Hamid Salim M A, Uplekar Mukund, Daru Paul, Aung Maug, Declercq E, Lönnroth Knut
Damien Foundation Bangladesh, Road 18, House 24, Dhaka, Bangladesh.
Bull World Health Organ. 2006 Jun;84(6):479-84. doi: 10.2471/blt.05.023929. Epub 2006 Jun 21.
In 1998, the Damien Foundation Bangladesh invited semi-qualified, private "gram dakter" (Bangla for "village doctors") to participate in tuberculosis (TB) programmes in a population of 26 million people in rural Bangladesh. The organization trained 12 525 village doctors to not only refer suspected TB cases for free diagnosis but also to provide directly observed treatment (DOT) free of charge. Source of referral and place of DOT was recorded as part of the standardized TB recording and reporting system, which enabled us to quantify the contribution of village doctors to case detection rates and also allowed disaggregated cohort analysis of treatment outcome. During 2002 and 2003, 11% of all TB cases with positive sputum smears in the study area had been referred by village doctors; the rate of positive tests in patients referred by village doctors was 14.4%. 18 792 patients received DOT from village doctors, accounting for between 20% and 45% of patients on treatment during the 1998-2003 period. The treatment success rate was about 90% throughout the period. Urine samples taken during random checks of treatment compliance were positive for isoniazid in 98% of patients treated by village doctors. Within the framework of Public-Private Mix DOTS, services provided by semi-qualified private health care providers are a feasible and effective way to improve access to affordable high quality TB treatment in poor rural populations. The large informal health workforce that exists in resource poor countries can be used to achieve public health goals. Involvement of village doctors in TB control has now become national policy in Bangladesh.
1998年，孟加拉国达米恩基金会邀请资质一般的私人“乡村医生”（孟加拉语为“gram dakter”）参与孟加拉国农村地区2600万人的结核病防治项目。该组织培训了12525名乡村医生，不仅让他们将疑似结核病病例转介以便进行免费诊断，还让他们免费提供直接观察治疗（DOT）。转介来源和直接观察治疗地点作为标准化结核病记录和报告系统的一部分进行记录，这使我们能够量化乡村医生对病例检出率的贡献，还能对治疗结果进行分组队列分析。在2002年至2003年期间，研究区域内所有痰涂片阳性的结核病病例中有11%是由乡村医生转介的；乡村医生转介患者的检测阳性率为14.4%。18792名患者接受了乡村医生的直接观察治疗，占1998 - 2003年期间接受治疗患者的20%至45%。在此期间，治疗成功率约为90%。在随机检查治疗依从性时采集的尿液样本中，98%接受乡村医生治疗的患者尿液中异烟肼呈阳性。在公私混合直接观察治疗的框架内，资质一般的私人医疗服务提供者提供的服务是改善贫困农村人口获得负担得起的高质量结核病治疗的可行且有效方式。资源匮乏国家中存在的庞大非正规卫生人力可用于实现公共卫生目标。乡村医生参与结核病控制现已成为孟加拉国的国家政策。
