Intermediary Agency to Bridge Govt& Private Sector
Over half of the estimated 4.6 million annual TB infections in India are treated by a scattered range of private providers. They can be ignored only at a national peril. WHP’s intervention in Patna is part of an initiative of the Ministry of Health and Family Welfare’s Central Tuberculosis Division to find innovative ways of engaging with the private sector.
WHP’s project initially covered the city of Patna (2 million population). It later expanded to the entire district (6 million population). The project networks doctors, laboratories, pharmacies, and informal providers into a cohesive system with a strong electronic backbone connecting them to enable better coordination of activities. The clients receive tests and medicines free. WHP, with support from the Bill and Melinda Gates Foundation, reimburses the private providers at market rates. (The efficiency of WHP’s rate of settlement has resulted in the organisation being entrusted with the settlement needs of two other projects of the Ministry in Gujarat and Maharashtra, both over 1200 kms away.)
Upon completion of the project, the system will transition to the public sector where government-procured drugs will replace private drugs at pharmacies and various incentives will sustain the interest of the providers.
The Bill and Melinda Gates Foundation with a first phase support of $2.9 million and second phase, started in Nov 2016, of $3 million.
LESSONS AND RESULTS:
The unique feature of this project is its implementation with the active participation of the government’s TB department so all decisions are aligned with larger policy norms to make transition to full government ownership easier. It acts as a bridge between the government’s flagship Revised National Tuberculosis Control Programme (RNTCP) and the dominant private sector, both formal and informal, to improve TB diagnosis and treatment that ultimately improves case notification and treatment success for TB patients. In order to sustain and scale the impact of the PPIA project, it is integrating its core functions with RNTCP over the next years. This entails a phased transition to the public sector of the diagnostic operations, private sector notifications, placement of free TB drugs in private pharmacies, abuse proof methods to issue drugs, incentives to private providers and knowledge transfer with support provided by the PPIA, or a similar intermediary. The model has produced spectacular results with 74,453 notifications as of January 11th 2019. The Patna project currently accounts for about 39% of all private sector TB notifications in the entire state and 89% of Patna district.