NTP-BANGLADESH

Public private partnership for TB control in Bangladesh - research to support scale up

Tuberculosis (TB) is a major public health problem and one of the significant causes of death in Bangladesh. Current estimates show that 300,000 people fall ill and 70,000 die of tuberculosis every year. With the alarming increase in HIV prevalence among intravenous drug users, TB/HIV co-infection is also looming. Private practitioners constitute a large proportion of the service delivery infrastructure and where almost half of the population turn to seek care for chest-related health problems. But it is argued that TB treatment outcomes in the private sector are generally poor, increasing the burden on TB patients and promoting multi-drug resistance. Ensuring good access to quality TB care is a national priority but the public sector cannot accomplish this task alone. This goal can only be achieved by diversifying the responsibilities of providing TB care through wider application of collaborative approaches between both public and private sector providers.

This project, therefore, aims to assist and assess scale up of the public-private partnership (PPP) model for effective involvement of private medical practitioners in the TB control programme in 4 selected urban settings. The specific objectives of the research relate to understanding the current PPP initiative, and developing protocols and guidelines for scaling up of a public-private partnership for TB control. The major areas of investigation include reviewing of current practices of PMPs in TB control activities, developing practical guidance for scaling up, monitoring and documenting the process of scaling up; assessing resource implications for scale up of PPP model; documenting the process of introduction and the use of tools and ACS (Awareness, Communication, and Social Mobilisation) materials; assessment of the pre and post intervention knowledge and practices of PMPs regarding diagnosis and treatment of TB patients. The interventions will be using TB control outcomes (case detection and treatment outcome). Refinement of PPP guidelines will be made before a country-wide scale up. The study is being implemented using an action research methodology with follow up evaluation of a systematic process and steps. Both quantitative and qualitative methods are being used for data collection. The research instruments were field-tested prior to data collection.