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Public-Private Mix DOTS (PPM DOTS)

Summary

This program trains private practitioners around Hyderabad to identify and refer tuberculosis (TB) patients to private clinics for government-provided Directly Observed Treatment, Short-course for TB (DOTS).

Program goals

This is one of the first few public-private partnership (PPP) models in health to implement the DOTS program in an area where there are no government healthcare centers. The program was developed and implemented in 1995 on a pilot basis in Hyderabad at Mahavir Trust hospital. It was observed that most of the time, private practitioners and nursing homes are usually first for identifying TB. The objective of the scheme is to implement a DOTS program, with the help of private practitioners and nursing homes, to reach and cure more patients suffering from TB, control the spreading of infection and also prevent drug-resistant TB.

Key program components

The Mahavir Trust Hospital acts as a coordinator between the government and private medical practitioners and also supervises the implementation of project. The private medical practitioners in the region, when they identify a patient suspected to be suffering from tuberculosis, refers the patient to any of the 30 specified neighborhood DOTS centers. The practitioner is updated with the progress of treatment at regular intervals. The Mahavir hospital and private practitioners maintain records as specified by Government. Five outreach workers track late or delinquent patients and provide community mobilization.

Presently the program operates in Hyderabad, covering 505,762 people. During 2009, 917 patients, and in 2010, 960 number of patients were provided treatment. The cure rates continued to be more than 95% and detection remained between 65-70%. Using the experience gained from such collaborations with the private and NGO sectors, the RNTCP developed national guidelines for formal collaborations with private practitioners and NGOs at the district level.

Initiatives to involve the medical colleges resulted in the formation of national, zonal and state task forces of medical colleges, and core committees within individual medical colleges. RNTCP has also involved corporate sector units such as tea gardens in the North-East and West Bengal, and Coal India in West Bengal. Health care facilities under central government departments (Employees State Insurance, Railways, Petroleum, Ports, Mines etc.) have also adopted RNTCP. The district TB control societies all over the country are being encouraged to collaborate with all suitable local partners.

A study on the feasibility and effectiveness of the PPM DOTS in Hyderabad and New Delhi revealed that the cost to the society per patient cured was lower in PPM DOTS compared to public sector RNTCP. Economic evaluations conducted recently in Bangalore revealed that by involving non-public sectors in RNTCP, the number of cases treated under RNTCP increased, while the average societal cost per patient treated fell from US$123 to US$87, including all direct and indirect costs to patients. These studies conclude that PPM DOTS could be cost effective and reduce the financial burden on patients and society.

This program serves more than 30,000 clients per year.