HERD - NEPAL

Assessment of sustainability of a public-private partnership for TB control in Lalitpur, Nepal.

International guidelines state that anyone with a cough of more than 2 weeks duration should be considered as a TB suspect. In Asia, 50% or more of such people initially seek diagnosis and treatment from a private medical practitioner (PP). Unfortunately, PPs generally provide a poor diagnostic service and poor treatment. Public-private partnerships (PPPs) for TB control can be used to take advantage of the strengths of various players in TB care: PPs as the first contact with TB suspects; public and NGO health services that can provide high quality care, recording and reporting; the NTP who can provide free drugs for TB patients and guidance to PPs on how best to diagnose TB; and NGOs who can provide tracers for late patients. PPPs thus give an opportunity for substantial DOTS expansion, a principal aim of the new international StopTB strategy.

In 1995, the Nuffield Centre for International Health and Development developed a plan for a PPP in Lalitpur Municipality, Nepal. The PPP was implemented by the NTP with support from NCIHD. An evaluation in 2001 showed that PPP had more than doubled the case finding rate in the project area, while maintaining treatment success rates at a very high level. In 2001 responsibility for the PPP project was transferred to the Municipality, and NCIHD withdrew. The PPP has now been running for 5 years without support from NCIHD or other external bodies. This study aims to evaluate the sustainability of the PPP, both to inform the NTP and the Municipality of progress since transfer, and to disseminate understanding of the sustainability or otherwise of the PPP more widely. To understand the reasons for success or failure in sustainability, partners' views of the PPP need to be analysed. This study aims to identify factors influencing the sustainability of PPPs and understand the reasons for the sustainability or otherwise of the PPP. Both quantitative and qualitative assessment will be used to assess sustainability of the PPP and reasons over the last 5 years. The findings of this study will be important to inform NTPs (and others) in Asia that are considering or involved in the development of PPPs.