Involvement of the private sector in the programmatic management of multidrug-resistant tuberculosis (MDR-TB)

 Dr Knut Lönnroth, focal point for public-private mix (PPM) and health systems in the Stop TB Department of WHO-HQ visited Bangladesh from 25-29 January 2009. The purpose of his visit was to undertake a rapid assessment of the involvement of the private sector in the programmatic management of MDR-TB as part of the preparations taken by WHO for the First Ministerial Meeting of the high MDR- and XDR-TB burden countries, which will be organized in Beijing, China from 1-3 April 2009.

 Following field visits to obtain first-hand information from public and private, formal and informal healthcare providers, Dr Knut concluded that the NGO sector has taken the lead in diagnosing and managing MDR-TB in a programmatic way and has one of the two centres of excellence in the country for MDR-TB diagnosis and treatment. The involvement of village doctors by Damien Foundation has been essential for the decentralization of the treatment in the continuation phase and has contributed to very low default rates for both drug-susceptible and MDR-TB cases. The approach has been proven to be sustainable as evidenced by more than ten years of DOT delivery for drug-susceptible cases.

 He also mentioned that the referral of MDR-TB suspects by private practitioners has gradually increased as MDR-TB diagnosis and treatment has become increasingly available including in the DOTS-Plus project initiated by the National Institute for Diseases of Chest and Hospital (NIDCH). The contribution of private healthcare providers to the development of MDR-TB has probably diminished over the past two to three years as referrals to the programme have increased wile non-standardized TB treatment regimens have been less frequently applied. This positive development is the result of: (i) strengthening of NTP; (ii) change from intermittent to daily treatment regimen in NTP; and (iii) an active PPM approach.