Challenge
Streamlining and integrating public and private service providers across the healthcare value chain to tackle the TB epidemic in India.

Outcome
Conceptualization, Development & selection of Public Private Interface Agencies for better TB control and patient care.

Impact
Increased notification of TB cases and reduced drop out of patients from TB care.

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Tuberculosis (TB) is a communicable disease affecting people across geographies and socio-economic boundaries. India has the highest TB burden globally with over 2 million new TB cases annually, accounting for 1/5th of the global incidence. TB is also associated with an unavoidable social stigma which prevents TB patients from seeking treatment. TB Care in India is characterized by inefficient patient tracking in public and private sector, Sub-optimal diagnosis and treatment in both public & private sectors and presence & necessity of mainstream and informal participants in TB lifecycle. There is a consensus among all the key stakeholders that the private sector needs to be engaged effectively for achieving higher detection rates early and accurately, and quality treatment completion rates.

The Bill and Melinda Gates Foundation (BMGF) on-boarded Intellecap to develop a model that would enable the Government of India to provide high quality tuberculosis care via private healthcare providers that include private practitioners, chemists, laboratories and hospitals. Intellecap reviewed and analyzed approaches and effectiveness of the previous initiatives and schemes of the Revised National Tuberculosis Control Program (RNTCP) to engage the private sector. Field visits were conducted to major cities including Delhi, Mumbai, Chennai and Patna were conducted along with engagement with key stakeholders across Government, NGOs, Social Enterprises, Clinical Practitioners, Informal Healthcare Providers and Diagnostic Laboratories. The interactions & research provided insights for key intervention opportunities, needs and incentives for private sector to engage actively with TB care. We designed the model to operationalize a National Technical Support Group (TSG) and State Level Public-Private Interface Agencies (PPIAs) with respect to detecting and treating TB cases in the private sector.

The PPIA has been beneficial for private practitioners. As one practitioner noted, “When I am unsure and suggest the diagnostics—with the results coming in quickly and the patients being tracked by the PPIA—I am quickly able to refer the patient to a chest physician.”

As of September 1, 2016, one of the state PPIA network comprised over 3,600 private practitioners, including over 2,000 Ayurveda Yoga and Naturopathy Unani Siddha and Homoeopathy (AYUSH), practitioners working in slums and over 1,500 qualified allopathic physicians working at 607 hospitals and clinics, along with 366 pharmacists and 268 laboratories. Under the project, 30,500 free chest X-rays and 22,779 GeneXpert tests have been conducted; PPIA network physicians have initiated 26,199 TB patients on treatment; and 11,095 patients have successfully completed treatment. The PPIA model enabled a four-fold increase in TB case notification rate from the private sector from 53 per 100,000 in 2014 to 227 per 100,000 in early 2016.

The engagement has over the years demonstrated that PPIAs can effectively leverage private sector efficiencies and integrate with the scale of public sector services for TB Care on a long-term basis.