Transforming TB care by collaborating with private sector for better outcomes

Tuberculosis remains one of the world’s deadliest infectious diseases, claiming 1.5 million lives annually despite being preventable and curable. Every year, 10 million people fall ill with TB, with low- and middle-income countries bearing the brunt of the epidemic, particularly Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa. The alarming reality is that a quarter of the global population – approximately 2 billion people – carries TB bacteria, with 5-10% at risk of developing active TB disease. Viet Nam’s National Tuberculosis Control Programme has achieved notable successes, yet significant underreporting persists, especially within the private healthcare sector.

Challenges in Private Sector Engagement

The private sector plays a significant role in healthcare in Vietnam, especially with the shift towards neoliberalism and the growth of private healthcare facilities. Patients often seek care in private clinics and pharmacies due to their flexibility in terms of diagnostic procedures, treatment methods, and operating hours. Studies have shown that between 50% to 70% of people with TB initially seek care in private settings. However, many of these cases remain unreported to the NTP, causing a gap in the country’s TB surveillance and control efforts.

Even though a mandatory notification law has been in place since 2007, compliance has been weak. This has resulted in many people with TB being ‘missed,’ meaning they are not counted in the official data. The lack of proper reporting makes it difficult for the NTP to accurately assess and tackle the TB burden, hampering efforts to end the disease.

New Ways to Increase TB Reporting

Innovative strategies are required to engage private healthcare providers better to address this gap. One promising approach was the establishment of an intermediary agency in two districts of Ho Chi Minh City. This agency aimed to incentivize private providers to refer people with presumptive TB to government facilities or report cases treated in their clinics.

The agency supported chest x-ray screenings and advanced testing for TB diagnosis and ensured that all data were recorded and reported. This initiative ran from July 2017 to March 2019 and involved 393 private healthcare providers. The results were encouraging, as 32.1% of the providers referred at least one symptomatic person for TB testing, while 3.6% reported TB patients who were treated within their practices.

Impact on TB Notifications

The initiative identified 1,203 people with TB through private provider engagement. While only 7.6% of these individuals were referred to government facilities for treatment, the remaining 92.4% received treatment in the private sector. Despite this, the referrals led to an increase of 8.5% in TB notifications in the intervention districts.

Conclusion

Viet Nam’s battle against TB can be greatly enhanced by involving the private sector more effectively. The intermediary agency model provides a blueprint for future initiatives, as it shows that private healthcare providers can play a crucial role in TB diagnosis and reporting. By including more TB cases from private clinics in official notifications, the NTP can better understand the disease burden and take stronger action towards eradicating TB.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558378/

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