Collaborating with all health care sectors to find and diagnose tuberculosis

In many countries, people who fall ill seek care in a variety of settings, both public and private health care facilities. In countries from Cambodia to Mexico, for example, pharmacies are often the first place people seek care for simple diseases—as well as serious ones like tuberculosis (TB). In some areas, friends, neighbors, and community leaders offer informal care without much understanding of the disease or technical knowledge and skills to manage it.

When it comes to TB, getting accurate and timely information is critical to the patient and important to the community and public health. It can help guide people to accurate diagnosis and appropriate treatment, cut down on TB transmission, and discourage the unregulated sale of anti-TB drugs.

Pioneering high-quality TB care

PATH is working to engage all health care providers—whether public, private, or informal—in delivering high-quality, standardized care for tuberculosis. The concept is called public-private mix.

PATH works with pharmacies and other health care facilities to train staff in:

• Recognizing signs and symptoms of TB.
• Providing information for people who are being evaluated for TB.
• Referring patients to facilities that provide standardized TB diagnosis and treatment.

Controlling TB through public-private partnerships

Public-private partnership programs that PATH first helped establish in Cambodia have been replicated in similar settings in India, Mexico, Tanzania, and Vietnam.

In Hai Phong, Vietnam, PATH linked private-sector providers to public health facilities that provide TB and HIV services. After building the skills and capacity of staff in private pharmacies and clinics, establishing referral systems, and piloting a partnership model between private clinics and public facilities, the program has seen measurable improvements in referrals and treatment for TB and HIV. With positive results in Hai Phong, PATH expanded the program to three additional provinces and has successfully transitioned the project in Hai Phong to local authorities.

In Mexico, PATH partnered with the country’s national TB program to introduce and expand a public-private mix approach. As a result, TB referrals in participating facilities increased from 40 percent to 95 percent in just one year. In two years, health workers increased the number of sputum smears for TB diagnosis given to people with symptoms that suggest TB by nearly 40 percent, and the number of TB cases detected increased by nearly 30 percent.

Working in the “informal” sector

Communities play a critical role in detecting TB, helping people access services, supporting those receiving treatment, and reducing stigma. PATH trains and supports a variety of people—traditional healers, private drug sellers, “sputum fixers” who support diagnosis, community-based organizations, and former TB patients—to deliver community-based TB interventions. In the Democratic Republic of Congo, for example, newly trained community health volunteers referred nearly 3,000 people for diagnosis in just one year and supported hundreds of patients in completing treatment.

Photo: PATH/Nguyen Ba Quang.