Samal Janmejaya
Independent Public Health Researcher, Bhubaneswar, Odisha, India .
J Clin Diagn Res. 2017 Feb;11(2):LA01-LA04. doi: 10.7860/JCDR/2017/19627.9126. Epub 2017 Feb 1.
The growing interest of utilizing the private practitioners in improving the outreach of public health services including Tuberculosis (TB) control programme stemmed out of people's preference for private health facilities in situations where public health facilities fail to meet the expectations. In different parts of India, many models of Public Private Partnership have been tried and tested and proved successful in providing quality TB care in the concerned community. In this paper, several ways and means have been proposed to effectively utilize private practitioners for TB care in India. These strategies are discussed under different headings: (1) identification of potential private practitioners: (2) orientation of private practitioners: (3) networking of private practitioners with patients and Directly Observed Treatment Short course (DOTS) provider: (4) follow-up and sensitization of patients by private practitioners: (5) let the word of mouth work: and (6) evaluation of the involvement of private practitioners in TB care. However the following points must be addressed before utilizing the private practitioners for TB care: time constraints in notifying the disease, adherence to DOTS regime/alternative to DOTS regime, referral of patients to public health facilities for diagnosis and treatment, follow-up and sensitization of the patients and behaviour change communication and awareness in the community by the private practitioners. Few of these are mandatory for the private practitioners; most are practicable. With the effective utilization of private practitioners many problems can be sorted out that are currently plaguing the system such as irrational and excessive use of certain drugs, over reliance on chest X-ray for diagnosis, under use of sputum microscopy, lack of knowledge regarding standard treatment protocols and varied prescription practices.
在公共卫生设施无法满足期望的情况下，人们更倾向于选择私立医疗机构，这使得利用私人执业者来改善包括结核病控制项目在内的公共卫生服务覆盖范围的兴趣日益浓厚。在印度不同地区，已经尝试并测试了多种公私合作模式，并且证明在相关社区提供高质量结核病护理方面是成功的。本文提出了几种在印度有效利用私人执业者提供结核病护理的方法和途径。这些策略在不同标题下进行了讨论：（1）识别潜在的私人执业者；（2）对私人执业者进行培训；（3）私人执业者与患者以及直接观察短程治疗（DOTS）提供者建立联系；（4）私人执业者对患者进行随访和宣传；（5）发挥口碑效应；（6）评估私人执业者参与结核病护理的情况。然而，在利用私人执业者提供结核病护理之前，必须解决以下几点：疾病报告的时间限制、对DOTS方案的遵守/替代DOTS方案、将患者转诊至公共卫生设施进行诊断和治疗、私人执业者对患者的随访和宣传以及社区中的行为改变沟通和意识。其中一些对私人执业者来说是强制性的；大多数是可行的。通过有效利用私人执业者，目前困扰该系统的许多问题可以得到解决，例如某些药物的不合理和过度使用、过度依赖胸部X光进行诊断、痰涂片显微镜检查使用不足、缺乏关于标准治疗方案的知识以及处方做法各异。
