Is Completeness and Timeliness of Public Health Action (PHA) a Robust Tool to Improve the TB Treatment Outcome in the Private Sector?

Background: Public health action (PHA) in tuberculosis (TB) includes six components: doing screening for HIV/diabetes, carrying out drug susceptibility testing, counseling on tobacco, counseling on nutrition, benefits of Nikshay Poshan Yojana, and contact tracing. All the patients notified by the private practitioners (PPs) and missing any of the above components are intervened by the government staff to cover all the above components. Objectives: The aim of the article is (1) to assess the timeliness and completeness of PHA and (2) to assess the impact of PHA on the quality of care for TB patients in the private sector. Methods: A sequential mixed-method (cross-sectional study followed by qualitative study) study was carried out in the Patan district, North Gujarat for a period of one year. Quantitative data were collected through home visits to patients residing in three randomly selected talukas out of nine talukas in the Patan district. Qualitative data were collected purposively from selected clinics of PPs (including a mix of PP notifying and not notifying TB till saturation is achieved) from the above talukas. Results: Out of a total of 176 patients from the private sector, 48 patients took all six components of PHA. Out of them, 98% were cured compared to 82% who did not receive PHA. None of the PP had heard about PHA or its components. Conclusion: The Public–private model for TB management needs strengthening. Regular and mandatory training of PPs on the latest TB management guidelines including importance of timely and complete PHA should be carried out.