Key lessons from public-private efforts will help us eliminate TB 

Source: The post is based on an article “Key lessons from public-private efforts will help us eliminate TB” published in the Business Standard on 2md August 2022. 

Syllabus: GS 2 Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources. 

Relevance: Reforms in delivery of public health services 

News: In the recent period, the central and state governments have engaged with the private sector in different disease areas, particularly TB. Because the private sector has the potential of providing disruptive innovation for serving the public health goals of the Central and State governments in India.  

Some private sector engagement programs  

(1) The Private-Provider Interface Agency (PPIA): It was implemented in Mumbai in Maharashtra, Patna in Bihar, and Mehsana in Gujarat. The agency worked with a network of private doctors, chemists, laboratories, and hospitals to ensure that TB diagnosis and treatment practices adhere to the prescribed ‘Standards of TB Care’ in India.  

As a result of the implementation of the PPIA program in Mumbai and Patna, there was a 351% and 532% increase in TB case notifications from the private sector, between 2014 and 2018. The actual reporting of cases resulted in a greater understanding of the TB burden on the ground.  

(2) The Patient-Provider Support Agency (PPSA) model: The government has expanded the PPP model to the PPSA model. The government’s annual TB report tells us that PPSA programs have now been scaled up and launched in more than 170 districts across India. 

(3) Others: Under the Chiranjeevi Yojana program, the Gujarat government is engaging with private providers to increase institutional deliveries. Under the Hausala Sajheedari initiative, the UP government is engaging private health facilities for family planning. The scheme works on a reimbursement basis under a public-private partnership (PPP) model  

Potential to engage private players for Tuberculosis (TB) 

The National Prevalence Survey talks about the actual burden of TB in India and health-seeking behaviors in the public and private sectors. 

According to the survey, almost half of all patients with TB symptoms seek care in the private sector.  

Some key challenges in the implementation of the PPSA Programme.  

(1) First, there have been cases of unstandardized care in the private sector that led to treatment delays, thus contributing to the emergence of drug-resistant TB and increased mortality. For example, as per a 2019 study, it was estimated that a symptomatic patient approached multiple private healthcare providers. Therefore, up to 65 days were taken before an accurate diagnosis.  

(2) The state and district administration will find it difficult to implement the PPSA because it is a new approach for the implementers. 

(3) At present, very few non-government organizations (NGOs) apply for PPSA because information on such contracting isn’t easily visible or is difficult to understand.  

What should be done? 

(1) The state and district administration need to be convinced and encouraged to support and implement the PPSA model across their region. For this, effort should be taken for their capacity building and hand-holding support should be given to the state and district administrators. For this, state technical support units (STSUs) have already been established in some states. 

(2) The tendering process should be expanded and advertised to allow diverse organizations in this segment to apply for consideration as PPSAs.  

(3) The government can adopt the model of output-based financing for PPSAs. The PPSAs should be paid from ensuring notifications to conducting advanced diagnostic tests, HIV-diabetes testing, etc. 

(4) The government can explore the applications of these models in various government initiatives such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) in case of difficult-to-treat forms of TB, such as extra-pulmonary TB, etc. 

(5) The Ayushman Bharat Digital Mission (ABDM), can help in achieving universal health coverage, quality healthcare for all, and also eliminating Tuberculosis (TB). This program aims to digitize the country’s healthcare ecosystem and to enable the creation of an enabling ecosystem for fostering public-private collaborations.