Khan Mishal S, Salve Solomon, Porter John D H
TB Centre, London School of Hygiene and Topical Medicine and Research Alliance for Advocacy and Development, Pakistan,
Department of Global Health and Development, London School of Hygiene and Tropical Medicine and Maharashtra Association of Anthropological Sciences (MAAS), Pune, India and.
Health Policy Plan. 2015 Dec;30(10):1289-95. doi: 10.1093/heapol/czu137. Epub 2015 Jan 20.
There has been a huge expansion in the private health-care sector over the past two decades, particularly in South Asia, resulting in over 80% of patients seeking care from private health providers. Despite concerns about the quality and equity of private sector service provision, most government public health bodies recognize that the private sector reaches individuals that public institutions cannot cater to, thereby being important in moving closer to universal health coverage. Numerous initiatives have been launched and are being planned to involve private practitioners in effectively diagnosing, reporting and managing infectious diseases such as tuberculosis. However, there is a notable dearth of papers discussing which elements of private sector engagement strategies are more or less successful and the ethical issues that arise when engagement strategies are operationalized. This article brings together the authors' experiences of working on projects to engage private allopathic health providers in Pakistan, Bangladesh and India for improved tuberculosis control. Motivations of and strategies required to engage private allopathic heath providers, specifically doctors, diagnostic laboratories and pharmacies, and some of the ethical issues that arise when designing programmes for engagement are discussed.
在过去二十年中，私营医疗保健部门大幅扩张，尤其是在南亚地区，导致超过80%的患者向私营医疗服务提供者寻求治疗。尽管人们对私营部门服务提供的质量和公平性存在担忧，但大多数政府公共卫生机构认识到，私营部门能够覆盖公共机构无法顾及的人群，因此在迈向全民健康覆盖方面具有重要意义。已经启动并正在规划许多举措，以使私营从业者有效参与结核病等传染病的诊断、报告和管理工作。然而，关于私营部门参与战略的哪些要素或多或少取得成功以及实施参与战略时出现的伦理问题的论文却明显匮乏。本文汇集了作者在巴基斯坦、孟加拉国和印度开展项目，促使私营对抗疗法医疗服务提供者参与改善结核病控制工作的经验。讨论了促使私营对抗疗法医疗服务提供者（特别是医生、诊断实验室和药店）参与的动机和所需策略，以及在设计参与项目时出现的一些伦理问题。
