नेपाल सरकारले सन् २००६ मा टीबी नियन्त्रण रणनीतिलाई राष्ट्रिय नीतिको रुपमा अंगिकार गरेपछि, राष्ट्रिय क्षयरोग कार्यक्रमले क्रमबद्ध रुपमा निजि र सामुदायिक स्वास्थ्य सेवा प्रदायकहरु लाइ समावेश गरि स्तरीय निदान, उपचार तथा नियमित स्वास्थ्य परिक्षणको बृहत्तर व्यवस्था सुनिश्चित गर्दै आएको छ | कार्यक्रमको प्रमुख क्रियाकलापमा निजि/सामुदायिक चिकत्सक, सहयोगी, नर्स, औद्योगिक कामदार, श्रमिक, कैदी-बन्दि, औषधि बिक्रेता, प्रयोगशालाका कर्मचारीहरु बीच DOTS कार्यक्रमको अभिमुखीकरण र तालिम संचालन रहदै आएको छ | Urban TB control program through mobilization of private health sectors, health personnel and volunteers is a part of PPP activities and country wide 43 municipalities are engaged till now.
Objectives of PPP:
To engage public and private health care providers to ensure provision of quality TB services in line with NTP policy, International Standard of TB Care (ISTC) and Patient Charter.
Urban TB control program:
The burden of TB in urban is high because the urban migration rate is in increasing trend. At the same time rapid expansion of private health care facilities in urban is in place to fulfill the diverse interest of urban people. NTP has initiated to engage private health providers of urban by developing linkage (recording, referral & feedback) mechanism between private health providers and NTP.
NTP has planned to extend its PPM activities in all 58 Municipalities of Nepal by 15 July 2015. The NTC carried out review of PPM programme in 2012 and made following recommendations for further development;
Regulation for managing Anti-TB drugs at market: Anti TB drugs are commonly available at the local markets at the price of NPR 36/per dose/day. There is not placed any mechanism to ensure the complete treatment of patients from the private sector. Hence, the NTC should take initiation to regulate for managing availability of Anti TB drugs at local market.
Expansion of DOTS in urban health clinic: The Municipality Offices have already established urban health clinics to provide public health services to the urban community. The NTP should developed aggressive plan for establishing DOT centres at urban health clinics to improve the accessibility of TB services and DOTS centres opening hours also should be flexible considering patient needs.
Establish strong coordination with likeminded stakeholders in the district: Every district has already formed PPM working committee but very few people have knowledge about that committee and its roles and responsibilities in the TB control activities. The district (public) health offices and partners needs to be developed very strong mechanism to make coordination among stakeholders effective.
Inventory of private health care providers: It is true that NTP has a lack of information about total private laboratories, clinics, nursing homes and other health care providers at the district. The NTC should prepare inventory of all private health service providers and prepare a plan of action to enhance the performance of PPM programme.
Involvement of private medical practitioners in TB control: It is evident that people are seeking tuberculosis care from private sectors, which requires involvement of private health care providers in the TB control programme. Depending upon the institutional capacity and resources, they can be involved in various areas such as TB screening, diagnosis, and treatment and referral. Particularly, private pharmacies might have a prominent role in suspect identification and referral; private lab for quality diagnosis and private practitioners in TB case management.
Training/Orientation to Private Medical Practitioners: private health care providers needs to be properly oriented and trained on TB and its services, and National protocol of TB case management: screening, diagnosis, treatment, monitoring, follow up and referral. It is recommended that NTP guidelines should be distributed to all the Private Medical Practitioners (PMP).
Quality assessment in private sector: TB patients have the right to get the quality care (diagnosis, treatment and follow-up) and ensuring that their rights are met is the prime responsibility of national TB control programme. Thus, it is crucial to assess the quality of microscopy in the private sectors.
Regular monitoring and mentoring to PMPs: While formalizing the programme agreement with private sector, a clear monitoring framework should be developed. Local TB supervisors should technically be able to provide onsite mentoring to PMPs. Local public health authorities should take the lead role to harmonize the public private mix in urban settings and ensure that the national standards are utilized, free diagnosis is provided, free drugs are given, and records are kept well and follow-up done as required.
Support from NTP and other stakeholders: Since private sectors are delivering TB services in the study areas, a strong support from the national TB control programme as well as from other stakeholders is needed in order to strengthen the existing services and ensure effective implementation and sustain of PPM activities.
Public awareness on TB and its services: Aggressive and innovative awareness activities on TB and its services among the people are needed so that they themselves seek quality care.