Joint Effort for Elimination of Tuberculosis [JEET] Model of the Patient Provider Support Agency [PPSA]

Studies have shown that nearly half of all patients with TB in India first seek care in the private sector, where there are significant gaps across the patient-care cascade, notably diagnostic delays, irrational and non-standardized regimens, and under-reporting to authorities. As a result, over a million cases of TB are missed in India every year. In order to address these challenges, project “Joint Effort for Elimination of Tuberculosis” (JEET) was envisaged. The key objective of this project is to set up effective and sustainable structures to strengthen existing systems and seamlessly extend quality TB care to patients in the private sector.

Patient Provider Support Agency (PPSA)

PPSA is one of the implementation Models under JEET Project and is responsible for continuous, end-to-end engagement of private sector to provide quality TB services to patients seeking care in private sector. The PPSA Model has the following key components:

1. Engagement of private providers

• Network with private sector providers and promotes quality and early diagnosis,

• Use of rapid diagnostics and Drug Susceptibility Testing (DST), TB notifications, and treatment as per Standards for TB Care in India (STCI)

• Utilisation of available public sector services under the National TB Elimination Programme (NTEP) for the patients seeking care in the private sector.

 2. Support engaged private sector providers for TB notifications in Ni-kshay 

• Through sensitisation

• By establishing mechanisms/ modalities to support private sector notifications.

3. Linkage to free diagnostics services by the programme

• All the presumptive TB cases are linked to free TB diagnostics services extended through a sample transport mechanism established under PPSA.

4. Linkage to free treatment services by the NTEP

• Facilitates issue of NTEP Fixed Dose Combinations (FDCs) through engaged private sector practitioners and chemists

• Facilitates linking patients to the public sector for initiation of treatment of Drug-sensitive TB (DS-TB) and Drug-resistant TB (DR-TB)

5. Support for treatment adherence

Adherence support is provided to patients through:

• A team of treatment coordinators

• NTEP provided Information and Communication Technology (ICT) enabled mechanism/ Call Centre for reminder SMS and phone calls.

6. Incentives to patients and private providers

• NTEP provisioned incentives as per the National Strategic Plan (NSP) are provided to the engaged private providers and patients seeking care through them.

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Figure: The Service Delivery Model for PPSA

Patient Provider Support Agency Lite (PPSA lite)

An alternative model of PPSA called PPSA lite is implemented in 141 cities across seven states. City officers in PPSA lite cities/ districts support:

• Mapping of private practitioners and identification of TB champions

• Private sector provider engagement through Continuing Medical Education (CMEs)

• Capacity building of NTEP staff to undertake private sector engagement.

• Providing program monitoring support and facilitating reviews.  

Resources

• Joint Effort for Elimination of Tuberculosis (JEET) Annual Report, 2018.

Assessment