Promoting a public-private mix for DOTS Expansion in Uganda

Introduction

Increasing the access points for DOTS is critical to ensuring that all those who need TB treatment can get it. In Partnership with the Uganda Ministry of Health (MOH), the USAID funded HIPS (Health Initiatives for the Private Sector) Project is pioneering an innovative approach to link private clinics into the National TB and Leprosy Program (NTLP) by training private providers, supporting clinics with necessary equipment, and facilitating the accreditation of private clinics.

Project Design

In Uganda, the management of TB – in particular the drugs and logistics system – is centrally controlled by the NTLP. The drugs for treatment of TB are supplied free of charge to patients only by the NTLP. For a health facility to be supplied with TB drugs, it must be subjected to the NTLP approval process which requires inspection of the facility and providers to assess capacity in respect to the following:

1. Adequate catchment population

2. Trained staff

3. Laboratory infrastructure and equipment

4. Provisions for infection control

5. Safe storage capacity and stock cards

6. Monitoring and reporting system

Once the clinic “passes” the accreditation review by the MOH, it may receive TB drugs from the MOH, strictly for use in treatment of community members.

Results and Conclusion:

During the first year, HIPS pioneered private sector accreditation for TB and worked closely with the NTLP to design an approach and accreditation tools. Eight workplace sites are currently participating in PPM-DOTS. Over 60 private medical professionals have been trained in PPM DOTS. Over 115 TB cases have been reported to NTLP by USAID-assisted private sector workplace providers, and 43 new smear-positive cases have been diagnosed and received treatment by non-NTLP providers. By 2010 HIPS expects to have more than 50 of its private partner facilities accredited as TB diagnostic and treatment centers, and the number of cases diagnosed and treated by these private clinics to double.

This model demonstrates one way that the private sector can be leveraged effectively in the fight against tuberculosis. HIPS plays a broker/facilitator role by helping private clinics get the tools and training they need, and linking them to public sector medicines and support supervision.