Initiating a district-based public–private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage.

Abstract

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.

Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide analysis of programme data and health system vulnerabilities

“…39 Private health facilities are key entry points for a large proportion of patients seeking health care in Indonesia, including for TB. 5,40 Additionally, the SITB registers drug-susceptible TB cases, and we could not assess the burden of multidrug/rifampicin-resistant (MDR/RR) cases.…”