Vasquez Nathaly Aguilera, Oga-Omenka Charity, Yellappa Vijayashree, Lestari Bony Wiem, Sassi Angelina, Sheokand Surbhi, Olusola-Faleye Bolanle, Huria Lavanya, Brubacher Laura Jane, Baruwa Elaine, Alisjahbana Bachti, Pai Madhukar
McGill International TB Centre, Montreal, Canada.
School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
J Clin Tuberc Other Mycobact Dis. 2024 Dec 2;38:100503. doi: 10.1016/j.jctube.2024.100503. eCollection 2025 Feb.
The COVID-19 pandemic created unprecedented challenges in the field of global health. Nigeria, Indonesia and India are three high tuberculosis (TB) burden countries with large private health sectors. Both TB and the private health sector faced challenges in these countries because of COVID-19. This study aimed to compare the COVID-19 control measures and policies in the provision of TB care services and gain insights from policymakers on how the pandemic affected the provision of TB services in the private healthcare sector, how each country adapted, and identify lessons learned for health system preparedness.
Qualitative, in-depth interviews were conducted among a purposive sample of 11 national and sub-national policymakers in each country. Thematic content analysis was conducted on the data collected using an adapted WHO Health Equity Policy Framework.
Results revealed three policy dimensions under costs, access, and quality. Under healthcare costs, policymakers highlighted resource allocation and diversion of TB resources to COVID response, and increased operational costs for private provider. Under healthcare access, key themes included reduced TB case detection due to fear of COVID-19, disrupted diagnostic services, and adaptations such as extended medicine supplies and tele-consultations. Under healthcare quality, themes included compromised TB diagnostic accuracy due to similar respiratory symptoms with COVID-19, and strain on laboratory infrastructure due to competing demands from both diseases. Policymakers across the three countries pointed to the need for strengthening private-public partnerships (PPP) for healthcare service delivery and continued private sector investment to facilitate the continuity of TB care within a pandemic context.
The results of this study provide an overview of the impact of the pandemic from the perspective of private facilities and policymakers in Nigeria, Indonesia and India, which can inform future policy and ways forward in strengthening PPP for healthcare service delivery in high TB burden countries.
新冠疫情给全球卫生领域带来了前所未有的挑战。尼日利亚、印度尼西亚和印度是三个结核病负担较重且私营卫生部门规模较大的国家。由于新冠疫情，结核病和私营卫生部门在这些国家都面临挑战。本研究旨在比较三国在提供结核病护理服务方面的新冠疫情防控措施和政策，并从政策制定者那里了解疫情如何影响私营医疗部门的结核病服务提供、各国如何应对，以及总结卫生系统应对准备方面的经验教训。
对每个国家11名国家和地方政策制定者进行了有目的抽样的定性深入访谈。使用经改编的世界卫生组织健康公平政策框架对收集到的数据进行了主题内容分析。
结果揭示了成本、可及性和质量三个政策维度。在医疗成本方面，政策制定者强调资源分配以及结核病资源转向新冠应对，私营医疗机构运营成本增加。在医疗可及性方面，关键主题包括因恐惧新冠疫情导致结核病病例发现减少、诊断服务中断，以及诸如延长药品供应和远程会诊等应对措施。在医疗质量方面，主题包括因与新冠疫情有相似呼吸道症状而导致结核病诊断准确性受损，以及由于两种疾病的竞争需求给实验室基础设施带来的压力。三国的政策制定者都指出，在疫情背景下，需要加强公私伙伴关系以提供医疗服务，并持续进行私营部门投资以促进结核病护理的连续性。
本研究结果从尼日利亚、印度尼西亚和印度的私营医疗机构及政策制定者角度概述了疫情的影响，可为未来政策及加强高结核病负担国家公私伙伴关系以提供医疗服务的前进方向提供参考。
