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Intensified scale-up of public-private mix: a systems approach to tuberculosis care and control in India.

SETTING
India'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.


OBJECTIVES
To describe the processes and outcomes of the systems approach adopted.


METHODS
National 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.


RESULTS
Intensified 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.


CONCLUSION
The 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.