Engaging private health care providers in TB care and prevention: a landscape analysis, second edition
Overview
TB remains one of the world’s top infectious killers, responsible for more than 1.4 million deaths in 2019. An estimated 10 million people fell ill with TB worldwide in 2019, and up to a quarter of the world’s population has TB infection (4). Efforts to combat TB are receiving increasing global attention, as evidenced by the first WHO Global Ministerial Conference on Ending TB, held in Moscow in November 2017 which brought together Ministers, and the first-ever United Nations General Assembly High-Level Meeting on TB which brought together Heads of State in September 2018. Progress in reaching all people with TB with quality care is being driven through initiatives such as the WHO Director General flagship initiative Find. Treat. All. #EndTB (with the Global Fund and the Stop TB Partnership), the Global Fund’s strategic initiative to find an additional 1.5 million people with TB by the end of 2019, and with continued support from the US Agency for International Development in countries and at the global level. The recent 2020 progress report on TB by the UN Secretary General also highlights the need to accelerate the TB response, including by scaling up private sector engagement to close gaps in care, in its priority recommendations. Policymakers’ attention has been drawn to the more than 2.9 million “missing people with TB” (the gap between the number of cases diagnosed and notified by official TB programmes and the estimated annual incidence) and, because many of them are assumed to be accessing treatment in the private sector, this has led to renewed interest in engaging private providers. Provisional data compiled by WHO from 84 countries indicates that an estimated 1.4 million fewer people received care for TB in 2020 than in 2019 - a reduction of 21% from 2019. In the group of 10 high-burden countries with the largest reported shortfalls compared with 2019, the overall shortfall was 28%. This further widens gaps in access to care. WHO estimates that these COVID-19 related disruptions in access to TB care could cause an additional half a million TB deaths.
Since 2001, WHO and its partners have offered support on engaging private providers for TB prevention and care, the need for which has been recognized in global TB strategies since 2006. Since 2002, the Public Private Mix Working Group of the Stop TB Partnership has held 15 global meetings on the subject. Several WHO guidance documents have been issued1 and a number of major reviews of the literature have been published. While considerable experience has been gained in a wide range of health market contexts, and some countries have made more sustained progress than others, overall engagement of private providers remains weak considering the important role of private providers in many high-burden countries. An essential premise of this document is that global and national goals in TB cannot be achieved unless private providers are engaged on a scale commensurate with their role in health systems.
In this context, the purpose of this document is ultimately to facilitate improved engagement of private providers, thereby contributing to universal access to quality and affordable TB care and the end of the TB epidemic. It focusses on the role of private for-profit providers and on specific challenges and experiences in engaging them for TB prevention and care.
