1. Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh
- Author
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Rupali Sisir Banu, Mahfuzur Rahman, Shamiul Islam, Farhana Haque, Shahriar Ahmed, Razia Khatun, Robert Stevens, John D. Clemens, S. M. Mazidur Rahman, Allen G. Ross, Jacob Creswell, Sonia Sultana, Sayera Banu, Senjuti Kabir, and Kishor Kumar Paul
- Subjects
Bacterial Diseases ,Economics ,Health Care Providers ,Social Sciences ,Geographical Locations ,Medical Conditions ,Health care ,Medicine and Health Sciences ,Mass Screening ,Medical Personnel ,Child ,Referral and Consultation ,Geographic Areas ,Bangladesh ,Multidisciplinary ,Geography ,Pharmaceutics ,Public sector ,Professions ,Infectious Diseases ,Models, Economic ,Treatment Outcome ,Scale (social sciences) ,Medicine ,Tuberculosis Diagnosis and Management ,Private Sector ,Algorithms ,Research Article ,Urban Areas ,Adult ,medicine.medical_specialty ,Tuberculosis ,Asia ,Referral ,Science ,Human Geography ,Urban Geography ,Drug Therapy ,Diagnostic Medicine ,Physicians ,medicine ,Revenue ,Humans ,Cities ,business.industry ,Private sector ,medicine.disease ,Tropical Diseases ,Metropolitan area ,Health Care ,Health Care Facilities ,Family medicine ,People and Places ,Earth Sciences ,Population Groupings ,Patient Care ,business ,Finance - Abstract
Background In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis. Methods and findings The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres’ operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area. Conclusion The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b’s screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.
- Published
- 2020