Thailand - Stop TB Partnership

Partnerships
Collaboration with private sector
The NTP considers strengthening coordination among public and private TB service providers
to be a priority. A donor-supported Public-Private Mix for DOTS (PPM DOTS) expansion
program has achieved promising initial results, but NTP leadership and financial support
will be necessary to ensure expansion of the program throughout the country. There are
still too few opportunities for public and private practitioners to identify common goals and
shared strategies for reaching them. Further study of pilot PPM DOTS projects could provide
a basis for more effective and systematic integration of private practitioners as partners
into the NTP’s DOTS expansion efforts.
The NTP faces significant barriers in its attempts to promote public-private partnerships.
Since private providers are not dependent on government funding, they have little
incentive to comply with DOTS. Public facilities are sometimes reluctant to share knowledge,
staff or equipment without the promise of receiving patient data in exchange. In turn,
private providers are frustrated by the complicated and time-consuming case recording and
reporting standards required by the NTP, especially since they see few if any benefits to
their own clinics and institutions. The deputy director of one private hospital in Bangkok
remarked that “people come to us for information and then they leave—they don’t tell us
what to do or what they’re doing.” 140
One pilot project has demonstrated that streamlining data collection systems made
private providers both more willing to comply with DOTS and more willing to provide
their patient data to the MoPH. When the MoPH, the U.S. Centers for Disease Control
Collaboration (TUC), and Bangkok Metropolitan Authority (BMA) jointly launched a userfriendly,
computerized case recording and reporting system, reporting from private hospitals
improved significantly. For example, one BMA TB center identified up to 600–700 new
TB cases, compared to 200 cases detected before the introduction of the computerized
system. 141 According to the TB clinical staff, the computerized TUC forms are “relatively
easy to complete.” 142 The BMA has also provided additional incentives to encourage private
practitioners’ participation, including free x-ray and sputum testing services, training, and
TB education materials. After a successful pilot phase, the project was expanded to seven
BMA districts, and aims to reach all BMA districts eventually.
University hospitals also play an important role in facilitating public-private
partnerships and in delivering technical services. For example, the Faculty of Medicine at
Mahidol University, in collaboration with a private hospital in Bangkok, established the
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TB POLICY IN THAILAND