Involvement of the private sector in TB care through integrated disease management approach in South Africa

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Overview

Using the private sector to address public health concerns is an underutilised resource that can, in this instance find the missing TB cases, and improve the quality of care amongst patients diagnosed with TB. Through partnerships with the Independent Private Practitioners Association of Port Elizabeth, District Health Management Team, and the community of Port Elizabeth (through the local administration), the project was able to introduce TB screening in the community, and integrate TB management in the private health sector, amongst participating GPs). The project was able to demonstrate feasibility of utilising the private sector to manage public health diseases (TB), using the NHI strategy as the guiding policy. Read More

Background

Nelson Mandela Metro Bay is one of the 19 high burden districts that account for up to 80% of the national TB burden[1] . Nelson Mandela Metro, where the project was implemented spans 2,000 km² and is characterized by sprawling subdivisions with high crime, scarce access to public health facilities, and tight living quarters. The population of the evaluation district, where intervention was implemented was 518,690, with a control population of 440,298.  Private sector GPs practice in these subdivisions out of small clinics. These clinics are preferred by residents despite high costs because they are often closer than the nearest health facility and may have more accessible opening times. There are about 180 private practices compared to 50 public health facilities.  Read More

Project activities/interventions implementation

Recruitment and Training of GPs

Port Elizabeth has a network of independent general practitioners, who meet on a regular basis to discuss to address issues that affect patient management in the private sector. AQUITY engaged the Independent Private Practitioners Association to brief them on project and how it interlinks with the National Health Insurance  (NHI) bill. The project recruited general practitioners from the IPPA based on their geographic location (the intervention area), and interest in participating in the intervention. A total of 10 private GPs were trained in recognizing symptoms and diagnosing TB in accordance with national TB guidelines. The project also expanded private GPs access to GeneXpert testing through collaboration with the public sector. Read More

Summary of Project Process Indicators

Project Process Indicators

Percentages for each intervention

percentages for each intervention

Impact on Case Notifications

Impact on Case Notifications

Achievements, Challenges, and Lessons

The project has successfully piloted the PPP project in Port Elizabeth with successful engagement of the stakeholders, with buy in being secured from the Private Practitioners Association, District Health Management Team, as well as the provincial health leadership. This was evidenced by the representation at the project launch.

While anecdotal evidence that the NHI fee for service would not be feasible in the private sector due to high disparities from the fees charged by the private sector. The average consultation is $42, excluding the cost of testing, medication and follow up. Read More