Tuberculosis (TB)

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

Frequently Asked Questions

What is PPM?
PPM is the involvement of all health care providers - public and private as well as formal and informal - in the provision of TB care, in line with International Standards for TB Care for patients who have or are suspected of having tuberculosis.

Question and Answer Archives

When is PPM needed?
PPM is needed when:
- there is high utilization of the private sector and non-NTP public sector such as medical colleges, army, etc.
- quality of care is poor in these facilities
- low case detection
- poor treatment outcomes
- delay and high costs for patients.

How does PPM enhance the quality of diagnosis, treatment, decentralize and make treatment conveniently accessible for patients?
PPM reduces malpractice by fostering evidence-based TB diagnosis and treatment in line with the International Standards for TB Care. This improves cure rates and reduces risks of drug resistance development. It also limits misdiagnosis of TB and unnecessary and often costly treatments.

How does PPM increase case detection and reduce diagnostic delays
PPM helps increase TB case detection and reduces diagnostic delays by involving all health care providers in timely referral ,diagnosis , ensures proper notification of all diagnosed cases and enrollment on appropriate treatment under programme guidelines. The engagement of private providers entails adequate training of these providers to ensure that the quality of their services is aligned with the International Standards for TB care. In addition evidence shows that private providers are often the first point of contact for health services. These providers (with adequate training) could play an important role in case detection and referral of patients to the public sector cutting down significantly on diagnostic delays.

Does PPM afford improved and equitable access to TB care to all patients
PPM improves access to treatment by involving health care providers from whom the poor, marginalized and most vulnerable seek care. Often public health facilities are situated at a distance from the home or workplace of the patient, therefore access to these services involves transportation costs and loss of wages which are barriers in access to health care for disadvantaged populations. The involvement of all providers in PPM enhances access of closer-to-home health services for both men and women.In addition PPM ensures that proper notification and enrollment for appropriate treatment under programme guidelines of all diagnosed patients is carried out.

How does PPM provide for reduced cost of care and financial protection for the poor?
PPM reduces costs to patients by ensuring that treatment for TB is free of charge and all other costs are kept to a minimum. PPM can also reduce indirect costs for patients by providing services closer to their homes or workplace.

Does PPM ensure better access to health care services for women as compared to other health services?
Women in many developing countries often have less power to make decisions on healthcare utilization. Additionally, public health facilities are not always easily accessible from their places of residence. The cost of transportation and the loss of income for both the patient and the guardian or escort are major inhibitors for women in access to public health care. Therefore in many cases they first approach the private sector for health services. PPM can ensure that women have access to good quality health care services close to their home.

Does PPM ensure gathering of essential epidemiological data?
PPM contributes towards completeness of epidemiological surveillance on TB when all care providers who diagnose and treat TB follow proper TB recording and reporting routines linked to national information systems.

What roles can private health care providers play in TB Control?
All health care providers both private and public can play one or more important roles in TB control including: helping identify people with TB; prescribing treatment; acting as treatment supervisors; tracing treatment defaulters; providing information and spreading awareness, training and supervision of health care staff; and management of drug supplies and equipment.

What is the evidence base for PPM?
Please refer to the resources section.

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