Menberu Melat, Kar Sonali, Ranjan Behera Manas
Kalinga School of Public Health, KIIT University, Bhubaneswar, Odisha, India.
KIMS, KIIT University, Bhubaneswar, Odisha, India.
Indian J Tuberc. 2022 Jul;69(3):277-281. doi: 10.1016/j.ijtb.2021.07.007. Epub 2021 Jul 15.
In India, around 70% of health care services are offered by the private sector. National strategic plan (NSP) has emphasized private sector engagement to TB program. Public private mix strategy along with web based mandatory notification of TB cases were established in 2002. However, feasibility of consulting an informal provider first was seen to be associated with significant increases in total delay (absolute increase 22.8 days, 95%CI 6.2-39.5) and in the risk of prolonged delay >90 days.
A mixed method literature review, descriptive information and evaluative outcomes data extracted and analysed.
This review aimed to systematically review public private mix strategy in TB control in Indian tuberculosis disease burden and efforts towards elimination.
Available published literatures were searched with key words, articles related with objectives were selected, analysed and systematically synthesized. Overall 30 studies were reviewed.
Available literatures were selected based on study objective and analysed. The modes of PPM strategy its success and problems of implementation and shortcomings were synthesized.
After implementing PPM from 2002, case detection is seen to have significantly increased for smear positive cases and high detection rate and better treatment outcomes achieved. However, implementation of PPM has been challenged to fully deliver the intended services. Interestingly, seeking initial care from PPs is significant risk factor for diagnostic delay.
PPM is a proven and tested strategy to achieve End TB goal globally and even in India. However, studies indicated there is the need to strengthen and motivate public sector to engage private practitioners in specific districts and sync their activities into the mainstream programme. Conflict of interest and mistrust between private practitioners and public sector has to be well addressed to build sustainable relationship among the sectors. Routine and institutionalized systematic monitoring and evaluation of the system is required to meet the End TB goal by 2025.
在印度，约70%的医疗服务由私营部门提供。国家战略计划（NSP）强调私营部门参与结核病防治项目。2002年制定了公私混合策略以及基于网络的结核病病例强制通报制度。然而，先咨询非正规医疗服务提供者的可行性被认为与总延误时间显著增加（绝对增加22.8天，95%置信区间6.2 - 39.5）以及延误超过90天的风险增加有关。
采用混合方法进行文献综述，提取并分析描述性信息和评估性结果数据。
本综述旨在系统回顾印度结核病疾病负担及消除结核病努力中公私混合策略在结核病控制方面的情况。
使用关键词搜索现有已发表文献，选择、分析并系统综合与目标相关的文章。共综述了30项研究。
根据研究目标选择并分析现有文献。综合了公私混合策略的模式、其成功之处、实施中的问题及不足之处。
自2002年实施公私混合策略后，涂片阳性病例的病例发现率显著提高，实现了高发现率和更好的治疗效果。然而，公私混合策略的实施在全面提供预期服务方面面临挑战。有趣的是，从非正规医疗服务提供者处寻求初始治疗是诊断延误的重要风险因素。
公私混合策略是在全球乃至印度实现终结结核病目标的经过验证和测试的策略。然而，研究表明有必要加强并激励公共部门让私营从业者参与特定地区的工作，并将他们的活动纳入主流项目。必须妥善解决私营从业者与公共部门之间的利益冲突和不信任问题，以建立各部门之间的可持续关系。需要对该系统进行常规和制度化的系统监测与评估，以在2025年前实现终结结核病目标。
