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. 2023 May 24:11:1132090.
doi: 10.3389/fpubh.2023.1132090. eCollection 2023.

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

Sushila Baral  1   2 , Rajesh Kumar Yadav  3 , Dipendra Kumar Yadav  4 , Sujan Babu Marahatta  2 , Yadunath Baral  5 , Khim Bahadur Khadka  6 , Sanjay Kumar Thakur  7 , Srijana Paudel  8 , Prabin Sharma  9 , Sony Pandey  2 , Kusum Shrestha  10 , Naveen Prakash Shah  7 , Laxman Basaula  6 , Amar Nagila  11 , Roshan Kumar Mahato  12 , Chhabi Lal Ranabhat  2   13
Affiliations

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

Sushila Baral et al. Front Public Health. .

Abstract

Background: The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.

Methods: We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.

Results: A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.

Conclusion: Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.

Keywords: Nepal; case finding; private public mix approach; qualitative; tuberculosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study site.
Figure 2
Figure 2
Barriers to implement PPM.
See this image and copyright information in PMC

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