Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh

Sayera Banu,Jacob Creswell,Md Shamiul Islam,Shahriar Ahmed,Rupali Sisir Banu,Kishor Kumar Paul,Allen G Ross,Sonia Sultana,Farhana Haque,Robert Stevens,Razia Khatun,Senjuti Kabir,Md Mahfuzur Rahman,John D Clemens,S M Mazidur Rahman,Frederick Quinn

doi:10.1371/journal.pone.0241437

Sayera Banu, Jacob Creswell + Show 14 more

Open Access

https://doi.org/10.1371/journal.pone.0241437

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Abstract

BackgroundIn Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis.Methods and findingsThe model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres’ operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area.ConclusionThe model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b’s screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.

Highlights

National tuberculosis programs (NTPs) detect, treat and report seven of every ten people who are estimated to develop tuberculosis (TB) each year [1]
The basic management units (BMUs) were linked with national tuberculosis programs (NTPs) system and had overall responsibility for diagnosing, reporting and treating TB cases according to WHO guidelines following well-structured protocols
All facilities were visited regularly, and a network was established with 8,466 private health care providers (PPs) (52% of the estimated PPs in the Dhaka Metropolitan Area (DMA))

Summary

Introduction

National tuberculosis programs (NTPs) detect, treat and report seven of every ten people who are estimated to develop tuberculosis (TB) each year [1] This gap translates to about 3 million people with TB who are missed, the majority of them residing in Asia where poor linkages of NTPs with the private sector is thought to be one of the biggest shortfalls [1,2,3]. Approaches primarily focused on small groups of PP trained to refer people with TB symptoms to public facilities for diagnosis and/or treatment [2, 8] While these approaches often showed small scale success, they did not engage deeply in the complicated web of factors driving private care and generally remained pilots. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis.

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