During the past decade, the concept of Public-Private Partnership (PPP) has gained much prominence in the healthcare sector in India. The foremost objective of such partnerships has been to improve the accessibility and quality of health care at relatively low cost. To control the spread of tuberculosis (TB), the World Health Organisation (WHO) has promoted the strategy of Directly Observed Treatment, Short course (DOTS). The Revised National Tuberculosis Control Programme (RNTCP) which has adopted this strategy since early 1990s has designed several specific schemes for involving the private sector and Non Governmental Organisation (NGOs) across the country. Our study aims at analysing the experience of PPP in the RNTCP, with special reference to Tamil Nadu and Kerala, two southern states of India. (We use the term PPP to encompass partnerships with NGOs as well as for-profit private providers). The objectives of the study are: (1) To examine the level and extent of involvement of NGOs and Private Practitioners (PP) in the implementation of RNTCP; (2) To identify and analyse the institutional and other factors that influence the design and implementation of schemes designed for partnerships with NGOs and PPs; and (3) To suggest policy measures for promoting and sustaining greater participation of the NGOs and PPs in the control and treatment of TB. The study was carried out during the period August 2003 - August 2004. It adopted both quantitative and qualitative methods of data collection. Some of the major findings were: (a) The overall participation of the NGOs has been very limited in both states. Most of these agencies, in both states, are vested only with the responsibility of DOTS provision. However, in Kerala many PPs are involved with microscopy activities. (b) Issues related to contractual arrangements, personnel, supervision of DOTS, financial aid, practice of 'dual treatment regimes', etc. are some of the major factors that influence the implementation of PPP schemes. The study suggests that there is vast scope for strengthening the PPP strategy. It argues that policy measures in future should aim to: (a) encourage private practitioners to accept the treatment regimes prescribed by RNTCP through better information and training; (b) involve NGOs and PPs to a greater extent through better incentive mechanisms; and (c) improve manpower for better monitoring and supervision of the NGOs/PPs involved in RNTCP.
Muraleedharan, V.; Andrews, S.; Rajaraman, B.; Jan, S. Private Sector in the Revised National Tuberculosis Control Programme: A study of the implementation of Private-Public Partnership strategy in Tamil Nadu and Kerala (India). (2005) 109 pp. [HEFP Working Paper 03/05]