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Meundi AD, Erasmus V, Nagaraja SB, Richardus JH. Voices of Those Who Bear the Brunt - Experiences of Programme Personnel Concerning Private Sector Tuberculosis Notifications in Bengaluru City, India. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:759-769. [PMID: 34478354 DOI: 10.1080/19371918.2021.1953665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aims to assess private and public sector contributions to Tuberculosis (TB) notification in Bengaluru city (2011 to 2016) and identify challenges of program personnel in their interaction with private practitioners and procedural barriers for TB notification from the private sector as perceived by them. A mixed methods study was carried out in Bengaluru city, India with TB notification data obtained from TB Units in addition to in-depth interviews with key program implementers. Results showed the contribution of private practitioners to TB notification to be about 20%. Barriers and challenges were: the private practitioners' hesitancy to refer the patients to public sector due to their fear of losing patients and dishonoring of diagnosis from private practitioners, lack of awareness about TB notification, lack of legal punitive measures and constant glitches on the notification website. These need to be resolved on priority to achieve the national target of TB elimination by 2025.
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Affiliation(s)
- Anand D Meundi
- Department of Community Medicine, Bowring and Lady Curzon Medical College and Research Institute, Bangalore, India
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sharath B Nagaraja
- Department of Community Medicine, ESIC Medical College and PGIMSR, Bangalore, India
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Arinaminpathy N, Nandi A, Vijayan S, Jha N, Nair SA, Kumta S, Dewan P, Rade K, Vadera B, Rao R, Sachdeva KS. Engaging with the private healthcare sector for the control of tuberculosis in India: cost and cost-effectiveness. BMJ Glob Health 2021; 6:bmjgh-2021-006114. [PMID: 34610905 PMCID: PMC8493898 DOI: 10.1136/bmjgh-2021-006114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public–Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control. Methods Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system. Findings A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95% uncertainty interval (UI): 159 to 320) per DALY averted and US$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB. Conclusions To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.
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Affiliation(s)
- Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, Imperial College London, London, London, UK
| | - Arindam Nandi
- Population Council, New York, New York, USA.,CDDEP, Washington, District of Columbia, USA
| | | | - Nita Jha
- World Health Partners, Patna, India
| | | | - Sameer Kumta
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Kiran Rade
- World Health Organization Country Office for India, New Delhi, India
| | | | - Raghuram Rao
- National Tuberculosis Elimination Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Kuldeep S Sachdeva
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
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Ahmadi A, Doshmangir L, Gordeev VS, Yazdizadeh B, Majdzadeh R. Behavioral barriers of tuberculosis notification in private health sector: policy implication and practice. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-01-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeUnderreporting of new tuberculosis (TB) cases is one of the main problems in TB control, particularly in countries with high incidence and dominating role of a private sector in TB cases diagnosing. The purpose of this paper was to explore behavioral determinants of underreporting of new TB cases among private sector physicians in Iran.Design/methodology/approachThe authors conducted a population-based, cross-sectional study of physicians working in private clinics. The data collection tool was designed using the theory of planned behavior (TPB). The authors used structural equation models with maximum likelihood estimation to examine attitude toward the notification behavior.FindingsOf 519 physicians, 433 physicians completed the questionnaire. Attitude toward notification had the highest score (mean score = 87.65; sd = 6.79; range: 0–100). The effect of perceived behavioral controls on the notification behavior ((β^) = 0.13; CI: 0.01–0.25) was stronger than the total effect of attitude ((β^) = 0.06; CI: 0.00–0.12) and subjective norms ((β^) = 0.01; CI: −0.00–0.03) on the behavior. However, the attitude was the main predictor of intention and justified 46% of the intention variance. Intention had a significant effect on the behavior ((ß^) = 0.09; CI: 0.1–0.16).Practical implicationsConsidering stronger effect of perceived behavioral control on the behavior, interventions aiming at facilitating notification process would be more effective than those aiming at changing the attitude or enhancing intention among physicians.Originality/valueTo the best of our knowledge, no other study previously explored determinants of underreporting from the behavioral and cognitive perspective. Specifically, the authors explored the role of the TPB constructs in predicting intention to notify new TB cases.
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Shah D, Vijayan S, Chopra R, Salve J, Gandhi RK, Jondhale V, Kandasamy P, Mahapatra S, Kumta S. Map, know dynamics and act; a better way to engage private health sector in TB management. A report from Mumbai, India. Indian J Tuberc 2019; 67:65-72. [PMID: 32192620 DOI: 10.1016/j.ijtb.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND India, world's leading Tuberculosis burden country envisions to End-TB by optimally engaging private-sector, in-spite of several unsuccessful attempts of optimal private sector engagement. Private Provider Interface Agency (PPIA), a new initiative for private-sector engagement, studied the private-sector networking and dynamics to understand the spread, typology of providers and facilities and their relations in TB case management, which was critical to design an intervention to engage private-sector. We report the observations of this exercise for a larger readership. METHOD ology: It is a descriptive analysis of mapping data (quantitative) and perceived factors influencing their engagement in the PPIA network (qualitative). RESULTS Of 7396 doctors, 2773 chemists and 747 laboratories mapped, 3776 (51%) doctors, 353 (13%) chemists and 255 (34%) laboratories were prioritized and engaged. While allopathic doctors highly varied between wards (mean ratio 48/100,000 population; range 13-131), non-allopathic doctors were more evenly distributed (mean ratio 58/100,000 population; range 36-83). The mean ratio between non-allopathic to allopathic doctors was 1.75. Return benefit, apprehension on continuity of funding and issues of working with the Government were top three concerns of private providers during engagement. Similarly, irrational business expectations, expectation of advance financing for surety and fear of getting branded as TB clinic were three top reasons for non-engagement. CONCLUSION A systematic study of dynamics of existing networking, typology and spread of private providers and using this information in establishing an ecosystem of referral network for TB control activities is crucial in an effort towards optimal engagement of private health providers. Understanding the factors influencing the network dynamics helped PPIA in effective engagement of private health providers in the project.
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Affiliation(s)
- Daksha Shah
- Department of Health, Municipal Corporation of Greater Mumbai, India
| | - Shibu Vijayan
- PATH Mumbai Office, Mumbai, India; PATH Headquarter, Seattle, WA, USA.
| | | | | | | | | | | | | | - Sameer Kumta
- Bill & Melinda Gates Foundation, New Delhi, India
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Siddaiah A, Ahmed MN, Kumar AMV, D’Souza G, Wilkinson E, Maung TM, Rodrigues R. Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study. BMJ Open 2019; 9:e023910. [PMID: 30782889 PMCID: PMC6377518 DOI: 10.1136/bmjopen-2018-023910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES India contributes approximately 25% of the 'missing' cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India's private sector, few are notified to the public healthcare system. India's TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study in a private hospital to assess the proportion notified and factors affecting TB notifications. We explored barriers and probable solutions to TB notification qualitatively from health provider's perspective. STUDY SETTING Private, tertiary care, teaching hospital in Bengaluru, South India. METHODOLOGY This was a mixed-methods study. Quantitative component comprised a retrospective review of hospital records between 1 January 2015 and 31 December 2017 to determine TB notifications. The qualitative component comprised key informant interviews and focus groups to elicit the barriers and facilitators of TB notification. RESULTS Of 3820 patients diagnosed and treated, 885 (23.2%) were notified. Notifications of sputum smear-positive patients were significantly more likely, while notifications of children were less likely. Qualitative analysis yielded themes reflecting the barriers to TB notification and their solutions. Themes related to barriers were: (1) basic diagnostic procedures and treatment promote notification; (2) misconceptions regarding notification and its process are common among healthcare providers; (3) despite a national notification system other factors have prevented notification of all patients; and (4) establishing hospital systems for notification will go a long way in improving notifications. CONCLUSIONS The proportion of patients with TB notified by the hospital was low. A comprehensive approach both by the hospital management and the national TB programme is necessary for improving notification. This includes improving awareness among healthcare providers about the requirement for TB notifications, establishing a single notification portal in hospital, digitally linking hospital records to Nikshay and designating one person to be responsible for notification.
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Affiliation(s)
- Archana Siddaiah
- Department of Community Health, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Mohammad Naseer Ahmed
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Ajay M V Kumar
- Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- Operational Research, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | - George D’Souza
- Department of Pulmonary Medicine, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Chester, UK
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Rashmi Rodrigues
- Department of Community Health, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
- Wellcome Trust/DBT India Alliance, Banjara Hills, Hyderabad, India
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Phalkey RK, Butsch C, Belesova K, Kroll M, Kraas F. From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance. BMC Health Serv Res 2017; 17:599. [PMID: 28841872 PMCID: PMC5574140 DOI: 10.1186/s12913-017-2476-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/27/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. METHODS Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. RESULTS The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. CONCLUSION The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed.
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Affiliation(s)
- Revati K. Phalkey
- Division of Epidemiology & Public Health, University of Nottingham, C111, Clinical Sciences Building 2, City Hospital, Hucknall Road, NG5 1PB Nottingham, Nottingham, UK
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, D-50923 Cologne, Germany
| | - Carsten Butsch
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, D-50923 Cologne, Germany
| | - Kristine Belesova
- London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Marieke Kroll
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, D-50923 Cologne, Germany
| | - Frauke Kraas
- Institute of Geography, University of Cologne, Albertus-Magnus-Platz, D-50923 Cologne, Germany
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Lestari BW, Arisanti N, Siregar AYM, Sihaloho ED, Budiman G, Hill PC, Alisjahbana B, McAllister S. Feasibility study of strengthening the public-private partnership for tuberculosis case detection in Bandung City, Indonesia. BMC Res Notes 2017; 10:404. [PMID: 28807020 PMCID: PMC5557311 DOI: 10.1186/s13104-017-2701-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/29/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Private practitioner’s (PPs) collaboration for detection, diagnosis and treatment of tuberculosis (TB) is recommended by the World Health Organization and encouraged by the Indonesian National TB control programme. TB case management by PPs, however, are mostly not in line with current guidelines. Therefore, we developed an intervention package for PPs comprising of TB training, implementation of a mobile phone application for notification of TB cases and a 6-month regular follow-up with PPs. This study aimed to evaluate the feasibility of the intervention package to increase TB case detection and notification rates among PPs in five community health centre areas in Bandung City, Indonesia. Results A total of 87 PPs were registered within the study area of whom 17 attended the training and 12 had the mobile phone application successfully installed. The remaining five PPs had phones that did not support the application. During the follow-up period, five PPs registered patients with TB symptoms and cases into the application. A total of 36 patients with TB symptoms were identified and 17 were confirmed TB positive.
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Affiliation(s)
- Bony Wiem Lestari
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. .,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Nita Arisanti
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Adiatma Y M Siregar
- Centre for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Estro Dariatno Sihaloho
- Centre for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Gelar Budiman
- Faculty of Electrical Engineering, Telkom University, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, 9054, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, 9054, New Zealand
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TB Notification from Private Health Sector in Delhi, India: Challenges Encountered by Programme Personnel and Private Health Care Providers. Tuberc Res Treat 2017; 2017:6346892. [PMID: 28845306 PMCID: PMC5563408 DOI: 10.1155/2017/6346892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 04/26/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To identify the challenges encountered by private health care providers (PHCP) to notify tuberculosis cases through a programme developed web-based portal mechanism called “NIKSHAY.” Study Design. It is a descriptive qualitative study conducted at two revised national tuberculosis control programme (RNTCP) districts of New Delhi. The study included in-depth interviews of PHCP registered with “NIKSHAY” and RNTCP programme personnel. Grounded theory was used to conceptualise the latent social patterns in implementation of tuberculosis case notification process and promptly identifying their challenges. Results The analysis resulted in identification of three broad themes: (a) system implementation by RNTCP: it emphasizes the TB notification process by the RNTCP programme personnel; (b) challenges faced by PHCP for TB notification with five different subthemes; and (c) perceived gaps and suggestions: to improvise the TB notification process for the private health sector. The challenges encountered by PHCP were mainly related to unsystematic planning and suboptimal implementation by programme personnel at the state and district level. The PHCP lacked clarity on the need for TB notification. Conclusion Implementation of TB notification among private health care providers requires systematic planning by the programme personnel. The process should be user-friendly with additional benefits to the patients.
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Nair P, James PT, Kunoor A, Rakesh PS. How we ensured 100% TB notification: experiences from a private tertiary care hospital in India. Public Health Action 2017; 7:179-180. [PMID: 28695095 DOI: 10.5588/pha.16.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Nair
- Amrita Institute of Medical Sciences, Kerala, India
| | - P T James
- Amrita Institute of Medical Sciences, Kerala, India
| | - A Kunoor
- Amrita Institute of Medical Sciences, Kerala, India
| | - P S Rakesh
- Amrita Institute of Medical Sciences, Kerala, India
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Bennett A, Avanceña ALV, Wegbreit J, Cotter C, Roberts K, Gosling R. Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings. Malar J 2017; 16:252. [PMID: 28615026 PMCID: PMC5471855 DOI: 10.1186/s12936-017-1901-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In malaria elimination settings, all malaria cases must be identified, documented and investigated. To facilitate complete and timely reporting of all malaria cases and effective case management and follow-up, engagement with private providers is essential, particularly in settings where the private sector is a major source of healthcare. However, research on the role and performance of the private sector in malaria diagnosis, case management and reporting in malaria elimination settings is limited. Moreover, the most effective strategies for private sector engagement in malaria elimination settings remain unclear. METHODS Twenty-five experts in malaria elimination, disease surveillance and private sector engagement were purposively sampled and interviewed. An extensive review of grey and peer-reviewed literature on private sector testing, treatment, and reporting for malaria was performed. Additional in-depth literature review was conducted for six case studies on eliminating and neighbouring countries in Southeast Asia and Southern Africa. RESULTS The private health sector can be categorized based on their commercial orientation or business model (for-profit versus nonprofit) and their regulation status within a country (formal vs informal). A number of potentially effective strategies exist for engaging the private sector. Conducting a baseline assessment of the private sector is critical to understanding its composition, size, geographical distribution and quality of services provided. Facilitating reporting, referral and training linkages between the public and private sectors and making malaria a notifiable disease are important strategies to improve private sector involvement in malaria surveillance. Financial incentives for uptake of rapid diagnostic tests and artemisinin-based combination therapy should be combined with training and community awareness campaigns for improving uptake. Private sector providers can also be organized and better engaged through social franchising, effective regulation, professional organizations and government outreach. CONCLUSION This review highlights the importance of engaging private sector stakeholders early and often in the development of malaria elimination strategies.
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Affiliation(s)
- Adam Bennett
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Anton L. V. Avanceña
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Jennifer Wegbreit
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Chris Cotter
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Kathryn Roberts
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Roly Gosling
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
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Singh Chadha S, Burugina Nagaraja S, Trivedi A, Satapathy S, N M D, Devi Sagili K. Mandatory TB notification in Mysore city, India: Have we heard the private practitioner's plea? BMC Health Serv Res 2017; 17:1. [PMID: 28049468 PMCID: PMC5209831 DOI: 10.1186/s12913-016-1943-z] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background The Government of India, made TB notification by private healthcare providers mandatory from May 2012 onwards. The National TB Programme developed a case based web based online reporting mechanism called NIKSHAY. However, the notification by private providers has been very low. We conducted the present study to determine the awareness, practice and anticipated enablers related to TB notification among private practitioners in Mysore city during 2014. Methods A cross-sectional study was conducted among private practitioners of Mysore city in south India. The private practitioners in the city were identified and 258 representative practitioners using probability proportional to size were interviewed using semi-structured questionnaire. Results Among the 258 study participants, only 155 (60%) respondents agreed to a detailed interview. Among those interviewed, 141 (91%) were aware that TB is a notifiable disease; however 127 (82%) of them were not aware of process of notification and NIKSHAY. Only one in six practitioners was registered in NIKSHAY, while one in three practitioners are notifying without registration. The practitioners expected certain enablers from the programme like free drugs, training to notify in NIKSHAY and timely feedback. 74 (47%) opined that notification should be backed by legal punitive measures. Conclusion The programme should develop innovative strategies that provide enablers, address concerns of practitioners while having simple mechanisms for TB notification. The programme should strengthen its inherent capacity to monitor TB notification. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1943-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarabjit Singh Chadha
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, Qutub institutional area, Hauz Khas, New Delhi, 110016, India
| | - Sharath Burugina Nagaraja
- Department of Community Medicine, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, 560010, India.
| | - Archana Trivedi
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, Qutub institutional area, Hauz Khas, New Delhi, 110016, India
| | - Sachi Satapathy
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, Qutub institutional area, Hauz Khas, New Delhi, 110016, India
| | - Devendrappa N M
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, Qutub institutional area, Hauz Khas, New Delhi, 110016, India
| | - Karuna Devi Sagili
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, Qutub institutional area, Hauz Khas, New Delhi, 110016, India
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Uplekar M, Atre S, Wells WA, Weil D, Lopez R, Migliori GB, Raviglione M. Mandatory tuberculosis case notification in high tuberculosis-incidence countries: policy and practice. Eur Respir J 2016; 48:1571-1581. [PMID: 27824601 PMCID: PMC5898941 DOI: 10.1183/13993003.00956-2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/08/2016] [Indexed: 11/05/2022]
Abstract
Mandatory tuberculosis (TB) notification is an important policy under the End TB Strategy, but little is known about its enforcement especially in high TB incidence countries. We undertook a literature search for selected high-incidence countries, followed by a questionnaire-based survey among key informants in countries with high-, intermediate- and low-TB incidence. Published literature on TB notification in high-incidence countries was limited, but it did illustrate some of the current barriers to notification and the importance of electronic systems to facilitate reporting by private providers. Required survey data were successfully gathered from 40 out of 54 countries contacted. TB is notifiable in 11 out of 15 high-incidence countries, all 16 intermediate-incidence countries, and all nine low-incidence countries contacted. TB case notification by public sector facilities is generally systematised, but few high-incidence countries had systems and tools to facilitate notification from private care providers. In the context of the new End TB Strategy aimed at eventual TB elimination, all countries should have TB on their national list of notifiable diseases. Enhancing the ease of notification by private providers is essential for effective implementation. To that effect, investing in strengthening disease surveillance systems and introducing digital tools to simplify notification are logical ways forward.
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Affiliation(s)
- Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Sachin Atre
- Johns Hopkins Clinical Trials Unit, BJ Medical College, Pune, India
| | - William A Wells
- US Agency for International Development, Washington, DC, USA
| | - Diana Weil
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Rafael Lopez
- World Health Organization Regional Office for Americas, Washington DC, USA
| | | | - Mario Raviglione
- Global TB Programme, World Health Organization, Geneva, Switzerland
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Accelerating TB notification from the private health sector in Delhi, India. Indian J Tuberc 2016; 63:8-12. [PMID: 27235938 DOI: 10.1016/j.ijtb.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/29/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In India, almost half of all patients with tuberculosis (TB) seek care in the private sector as the first point of care. The national programme is unable to support such TB patients and facilitate effective treatment, as there is no information on TB and Multi or Extensively Drug Resistant TB (M/XDR-TB) diagnosis and treatment in private sector. OBJECTIVE To improve this situation, Government of India declared TB a notifiable disease for establishing TB surveillance system, to extend supportive mechanism for TB treatment adherence and standardised practices in the private sector. But TB notification from the private sector is a challenge and still a lot needs to be done to accelerate TB notification. METHODS Delhi State TB Control Programme had taken initiatives for improving notification of TB cases from the private sector in 2014. Key steps taken were to constitute a state level TB notification committee to oversee the progress of TB notification efforts in the state and direct 'one to one' sensitisation of private practitioners (PPs) (in single PP's clinic, corporate hospitals and laboratories) by the state notification teams with the help of available tools for sensitising the PP on TB notification - TB Notification Government Order, Guidance Tool for TB Notification and Standards of TB Care in India. RESULTS As a result of focussed state level interventions, without much external support, there was an accelerated notification of TB cases from the private sector. TB notification cases from the private sector rose from 341 (in 2013) to 4049 (by the end of March 2015). CONCLUSION Active state level initiatives have led to increase in TB case notification.
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Bronner Murrison L, Ananthakrishnan R, Sukumar S, Augustine S, Krishnan N, Pai M, Dowdy DW. How Do Urban Indian Private Practitioners Diagnose and Treat Tuberculosis? A Cross-Sectional Study in Chennai. PLoS One 2016; 11:e0149862. [PMID: 26901165 PMCID: PMC4762612 DOI: 10.1371/journal.pone.0149862] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 02/05/2016] [Indexed: 12/04/2022] Open
Abstract
Setting Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. Inappropriate TB management practices among private practitioners may contribute to delayed TB diagnosis and generate drug resistance. However, these practices are not well understood. We evaluated diagnostic and treatment practices for active TB and benchmarked practices against International Standards for TB Care (ISTC) among private medical practitioners in Chennai. Design A cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 in Chennai city who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment in Chennai. Practitioners were interviewed using standardized questionnaires. Results Among 228 private practitioners, a median of 12 (IQR 4–28) patients with TB were seen per year. Of 10 ISTC standards evaluated, the median of standards adhered to was 4.0 (IQR 3.0–6.0). Chest physicians reported greater median ISTC adherence than other MD and MS practitioners (score 7.0 vs. 4.0, P<0.001), or MBBS practitioners (score 7.0 vs. 4.0, P<0.001). Only 52% of all practitioners sent >5% of patients with cough for TB testing, 83% used smear microscopy for diagnosis, 33% monitored treatment response, and 22% notified TB cases to authorities. Of 228 practitioners, 68 reported referring all patients with new pulmonary TB for treatment, while 160 listed 27 different regimens; 78% (125/160) prescribed a regimen classified as consistent with ISTC. Appropriate treatment practices differed significantly between chest physicians and other MD and MS practitioners (54% vs. 87%, P<0.001). Conclusion TB management practices in India’s urban private sector are heterogeneous and often suboptimal. Private providers must be better engaged to improve diagnostic capacity and decrease TB transmission in the community.
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Affiliation(s)
- Liza Bronner Murrison
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | | | | | - Madhukar Pai
- McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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Thomas BE, Velayutham B, Thiruvengadam K, Nair D, Barman SB, Jayabal L, Ovung S, Swaminathan S. Perceptions of Private Medical Practitioners on Tuberculosis Notification: A Study from Chennai, South India. PLoS One 2016; 11:e0147579. [PMID: 26820750 PMCID: PMC4731139 DOI: 10.1371/journal.pone.0147579] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background The Government of India declared TB as a notifiable disease in 2012. There is a paucity of information on the government's mandatory TB notification order from the perspective of private medical practitioners (PPs). Objective To understand the awareness, perception and barriers on TB notification among PPs in Chennai, India. Methods Total of 190 PPs were approached in their clinics by trained field staff who collected data using a semi-structured and pre-coded questionnaire after getting informed consent. The data collected included PPs' specialization, TB management practices, awareness about the TB notification order, barriers in its implementation and their suggestions to improve notification. Results Of 190 PPs from varied specializations, 138 (73%) had diagnosed TB cases in the prior three months, of whom 78% referred these patients to government facilities. Of 138 PPs, 73% were aware of the order on mandatory TB notification, of whom 46 (33%) had ever notified a TB case. Of 120 PPs, 63% reported reasons for not notifying TB cases. The main reasons reported for not notifying were lack of time (50%), concerns regarding patients' confidentiality (24%) and fear of offending patients (11%). Of 145 PPs, 76% provided feedback about information they felt uncomfortable reporting during notification. PPs felt most uncomfortable reporting patient's government-issued Aadhar number (77%), followed by patient's phone number (37%) and residential address (26%). The preferred means of notification was through mobile phone communication (24%), SMS (18%) and e-mail (17%). Conclusion This study highlights that one-fourth of PPs were not aware of the TB notification order and not all those who were aware were notifying. While it is important to sensitize PPs on the importance of TB notification it is also important to understand the barriers faced by PPs and to make the process user-friendly in order to increase TB notification.
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Affiliation(s)
- Beena Elizabeth Thomas
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India
- * E-mail:
| | - Banurekha Velayutham
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India
| | - Kannan Thiruvengadam
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India
| | - Dina Nair
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India
| | | | | | - Senthanro Ovung
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, India
| | - Soumya Swaminathan
- Department of Health Research & Indian Council of Medical Research, New Delhi, India
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Yeole RD, Khillare K, Chadha VK, Lo T, Kumar AMV. Tuberculosis case notification by private practitioners in Pune, India: how well are we doing? Public Health Action 2015; 5:173-9. [PMID: 26399287 DOI: 10.5588/pha.15.0031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING Pimpri Chinchwad Municipal Corporation area, Pune, India. OBJECTIVE To assess the proportion of private practitioners (PPs) who notified tuberculosis (TB) patients during February-April 2013 and their contribution to the overall number notified, and to determine their perceived challenges in reporting TB cases. DESIGN Mixed-method study including an analysis of notification data, followed by in-depth interviews with PPs. Interviews were transcribed and inductive content analysis was performed to derive themes. RESULTS Of 831 PPs, 533 (64%) participated in case notification; of these 87 (16%) notified at least one TB case during the study period. In all, 138 TB cases were notified by PPs, accounting for 20% of the total TB cases notified. Emerging themes among perceived challenges and barriers were lack of complete knowledge about TB notification, fear of a breach of patient confidentiality, lack of a simplified operational mechanism of notification, and lack of trust and coordination with the government health system. CONCLUSION About two thirds of PPs participated in case notification and contributed significantly to the overall TB cases notified. India's national TB programme should focus on training PPs and targeted media communication campaigns, and establish alternative mechanisms for notification, such as the internet and mobile telephones, to overcome perceived barriers.
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Affiliation(s)
- R D Yeole
- World Health Organization Country Office for India, New Delhi, India
| | - K Khillare
- City TB Office, Pimpri Chinchwad Municipal Corporation, Pune, India
| | - V K Chadha
- Epidemiology and Research Division, National TB Institute, Bangalore, India
| | - T Lo
- Centers for Disease Control and Prevention, Epidemic Intelligence Service Officer, Division of Tuberculosis Elimination, International Research and Programs Branch, Atlanta, Georgia, USA
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
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