Anand Tanu, Babu Ranjith, Jacob Anil G, Sagili Karuna, Chadha Sarabjit S
North Delhi Municipal Corporation Medical College, Hindu Rao Hospital, New Delhi, India.
International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India.
Lung India. 2017 Nov-Dec;34(6):538-544. doi: 10.4103/0970-2113.217577.
India accounts for the highest number of incident tuberculosis (TB) cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs) has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS) helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program.
印度是全球新发结核病病例数最多的国家。因此，为了影响全球结核病发病率，迫切需要在该国开展并加速结核病控制活动。近一半的结核病患者最初在私营部门寻求结核病治疗。然而，私人执业医生在结核病预防和治疗方面的参与情况参差不齐，公私部门之间存在不信任。私人执业医生通常有各种各样不充分的诊断和治疗方法，这增加了耐药风险。因此，如果我们要在全球层面实现结核病控制，在印度将他们作为关键利益相关者进行监管并让其参与结核病预防和治疗至关重要。然而，仍然存在一些障碍和差距，阻碍了他们的扩大参与。本文旨在讨论印度私营部门参与结核病预防和治疗的现状。本文还讨论了政府在这方面采取的战略和举措，因为有证据表明，私营部门参与直接督导下的短程化疗（DOTS）有助于提高病例发现率和治疗效果；它能在更大的地理范围内提高优质结核病治疗的可及性。除了公私合作模式外，直接督导下的短程化疗已被证明更具成本效益，并减轻了患者的经济负担。本文还提出了一些在政策和项目层面的更多解决方案，以扩大私人执业医生在国家结核病控制项目中的参与度。
