TB patients, have now been investigated in the Bolivian city of Cochabamba. Bolivia is the Latin American country with the highest incidence of TB. It is covered by a national TB programme that provides free diagnosis and free treatment for smear-positive patients. Structured interviews with 144 smear-positive patients enrolled in this programme revealed median patient, provider and total delays of 3.6, 6.2 and 12.9 weeks, respectively. The total delays were longer for the female patients than for the male, and for patients who consulted private doctors than for the other patients. When the first healthcare provider was a doctor, the median provider delay was 4.9 weeks in the public sector but 7.2 weeks in the private. The median out-of-pocket medical expenditure per patient, which was U.S.$13.2 overall, was much higher for those who consulted a private doctor than for those who did not (U.S.$21.9 v. U.S.$5.4, respectively; P<0.001). It appears that interventions targeting doctors (in both the private and public sectors) are likely to have a larger impact on the shortening of delays in TB treatment than interventions targeting patients. They could also reduce unnecessary out-of-pocket expenditure.

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El objetivo de este artículo fue aportar luces sobre la cuestión de cuáles son los componentes de la estrategia de operaciones que pueden favorecer el control del servicio y la orientación al cliente, para lograr paulatinamente altos estándares en la entrega del servicio, acordes con los cambios en el mercado y con la cadena de valor de la compañía. Para esto, se realizó una investigación exploratoria que usó el método inductivo a través de análisis factorial exploratorio con el modelo Promax de rotación oblicua. Las indagaciones de tipo exploratorio se realizaron a 43 empresas a través de un muestreo a conveniencia en departamento del Valle del Cauca (Colombia). Se buscaron, principalmente, empresas del sector servicios, de alguna consolidación en el mercado y que facilitaran la aplicación de una encuesta presencial y de calidad al personal de dirección. Como resultado, se dejan las bases para un modelo conceptual que aporte al control de la estrategia de operaciones, de modo que sea posible concebir el valor para el cliente desde una estrategia de operaciones que parte de los atributos de calidad del servicio y se fundamenta en los factores subyacentes hallados en el modelo explorado, tales como: el control del servicio, la gestión de las instalaciones orientadas al cliente, sistemas de información y tecnologías asociadas. Como perspectiva, se plantea la necesidad de análisis factorial confirmatorio, con mayor tamaño de muestra para organizaciones de servicio con trayectoria en el mercado.