Public‐Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB Patients

Abstract

AbstractBackground: Despite enormous efforts, Bangladesh has one of the highest burdens of tuberculosis (TB) in the world. Treatment in the private sector is common and popular among TB patients in South‐Asian countries, including Bangladesh, even though the quality of diagnosis and treatment of TB patients has been shown to be poor in several such countries. The Bangladesh National Tuberculosis Programme (NTP) has recently shown considerable interest in exploring policy options to address this problem. Consequently, the NTP and Non‐Governmental Organisation (NGO) partners planned to develop a public‐private partnership (PPP) model for effective involvement of private medical practitioners (PMPs) in TB control. However, there was a lack of solid data on TB case management practice by PMPs which was needed to appraise the potential role and contribution of PMPs in TB control. The purpose of the study is therefore to assess the knowledge, attitudes and practices of PMPs on TB control in an urban setting in Bangladesh in order to inform development of a public‐private collaboration model. Methods: A cross sectional study was carried out in four areas of Dhaka city involving the NTP and three NGO partners. A mapping of PMPs was carried out: of the 250 PMPs identified, 97 showed an interest in becoming involved in the public‐private collaboration model and agreed to be interviewed. Information was also collected from focus group discussions with PMPs, and through a workshop. Results: PMPs were not aware of the NTP‐recommended regimen for treating TB: their prescribing patterns varied widely and were not related to the TB case categorisation. X‐ray was the preferred investigation of PMPs, who sent TB suspects to their preferred private‐run laboratory for diagnostic tests. Virtually no PMP had knowledge of the Bangladesh national policy for TB control (based on the WHO DOTS strategy), and the great majority did not know the locations of neighbouring DOTS centres. The quality of care provided by the public sector was perceived as poor by PMPs, who were therefore reluctant to refer TB patients to the NTP. Conclusions: There is enormous potential for improving TB treatment and control through partnerships between the NTP and PMPs, if the issues identified in this study are adequately addressed. PMPs must be encouraged to follow NTP guidelines for diagnosis and treatment. They should be motivated to refer patients to nearby DOTS centres. Proper training is required for PMPs to enhance their knowledge on diagnosis, treatment, and follow‐up. Appropriate tools and protocols and customised training packages need to be developed, focusing on appropriate diagnosis and treatment, including ways to refer patients to DOTS centres for diagnosis and treatment supervision.