Global Tuberculosis Report -- 2012.pdf

TABLE 3.3 Contribution of public–private and public–public mix (PPM) to notifications of TB cases in 21 countries, 2011
WHO REGION AND COUNTRY
TYPES OF NON-NTP CARE PROVIDERS ENGAGED
NUMBER OF NEW TB CASES
NOTIFIED IN 2011
CONTRIBUTION TO TOTAL
NOTIFICATIONS OF NEW TB
CASES IN 2011
AFRICAN REGION
Angola Diverse private and public providers 13 989 28%
Ethiopia Diverse private providers 15 052 9.5%
Ghana Diverse private and public providers 1 781 11%
Kenya Private clinics and hospitals and prisons 10 076 9.6%
Nigeria Private clinics and hospitals 21 562 23%
UR Tanzania Private facilities and faith-based organizations 13 067 21%
REGION OF THE AMERICAS
El Salvador Diverse private and public providers 581 30%
Haiti Private practitioners, NGOs and prison services 5 170 36%
EASTERN MEDITERRANEAN REGION
Iran (Islamic Republic of) Diverse private and public providers 3 563 31%
Iraq Diverse private and public providers 5 624 61%
Pakistan a Private clinics and hospitals 21 117 20%
Egypt Health insurance organizations, NGOs and other public providers 2 234 24%
Sudan Diverse private and public providers 2 277 11%
Syrian Arab Republic Diverse private and public providers 2 694 73%
SOUTH-EAST ASIA REGION
Bangladesh Diverse private, public and NGO providers 19 668 12%
India b Diverse private, public and NGO providers 13 991 2.1%
Indonesia Public and private hospitals 71 454 22%
Myanmar Diverse private, public and NGO providers 31 838 22%
WESTERN PACIFIC REGION
China General public hospitals 389 112 43%
Philippines Private clinics and hospitals 24 031 12%
Republic of Korea Diverse private providers 44 684 89%
a
Data are for smear-positive cases of pulmonary TB only.
b
Data are for smear-positive cases of pulmonary TB in 14 cities where PPM surveillance is in place.
gated data nationally. 1 Nonetheless, a growing number
of countries are systematically recording and reporting
data on the contribution of PPM initiatives to TB notifications
(Table 3.3). In most of the 21 countries (including
11 HBCs) for which data were reported, PPM initiatives
contributed about 10% to 40% of total notifications.
Approaches to engage non-NTP care providers vary
according to the local context. For example, in the Philippines,
the national health insurance organization has
designed a special TB package for providers that collaborate
with the NTP. India has incentive-based schemes
for individual and institutional providers. China uses
an Internet-based system for mandatory reporting of TB
cases by all providers. It is also noticeable that countries
have prioritized different types of care providers. These
include general public hospitals (in China), private clinics
and hospitals (in Nigeria and the Republic of Korea),
1
WHO recommends that the source of referral and the place of
treatment should be routinely recorded and reported.
medical colleges (in India) and health insurance organizations
that also provide health services (in Egypt). Social
security organizations and prison health services are the
main non-NTP providers in the Region of the Americas
and in Eastern Europe, respectively.
Comparisons with data reported by countries in previous
years show that the contribution of PPM to case notifications
has grown in some countries, including China,
Indonesia, Myanmar and the Republic of Korea. The
unexplained variations in the data from other countries
indicate that their PPM initiatives, and the recording and
reporting aspects in particular, need to be strengthened.
In most countries, only a small proportion of targeted
care providers collaborate actively with NTPs and contribute
to TB case notifications. Achieving early TB case
detection to minimize disease transmission will require
greater involvement of front-line health workers such as
community-based informal providers, general practitioners
and pharmacists – who are often the first point of
contact for people with symptoms of TB. The need for
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