Background District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy. Methods The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression. Results District TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05). Conclusions Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.

Latar belakang. Tuberkulosis adalah penyakit yang masih menjadi masalah kesehatan di dunia. Pada tahun 2014 terjadi peningkatan insidens, prevalens bahkan kematian karena TB di Indonesia. Tujuan. Mengetahui besar risiko tidak diimunisasi BCG terhadap kejadian TB Paru pada anak di Kota Sukabumi tahun 2015-2016 setelah dikontrol oleh variabel umur, jenis kelamin, berat badan lahir, pemberian ASI Eksklusif, kunjungan Neonatal, pemberian Vitamin A, pendidikan Ibu dan Pekerjaan Ibu. Sedangkan tujuan sekunder dari studi ini adalah mengidentifikasi status imunisasi BCG dan kejadian TB Paru pada anak serta variable covariatnya dan mengetahui besar risiko anak yang tidak diimunisasi serta mengetahui besar Efektivitas vaksin BCG. Metode. Penelitian ini menggunakan desain case control. Kasus dan kontrol adalah anak kota Sukabumi usia 0-5 tahun yang diperoleh dari laporan rutin program TB, imunisasi, KIA dan Gizi di Dinas Kesehatan Kota Sukabumi. Hasil. Analisis multivariat menunjukkan bahwa risiko anak yang tidak diimunisasi BCG dan KN sebanyak 3 kali adalah 1,13 kali lebih besar untuk terkena TB paru dibandingkan kelompok rujukan dan anak yang diimunisasi BCG. Dari hasil tersebut diketahui bahwa efektivitas vaksin BCG tanpa interaksi 67%, sedangkan dengan interaksi 82%. Kesimpulan. Imunisasi di Kota Sukabumi masih merupakan salah satu upaya yang efektif untuk mencegah terjadinya TB paru pada anak.

Background: District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. This research aims to analyze the readiness stakeholders' engagement in the context of initiating the implementation of DPPM.Methods: The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through participant observation, in-depth interviews and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in stage I. Data were analyzed using Rasch modeling and logistic regression.Results: District TB case detection rates (CDRs) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were none or minimal from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of private facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05).Conclusions: Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach and encourages institutional support of health facilities for the TB program. Private sector engagement is a process that must be managed and not allowed to naturally happen.