Every provider counts: effect of a comprehensive public-private mix approach for TB control in a large metropolitan area in India

Abstract

Setting: Mumbai, India.

Objectives: To assess impact on case notification and treatment outcome of a public-private mix approach for tuberculosis (TB) control involving private providers, non-governmental organisations (NGOs), and public providers not previously involved in the Revised National TB Control Programme (RNTCP).

Methods: Under the stewardship of the RNTCP, providers were allocated different roles in referral, diagnosis, treatment initiation, directly observed treatment (DOT) provision, training and supervision. Referral forms were introduced and RNTCP registers were adapted to enable monitoring of case notification by different providers and cohort analysis disaggregated by provider type.

Results: A fraction of all non-RNTCP providers had become actively involved by the end of 2003. These providers contributed 2145 new smear-positive cases in 2003, an increment of 40% above the 5397 cases detected in RNTCP facilities. The treatment success rate for new smear-positive cohorts for 2002 was 85% in RNTCP facilities, 81% in private clinics, 88% in medical colleges, 91% in NGOs and 73% in the TB hospital (where the death rate was 16%).

Conclusion: Active involvement of some key public and private providers can increase case notification substantially while maintaining acceptable treatment outcomes. The impact can be expected to be even larger when all health providers have been involved.