Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods

Research in Dhaka to develop and evaluate a public–private partnership model within the National TB Control Programme

Abstract

Objectives

In Bangladesh, private healthcare is common and popular, regardless of income or area of residence, making the private sector an important player in health service provision. Although the private sector offers a good range of health services, tuberculosis (TB) care in the private sector is poor. The authors conducted research in Dhaka, between 2004 and 2008, to develop and evaluate a public–private partnership (PPP) model to involve private medical practitioners (PMPs) within the National TB Control Programme (NTP)'s activities. Since 2008, this PPP model has been scaled up in 2 other big cities, Chittagong and Sylhet. This paper reports the results of this development, evaluation and scale-up.

Design

Mixed method, observational study design. They used NTP service statistics to compare the TB control outcomes between intervention and control areas. To capture detailed insights of PMPs and TB managers about the process and outcomes of the study, they conducted in-depth interviews, focus group discussions and workshops.

Setting

Urban setting, piloted in 4 areas in Dhaka city; later scaled up in other areas of Dhaka and in 2 major cities.

Findings

The partnership with PMPs yielded significantly increased case finding of sputum smear-positive TB cases. Between 2004 and 2010, 703 participating PMPs referred 3959 sputum smear-positive TB cases to the designated Directly Observed Treatment, Short-course (DOTS) centres, contributing about 36% of all TB cases in the project areas. There was a steady increase in case notification rates in the project areas following implementation of the partnership.

Conclusions

The PPP model was highly effective in improving access and quality of TB care in urban settings

This research was supported by the Department for International Development’s COMDIS Programme which is led by the University of Leeds. There is a COMDIS briefing on this research along with a COMDIS case study entitled ‘Using public-private partnerships to influence healthcare policy and practice in Bangladesh’

Citation

Zafar Ullah, A.N..; Huque, R.; Husain, A.; Akter, S.; Akramul Islam; Newell, J.N. Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods. BMJ Open (2012) 2 (6) e001534. [DOI: 10.1136/bmjopen-2012-001534]

Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods

Published 18 December 2012