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

BMJ 2006; 332 doi: (Published 09 March 2006) Cite this as: BMJ 2006;332:574
  1. Puneet K Dewan, medical officer (phd8{at},
  2. S S Lal, national professional officer2,
  3. Knut Lonnroth, secretariat, public-private mix subgroup3,
  4. Fraser Wares, medical officer2,
  5. Mukund Uplekar, secretariat, public-private mix subgroup3,
  6. Suvanand Sahu, national professional officer2,
  7. Reuben Granich, medical officer2,
  8. Lakhbir Singh Chauhan, deputy director general for tuberculosis4
  1. 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. 2 Office of the World Health Organization Representative to India, New Delhi, India
  3. 3 Tuberculosis Strategy and Operations, Stop TB Department, World Health Organization, Geneva, Switzerland
  4. 4 Central Tuberculosis Division, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
  1. Correspondence to: P K Dewan
  • Accepted 17 November 2005


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

Design Literature review.

Data sources Review of surveillance records from Indian tuberculosis programme project, evaluation reports, and medical literature for public-private mix projects in India.

Data extraction Project characteristics, tuberculosis case notification of new patients with sputum smear results positive for acid fast 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 reviewed projects, the public sector tuberculosis programme provided training and supervision of private providers. Among the five projects with available data on historical controls, case notification rates were higher after implementation of a public-private mix project. Among seven projects involving private practitioners, 2796 of 12 147 (23%) new patients positive for acid fast bacilli were attributed to private providers. Corporate based and non-governmental organisations served as the main source for tuberculosis programme services in seven project areas, detecting 9967 new patients positive for acid fast bacilli. In nine of 12 projects with data on treatment outcomes, private providers exceeded the programme target of 85% treatment success for new patients positive for acid fast bacilli.

Conclusions Public-private mix activities were associated with increased case notification, while maintaining acceptable treatment outcomes. Collaborations between public and private providers of health care hold considerable potential to improve tuberculosis control in India.


  • Embedded ImageProjects are listed

    RG is technical adviser and programme officer for the Office of the US Global AIDS Coordinator, Washington DC, USA.

  • Contributors All authors developed the idea for this article. PD produced the first draft of the article, and all authors prepared the final draft. PD is guarantor.

  • Funding None.

  • Competing interests KL and MU work with the public-private mix for DOTS initiative in the WHO's Stop TB Department.

  • Ethical approval Not required.

  • Amendment This is Version 2 of the paper. In this version Dr Chauhan's first name has been correctly spelt as Lakhbir [not Lakbir as in previous version].

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