Improving tuberculosis control through public-private collaboration in India: literature review

doi:10.1136/bmj.38738.473252.7C

BMJ 2006;332:574-578 (11 March), doi:10.1136/bmj.38738.473252.7C (published 8 February 2006)

Research

Improving tuberculosis control through public-private collaboration in India: literature review

Puneet K Dewan, medical officer¹, S S Lal, national professional officer², Knut Lonnroth, secretariat, public-private mix subgroup³, Fraser Wares, medical officer², Mukund Uplekar, secretariat, public-private mix subgroup³, Suvanand Sahu, national professional officer², Reuben Granich, medical officer², Lakhbir Singh Chauhan, deputy director general for tuberculosis⁴

¹ International Research and Programs Branch, Division of Tuberculosis Elimination, 1600 Clifton Road, MS E-10, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA, ² Office of the World Health Organization Representative to India, New Delhi, India, ³ Tuberculosis Strategy and Operations, Stop TB Department, World Health Organization, Geneva, Switzerland, ⁴ Central Tuberculosis Division, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India

Correspondence to: P K Dewan phd8{at}cdc.gov

Abstract

Objective To review the characteristics of public-private mixprojects in India and their effect on case notification andtreatment outcomes for tuberculosis.

Design Literature review.

Data sources Review of surveillance records from Indian tuberculosisprogramme project, evaluation reports, and medical literaturefor public-private mix projects in India.

Data extraction Project characteristics, tuberculosis case notificationof new patients with sputum smear results positive for acidfast bacilli, and treatment outcome.

Data synthesis Of 24 identified public-private mix projects,data were available from 14 (58%), involving private practitioners,corporations, and non-governmental organisations. In all reviewedprojects, the public sector tuberculosis programme providedtraining and supervision of private providers. Among the fiveprojects with available data on historical controls, case notificationrates were higher after implementation of a public-private mixproject. Among seven projects involving private practitioners,2796 of 12 147 (23%) new patients positive for acid fast bacilliwere attributed to private providers. Corporate based and non-governmentalorganisations served as the main source for tuberculosis programmeservices in seven project areas, detecting 9967 new patientspositive for acid fast bacilli. In nine of 12 projects withdata on treatment outcomes, private providers exceeded the programmetarget of 85% treatment success for new patients positive foracid fast bacilli.

Conclusions Public-private mix activities were associated withincreased case notification, while maintaining acceptable treatmentoutcomes. Collaborations between public and private providersof health care hold considerable potential to improve tuberculosiscontrol in India.

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Rapid Responses:

Read all Rapid Responses

Public-private partnership for tuberculosis?: Pierre De Paepe, et al.
bmj.com, 24 Feb 2006 [Full text]
Collaboration or communication with private providers? Conclusions based on insufficient evidence.: Shifalika Goenka
bmj.com, 14 Mar 2006 [Full text]
Public-private partnerships for tuberculosis control: opportunity cost?: Marie-Laurence Lambert, et al.
bmj.com, 21 Mar 2006 [Full text]
Authors' Reply: Puneet K Dewan, et al.
bmj.com, 8 Apr 2006 [Full text]