TB case detection in Cambodia is at 61% which means that “we are not getting people that we are supposed to be getting to diagnose and treat them for TB as required” said Hara. Cambodia ranks at 21st position in the list of 22 TB high-burden countries in the world. It is estimated that 64% population in Cambodia has latent TB infection.
Just like India where close to 70-80% patients go to private sector on first symptom and not to a public sector or government healthcare facility, in Cambodia too, an assessment conducted by the National TB Control Programme (NTCP) 2004 had found that 75% of TB suspects in Cambodia first seek healthcare in the private sector. These findings were very similar with the findings of the 2002 prevalence survey report, said Hara.
In Cambodia, in the large private sector, pharmacy is biggest, and then come private clinics and private labs.
In the year 2000, advocacy efforts began with the ministry of health and the national TB control programme in Cambodia to involve other sectors, said Hara. In 2004, the assessment mentioned above was conducted that clearly showed that 75% of TB suspects first seek healthcare in private sector. In response to this assessment, by 2005, a private public mix (PPM) strategy was developed and approved, and then piloted in two districts in 2005-2006. From 2006 to 2010, this PPM strategy was scaled up in 11 provinces and 42 operational districts.
Almost 2000 pharmacies from 11 provinces were engaged in TB control as partners. They were regularly referring, reporting and recording suspected TB patients. Also the sale of anti-TB treatment drugs went down in private pharmacies. Before PPM strategy, the team had confirmed the availability of anti-TB treatment drugs in private pharmacies, and in recent evaluation it was found that there were no anti-TB drugs in the pharmacies participating in PPM activities. This reduces the risk of anti-TB drug resistance, said Hara.
PPM is not easy to implement, needs persistence, collaboration and networking skills, said Hara.
There was no financial incentive for private pharmacies over the past years to help improve TB programme performance, but they were recognised as equal partners in TB control, felicitated depending upon the number of confirmed active TB cases they had referred to, and were motivated to help at a human level, said Hara. One pharmacist said that he makes merit by referring TB patients to the proper healthcare facilities.
Bobby Ramakant - CNS