Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan

Abstract

To improve involvement of the private sector in the national tuberculosis (TB) programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37 656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification (58.3%), followed by the hospital-based model (18.9%). Treatment success was highest for the district-led model (94.1%) and lowest for the hospital-based model (74.2%). The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects. 1National TB Control Programme, Islamabad, Pakistan (Correspondence to A.A. Chughtai: doctorahmad75@gmail.com

“They Know, They Agree, but They Don’t Do”- The Paradox of Tuberculosis Case Notification by Private Practitioners in Alappuzha District, Kerala, India

“…Perceptional conflicts influence private-public divide in national programmes [ 20 ]. Models in Pakistan, India and Nepal reiterate the untapped but significant potential of private sector to impact public health programmes [ 3 , 4 , 21 ]. A standardized reporting system yielding a comprehensive epidemiological situation of tuberculosis may evolve only over many years of collaboration like the European TB Surveillance System [ 22 ].…”

Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan

“…[5][6][7] While these results are encouraging, there is scope for further improvement. The studies that assessed treatment outcomes were conducted among registered patients receiving treatment, and did not consider the loss to follow-up (LTFU) that may have occurred before the initiation of treatment.…”

“…The studies that assessed treatment outcomes were conducted among registered patients receiving treatment, and did not consider the loss to follow-up (LTFU) that may have occurred before the initiation of treatment. 7 The WHO now recommends that every diagnosed patient should be registered and accounted for and that those patients who were not initiated on treatment be reported as pre-treatment LTFU. 8 Based on anecdotal evidence obtained during routine field visits, we hypothesised that there is a gap between the number of patients diagnosed and the number started on treatment in the four models of PPM: general practitioners (GPs; PPM1), non-governmental organisations (PPM2), private hospitals (PPM3) and others (PPM4).…”

Is the public-private mix approach increasing tuberculosis case notification in Azad Jammu and Kashmir, Pakistan? A cross-sectional study

“…Districts without PPM Support n=06 case notification has been increased due to involvement of private health care providers 14 . Similar studies from Pakistan also suggested that TB case notification has been improved due to involvement of private health care providers 6,7,19 .…”

“…In 2006, Pakistan adopted PPM model which has been gradually scaled-up 13 . The contribution of PPM in all case notification in Pakistan has been reported to be up to 18% 14 . Studies from Pakistan have revealed that PPM can play a substantial role in achieving the targets of treatment success rate and case detection 7, 15,16 .…”