• S S Lal, S Sahu, F Wares, K Lönnroth, L S Chauhan, and M Uplekar.
• Office of the World Health Organization Representative to India, New Delhi, India. lal.sadasivan@theglobalfund.org
• Int. J. Tuberc. Lung Dis. 2011 Jan 1;15(1):97-104.

SettingIndia's Revised National Tuberculosis Control Programme (RNTCP) implemented an intensified scale-up of public-private mix (PPM) DOTS covering 50 million population in 14 major cities.ObjectivesTo describe the processes and outcomes of the systems approach adopted.MethodsNational schemes for engagement with different providers were applied. Additional human resources were provided to assist with implementation. All health care providers were mapped, a concise training module and advocacy kit were developed, and sensitisation and training activities were conducted. National advocacy efforts complemented local initiatives. Data were captured in a PPM-focused surveillance system.ResultsIntensified PPM resulted in a 12% increase in notification of new smear-positive pulmonary TB cases. Contribution to case notification by providers varied widely: health department 67%, medical colleges 16%, private practitioners 6%, non-government organisations 7%, and the rest 4%. Treatment success was above the 85% target for all sectors combined. Strong public sector implementation and differentiation of roles and responsibilities among providers played major roles. The lessons learnt have been used by the RNTCP to inform future policy development.ConclusionThe systems approach to the intensified PPM scale-up used in the 14 cities was productive. However, many challenges and barriers to scale-up of PPM DOTS in India remain.

22 keywords...

hide…