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Public-Private Mix (PPM) for TB Care and Control

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The Seventh Meeting of the PPM Subgroup for TB care and control

The seventh meeting of the Subgroup on Public-Private Mix for TB care and control (PPM Subgroup) was held in Lille, France on 23-24 October 2011. The meeting reviewed the significant global, regional and country level progress on PPM expansion, highlighted country approaches to regulate irrational use of TB medicines and discussed how PPM programmes can facilitate introduction and expansion of new diagnostics and new drugs to non-programme care providers.

• To access the meeting report, please click here
  pdf, 868kb
• To access the meeting presentations, please click here

In most resource-poor countries with a high TB-burden, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health-care providers. These care providers, often not linked to public sector-based national tuberculosis programmes (NTPs), may serve a large proportion of TB suspects. The size, types and roles of these care providers vary greatly within and across countries. In some settings there is a large private commercial sector and numerous non governmental organizations (NGOs) while in others there are public sector providers (such as general and specialized hospitals) that operate outside the scope of NTPs. Evidence suggests that failure to involve all care providers used by TB suspects and patients hampers case detection, delays diagnosis, leads to inappropriate and incomplete treatment, contributes to increasing drug resistance and places an unnecessary financial burden on patients.

Engaging all relevant health care providers in TB care and control through public-private mix approaches is an essential component of the World Health Organization's (WHO's) Stop TB Strategy. Public-Private Mix (PPM) for TB Care and Control represents a comprehensive approach for systematic involvement of all relevant health care providers in TB control to promote the use of International Standards for TB Care and achieve national and global TB control targets. PPM encompasses diverse collaborative strategies such as public-private (between NTP and the private sector), public-public (between NTP and other public sector care providers such as general hospitals, prison or military health services and social security organizations), and private-private (between an NGO or a private hospital and the neighborhood private providers) collaboration. PPM also implies engaging relevant care providers in prevention and management of MDR-TB and in the implementation of TB/HIV collaborative activities.

Currently, nearly all high TB-burden countries are implementing PPM activities. Reports from countries and several project evaluations have shown that PPM could help increase case detection (between 10% and 60%), improve treatment outcomes (over 85%), reach the poor and save costs.