Nearly 20 years after the Revised National Tuberculosis Control Programme India (RNTCP) was implemented under guidelines from the World Health Organisation, there continues to be a disconnect between private practitioners and government initiatives.
A recent study published in the peer-reviewed International Journal of Tuberculosis and Lung Disease uses the example of cases referred by private practitioners in Tumakuru to highlight the absence of a formal collaboration between private practitioners and the National Tuberculosis Programme.
A team led by Vijayashree Yellappa of the Institute of Public Health (IPH), Bengaluru, surveyed 424 private practitioners (PPs) in Tumakuru and found that none had signed up for any public-private mix scheme under the RNTCP. However, at least 22 per cent made at least one referral to a designated microscopy centre in the district.
“I selected Tumakuru for the study as IPH has been working in the district in the last 10 years to strengthen the health system, in collaboration with the Karnataka government,” said Dr. Yellappa. “Around 70 per cent of patients first visit private clinics,” she said, “and they may not have the resources to ensure that the patient follows the full course of treatment (six to eight months for first-time patients). This is one of the reasons multi-drug resistant TB is on the rise in the country.”
Dr. Yellappa is a Senate member of the Rajiv Gandhi University of Health Sciences.
Shashidar Buggi, director, Rajiv Gandhi Institute of Chest Diseases in Bengaluru, said that the role of private practitioners has been a glaring loophole since the programme was begun in the early nineties.
“One of the goals of the State TB Association was to increase awareness of the DOTS (Directly Observed Treatment Short Course) programme among private practitioners. Practitioners can write to the TB district officer offering to become DOTS centres. If there are 10,000 doctors in a district, officials should find out how many have offered to become DOTS centres and how many are referring patients, and follow up with them,” he said. The programme officer should instil confidence in private practitioners, he added.
Roping in PPs
To improve private-public cooperation, Dr. Yellappa spoke to various stakeholders and based on the feedback, formed an intervention programme to involve private practitioners in the TB programme. One of the ideas was to implement an SMS feedback mechanism; if a PP refers a case to the government programme, once the tests are obtained, she or he would receive an SMS with test results.
“This helps doctors feel more confident about referring their patients to the government,” said Dr. Yellappa.
This, along with other interventions, like implementing easy-to-follow directions to sputum test labs in government hospitals and providing TB-related health education material to private practitioners for counselling patients, was carried out on pilot basis in 100 clinics in Tumakuru in 2015, with another 100 kept as control.
Sanath Kumar, Tumakuru district tuberculosis officer, said that more than 90 per cent of the 100 clinics involved in the pilot project were referring cases to the NTP. “Following the baseline study, the number of cases being referred had gone up to over 30 per cent,” said Dr. Kumar. “Our workers are visiting PPs and asking them to be a part of the programme.”
A team led by Vijayashree Yellappa of the Institute of Public Health, Bengaluru, surveyed 424 private practitioners (PPs) in Tumakuru
and found that none had signed up for any
public-private mix scheme under the RNTCP