Review on public private mix TB control strategy in India

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. Study design A mixed method literature review, descriptive information and evaluative outcomes data extracted and analysed. Objective This review aimed to systematically review public private mix strategy in TB control in Indian tuberculosis disease burden and efforts towards elimination. Methods Available published literatures were searched with key words, articles related with objectives were selected, analysed and systematically synthesized. Overall 30 studies were reviewed. Result 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. Discussion 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. Conclusion 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.