Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods

Abstract

ObjectivesIn Bangladesh, private healthcare is common and popular, regardless of income or area of residence, making the private sector an important player in health service provision. Although the private sector offers a good range of health services, tuberculosis (TB) care in the private sector is poor. We conducted research in Dhaka, between 2004 and 2008, to develop and evaluate a public–private partnership (PPP) model to involve private medical practitioners (PMPs) within the National TB Control Programme (NTP)'s activities. Since 2008, this PPP model has been scaled up in two other big cities, Chittagong and Sylhet. This paper reports the results of this development, evaluation and scale-up.DesignMixed method, observational study design. We used NTP service statistics to compare the TB control outcomes between intervention and control areas. To capture detailed insights of PMPs and TB managers about the process and outcomes of the study, we conducted in-depth interviews, focus group discussions and workshops.SettingUrban setting, piloted in four areas in Dhaka city; later scaled up in other areas of Dhaka and in two major cities.FindingsThe partnership with PMPs yielded significantly increased case finding of sputum smear-positive TB cases. Between 2004 and 2010, 703 participating PMPs referred 3959 sputum smear-positive TB cases to the designated Directly Observed Treatment, Short-course (DOTS) centres, contributing about 36% of all TB cases in the project areas. There was a steady increase in case notification rates in the project areas following implementation of the partnership.ConclusionsThe PPP model was highly effective in improving access and quality of TB care in urban settings.

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Treatment referral system for tuberculosis patients in Dhaka, Bangladesh

“…1 Governmental, non-governmental and private sector providers are highly committed to working together to achieve TB control. 2 One of the current priorities of the Bangladesh National TB Programme (NTP) is to develop an urban strategy that can effectively engage diverse health care providers in providing accessible care for the poor. 3 The population density of Bangladesh's capital, Dhaka, is about 19 380 per km 2 (50 000/square mile), 4 and the total population is 14.5 million.…”

Involving private practitioners in the Indian tuberculosis programme: a randomised trial

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