Abstract
BackgroundIn South Asia a large number of patients seek treatment for TB from private practitioners (PPs), and there is increasing international interest in involving PPs in TB control. To evaluate the feasibility, effectiveness and costs of public-private partnerships (PPPs) for TB control, a PPP was developed in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. From the clinical perspective the PPP was shown to be effective. The aim of this paper is to assess and report on the costs involved in the PPP scheme.MethodsThe approach to costing took a comprehensive view, with inclusion of costs not only incurred by health facilities but also social costs borne by patients and their escorts. Semi-structured questionnaires and guided interviews were used to collect start-up and recurrent costs for the scheme.ResultsOverall costs for treating a TB patient under the PPP scheme averaged US$89.60. Start-up costs per patient represented 12% of the total budget. Half of recurrent costs were incurred by patients and their escorts, with institutional costs representing most of the rest. Female patients tended to spend more and patients referred from the private sector had the highest reported costs.ConclusionTreating TB patients in the PPP scheme had a low additional cost, while doubling the case notification rate and maintaining a high success rate. Costs incurred by patients and their escorts were the largest contributors to the overall total. This suggests a focus for follow-up studies and for cost-minimisation strategies.
Highlights
In South Asia a large number of patients seek treatment for TB from private practitioners (PPs), and there is increasing international interest in involving PPs in TB control
The internationally recommended DOTS strategy [3,4] has been successfully implemented in the public sector by many National Tuberculosis Programmes (NTPs), but in the private sector the quality of care is generally very poor [5,6,7] This is a cause for concern since the private sector is a major provider of TB care in South Asia, in urban centres [8]
After a follow-up with the Treatment Centres (TCs) we found that this largely due to their inability to distinguish between start-up costs that were attributed to the private partnerships (PPPs) scheme and other similar activities performed by the institution
Summary
In South Asia a large number of patients seek treatment for TB from private practitioners (PPs), and there is increasing international interest in involving PPs in TB control. Effectiveness and costs of public-private partnerships (PPPs) for TB control, a PPP was developed in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. In Nepal, over 14,000 new cases of smear positive (i.e. infectious) tuberculosis are notified each year [13], and it has been estimated that in urban areas 50% of TB patients were (poorly) managed in the private sector [14,15]. Following consultation of various policy options, the Nepal NTP and the research team developed a public-private partnership (PPP) for TB control in urban Nepal. Lalitpur Municipality, a medium-sized city in the Kathmandu valley with a population of about 200,000 – a typical urban setting in the Nepalese context – was chosen as a pilot site for this initiative
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