Tuberculosis (TB)

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Public-Private Mix (PPM) for TB Care and Control

Public-Private Mix

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Ninth Meeting of the Subgroup on Public-Private Mix for TB Care and Control

The ninth meeting of the Subgroup on Public-Private Mix for TB care and control (PPM Subgroup) was held in Bangkok, Thailand from 28 - 30 August 2013. The meeting was organized in the context of the development of the post-2015 TB strategy. It overviewed global progress in PPM to-date, discussed ways to accelerate PPM scale up and mainstreaming within the post-2015 TB strategy.

With a view of drawing attention to the possibility of substantially enhancing TB case notifications while also improving TB management among people with TB presenting to large hospitals, a workshop on the unfinished business of effective engagement of large hospitals in TB care and control was organised in conjunction with the Subgroup meeting. The evidence generated from documented field projects was presented and discussed, and field visits were undertaken for participants to examine first-hand some working examples of effective hospital engagement in TB care and control in Bangkok.

In most resource-poor countries with a high TB-burden, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health-care providers. These care providers, often not linked to public sector-based national tuberculosis programmes (NTPs), may serve a large proportion of TB suspects. The size, types and roles of these care providers vary greatly within and across countries. In some settings there is a large private commercial sector and numerous non governmental organizations (NGOs) while in others there are public sector providers (such as general and specialized hospitals) that operate outside the scope of NTPs. Evidence suggests that failure to involve all care providers used by TB suspects and patients hampers case detection, delays diagnosis, leads to inappropriate and incomplete treatment, contributes to increasing drug resistance and places an unnecessary financial burden on patients.

Engaging all relevant health care providers in TB care and control through public-private mix approaches is an essential component of the World Health Organization's (WHO's) Stop TB Strategy. Public-Private Mix (PPM) for TB Care and Control represents a comprehensive approach for systematic involvement of all relevant health care providers in TB control to promote the use of International Standards for TB Care and achieve national and global TB control targets. PPM encompasses diverse collaborative strategies such as public-private (between NTP and the private sector), public-public (between NTP and other public sector care providers such as general hospitals, prison or military health services and social security organizations), and private-private (between an NGO or a private hospital and the neighborhood private providers) collaboration. PPM also implies engaging relevant care providers in prevention and management of MDR-TB and in the implementation of TB/HIV collaborative activities.

Currently, nearly all high TB-burden countries are implementing PPM activities. Reports from countries and several project evaluations have shown that PPM could help increase case detection (between 10% and 60%), improve treatment outcomes (over 85%), reach the poor and save costs.

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