Bulletin of the World Health Organization

Public–private partnership for tuberculosis control: the bill please?

Article: Newell et al. 2004;82:92-8

16 February 2004. Sir – We applaud James Newell and colleagues’ excellent documentation of a successful public–private mix for tuberculosis control (February 2004, p 92-8) 1. However, we regret the authors have not given a fair amount of attention to discussion of critical success factors, bearing in mind such public health intervention is very much context bound. Newell and colleagues for example only note briefly at the end of their discussion and at the conclusion part of their abstract that the input required is limited without giving any further details. This raises question especially considering the authors’ note of donor funding.

We recently designed a public–private partnership in tuberculosis control for Yogyakarta and Bali province of Indonesia, where it is also estimated that around 50% of tuberculosis patients are managed in the private sector. With a target population of about six million inhabitants from the two provinces and estimated 8080 new smear positive cases appearing annually in the combined community, we aim to achieve additional successful treatment of 1971 patients within one year. Strengthening regulatory framework, selective training plus academic detailing and scaling up an existing hospital DOTS linkage are the main strategies for meeting the project’s objective. The estimated costs amounted to about US$ 153 000, providing the cost per additional treatment success of US$ 78. This level of information can already be available even at the planning stage and would be very useful to those thinking to adopt the strategy should the project succeed.

Decisions to scale up or replicate public–private partnerships are to be made under resources constrained settings and in the midst of competing interests. Advocates would thus appreciate more information on critical success factors, at the least in the form of rough cost figures. We urgently need to go beyond demonstrating whether public–private partnership can work and focus more on why it works for the sake of reaching global tuberculosis control targets and alleviating the suffering of millions.

Yodi Mahendradhata (1,2,*) and Adi Utarini (1)

1 Department of Public Health, Faculty of Medicine Gadjah Mada University Sekip Utara, Yogyakarta 55281 Indonesia Email: ymahendradhata@itg.be *corresponding author

2 Department of Public Health Institute of Tropical Medicine Nationalestraat 155 Antwerp 2000 Belgium