Enablers and barriers to the effective use of public-private mix in tuberculosis control within Cape Town: the private sector perspective

• Main Author: Jacobs, Lee-Ann Juliana
• Other Authors: Sinanovic, Edina
• Format: Dissertation
• Language: English
• Published: University of Cape Town 2014
• Subjects: Public Health
• Online Access: http://hdl.handle.net/11427/9394

Includes bibliographical references. === Tuberculosis (TB) remains a significant contributor to global morbidity and mortality, and South Africa has one of the highest burdens of TB in the world. Current WHO recommendations include the need for private practitioners to be engaged in national TB strategies. Within Cape Town South Africa, specific strategies are required to effectively involve private practitioners in TB control. This study aimed to investigate private practitioners' perceptions of the enablers and barriers to the effective use of public-private mix (PPM) in TB control in Cape Town. It also explored private provider perspectives on the main components of PPM in TB. Private practitioners included medically trained doctors in private practices, non allopathic medical practitioners, private pharmacists, laboratory technicians and microbiologists. The study employed the convenience sampling method. A total of 50 interviews were conducted with the use of self-administered semi-structured questionnaires. The study found that certain enablers (i.e. direct and indirect incentives), facilitated increased willingness of private providers to participate in PPM initiatives in TB control. The main incentive was financial remuneration. Other incentives included training, the free supply of drugs, private providers improved reputation and the provision of quality assured subsidized microscopy and radiological services. Private providers also identified barriers in both sectors that currently limit their participation in PPM initiatives. The deficiencies of the current system included the need for the development of more effective health promotion campaigns, improving diagnostic services, promoting interaction between the private and public sectors and training. The main recommendations included the facilitation of increased collaboration/communication between the staff in both sectors and strong government stewardship. Further recommendations included the development of a strategy for phased implementation of PPM TB control initiatives, pilot studies with context-specific PPM of TB care in diverse settings and their evaluation in terms of health outcomes, cost-effectiveness, equity and quality of care.