Using the Bundling Approach

In scenarios where multiple systemic gaps have been identified during needs assessment, the program manager may consider using more than one partnership option. Bundling refers to combining a series of partnership options in a logical and sequential manner to ensure that no patient is left out at any point in the care cascade.

Advantages of Bundling

• Increased coverage - multiple activities in the cascade of PB care from diagnosis to treatment completion can be provided to the TB patients.
• Fewer contracts to process- bundling is cost effective and easy to implement as multiple contracts can be processed together.
• Opportunities for collaboration- bundling allows for service providers to partner with other agencies who have the skills sets and capacities to offer support for complementary services.
• Reduces supervision and verification costs.

Types of Bundling

A. Service or vertical bundles

Under this approach the program manager should consider the continuum of full range of services to patients. For example rather than partnering for only a microscopy centre at a private sector hospital, it is recommended that other allied and supporting services are made available at the same hospital so as to ensure patients have access to comprehensive care as well as easy access to services. The elite partnership options could cover the spectrum of treatment. For instance, if the program manager is planning to outsource a diagnostic test such as nucleic acid amplification test (NAAT), they can also consider how to avail services from the same service provider for specimen collection and transportation.

 It is not necessary to outsource all services, but the program manager should deliberate on how this ties in with end-to-end services.

B. Geographical expansion of services or horizontal bundles

To create an impact at a large scale with more concentrated effort and focused monitoring, the program manager may pick a standalone service and engage a service provider in a 'horizontal bundle' for services across clusters of TB units, cluster of districts, regional, zonal or statewide For example, to engage a service provider such as courier or chain laboratory or postal services or drug distributors who can be responsible for specimen transportation from public or private sector providers and/or drug distribution to treatment provision sites for a cluster of districts or states.

C. Services which require similar capabilities of the partner agencies

Under this approach the program manager may consider bundling of all services which require identical skill sets of the service provider. For example drug distribution and specimen transportation require agencies with similar skill sets and capability of supply chain management and logistics.

Partnership options may be implemented in isolation, but it is preferable if if service providers extend these options to ensure a continuum of care to the patients by themselves or by providing subcontract to another service provider.

Resources

• Guidance document on partnerships RNTCP 2019

Assessments