A Novel Step for Engaging Private Sector to End TB in Kerala

Problem Statement

Approximately half of the TB patients in India seek care from private sector. Concerted efforts by the National TB Programme are going on to get all these cases notified. In addition, leaks in TB care cascade were identified in the country.

Programme Description

System for TB Elimination in Private Sector (STEPS) in Kerala is envisioned as collective efforts by public and private sector for the benefit of the society. It has three major interventions:

• System for TB Elimination in Private Sector (STEPS) Centres is a single-window in a private health facility serving as a nodal centre to systematically track every TB patient diagnosed by in-house clinical departments, units and clinicians, notify them to RNTCP, follow them up during the entire treatment and report treatment outcomes to RNTCP from the facility itself in the most patient centric way so that each patient receives highest standards of TB care from the health facility of his/her choice. STEPS centres were established in 318 private hospitals. 
• To support STEPS, consortium of private hospitals is being formed with state and all districts.
• To sensitize and support specialist practitioners for TB notification, a coalition of professional medical associations is being organised at state and all districts.

Programme Outcomes

Health facilities that established STEPS have reported 100% notification verified through their MRD and pharmacy data. The overall notification from private hospitals [Enrolled/diagnosed] improved from 3829 in [Jan- Sep 2018] to 5040 [Jan-Sep 2019]- a 31% increase in notification from private sector. STEPS also led to an evident compartment shift from private anti TB regimen to RNTCP regimen leading to 2000 additional cases put on RNTCP regimen, which is 70% of all notified cases from private sector. This also led to improvement is microbiological confirmation of cases [From 32% to 41%], Universal DST [from 16% to 41%], providing Direct Benefit Transfer to patients reaching private sector [from 51% to 67%] and HIV screening status [from 42% to 71%] among patients reaching private sector.

Scalability

It is based on social responsibility of the private sector blended well with profitable customer care services and self-realisation of Government about its actual role to serve entire citizens. It is a win-win-win scenario for Public, Private and Society, so itself easily replicable.

Implementation Partners

Indian Medical Association, Project JEET, Private hospital Consortiums & Coalition of Professional Medical Associations for TB Free Kerala.

Financial Implications

It is a zero-cost model. No additional financial implications to the program.

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019