Enhancing Tuberculosis Care in Madhya Pradesh Through Public-Private Partnerships: An Evaluation of the Patient Provider Support Agency (PPSA) Model

Abstract

BackgroundThe quality of care that patients receive in the private sector has been reported to be poor. Madhya Pradesh began adopting the PPSA model in September 2020, initially covering 44 districts. By April 2022, the state achieved 100% coverage, becoming the first state in the country to implement PPSA across all 52 districts. Although PPSA is now operational in every district, health indicators in the private sector have shown little improvement, and notifications from the private sector remain significantly below the annual targets The patient provider support agency (PPSA) pilot program has demonstrated newer strategies for private sector engagement to be able to deliver significant outcomes. the study explores the strengths and limitations of the private sector engagement model from the healthcare providers’ perspective MethodsThis was a mixed–methods study in which both quantitative and qualitative data were simultaneously collected. Quantitative data collection (using routinely collected programmatic data) is supported by qualitative data collection (in-depth interviews).This study was conducted to study the impact of the PPSA service implementation model on notification status, patient care activities and outcomes through record review among all 52 districts of Madhya Pradesh between October 2020- December 2022 as well as to explore the strengths and limitations of the PPSA model from the healthcare providers’ perspectives using a mixed-methods approach. ResultThere was a increase in the number of TB patients notified in the private sector (62%), number of patients receiving benefits of the Nikshay Poshan Yojna through Direct Bank Transfer (91%), number of patients tested for Human Immunodeficiency Virus (100%), Diabetes, and universal drug susceptibility testing (25%), as well as successful treatment outcomes in the post-PPSA period as compared to the pre-PPSA period. Seventeen in-depth interviews of health care providers from the public (n=8) and private sector (n=9) highlighted the operational challenges and solutions to implementation of the PPSA. Inadequate Human resource, poor coordination with NTEP Staff, poor mapping of PP’s, mobile based counselling & limited home visit to TB patients were the perceived challenges and regular support to the private health facilities and MIS data, trainings and hand-holding, supportive supervision from the State, and strict need based tendering policies were few of the suggestions to improve the PPSA model were some of the solutions. ConclusionThe implementation of the Patient Provider Support Agency (PPSA) model in Madhya Pradesh has not only improved notification rates and successful treatment outcomes but also strengthened the overall engagement of private healthcare providers in TB management. Enhanced collaboration, regular facility mapping, and sustained educational efforts have led to a more robust approach to TB care that extends across both public and private sectors. While challenges such as funding inconsistencies and service delivery fluctuations highlight areas for further improvement, the overall success of the PPSA model in Madhya Pradesh provides a promising framework for other regions aiming to enhance TB care through public-private partnerships. Future efforts should focus on addressing the identified gaps and scaling up these successful practices to ensure high-quality care for all TB patients, irrespective of where they seek treatment.