When close to 70 per cent of patients go to a private medical practitioner on their first visit, limiting directly observed treatment shortcourse (DOTS) in India to public sector healthcare services will not have desired patients' outreach, said members of the Indian Medical Association (IMA) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.
The involvement of private healthcare providers is seen as crucial to effective TB control and care, particularly in high-burdened countries. In India, 75% of all anti-TB drugs given to patients are administered by the private sector.
WHO's Stop TB Strategy envisages the engagement of all care providers using public-to-private and public-to-public approaches in line with the International Standards for Tuberculosis Care and the Patients' Charter for Tuberculosis Care.
Dr Balasubramanian Muthiah from IMA said that the reach of IMA is extensive in India, with 1676 branches and more than 180,000 members across the country. IMA has also been working with a range of issues including polio and other immunization, HIV/AIDS, blood safety, family planning, female foeticide, blindness control and tuberculosis control too.
In 2007, IMA got financial support from the Global Fund to fight AIDS, TB and Malaria (GFATM) and the project IMA-GFATM-RNTCP-PPM commenced. This was in collaboration with the revised national TB control programme (RNTCP) on public-private mix. In 2007, the project began in five states of India covering 167 districts.
By 2009, the project was scaled up to 15 states covering 850 million population in 406 districts in India.
IMA believes in providing no financial incentives to doctors and encouraging one-to-one peer sensitization on TB control.
The doctors were sensitized, trained, as a significant number of private medical practitioners don’t practice DOTS, said Dr Balasubramanian. So it was a process to mobilize them to accept DOTS and to encourage them to establish DOTS centres in their private healthcare settings.
By February 2009, under this IMA led project, 489 continuing medical education sessions were held reaching out to 21,788 private medical practitioners. District TB programmes were started in 120 districts and 2,532 private medical practitioners were trained. 557 DOTS centres were also opened in private healthcare settings by end of February 2009.
The new TB case detection rates have gone up, said Dr Balasubramanian.
In India, national programs collaborate with the Indian Medical Association, Indian Academy of Paediatrics, Federation of family Physicians of India and several other healthcare associations.
Efforts are also being made to link these associations to groups working at a district rather than national level and training programs and continued medical education sessions are often organized to encourage doctors to become involved in TB care and control.
- Bobby Ramakant