Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection

Abstract

This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further.

Patient’s satisfaction regarding directly observed treatment short course under RNTCP in a district of North India

“…These results are in conformity with the findings of other studies. 11,12 In the present study, pulmonary TB was found in 80.70 % and extra pulmonary in 19.30% patients which is almost similar to the finding of another study conducted in Thailand where corresponding figures were 77% and 23% respectively. 13 Similar trend was revealed in a study conducted in Meerut (PTB 91.70% and extra pulmonary in 8.30%) 10 and in another study of Howrah (pulmonary cases 86.70% and extra pulmonary cases 13.30%).…”

Social Marketing on Dengue Hemorrhagic Fever and Tuberculosis Prevention and Control Program in Pati, Central Java, Indonesia

“…A research results from Lo¨nnroth, Aung, Maung, Kluge, and Uplekar (2007) concluded that TB program services are better through franchise clinics. This study suggests that social franchising of TB care can contribute positively to public health, including equity in access to quality care and financial protection for the poor.…”

The Incremental Cost-Effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia

“…Increases in TB case notification after involvement of private providers have also been reported by studies in Vietnam (18%), 20 Nepal (92%), 21 India (11%), 22 and Myanmar (21%). 23 The differences between these increases are likely caused by differences of context (e.g., TB incidence, baseline case notification, care seeking behavior), general intervention characteristics and task mix (e.g., suspect referral, treatment by PPs), and output (e.g., number, type and distribution of private providers effectively engaged). Furthermore, it is not appropriate to fully attribute the incremental effectiveness in all these studies to the PPs strategies.…”