Many developing country governments are struggling to control the tuberculosis (TB) epidemic. Public-private partnerships are a practical way to increase TB control capacity and improve the quality of private sector care. Researchers from the UK Nuffield Institute for Health propose a process for developing new partnership models, using Bangladesh as an example.

The World Health Organisation (WHO) advocates the directly observed treatment short-course (DOTS) strategy for TB control, which has been successful in many settings. But many TB programmes suffer from limited capacity and quality. So people often seek care from private medical practitioners, who are rarely regulated or controlled and generally fail to prescribe internationally accepted treatments. One way to increase accessibility, capacity and quality of TB control is to develop partnerships involving the public sector TB Control Programme, non-governmental organisations (NGOs), private medical practitioners, patients and the community. Additional partners could include private laboratories and local government.

The Nuffield researchers developed a conceptual framework for such partnerships and used this generic model to analyse existing public-private partnerships for TB control in India, Nepal, Indonesia, the Philippines and the Democratic Republic of Congo. They found that the contribution of NGOs and the private sector to national TB control efforts increases case detection rates and improves treatment outcomes. Essential features of successful partnerships include:

• adherence to national TB guidelines and DOTS strategies
• an intermediary organisation, such as an NGO, to facilitate and coordinate activities
• a charismatic leader or liaison person to gain stakeholders’ confidence during the initial stages
• intensive and open dialogue, frequent communication and clear delineation of responsibilities among partners
• joint reporting and monitoring to demonstrate programme sustainability and effectiveness
• inclusion of only registered practitioners.

The researchers applied these principles to develop a partnership to improve TB control in Bangladesh, where the case detection rate in 2001 was only 28 percent – well below WHO targets. The National TB Programme in Bangladesh has worked with NGOs since the introduction of DOTS in 1993 and NGOs now share more than half of the work. Building on this experience, the proposed partnership includes:

• an NGO, the Bangladesh Rural Advancement Committee, which would facilitate and coordinate activities, train and support health professionals, provide health education, community mobilisation and late patient tracing, and ensure communication between partners
• the government TB Programme and local government, which would provide the policy environment, regulatory and operational frameworks, joint supervision, training and logistic supplies
• the medical association, which would negotiate on behalf of its member practitioners and would facilitate supervision, training, recording and reporting
• private practitioners, who would follow national guidelines while dealing with suspected TB cases
• TB patients, who would raise community awareness through peer education and motivation.

Source(s):
‘A model for effective involvement of private medical practitioners in TB care’, International Journal of Health Planning and Management 19: 227-245 by Z. Ullah, M. Lubben and J. Newell, 2004

id21 Research Highlight: 31 March 2005

Further Information:
A. N. Zafar Ullah
Nuffield Institute for Health
University of Leeds
71-75 Clarendon Road
Leeds
LS2 9PL
UK

Contact the contributor: hss1anuz@leeds.ac.uk

Nuffield Institute for Health, University of Leeds, UK

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