Abstract
BackgroundPublic-private partnerships (PPP) could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient.MethodsTwo different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT). Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated.ResultsCost per case cured was significantly lower in PNP (US $354–446), and comparable between PWP (US $788–979) and public sites (US $700–1000). PPP models could significantly reduce costs to the patient by 64–100%. Relative to pure public sector provision and financing, expansion of PPPs could reduce government financing required per TB patient treated from $609–690 to $130–139 in PNP and $36–46 in PWP.ConclusionThere is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.
Highlights
Public-private partnerships (PPP) could be effective in scaling up services
Projections suggest that at current rates, even if there were 100% global coverage by DOTS – the internationally recommended control strategy for TB, only half of new infectious cases would be detected [2]. Key reasons for this are that patients do not have access to public health facilities or seek care from providers not linked to national programmes or the public health system – such as private doctors working in their own facilities or for employer health services [2,3]
The PNP model is a partnership between provincial TB programmes and non-governmental organisations (NGOs) providing community-based directly observed treatment (DOT) in which these NGOs are paid a monthly sum per patient to manage community-based TB programmes
Summary
Public-private partnerships (PPP) could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient. Projections suggest that at current rates, even if there were 100% global coverage by DOTS – the internationally recommended control strategy for TB, only half of new infectious cases would be detected [2]. Key reasons for this are that patients do not have access to public health facilities or seek care from providers not linked to national programmes or the public health system – such as private doctors working in their own facilities or for employer health services [2,3]. Private TB treatment provision has been characterised by limited notification of cases from the private sector, inappropriate drug regimens, and unknown treatment outcomes [4,5]
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