Tuberculosis Referral Cases In Primary Care: An Evaluation On Public-Private Mix Program In Indonesia

Background.The public-private mix (PPM) has been considered as a successful strategy for tuberculosis (TB) care and control worldwide. Despite the implementation and regulation of the PPM approach, the distribution of TB patients has still been one-sided that public health centers were still more preferred by the patients rather than the private provider. Objective. This study was aimed to evaluate the enactment of PPM in the Indonesian context by analyzing the difference of referral cases in primary care. Method.Drawing on a cross-sectional analysis, based on visitation data of TB patients in Indonesia (n = 19,462).Samples were collected by stratified, non-proportional random sampling method. Results. The analysis shows that the distribution of TB patients is still one-sided, that the majority of the patients chose public health centers (69.13%). TB visitors between public and private health providers were still not in balance. Visits to a practicing doctor (OR = 7.93; p < 0.001) and a primary clinic (OR = 8.16; p < 0.001) will have a risk of further referral. Conclusions.The involvement of the private sector is needed. The district-based public-private mix is the chosen method to improve the TB service network, especially in areas with high visits to the private sector.