• Users Online: 262
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
SHORT COMMUNICATION
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 69-71

Incorporating private health sector in tuberculosis control activities in India: An overview


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

Date of Web Publication25-Jun-2014

Correspondence Address:
Saurabh R Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam, Kancheepuram - 603 108, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.135379

Rights and Permissions
  Abstract 

Tuberculosis (TB) has been acknowledged as the leading public health disease of an infectious nature. In the global vision to extend the gamut of services to the community, the primary strategy is to involve and engage all health care providers in the Revised National TB Control Program (RNTCP) to have an epidemiological impact on the magnitude of the disease. RNTCP has proposed ten different schemes for encouraging the involvement of NGOs and private providers namely Advocacy, communication, and social mobilization; Sputum collection center; Sputum pick-up and transport; Designated microscopy cum treatment centre; Laboratory technician; Culture and drug sensitivity testing; Treatment adherence; Slum scheme; Tuberculosis unit; and TB-HIV scheme, so that the services available under the program reach even those remote rural / tribal areas where there are no public sector health care establishments. To conclude, roping in all private sector health care providers / establishments in the program under the public-private partnerships schemes with active supervision by RNTCP program managers cannot only contribute optimally for the betterment of the program but also ensuring universal access to TB care.

Keywords: India, public-private mix, tuberculosis


How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Incorporating private health sector in tuberculosis control activities in India: An overview. Int J Health Syst Disaster Manage 2014;2:69-71

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Incorporating private health sector in tuberculosis control activities in India: An overview. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2019 Jan 17];2:69-71. Available from: http://www.ijhsdm.org/text.asp?2014/2/1/69/135379

Tuberculosis (TB) has been acknowledged as the leading public health disease of infectious in nature accounting for 11.6 million new cases globally, of which India has contributed to almost one-quarter of the cases. [1] India has also been identified as one of the leading countries in adding to the burden of drug resistant forms of TB. [1] The Indian scenario has been further complicated because of the weak public health care delivery system (viz, accessibility and availability-inadequate number of healthcare establishments, inequitable geographical distribution, insufficient number of trained healthcare providers) and limited rates of utilization of the government health establishments by the community. [2],[3]

In the global vision, to extend the gamut of services to the community, the primary strategy is to involve, and engage all healthcare providers in the Revised National TB Control Program (RNTCP), namely, government facilities outside health departments (viz. employee state insurance scheme hospitals; central government health scheme hospitals, railways hospital, etc.); medical colleges; private providers (viz. private hospitals, nursing homes, allopathic private practitioners (PP), pharmacist shops, and other systems of medicine); non-governmental organizations (NGOs); and corporate sectors to have an epidemiological impact on the magnitude of the disease. [4] The RNTCP, has proposed ten different schemes for encouraging the involvement of NGOs and private providers, so that the services available under the program reach even those remote rural/tribal areas where there are no public sector healthcare establishments. [4] The details of these schemes are as follows:

TB advocacy, communication, and social mobilization (ACSM) scheme-The purpose of the scheme is to spread awareness about the disease among the community so as to enhance local political commitment and number of resources; bring about an improvement in case detection and treatment adherence; to empower the people and communities affected by TB; and to reduce the stigma and discrimination associated with the disease. The concerned NGOs or organizations must extend ACSM activities to a minimum of one million population or greater. The involved NGOs will be granted an amount of Rs 1.5 lac per 10 lac population per year

Sputum collection center (SCC) scheme-The objective is to nullify the issue of geographical inaccessibility to the designated microscopy centers (DMCs). The involved private providers will be assisted with Rs. 3000 (rent of the place, provided it is a private premise) and Rs 2000 (service cost) on a monthly basis, accounting to a total financial assistance of Rs 60000/Rs 24000 (SCC in a government premise) per year for every sputum collection center

Sputum pick-up and transport service scheme-The basis of this scheme is to transport the collected sputum specimen to DMC for examination and thus expanding the coverage of RNTCP with the help of NGOs or private sector. The engaged private provider will be provide monetary support of Rs 24000 per annum for a maximum of 20 visits per month

Designated microscopy cum treatment center scheme-The scheme has two provisions, one concerned with doing microscopic testing and providing treatment and another with performing only microscopic examinations. RNTCP will ensure provision of laboratory consumables, forms/TB registers, training of the laboratory technicians, and anti-TB drugs. All these services are offered free-of-cost to the patients. However, the involved NGO/PP laboratory will be supported financially with an annual one time grant of Rs 1.5 lac (microscopy and treatment) and Rs 25 for every slide stained and reported to the health authorities (only microscopy)

Laboratory technician (LT) scheme-The scheme should be looked upon as an option, if in a particular area there is no availability of LT and the caseload is high. In this, LTs who wish to enroll themselves in the public-private project can apply for the post. They receive training in RNTCP and they will be provided a monthly salary of Rs 8500 with an annual increment of 5%. The basic difference with the previous scheme is that in the designated microscopy cum treatment center scheme, technician is supposed to work in the private laboratory while in LT scheme, the technician has to work in any establishment (government/private) where no LTs are available

Culture and drug sensitivity testing (C and DST) scheme-In order to up-scale the nation-wide network of quality assured sputum/specimen C and DST laboratories, this scheme was initiated wherein an existing well-functioning culture and DST laboratory in the private/NGO sector can apply and will be financially assisted with Rs 400 per specimen for doing smear/culture/species identification while Rs 2000 will be provided for DST

Treatment adherence scheme-Considering the long duration of treatment varying from six to eight months in category-I and II to almost 24-27 months in multi-drug resistant (MDR) TB, there is an immense need for maintaining compliance with the treatment as any patient managed inappropriately may present as a case of drug resistant TB. [4],[5] Under this scheme, any directly observed treatment (DOT) provider who is willing to undertake initial home visit for address verification and defaulter retrieval for missed doses will be given an honorarium of Rs 400 for every patient who has completed treatment and is declared as either cured/treatment completed. However, those DOT providers, who only administer treatment, will be given an honorarium of Rs 250. In case of MDR-TB treatment, an honorarium of Rs 2500 (viz. Rs 1000 for the intensive phase and Rs 1500 for the continuation phase) is given for each patient completing the treatment

Slum scheme-The scheme is for the benefit of people living in urban slums who have limited accessibility to the urban public health delivery system. These groups are highly vulnerable to the infection of TB because of poor physical and social environment and thus require intensive focus and support from the tuberculosis program. The involved NGO/collaborating partner should be responsible for organization of awareness activities in slum population, counseling of patients and their family members, initial verification of address, facilitation of sputum collection and transport, DOT provision, and retrieval of default patients addressing special needs of patients (viz. drug abuse/alcohol addiction). The engaged organization will be given a financial support of Rs. 50000 for every 20000 population catered

Tuberculosis unit scheme-In this scheme, the concerned NGO has to provide all RNTCP services for a pre-defined TB unit (viz. 0.5 million population). This scheme should only be considered in those regions where the public health infrastructure is low, and thus effective RNTCP implementation cannot be ensured

TB-HIV scheme-The scheme has been designed to extend the targeted interventions to high-risk groups like commercial sex workers, truck drivers, men having sex with men, eunuchs, etc. NGOs undertaking these targeted interventions have to detect these vulnerable population pockets, develop linkages, and extend a package of preventive and therapeutic services to the identified groups. A grant amount of Rs 120000 per NGO per 1000 target population is available under this scheme.

The role of the District TB Officer/State TB Officer is crucial in facilitating the involvement of private sector, starting from the identification of the issues that need to be addressed; joint planning with the NGO/PPs to execute the plan of action, and for the regular monitoring and evaluation of the proposed measures to check their effectiveness. [4],[5] In addition, RNTCP program managers have also tried to develop strong bonds with different professional associations like Indian Medical Associations/Indian Pharmacist Associations, etc. for engaging the diversified stakeholders. The program is determined in organizing training and re-training sessions for the PPs and other healthcare providers. Special measures have been taken to facilitate the process of notification from private healthcare providers and laboratories to get an exact estimate of the magnitude of the disease. [6]

To conclude, roping in all private sector healthcare providers/establishments in the program under the public-private partnerships schemes with active supervision by RNTCP program managers not only contribute optimally for the betterment of the program but also ensuring universal access to TB care.

 
  References Top

1.World Health Organization. Global Tuberculosis Control Report 2013. Geneva: WHO press; 2013.  Back to cited text no. 1
    
2.Ministry of Health and Family Welfare. National family health survey (NFHS-3); 2005-06. Available from: http://www.measuredhs.com/pubs/pdf/SR128/SR128.pdf [Last accessed on 2013 Sep 16].  Back to cited text no. 2
    
3.Shrivastava SR, Shrivastava PS, Ramasamy J. Implementation of public health practices in tribal populations of India-Challenges and Remedies. Healthc Low Res Settings 2013 ;1:e3.  Back to cited text no. 3
    
4.Managing the RNTCP in your area-A training course (Modules 5-9). Available from: http://tbcindia.nic.in/documents.html [Last accessed on 2013 Sep 22].  Back to cited text no. 4
    
5.Guidelines for PMDT in India, 2012. Available from: http://tbcindia.nic.in/documents.html [Last accessed on 2013 Sep 16].  Back to cited text no. 5
    
6.Guidance for TB notification in India; 2012. Available from: http://tbcindia.nic.in/pdfs/Guidance%20tool%20for%20TB%20notification%20in%20India%20-%20FINAL.pdf [Last accessed on 2013 Sep 25].  Back to cited text no. 6
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
References

 Article Access Statistics
    Viewed3439    
    Printed52    
    Emailed0    
    PDF Downloaded299    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]