Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Trop Med Int Health. 2021 Jul;26(7):730-742. doi: 10.1111/tmi.13574. Epub 2021 May 4.
National averages obscure geographic variation in program performance. We determined Parliamentary Constituency (PC)-wise estimates of TB notification to guide political engagement.
We extracted district-level TB notification data from the 2018 annual TB report. We derived PC-level estimates by building a 'cross-walk' between districts and PCs using boundary shapefiles. We described the spatial distribution of the PC-wise estimates of Total Notification Rate and percentage of Private Sector Notification.
The median PC-wise Total Notification Rate was 126.24/100 000 (IQR: 94.86/100 000, 162.22/100 000). The median PC-wise Percentage Private Sector Notification was 18.03% (IQR: 9.56%, 26.84%). Only 16 (2.94%) PCs met the target of 50% private sector notification. Most of high notification rates in PCs were driven by high notification in public sector. There was geographic - both interstate and within state inter-PC - variation in the estimates of these indicators. The study identified some geographic patterns of notification - high positive outlier PCs with adjoining PCs in lower deciles of notification rates, intra-state differences in PC performance, and similarities in notification rates of adjoining PCs in different states.
In addition to regional inequality, the study identified geospatial patterns that can aid in the formulation of suitable interventions. These include decongestion of overburdened facilities by strengthening poorly performing units. The PCs with a high percentage Private Sector Notification can act as role models for neighbouring PCs to improve private sector engagement. MPs can play a crucial role in mobilising additional resources, creating awareness, and establishing inter-PC and inter-state collaboration to improve TB program performance.
国家平均水平掩盖了项目绩效的地域差异。我们确定了议会选区（PC）的结核病通知估计数，以指导政治参与。
我们从 2018 年年度结核病报告中提取了地区一级的结核病通知数据。我们通过使用边界形状文件在地区和选区之间建立“交叉映射”，得出选区一级的估计值。我们描述了总通知率和私营部门通知比例的选区级估计值的空间分布。
中位数 PC 级总通知率为 126.24/100000（IQR：94.86/100000，162.22/100000）。中位数 PC 级私营部门通知比例为 18.03%（IQR：9.56%，26.84%）。只有 16 个选区（2.94%）达到了 50%私营部门通知的目标。PC 级高通知率主要是由公共部门的高通知率驱动的。这些指标的估计值存在州际和州内选区之间的地理差异。该研究确定了一些通知的地理模式——高通知率的正离群值选区与通知率较低的邻接选区，州内选区绩效的差异，以及不同州邻接选区的通知率相似性。
除了区域不平等之外，该研究还确定了有助于制定适当干预措施的地理空间模式。其中包括通过加强表现不佳的单位来缓解负担过重的设施的拥堵。高私营部门通知比例的选区可以作为邻接选区提高私营部门参与度的榜样。议员可以在动员额外资源、提高认识以及建立选区间和州际合作以提高结核病规划绩效方面发挥关键作用。
