TB care in private sector found wanting: Study

Even as India aims to eliminate tuberculosis by 2025, the quality of TB care and management provided by the urban private healthcare sector was found to be “suboptimal and variable”, according to a study published in PLOS Medicine.

The study was part of two Government-run pilot projects in Mumbai and Patna, where the private sector was engaged by local health agencies, RNTCP and partners, Dr Madhukar Pai, Director of the McGill International TB Centre and a joint author of the study, told Business Line. The data reflects the reality during the 2014-15 period when the project was in its early days, he added.

Role of private sector

“Private practitioners are delivering a wide range of largely inadequate care to these patients,” the study found. Pai along with Ada Kwan, a PhD student at the University of California at Berkeley, Benjamin Daniels and Dr Jishnu Das from the World Bank, and other colleagues utilised 24 standardized patients (SPs) – seemingly healthy actors trained to portray four different tuberculosis case scenarios during unannounced visits – to assess management and quality outcomes of private providers stratified by qualification in Patna and Mumbai, a note on the study explained.

The study comes even as heads of State gather in New York on Wednesday at the United Nations General Assembly’s first-ever high-level meeting on TB to accelerate efforts to end TB and reach all affected people with prevention and care.

India accounts for a quarter of the world's estimated 10.4 million new TB cases per year , nearly a third of the 1.7 million annual TB deaths and a third of the estimated 4 million missing patients who are not diagnosed or reported into the national TB programme.

And the private health sector provides the bulk of primary care in India , serving as the first point of contact for 50 to 70 per cent of patients with TB symptoms, the note said. They described the private sector to include allopathic doctors with Bachelor of Medicine, Surgery or higher degrees; Ayush practitioners are those with degrees in alternative or traditional medicine such as Ayurveda, Yoga, Unani, Siddha or Homeopathy.

Allopathy vs alternative medicine

“The Indian government is working hard to engage the private health sector, but little is known about the quality of care they provide,” said Pai, who also a Professor of Epidemiology at McGill University and a Scientist at the Research Institute of the McGill University Health Centre.

Giving details on the study, the note said, “A total of 2,652 SP-provider interactions were analysed across 473 Patna providers and 730 Mumbai providers and weighted for city-representative interpretation. Providers correctly managed SP cases according to national and international standards in only 949 interactions...”

The study also found that allopathic providers were more likely to correctly manage cases than non-MBBS providers. There was near-zero use of anti-TB drugs among non-MBBS providers. Finally, providers who were presented with more diagnostic information by the patient offered better care, even if it meant referring their patients to the public sector TB program, the note said.

“Merely engaging or educating the private sector providers is not enough. We need to work them to improve the quality of TB care they deliver to patients. So, the government should increase its efforts to improve TB care in the private sector,” said Pai.