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Yassin MA, Kimbo L, Wandwalo E, Rashid A, Dzokoto A, Weber U, Stallworthy G. Leveraging Global Fund's investments to expand innovative public-private provider engagement in TB. IJTLD OPEN 2024; 1:250-257. [PMID: 39021451 PMCID: PMC11249657 DOI: 10.5588/ijtldopen.24.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/02/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND TB remains a significant global health threat, claiming 1.3 million lives annually. The COVID-19 pandemic disrupted progress in the global TB response. Most patients with TB initially seek care from private providers, whereas only a small proportion are engaged by national programmes. The Global Fund is the major international source of funding for TB responses and supports the scale-up of innovative private-public mix (PPM) models in TB. METHODS We collected programmatic and financial data on TB from 11 priority countries implementing PPM activities. Country examples and trends in the budget of Global Fund grants were analysed. RESULTS These countries account for 60% of the global TB burden and Global Fund TB portfolio. PPM contributed 29% of national TB notifications in 2022 (range: 8% to 49%). During 2021-2023, US$1.4 billion was allocated for TB and US$155 million (11%) for PPM, while PPM contributed to 35% of national TB notification targets. PPM budgets increased over time from US$43 million (2002 to 2014) to US$129 million (2024 to 2026). CONCLUSION The Global Fund's investments facilitated the expansion of innovative PPM models, improved access, and enhanced TB responses. Our indicative analysis underscores the need for evidence-based planning, collaboration, and increased domestic investment to accelerate the end of TB.
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Affiliation(s)
- M A Yassin
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - L Kimbo
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - E Wandwalo
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - A Rashid
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - A Dzokoto
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - U Weber
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Chijioke-Akaniro O, Onyemaechi S, Kuye J, Ubochioma E, Omoniyi A, Urhioke O, Lawanson A, Ombeka VO, Hassan A, Asuke S, Anyaike C, Merle CS. Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study. BMJ Open 2023; 13:e069123. [PMID: 37709312 PMCID: PMC11148675 DOI: 10.1136/bmjopen-2022-069123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria. DESIGN This is a mixed methods study comprising a quantitative retrospective review and qualitative study. SETTING Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria. PARTICIPANTS We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities. PRIMARY AND SECONDARY OUTCOME MEASURES The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification. RESULTS A total of 13 (11.0%) out of 118 private HF were designated as 'engaged' TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB. CONCLUSION Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.
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Affiliation(s)
| | | | | | | | | | - Ochuko Urhioke
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Adebola Lawanson
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Victor O Ombeka
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | | | | | - Chukwuma Anyaike
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
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Balquis F, Sohail MF, Hamid H, Ullah W, Khan AH, Shahnaz G. Potential and weak links in the management of tuberculosis by Pakistani private pharmacy staff. Front Public Health 2023; 11:983997. [PMID: 36969650 PMCID: PMC10034968 DOI: 10.3389/fpubh.2023.983997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionThe emergence of MDR-TB is a global threat and an obstacle to the effective control of TB in Pakistan. A lack of proper TB knowledge among the staff in private pharmacies and the sale of compromised quality anti-TB drugs are the main instigators of multidrug-resistant tuberculosis (MDR-TB). Thus, this study was aimed at investigating the quality and storage conditions of fixed-dose combination (FDC) anti-TB drugs along with the awareness of staff working in private pharmacies regarding the identification of potential patients with TB and dispensing the inappropriate treatment regimens contributing to MDR-TB.MethodsThe study is completed in two phases. In phase I a cross-sectional study is performed using two quantitative research designs, i.e., exploratory and descriptive, to evaluate the knowledge of private pharmacy staff. The sample of 218 pharmacies was selected. While in phase II cross sectional survey is conducted in 10 facilities from where FDC anti TB drugs were sampled for analyzing their quality.ResultResults revealed the presence of pharmacists only at 11.5% of pharmacies. Approximately 81% of staff at pharmacies had no awareness of MDR-TB, while 89% of pharmacies had no TB-related informative materials. The staff identified that most of the patients with TB (70%) were of poor socio-economic class, which restricted their purchase of four FDCs only up to 2–3 months. Only 23% were acquainted with the Pakistan National TB Program (NTP). Except for MDR-TB, the results showed a significant correlation between the experiences of staff with TB awareness. Findings from the quality evaluation of four FDC-TB drugs indicated that the dissolution and content assay of rifampicin were not according to the specifications, and overall, 30% of samples failed to comply with specifications. However, the other quality attributes were within the limits.ConclusionIn light of the data, it can be concluded that private pharmacies could be crucial to the effective management of NTP through the timely identification of patients with TB, appropriate disease and therapy-related education and counseling, and proper storage and stock maintenance.
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Affiliation(s)
- Fatima Balquis
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Farhan Sohail
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Lahore Campus, Lahore, Pakistan
| | - Huma Hamid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Islamabad Campus, Islamabad, Pakistan
| | - Waseem Ullah
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Science, University Sains Malaysia, Gelugor, Penang, Malaysia
| | - Gul Shahnaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- *Correspondence: Gul Shahnaz
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Mannan S, Oga-Omenka C, Soman ThekkePurakkal A, Huria L, Kalra A, Gandhi R, Kapoor T, Gunawardena N, Raj S, Kaur M, Sassi A, Pande T, Shibu V, Sarin S, Singh Chadha S, Heitkamp P, Das J, Rao R, Pai M. Adaptations to the first wave of the COVID-19 pandemic by private sector tuberculosis care providers in India. J Clin Tuberc Other Mycobact Dis 2022; 28:100327. [PMID: 35874450 PMCID: PMC9295336 DOI: 10.1016/j.jctube.2022.100327] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background India’s dominant private healthcare sector is the destination for 60–85% of initial tuberculosis care-seeking. The COVID-19 pandemic in India drastically affected TB case notifications in the first half of 2020. In this survey, we assessed the impact of the first wave of COVID-19 in India on private providers, and changes they adopted in their practice due to the pandemic. Methods The Joint Effort for Elimination of TB (JEET) is a nationwide Global Fund project implemented across 406 districts in 23 states to extend quality TB services to patients seeking care in private sector. We conducted a rapid survey of 11% (2,750) of active providers engaged under JEET’s intense Patient Provider Support Agency (PPSA) model across 15 Indian states in Q1 (February–March) of 2021. Providers were contacted in person or telephonically, and consenting participants were interviewed using a web-based survey tool. Responses from participants were elicited on their practice before COVID-19, during the 2020 lockdowns (March–April 2020) and currently (Q1 2021). Data were adjusted for survey design and non-response, and results were summarised using descriptive statistics and logistic regression. Results Of the 2,750 providers sampled, 2,011 consented and were surveyed (73 % response). Nearly 50 % were between 30 and 45 years of age, and 51 % were from Uttar Pradesh, Maharashtra and Gujarat. Seventy percent of providers reported reduced daily out-patient numbers in Q1 2021 compared to pre-COVID times. During the lockdown, 898 (40 %) of providers said their facilities were closed, while 323 (11 %) offered limited services including teleconsultation. In Q1 2021, 88 % of provider facilities were fully open, with 10 % providing adjusted services, and 4 % using teleconsultation. Only 2 % remained completely closed. Majority of the providers (92 %) reported not experiencing any delays in TB testing in Q1 2021 compared to pre-COVID times. Only 6 % reported raising costs at their clinic, mostly to cover personal protective equipment (PPE) and other infection control measures, although 60–90 % implemented various infection control measures. Thirty-three percent of TB providers were ordering COVID-19 testing, in addition to TB testing. To adapt, 82% of survey providers implemented social distancing and increased timing between appointments and 83% started conducting temperature checks, with variation by state and provider type, while 89% adopted additional sanitation measures in their facilities. Furthermore, 62% of providers started using PPE, and 13% made physical changes (air filters, isolation of patient areas) to their clinic to prevent infection. Seventy percent of providers stated that infection control measures could decrease TB transmission. Conclusion Although COVID-19 restrictions resulted in significant declines in patient turn-out at private facilities, our analysis showed that most providers were open and costs for TB care remained mostly the same in Q1 2021. As result of the COVID-19 pandemic, several positive strategies have been adapted by the private sector TB care providers. Since the subsequent COVID-19 waves were more severe or widespread, additional work is needed to assess the impact of the pandemic on the private health sector.
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Affiliation(s)
| | - Charity Oga-Omenka
- McGill International TB Centre, Montreal, Canada.,School of Public Health Sciences, University of Waterloo, Canada
| | | | - Lavanya Huria
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics (FIND), India
| | | | | | - Nathali Gunawardena
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Shekhar Raj
- Centre for Health Research and Innovation (CHRI), India
| | - Manjot Kaur
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Angelina Sassi
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Tripti Pande
- McGill International TB Centre, Montreal, Canada
| | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics (FIND), India
| | | | - Petra Heitkamp
- McGill International TB Centre, Montreal, Canada.,TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, India
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
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5
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Azzopardi PS, Hennegan J, Prabhu SM, Dagva B, Balibago MM, Htin PPW, Swe ZY, Kennedy EC. Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100242. [PMID: 34528016 PMCID: PMC8357832 DOI: 10.1016/j.lanwpc.2021.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/04/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
Background Public health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships. Methods The study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines. Findings The private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts. Interpretation This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.
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Affiliation(s)
- Peter S Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Adolescent health and wellbeing program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Paediatrics, School of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne Australia
| | - Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne
| | - Shirley Mark Prabhu
- Adolescent Health, Mental Health and HIV Specialist, UNICEF Middle East and North Africa Regional Office, Amman, Jordan (formerly UNICEF East Asia and Pacific Regional Office)
| | | | - Mx Mar Balibago
- Adolescent health and HIV/AIDS Specialist, UNICEF Philippines
| | | | - Zay Yar Swe
- Myanmar country program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Elissa C Kennedy
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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6
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Ullah W, Wali A, Haq MU, Yaqoob A, Fatima R, Khan GM. Public-Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Front Public Health 2021; 9:703631. [PMID: 34447737 PMCID: PMC8383070 DOI: 10.3389/fpubh.2021.703631] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Pakistan ranks fifth in the globally estimated burden of tuberculosis (TB) case incidence. Annually, a gap of 241,688 patients with TB exists between estimated TB incidence and actual TB case notification in Pakistan. These undetected/missed TB cases initiate TB care from providers in the private healthcare system who are less motivated to notify patients to the national database that leads to significant underdetection of actual TB cases in the Pakistani community. To engage these private providers in reaching out to missing TB cases, a national implementation trial of the Public–Private Mix (PPM) model was cohesively launched by National TB Control Program (NTP) Pakistan in 2014. The study aims to assess the implementation, contribution, and relative treatment outcomes of cohesively implemented PPM model in comparison to the non-PPM model. Methods: A retrospective record review of all forms (new and relapse) patients with TB notified from July 2015 to June 2016 was conducted both for PPM- and non-PPM models. Results: The PPM model was implemented in 92 districts in total through four different approaches and contributed 25% (81,016 TB cases) to the national TB case notification. The PPM and non-PPM case notification showed a strong statistical difference in proportions among compared variables related to gender (p < 0.001), age group (p < 0.000), and province (p < 0.000). Among PPM approaches, general practitioners and non-governmental-organization facilities achieve a treatment success of 94–95%; private hospitals achieve 82% success, whereas Parastatals are unable to follow more than half of their notified TB cases. Discussion: The PPM model findings in Pakistan are considerably consistent with countries that have prioritized PPM for an increasing trend in the TB case notification to their national TB control programs. Different PPM approaches need to be scaled up in terms of PPM implemented districts, PPM coverage, PPM coverage efficiency, and PPM coverage outcome in the Pakistani healthcare system in the future.
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Affiliation(s)
- Waseem Ullah
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.,Department of Pharmacy Practice, Shifa Tameer-e-Millat University Islamabad, Islamabad, Pakistan
| | - Ahmad Wali
- Health Department, Provincial Tuberculosis Control Program Balochistan, Quetta, Pakistan
| | - Mahboob Ul Haq
- Policy Strategy and Drug Management Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Aashifa Yaqoob
- Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Razia Fatima
- Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.,Islamia College University, Peshawar, Pakistan
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7
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Deo S, Jindal P, Papineni S. Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India. BMC Infect Dis 2021; 21:123. [PMID: 33509114 PMCID: PMC7844908 DOI: 10.1186/s12879-021-05817-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Xpert MTB/RIF (Xpert) has been recommended by WHO as the initial diagnostic test for TB and rifampicin-resistance detection. Existing evidence regarding its uptake is limited to public health systems and corresponding resource and infrastructure challenges. It cannot be readily extended to private providers, who treat more than half of India’s TB cases and demonstrate complex diagnostic behavior. Methods We used routine program data collected from November 2014 to April 2017 from large-scale private sector engagement pilots in Mumbai and Patna. It included diagnostic vouchers issued to approximately 150,000 patients by about 1400 providers, aggregated to 18,890 provider-month observations. We constructed three metrics to capture provider behavior with regards to adoption of Xpert and studied their longitudinal variation: (i) Uptake (ordering of test), (ii) Utilization for TB diagnosis, and (iii) Non-adherence to negative results. We estimated multivariate linear regression models to assess heterogeneity in provider behavior based on providers’ prior experience and Xpert testing volumes. Results Uptake of Xpert increased considerably in both Mumbai (from 36 to 60.4%) and Patna (from 12.2 to 45.1%). However, utilization of Xpert for TB diagnosis and non-adherence to negative Xpert results did not show systematic trends over time. In regression models, cumulative number of Xpert tests ordered was significantly associated with Xpert uptake in Patna and utilization for diagnosis in Mumbai (p-value< 0.01). Uptake of Xpert and its utilization for diagnosis was predicted to be higher in high-volume providers compared to low-volume providers and this gap was predicted to widen over time. Conclusions Private sector engagement led to substantial increase in uptake of Xpert, especially among high-volume providers, but did not show strong evidence of Xpert results being integrated with TB diagnosis. Increasing availability and affordability of a technically superior diagnostic tool may not be sufficient to fundamentally change diagnosis and treatment of TB in the private sector. Behavioral interventions, specifically aimed at, integrating Xpert results into clinical decision making of private providers may be required to impact patient-level outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05817-1.
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Affiliation(s)
- Sarang Deo
- Indian School of Business, AC 3, L1, #3113, ISB Campus, Gachibowli, Hyderabad, 500032, India.
| | - Pankaj Jindal
- Indian School of Business, AC 3, L1, #3113, ISB Campus, Gachibowli, Hyderabad, 500032, India.,UCLA Anderson School of Management, Los Angeles, United States
| | - Sirisha Papineni
- Harvard Medical School, Boston, United States.,World Health Partners, New Delhi, India
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Deo S, Jindal P, Sabharwal M, Parulkar A, Singh R, Kadam R, Dabas H, Dewan P. Field sales force model to increase adoption of a novel tuberculosis diagnostic test among private providers: evidence from India. BMJ Glob Health 2020; 5:bmjgh-2020-003600. [PMID: 33376100 PMCID: PMC7778745 DOI: 10.1136/bmjgh-2020-003600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Impact of novel high-quality tuberculosis (TB) tests such as Xpert MTB/RIF has been limited due to low uptake among private providers in high-burden countries including India. Our objective was to assess the impact of a demand generation intervention comprising field sales force on the uptake of high-quality TB tests by providers and its financial sustainability for private labs in the long run. Methods We implemented a demand generation intervention across five Indian cities between October 2014 and June 2016 and compared the change in the quantity of Xpert cartridges ordered by labs in these cities from before (February 2013–September 2014) to after intervention (October 2014–December 2015) to corresponding change in labs in comparable non-intervention cities. We embedded this difference-in-differences estimate within a financial model to calculate the internal rate of return (IRR) if the labs were to invest in an Xpert machine with or without the demand generation intervention. Results The intervention resulted in an estimated 60 additional Xpert cartridges ordered per lab-month in the intervention group, which yielded an estimated increase of 11 500 tests over the post-intervention period, at an additional cost of US$13.3–US$17.63 per test. Further, we found that investing in this intervention would increase the IRR from 4.8% to 5.5% for hospital labs but yield a negative IRR for standalone labs. Conclusions Field sales force model can generate additional demand for Xpert at private labs, but additional strategies may be needed to ensure its financial sustainability.
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Affiliation(s)
- Sarang Deo
- Max Institute of Healthcare Management, Indian School of Business, Mohali, Punjab, India .,Operations Management, Indian School of Business, Hyderabad, Telangana, India
| | - Pankaj Jindal
- Operations Management, Indian School of Business, Hyderabad, Telangana, India
| | | | | | - Ritu Singh
- Clinton Health Access Initiative, New Delhi, India
| | | | | | - Puneet Dewan
- Bill and Melinda Gates Foundation, New Delhi, India
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9
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Ullah W, Almansour H, Fatima R, Saini B, Khan GM. Engaging Community Pharmacies in Early Detection of Missing Tuberculosis Patients through Public-Private Mix Intervention in Pakistan. Am J Trop Med Hyg 2020; 103:221-230. [PMID: 32372744 DOI: 10.4269/ajtmh.19-0939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Globally, Pakistan ranks fifth in terms of missing tuberculosis (TB) patients' burden. Missed TB cases are either undiagnosed or diagnosed but not notified to the national TB database. Public-private mix interventions are contributing significantly to the case detection, diagnosis, and treatment of TB in Pakistan. However, it is estimated that many cases of infected TB patients go undetected. It is likely that these "undiagnosed" active TB cases seek treatment from community pharmacies, among other venues. This study aimed at assessing the feasibility of community pharmacy-based TB case detection. Case detection protocol implementation in three Pakistani districts in a nonrandom selection of pharmacies was followed by a review of routinely maintained prospective records of patients referred from these private community pharmacies to general practitioner (GP) clinics. The study engaged 500 community pharmacies for referring presumptive TB patients to GP clinics. In total, 85% of the engaged pharmacies remained active in providing referrals during the study period. The community pharmacy-referral network achieved an annual referral rate of 3,025 presumptive TB patients and identified 547 active TB cases for the period January-December 2017. Every fifth referral among presumptives presenting and counseled at pharmacies was diagnosed with TB at GP clinics. This contribution was 9% of all new TB cases identified in these districts through all other private venues linked with the Greenstar Social Marketing setup. Identified barriers and facilitators to implementation and cost effectiveness of pharmacy models for TB case detection should be considered if the model were to be scaled up.
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Affiliation(s)
- Waseem Ullah
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Greenstar Social Marketing Pakistan Guarantee Limited, Lahore, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Hadi Almansour
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Razia Fatima
- Chief Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Bandana Saini
- The Woolcock Institute of Medical Research, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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10
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Khan MS, Bory S, Rego S, Suy S, Durrance-Bagale A, Sultana Z, Chhorn S, Phou S, Prien C, Heng S, Hanefeld J, Hasan R, Saphonn V. Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries? HUMAN RESOURCES FOR HEALTH 2020; 18:10. [PMID: 32046723 PMCID: PMC7014603 DOI: 10.1186/s12960-020-0452-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/30/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low- and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs. METHODS We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR-Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries. RESULTS Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education. CONCLUSIONS In light of the weaknesses in HCP professionalism identified, we conclude that global guidelines urging patients to only seek care at qualified HCPs should consider whether HCP professional education is equipping them to act in the best interest of the patient and society. Our findings suggest that improvements to HCP professional education are needed urgently and that these should focus not only on the curriculum content and learning methods, but also on the social purpose of graduates.
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Affiliation(s)
- Mishal S Khan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
- Aga Khan University, Karachi, Pakistan.
| | - Sothavireak Bory
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Sonia Rego
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Sovanthida Suy
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Anna Durrance-Bagale
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | | | | | - Socheata Phou
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Chanra Prien
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Johanna Hanefeld
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Rumina Hasan
- Aga Khan University, Karachi, Pakistan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Suy S, Rego S, Bory S, Chhorn S, Phou S, Prien C, Heng S, Wu S, Legido-Quigley H, Hanefeld J, Saphonn V, Khan MS. Invisible medicine sellers and their use of antibiotics: a qualitative study in Cambodia. BMJ Glob Health 2019; 4:e001787. [PMID: 31637030 PMCID: PMC6768357 DOI: 10.1136/bmjgh-2019-001787] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Global attention to antimicrobial resistance has increased interest in tackling the widespread inappropriate dispensing of antibiotics by informal, for-profit healthcare providers (HCPs). We provide new evidence on an understudied group of informal HCPs: invisible medicine sellers (IMS) who operate without any marked facility. We investigated factors that influence community decisions on which HCPs to purchase medicines from, focusing on reasons for using IMS, and compared different HCPs' knowledge of antibiotic use. METHODS We conducted community focus group discussions (FGDs) in seven purposively selected villages representing high and low informal HCPs use in two peri-urban districts in Phnom Penh, Cambodia. Using information from the FGDs to identify HCPs that sell medicines, we interviewed 35 participants: 21 HCPs (including five IMS) and 14 key informants, including government HCPs and village leaders. We adopted an interpretative approach and conducted a thematic analysis. RESULTS Community members typically knew of several formal and informal HCPs selling medicines nearby, and IMS were common, as were doctors that sell medicines covertly. Two factors were most salient in influencing the choice of HCP for medicine purchasing. The first was trust in the effectiveness of medicines provided, judged by the speed of symptomatic relief. This pushed HCPs to provide several medicines, including antibiotics, at the first consultation. The second was the convenience offered by IMS and other informal HCPs: supplying medicines when other facilities are closed, accepting delayed payments, providing incomplete courses of medication and selling human antibiotics for animal use. CONCLUSION This first study focusing on IMS indicates that it is important, but challenging, for public health agencies to engage with them to reduce inappropriate use of antibiotics. Although public health facilities must fill some gaps that informal HCPs are currently addressing, such as access to medicines at night, reducing demand for unnecessary antibiotics is also critical.
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Affiliation(s)
- Sovanthida Suy
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Sonia Rego
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sothavireak Bory
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Socheata Phou
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Chanra Prien
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Helena Legido-Quigley
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Johanna Hanefeld
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mishal S Khan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Khan MS, Mehboob N, Rahman-Shepherd A, Naureen F, Rashid A, Buzdar N, Ishaq M. What can motivate Lady Health Workers in Pakistan to engage more actively in tuberculosis case-finding? BMC Public Health 2019; 19:999. [PMID: 31345194 PMCID: PMC6657372 DOI: 10.1186/s12889-019-7326-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Many interventions to motivate community health workers to perform better rely on financial incentives, even though it is not clear that monetary gain is the main motivational driver. In Pakistan, Lady Health Workers (LHW) are responsible for delivering community level primary healthcare, focusing on rural and urban slum populations. There is interest in introducing large-scale interventions to motivate LHW to be more actively involved in improving tuberculosis case-finding, which is low in Pakistan. Methods Our study investigated how to most effectively motivate LHW to engage more actively in tuberculosis case-finding. The study was embedded within a pilot intervention that provided financial and other incentives to LHW who refer the highest number of tuberculosis cases in three districts in Sindh province. We conducted semi-structured interviews with 20 LHW and 12 health programme managers and analysed these using a framework categorising internal and external sources of motivation. Results Internal drivers of motivation, such as religious rewards and social recognition, were salient in our study setting. While monetary gain was identified as a motivator by all interviewees, programme managers expressed concerns about financial sustainability, and LHW indicated that financial incentives were less important than other sources of motivation. LHW emphasised that they typically used financial incentives provided to cover patient transport costs to health facilities, and therefore financial incentives were usually not perceived as rewards for their performance. Conclusions This study indicated that interventions in addition to, or instead of, financial incentives could be used to increase LHW engagement in tuberculosis case-finding. Our finding about the strong role of internal motivation (intrinsic, religious) in Pakistan suggests that developing context-specific strategies that tap into internal motivation could allow infectious disease control programmes to improve engagement of community health workers without being dependent on funding for financial incentives.
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Affiliation(s)
- Mishal S Khan
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | - Afifah Rahman-Shepherd
- Centre on Global Health Security, Chatham House, 10 St James's Square, London, SW1Y 4LE, UK
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13
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Khan MS, Hashmani FN. Political and technical barriers to improving quality of health care. Lancet 2018; 392:2146-2147. [PMID: 30195399 DOI: 10.1016/s0140-6736(18)32075-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Mishal S Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Farah N Hashmani
- People's Primary Healthcare Initiative, Sindh, Karachi, Pakistan
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Mustafa T, Shahzad Y, Kiani A. A survey of knowledge, attitude, and practices of private retail pharmacies staff in tuberculosis care: study from Dera Ismail Khan City, Pakistan. J Pharm Policy Pract 2018; 11:7. [PMID: 29610667 PMCID: PMC5872510 DOI: 10.1186/s40545-018-0134-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/15/2018] [Indexed: 11/14/2022] Open
Abstract
Background In order to engage pharmacies in tuberculosis (TB) care, a survey was conducted in the Dera Ismail (DI) Khan City of the Khyber Pakhtoon Khwa province, Pakistan. The objectives were to; 1) characterize the retail pharmacies; 2) determine knowledge of the staff on various aspects of pulmonary TB; 3) determine practices related to the sale of anti-TB drugs, and referrals of presumptive TB patient, and willingness to participate in the National Tuberculosis Control Programme’s (NTP) Directly Observed Treatment Short-Course (DOTS) strategy. Methods A cross-sectional survey was conducted by using a structured questionnaire to collect data from pharmacy staff at all the private retail pharmacies of the DI khan city. Results All the interviewed staff (n = 82) were males, only 38% had formal training as pharmacist (5%) or as a pharmacy assistant (33%). Pharmacies established for a longer period were better staffed and had high customer load. About 92% of the interviewed staff knew that persistent cough is a symptom for TB, 82% knew that TB is diagnosed by examination of sputum. Almost 66% of the pharmacy staff did not know multi-drug resistance TB as a consequence of improper treatment. Those with formal training and longer experience in retail pharmacy had better knowledge of various aspects of TB as compared to the staff with no formal pharmacy training and lesser experience (p < 0.01). Only 57% were aware of NTP while only 30% had heard of the DOTS strategy. All reported sale of first-line TB drugs as fixed dose combinations. The majority (80%) referred presumptive TB patients to chest physicians and no patient was referred to the NTP. Nearly 83% of the interviewed staff was willing to be involved in TB control efforts by getting training and referring patients to the DOTS facility. Conclusion There was shortage of professionally qualified and female staff in private retail pharmacies. Knowledge of professionally qualified staff about TB seemed sufficient to identify presumptive TB patients; however, their knowledge about NTP and DOTS was poor, and referral practices to NTP and DOTS centers were suboptimal. Majority of staff was willing to be involved in TB control efforts.
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Affiliation(s)
- Tehmina Mustafa
- 1Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.,2Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Yasir Shahzad
- 1Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, N-5020 Bergen, Norway
| | - Ayyaz Kiani
- 3Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
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15
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Yellappa V, Battaglioli T, Gurum SK, Narayanan D, Van der Stuyft P. Involving private practitioners in the Indian tuberculosis programme: a randomised trial. Trop Med Int Health 2018; 23:570-579. [PMID: 29575386 DOI: 10.1111/tmi.13053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess a multicomponent intervention to improve private practitioners (PPs) involvement in referral of presumptive pulmonary TB (PTB) cases to the Revised National TB Control Programme (RNTCP) for sputum examination. METHODS Randomised controlled trial. We randomly allocated all 189 eligible PPs in Tumkur city, South India, to intervention or control arm. The intervention, implemented between December 2014 and January 2016, included two sets of activities, one targeted at health system strengthening (building RNTCP staff capacity to collaborate with PPs, provision of feedback on referrals through SMS) and one targeted at intervention PPs (training in RNTCP, provision of referral pads and education materials and monthly visits to PPs by RNTCP staff). Crude and adjusted referral and PTB case-finding rate ratios were calculated with negative binomial regression. RESULTS PPs referred 836 individuals (548 from intervention and 169 from control arm PPs) of whom 176 were diagnosed with bacteriologically confirmed PTB. The proportion (95% confidence interval) of referring PPs [0.59 (0.49, 0.68) vs. 0.42 (0.32, 0.52) in the intervention and control arm, respectively], mean referral rate per PP-year [(5.7 (3.8, 8.7) vs. 1.8 (1.2, 2.8)] and smear-positive PTB case-finding rate per PP-year [(1.5 (0.9, 2.2) vs. 0.6 (0.3, 0.9)] were significantly higher in the intervention than the control arm. Stratifying by qualification, a statistically significant difference in the above indicators remained only among GPs and internists. Overall, surgeons, paediatricians and gynaecologists referred few patients. PP referrals contributed to 20% of the sputum smear positive PTB cases detected by RNTCP in Tumkur city (14% were from intervention arm PPs). CONCLUSIONS We demonstrated the effectiveness of a health system-oriented intervention to improve PP's referrals of presumptive PTB cases to RNTCP.
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Affiliation(s)
- Vijayashree Yellappa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Institute of Public Health, Bangalore, India
| | - Tullia Battaglioli
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sanath Kumar Gurum
- Department of Health and Family Welfare, Karnataka Government, Bangalore, India
| | | | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium
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Boulanger RF, Hunt MR, Benatar SR. Where Caring Is Sharing: Evolving Ethical Considerations in Tuberculosis Prevention Among Healthcare Workers. Clin Infect Dis 2017; 62 Suppl 3:S268-74. [PMID: 27118857 DOI: 10.1093/cid/ciw013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In many settings, the dedication of healthcare workers (HCWs) to the treatment of tuberculosis exposes them to serious risks. Current ethical considerations related to tuberculosis prevention in HCWs involve the threat posed by comorbidities, issues of power and space, the implications of intersectoral collaborations, (de)professionalization, just remuneration, the duty to care, and involvement in research. Emerging ethical considerations include mandatory vaccination and the use of geolocalization services and information technologies. The following exploration of these various ethical considerations demonstrates that the language of ethics can fruitfully be deployed to shed new light on policies that have repercussions on the lives of HCWs in underresourced settings. The language of ethics can help responsible parties get a clearer sense of what they owe HCWs, particularly when these individuals are poorly compensated, and it shows that it is essential that HCWs' contribution be acknowledged through a shared commitment to alleviate ethically problematic aspects of the environments within which they provide care. For this reason, there is a strong case for the community of bioethicists to continue to take greater interest both in the micro-level (eg, patient-provider interactions) and macro-level (eg, injustices that occur as a result of the world order) issues that put HCWs working in areas with high tuberculosis prevalence in ethically untenable positions. Ultimately, appropriate responses to the various ethical considerations explored here must vary based on the setting, but, as this article shows, they require thoughtful reflection and courageous action on the part of governments, policy makers, and managers responsible for national responses to the tuberculosis epidemic.
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Affiliation(s)
- Renaud F Boulanger
- Advisory Committee on Research Ethics, International Development Research Centre, Ottawa, Ontario Biomedical Ethics Unit, McGill University Centre for Interdisciplinary Research in Rehabilitation
| | - Matthew R Hunt
- Centre for Interdisciplinary Research in Rehabilitation School of Physical and Occupational Therapy, McGill University, Montreal, Québec
| | - Solomon R Benatar
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada Bioethics Centre, Faculty of Health Sciences, University of Cape Town, South Africa
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Process evaluation of integrated early child development care at private clinics in poor urban Pakistan: a mixed methods study. BJGP Open 2017; 1:bjgpopen17X101073. [PMID: 30564679 PMCID: PMC6169929 DOI: 10.3399/bjgpopen17x101073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background In poor urban Pakistan, private GP clinics lack adequate services to promote early child development (ECD) care. A clinic-based contextualised ECD intervention was developed for quarterly tool-assisted counselling of mothers. Aim To explore the experience and implementation of ECD intervention by the private care providers and clients, for further adaptation for scaling of quality ECD care, at primary level private healthcare facilities in Pakistan. Design & setting A mixed methods approach using quantitative records review and qualitative interviews at poor urban clinics in Rawalpindi and Lahore, Pakistan. Method Quantitative data from study-specific records were reviewed for 1242 mother-child pairs registered in the intervention. A total of 18 semi-structured interviews with clinic staff, mothers, and research staff were conducted at four clinics. The interviews were audiorecorded and transcribed verbatim. Results District Health Office (DHO) support allowed transparent and effective selection and training of clinic providers. Public endorsement of ECD care at private clinics and the addition of community advocates promoted ECD care uptake. Clinic settings were found feasible for clinic assistants, and acceptable to mothers, for counselling sessions. Mothers found ECD counselling methods more engaging compared to the usual care provided. Conclusion In poor urban settings where public health care is scarce, minimal programme investment on staff training and provision of minor equipment can engage private clinics effectively in delivering ECD care.
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Salve S, Sheikh K, Porter JDH. Private Practitioners' Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State. Int J Health Policy Manag 2016; 5:631-642. [PMID: 27801358 PMCID: PMC5088723 DOI: 10.15171/ijhpm.2016.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/01/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. METHODS The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. RESULTS PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector's dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as 'partners with the TB programme.' CONCLUSION Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported.
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Affiliation(s)
- Solomon Salve
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- The Maharashtra Association of Anthropological Sciences, Centre for Health Research and Development (MAAS-CHRD), Savitribai Phule Pune University, Pune, India
| | - Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - John DH Porter
- Departments of Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Enhancing the role of pharmacists in the cascade of tuberculosis care. J Epidemiol Glob Health 2016; 7:1-4. [PMID: 27260385 PMCID: PMC7320509 DOI: 10.1016/j.jegh.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022] Open
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Dar OA, Hasan R, Schlundt J, Harbarth S, Caleo G, Dar FK, Littmann J, Rweyemamu M, Buckley EJ, Shahid M, Kock R, Li HL, Giha H, Khan M, So AD, Bindayna KM, Kessel A, Pedersen HB, Permanand G, Zumla A, Røttingen JA, Heymann DL. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet 2016; 387:285-95. [PMID: 26603921 DOI: 10.1016/s0140-6736(15)00520-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains-responsible use, surveillance, and infection prevention and control-and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions.
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Affiliation(s)
- Osman A Dar
- Public Health England, London, UK; Chatham House Centre on Global Health Security, London, UK.
| | | | - Jørgen Schlundt
- School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore
| | - Stephan Harbarth
- University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | | | - Mark Rweyemamu
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Mohammed Shahid
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | | | - Henry Lishi Li
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, UK; Research Alliance for Advocacy and Development, Karachi, Pakistan
| | - Anthony D So
- Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Anthony Kessel
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Alimuddin Zumla
- University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College Hospitals NHS Trust, London, UK
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David L Heymann
- Public Health England, London, UK; Chatham House Centre on Global Health Security, London, UK; London School of Hygiene & Tropical Medicine, London, UK
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Yuen CM, Amanullah F, Dharmadhikari A, Nardell EA, Seddon JA, Vasilyeva I, Zhao Y, Keshavjee S, Becerra MC. Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment. Lancet 2015; 386:2334-43. [PMID: 26515675 PMCID: PMC7138065 DOI: 10.1016/s0140-6736(15)00322-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To halt the global tuberculosis epidemic, transmission must be stopped to prevent new infections and new cases. Identification of individuals with tuberculosis and prompt initiation of effective treatment to rapidly render them non-infectious is crucial to this task. However, in settings of high tuberculosis burden, active case-finding is often not implemented, resulting in long delays in diagnosis and treatment. A range of strategies to find cases and ensure prompt and correct treatment have been shown to be effective in high tuberculosis-burden settings. The population-level effect of targeted active case-finding on reducing tuberculosis incidence has been shown by studies and projected by mathematical modelling. The inclusion of targeted active case-finding in a comprehensive epidemic-control strategy for tuberculosis should contribute substantially to a decrease in tuberculosis incidence.
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Affiliation(s)
| | | | | | | | | | | | - Yanlin Zhao
- Chinese Centre for Disease Control and Prevention, Beijing, China
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Wells WA, Uplekar M, Pai M. Achieving Systemic and Scalable Private Sector Engagement in Tuberculosis Care and Prevention in Asia. PLoS Med 2015; 12:e1001842. [PMID: 26103555 PMCID: PMC4477873 DOI: 10.1371/journal.pmed.1001842] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
William Wells and colleagues describe opportunities for improving public-private health provider partnerships to tackle TB.
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Affiliation(s)
- William A. Wells
- US Agency for International Development, Washington, D.C., United States of America
| | - Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Madhukar Pai
- McGill Global Health Programs and McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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