One year of COVID-19 and its impact on private provider engagement for TB: A rapid assessment of intermediary NGOs in seven high TB burden countries

Abstract

The COVID-19 pandemic has impacted health systems and health programs across the world. For tuberculosis (TB), it is predicted to set back progress by at least twelve years. Public private mix (PPM) is a collaborative approach to engage private providers in quality TB care. It has made a vital contribution to reach End TB targets with a ten-fold rise in TB notifications from private providers between 2012 and 2019. This is due in large part to the efforts of intermediary agencies, which aggregate demand from private providers. The COVID-19 pandemic has put these gains at risk over the past year. In this rapid assessment, representatives of 15 intermediary agencies from seven countries that are considered the highest priority for TB PPM (the Big Seven) share their views on the impact of COVID-19 on their programs, the private providers operating under their PPM schemes, and their private TB clients. All intermediaries reported a drop in TB testing and notifications, and the closure of some private practices. While travel restrictions and the fear of contracting COVID were the main contributing factors, there were also unanticipated expenses for private providers, which were transferred to patients via increased prices. Intermediaries also had their routine activities disrupted and had to shift tasks and budgets to meet the new needs. However, the intermediaries and their partners rapidly adapted, including an increased use of digital tools, patient-centric services, and ancillary support for private providers. Despite many setbacks, the COVID-19 pandemic has underlined the importance of effective private sector engagement. The robust approach to fight COVID-19 has shown the possibilities for ending TB with a similar approach, augmented by the digital revolution around treatment and diagnostics and the push to decentralize health services.

COVID-19 Pandemic Disruption on the Management of Tuberculosis Treatment in Indonesia

“… 23 Moreover, concern about contracting the virus when visiting health-care facilities also could affect the whole agenda of early diagnosis and seeking care. 24 These facilities have minimized their services to reduce the risk of transmission. Most TB hospitals in Indonesia have been designated COVID-19 hospitals at provincial levels, leading to a significant delay in TB diagnosis because of additional workload.…”

“…Nevertheless, their contribution to support TB services drastically increased since the end of 2020. 24 These activities could not be implemented because of several factors, such as travel restrictions. This situation might hinder ending TB by 2035, as the UN and WHO targeted.…”

Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria—A mixed methods study

“…Other detailed reports of facility closures, service disruptions, and increases in costs for patients have begun to be published [15,16,31,32]. The results of our study agree with results obtained in a previous rapid assessment by Klinton et al on the impact of the pandemic on TB services in the private sector in seven high-burden TB countries including Nigeria [16]. This rapid assessment reported fear of COVID-19 infection in facilities on both the patient and provider side, which was heightened by the overlapping TB and COVID-19 symptoms.…”

“…After five weeks of a federally mandated lockdown, restrictions were gradually eased. COVID-19 infection control measures were implemented early in the pandemic to reduce infection and disease transmission; however, earlier reports indicated that they also led to challenges in accessing health services, especially for already vulnerable populations such as individuals with TB in Nigeria [6,14,15], as they did in other high burden countries [16,17].…”

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

“…Notably, a recent report estimated that Indonesian healthcare workers had a five times higher chance of death from COVID-19 than the general population. 33,34 Second, the pandemic affected patient health-seeking behaviour as well as access to essential health services, because of fear of contracting COVID-19 and extra costs for personal protective equipment 35 , and government-mandated local lockdowns. 36 Third, emerging data suggest that biological interactions between both pathogens can result in shared dysregulation of immune responses and a dual risk for COVID-19 severity and TB disease progression or poor outcomes.…”