Newell James N, Pande Shanta B, Baral Sushil C, Bam Dirgh S, Malla Pushpa
Nuffield Institute for Health, University of Leeds, Leeds, England.
Bull World Health Organ. 2004 Feb;82(2):92-8. Epub 2004 Mar 16.
To implement and evaluate a public-private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector.
A local working group developed a public-private partnership for control of TB, which included diagnosis by private practitioners, direct observation of treatment and tracing of patients who missed appointments by nongovernmental organizations, and provision of training and drugs by the Nepal National TB Programme (NTP). The public-private partnership was evaluated through baseline and follow-up surveys of private practitioners, private pharmacies, and private laboratories, together with records kept by the Nepal NTP.
In the first 36 months, 1328 patients with TB were registered in the public-private partnership. Treatment success rates were >90%, and <1% of patients defaulted. Case notification of sputum-positive patients in the study area increased from 54 per 100 000 to 102 per 100 000. The numbers of patients with TB started on treatment by private practitioners decreased by more than two-thirds, the number of private pharmacies that stocked anti-TB drugs by one-third, the number of pharmacies selling anti-TB drugs by almost two-thirds, and sales of anti-TB drugs in pharmacies by almost two-thirds. Private practitioners were happy to refer patients to the public-private partnership. Not all private practitioners had to be involved: many patients bypassed private practitioners and went directly to free DOTS centres.
A combination of the strengths of private practitioners, nongovernmental organizations, and the public sector in a public-private partnership can be used to provide a service that is liked by patients and gives high rates of treatment success and increased rates of patient notification. Similar public-private partnerships are likely to be replicable elsewhere, as inputs are not large and no special requirements exist.
在尼泊尔拉利特布尔市实施并评估一项公私合作项目，以推行国际推荐的结核病（TB）控制策略——直接督导下的短程化疗（DOTS）。据估计，该市50%的结核病患者在私立部门接受治疗。
一个当地工作小组建立了一个结核病控制公私合作项目，其中包括私立执业医师进行诊断、非政府组织对治疗进行直接观察并追踪失约患者，以及尼泊尔国家结核病规划（NTP）提供培训和药品。通过对私立执业医师、私立药店和私立实验室进行基线调查及随访，并结合尼泊尔NTP保存的记录，对该公私合作项目进行评估。
在最初的36个月里，公私合作项目登记了1328例结核病患者。治疗成功率超过90%，患者违约率低于1%。研究区域内痰涂片阳性患者的病例报告率从每10万人口54例增至102例。私立执业医师开始治疗的结核病患者数量减少了三分之二以上，储备抗结核药物的私立药店数量减少了三分之一，销售抗结核药物的药店数量减少了近三分之二，药店抗结核药物销售额减少了近三分之二。私立执业医师乐意将患者转介至公私合作项目。并非所有私立执业医师都必须参与：许多患者绕过私立执业医师，直接前往免费的DOTS中心。
公私合作项目将私立执业医师、非政府组织和公共部门的优势结合起来，能够提供一种患者满意、治疗成功率高且患者报告率增加的服务。由于投入不大且没有特殊要求，类似的公私合作项目可能在其他地方得以推广。
