Delivery of TB Care in Private Sector

The private sector for tuberculosis (TB) care is everything outside the ambit of government-run public health initiatives. It consists of a wide range of providers from individual medical practitioners of many different systems of medicine, including:

• Modern medicine
• Indian systems of medicine
• Homeopathy
• Paramedics
• Traditional healers
• Private hospitals and nursing homes
• Non-governmental organization-run hospitals
• Corporate sector health care institutions

As per the National Sample Survey Organization report of the 75th round, more than 70% of patients seek care in private clinics or hospitals.

Challenges with TB care in the private sector:

• Delays in diagnosis
• Over-diagnosis of TB due to an over-dependence on X-rays
• Use of multiple non-standard regimens for inappropriate durations
• Lack of a mechanism to ensure the full course of treatment and to record treatment outcomes

Regulatory tools to improve TB care services: The following are existing regulatory tools to improve TB care services in the private sector:

• Standards for TB care in India
• Mandatory TB notification on Nikshay
• Ban on sero-diagnostics
• Amendments in H1 schedule

Regulatory tools, however, are limited, and partnership is preferred. 

Steps/approaches to strengthen private sector engagement:

Partnership approaches include:

• An expanded acceptance by National TB Elimination Program (NTEP) of internationally approved diagnostic and treatment protocols
• Reliance on market forces rather than normative exhortation, that is, engaging and prioritising health care providers that offer the highest market value
• Increased use of accreditation and contracting

Other NTEP initiatives include:

1. Outreach to private laboratories
2. Increased control of TB drugs
3. Innovative use of information and communication technologies for TB notification and treatment adherence monitoring

NTEP has systematically mapped private healthcare providers (single and multispecialty hospitals), private laboratories and chemists in the Nikshay online portal through which these health facilities can notify TB patients.

Resources

• Training Modules (1-4) for Programme Managers & Medical Officers, 2020.
• Key Indicators of Social Consumption in India: Health, NSS 75th Round Report, Ministry of Statistics and Programme Implementation, 2019.
• JEET Brochure.

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