Increasing private practitioner engagement with tuberculosis

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Content from the Brookings Institution India Center is now archived. After seven years of an impactful partnership, as of September 11, 2020, Brookings India is now the Centre for Social and Economic Progress, an independent public policy institution based in India.

Tuberculosis is an infectious disease that is most prevalent in South Asia. It is caused by the bacillus Mycobacterium tuberculosis and primarily affects the lungs. A small fraction of infected individuals develop symptoms and the capability of transmission. In 2015, India accounted for 2.2 million of the 9 million tuberculosis cases in the world. Out of these 2.2 million cases, an estimated 300,000 deaths were caused by tuberculosis. More than a million estimated tuberculosis cases are treated and diagnosed in the private sector.

India accounted for 2.2 million of the 9 million tuberculosis cases in the world. Out of these 2.2 million cases, an estimated 300,000 deaths were caused by tuberculosis.

In our recent development seminar, Sarang Deo, an associate professor of Operations Management at the Indian School of Business, discussed the formulation, results and outcomes of a pilot study he conducted in order to increase private practitioner engagement with tuberculosis. At present, most private practitioners refer patients to the public sector for TB engagement; however, it takes a considerable amount of time for practitioners to discern that their patient is, in fact, experiencing symptoms of TB. This delay in diagnosis, and further delay in referral, allows for the rapid transmission of tuberculosis. In order to meet the Ministry of Health’s goal of TB eradication by 2025, it is imperative that the private sector is quick with the diagnosis, and the treatment.

Deo shared insights from the Private Provider Interface Agency (PPIA), a model developed and tested, under which private practitioners were provided free usage of Gene Xpert (a relatively new device that more accurately diagnosis TB than previous methods), patients were provided free drugs, and information on  is recorded by NGOs. This interface was implemented in two urban areas of Maharashtra: Mumbai and Pune by PATH and World Health Partners. Deo’s findings suggest that PPIA reduced diagnosis time by 43 percent for less than fully-qualified practitioners and 30 percent for fully-qualified practitioners.

Through the offering of Gene Xpert (GX), Deo is also able to measure how new technologies are incorporated into the private sector. He finds positive trends in the percentage of practitioners that utilise GX, but he also finds that practitioners are likelier to start treatment on a negative result from GX than from a positive one. This indicates that although the new technology spreads at a decent pace, trust in it is relatively low.

Lastly, Deo uses the cost of the experiment to extrapolate the cost of the program if it was scaled to the national level. He estimates that the government would have to double its expenditure on TB to handle twice the number of patients. His estimated cost per case in the private sector is not significantly different that the government’s current expenditure of cost per case.

The discussant of the event, Anand Ranganathan – Associate Professor at JNU’s Centre for Molecular Biology, followed the presentation by bringing up the importance of the utilisation of GX due to its lower false positive/false negative rate. He then explained his research which sought out perfect protein matches used by bacterium like Mycobacterium Tuberculosis in order to infiltrate human cells. Ranganathan’s research will probably lead to more methods to diagnose, treat, and vaccinate the human body against diseases like TB and Malaria, but as Deo’s research showed, incorporation of new better practices can be slow.

Through the seminar, Deo highlighted the importance of engaging the private sector in order to eradicate tuberculosis, the strength of his proposed Private Provider Interface Agency, the relatively fast adoption rate of new technologies, and low trust in new technology. If India is to defeat tuberculosis, engaging the private sector should be its priority.