Public- Private Mix: Increasing Access and Quality of TB- Care in Ethiopia

*Background:Ethiopia ranks 7th among highly TB burdened countries, achieving 50% TB case detection rate, and only 37% of TB patients tested for HIV (WHO 2010 TB-Report). In October 2006, with the support of USAID| Private Health Sector Program led by Abt Associates Inc., the Ethiopian Ministry of Health piloted PPM-DOTS program in 20 private clinics. The program has since expanded to 83 private health facilities in 3 of 14 regions, namely Addis, Oromia and Amhara.

*Design/Methods:Oct 2009-Sept 2010 quarterly joint Supportive-Supervision(SS) and data collections were conducted to monitor the performance of the private facilities and to take corrective actions. During the same visit, Regional Laboratory Experts collected 4689 AFB slides as part of the External Quality Assurance(EQA) using a blind verification method.

*Results/Outcome: PPM-DOTS facilities diagnosed a total of 12,709 TB-patients, of which 2950 were enrolled for treatment in the diagnosing facilities, and 9759 patients were referred to other facilities to start treatment. Out of the enrolled, 1,504 (51.0%) TB patients were tested for HIV, of which 452 (30.1%) were found to be HIV-positive. The SS findings showed high level technical-competency, compliance to standards, and availability of supplies. The lab EQA results showed 1.7% discordance rate, 4.0% false negative and 0.8% false positive with 96% sensitivity & 99% specificity. The results were within the nationally set standards of 5.0% and 2% respectively.

*Conclusions:PPM-implementation enhances greater access to improved TB care for large segment of Ethiopians which advance trust, confidence and partnership between public and private health sectors.