ASD - PAKISTAN

Public-private partnership TB guidelines and materials in Pakistan

Tuberculosis in Pakistan contributes considerably to morbidity and mortality among the poor. The National TB Control Programme (NTP) has made remarkable progress in achieving countrywide public sector DOTS coverage by mid 2005. The current case detection (47%) is below the national target of 70%. A nationwide implementation of public-private partnership was planned by the NTC to enhance case detection and treatment. The approved model is a district-focussed public sector led approach to public-private partnership development, in which the public sector would enable and support the private sector for implementing DOTS protocols. The District Health Office (EDO-H) would involve, enable and support the private sector for implementing DOTS protocols. The inputs for private providers (hospitals, clinics and laboratories) would mainly include training, material supplement, and monitoring/supervision. The programme has earmarked about 10 million US$ (PC-1) for nationwide implementation of the public-private partnership model. This covers mainly the core implementation cost of the intervention. But the PC-1 has identified a list of development tasks to be carried out for enabling the programme and the districts to effectively implement the public-private partnership agenda including partner identification, enabling private providers and laboratories to provide care.

The government has already suggested that the Programme develops the PPM mechanisms and tools on a priority basis. The Provincial TB Control Programme (PTP) Punjab has already received support from TAMA-DFID to carry out the required guideline and training materials development work during the third quarter of 2007. This proposed research and development exercise aims to assist the TB control programme to operationalise, evaluate and refine these guidelines and training materials for effective district-based public-private partnership before countrywide scaling-up. First, training of health workers will be conducted using the new guidelines and training materials in two districts of Punjab. Post-training performance of health workers (doctors, microscope staff and supervisors) will be evaluated. The effectiveness and feasibility of the PPM model, its operation and tools used for PPM development in TB control will then be evaluated. The study also aims to assess patients' perceived access and quality of TB care offered through PPM arrangement.