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[NEW DELHI] Most tuberculosis (TB) patients in India seek treatment in the largely unsatisfactory private sector, a situation that needs to be remedied if the country is to eliminate the disease by 2025, says new study. 
India accounts for a quarter of the estimated 10.4 million new TB cases annually worldwide and nearly a third of the annual TB deaths. India also has third of the estimated four million ‘missing patients’ who are not diagnosed or reported and who pose the threat of further spreading the contagious disease.

“Given the much higher use of the private sector than previously thought, it is critical to assess the quality of care that they deliver to patients”

Jishnu Das, World Bank

Researchers used 24 healthy adults trained to act as ‘standardised patients’ with symptoms of illness to interact with private health providers — 473 in Patna and 730 in Mumbai — to produce 2,602 interactions for the study, published last month (September) in PLoS Medicine.

The standardised patients portrayed to the providers cases representing four different stages of TB progression and reported their responses and prescriptions for analysis.  

Of the 2,602 interactions, correct treatment was provided in only 959 (37 per cent) interactions. While anti-TB drugs were prescribed in 118 (4.5 per cent) interactions, correct prescriptions were provided in only 45 of them.

The study found that when higher diagnostic certainty was provided by the patient the response tended to be TB-focused.  

Most importantly, correct treatment was found more likely to be provided by practitioners with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher. 
According to study author Jishnu Das, lead economist of the Development Research Group at the World Bank, Washington, private health providers are the first point of contact for 50—70 per cent of patients with TB symptoms. “Given the much higher use of the private sector than previously thought, it is critical to assess the quality of care that they deliver to patients,” he notes.  
Sean Sylvia, assistant professor, health policy and management, UNC Gillings School of Global Public Health, North Carolina, US, tells SciDev.Net: “This is an immensely important study as it provides the best evidence to date on the quality of care received by patients with TB symptoms in the private sector, where most patients seek initial care.” According to Manoj Mohanan, assistant professor, public policy and global health, Duke Global Health Institute, North Carolina, most patients are unaware they have TB when they develop the symptoms. “So they go for treatment to private sector providers until diagnosed correctly and a share of these patients gets referred to public sector.” 
On the other hand,Mishal Khan, assistant professor, health policy and systems research, London School of Hygiene and Tropical Medicine, says that India needs to strengthen its primary health care system rather than focus on TB-specific services. “It is essential to have good quality, trusted health care services close to patients so that they do not have to turn to untrained providers.”   
This piece was produced by SciDev.Nets Asia & Pacific desk. 

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