How to reach out to TB patients in the private sector

Existing tools to improve TB care services in the private sector, adopted by the National TB Elimination Programme (NTEP) are:

• Standards for Tuberculosis (TB) care in India
• Mandatory TB notification
• Use of NIKSHAY
• Ban on sero-diagnostics
• Amendments in H1 schedule

The learnings that guide the efforts to invoke support from the private sector and provide public services to its patients include the following:

1. The government will be an enabler and not see itself as the sole provider of TB care. The government’s role is just to ensure that the standards for TB care are followed.
2. “Go where the patients go” should be the strategy for inclusiveness and the patient's choice of providers have to be honoured. Currently more than half of the TB patients go to the private sector. This should be kept in mind while framing policies and making investments. 
3. The cost of involving the private sector is not very high and is almost the same or marginally higher than the cost in the public sector.
4. Investments in private sector involvement yield significant returns in case detection, which increases the case notification rates, thereby reducing the “missing” patients for care.
5. Public health needs should be provided to support the private sector for better outcomes related to access, notifications, adherence, treatment outcomes and cost savings.

Few recommendations from the universal access to TB care model pilot project to reach out to the TB patients in the private sector were:

1. Drug sales monitoring to be incorporated into the routine program monitoring and evaluation framework to be able to use this as an indicator wherever a private provider outreach is planned.
2. The approach of drug tracking provides an important guide to the programme as to the extent of the coverage and the need for additional efforts.
3. In order to avoid duplication of patients, e-Nikshay has to be streamlined, and the Aadhar number, which is a unique personal identifier in India needs to be mainstreamed in the patient registration.

Resources

• National Strategic Plan for Tuberculosis Elimination, 2017–2025.
• UATBC Concurrent Assessment Report, May 2016.

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