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Despite
much worldwide attention and implementation of the WHO recommended DOTS
strategy
by 119 countries, only 40% of estimated tuberculosis cases are notified
worldwide. Experts believe that private practitioners manage a large proportion
of the unreported majority of tuberculosis cases. A large proportion of
tuberculosis patients in high prevalence countries such as India, Pakistan,
Philippines, Vietnam, and Uganda first approach a private practitioner. For
example, a household survey in India found that 60% individuals with a
longstanding cough first went to a private practitioner. Another study noted
that 88% of rural and 85% of urban patients with tuberculosis first went to a
private practitioner. Tuberculosis management practices of private practitioners
have recently come under scrutiny worldwide. (Private practitioners and public
health: weak links in tuberculosis control: Mukund Uplekar, Vikram Pathania,
Mario Raviglione,Lancet 2001; 358:
912-916 ) With
this background in mind our organization, Health & Development
Initiative-India, conducted
personal interviews with 25 private practitioners of Amritsar District
(population 3.2 million) of Punjab State of India , who treat patients
of Tuberculosis on regular basis. The objectives of these interviews
were to assess the load of TB patients in their practice settings,
determine their current level of involvement with National TB Control
Program (NTP) and explore the avenues of possible communication and
collaboration with them. |
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| The participants were asked the following questions and their responses are as follows: | ||||||
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The following messages are
drawn from results of these interviews: |
Private practitioners
(PPs)
get a large number of fresh cases with PTB. 36% PPs diagnose as many as 5
to 10 fresh cases every month.
The awareness of these PPs
is awfully low about NTP guidelines. It is much worse than their colleagues in
public health system. Only 12% actually ask of Sputum examination for AFB in
patient with cough lasting for three or more weeks .
The public health system
seems to have consciously chosen to keep PPs out of the purview of NTP. All the
respondents had never been contacted by NTP managers to inform about its
guidelines.
The opportunities for PPs to
acquire knowledge about latest in TB control and management do not exist in the
field. 64% of those interviewed never had an occasion to participate in a CME
program on TB control. Only 20% participated in such a program in the last 12
months. One third of these meetings were organized by pharmaceutical houses.
A large number of PPs (96%)
are prepared to participate and collaborate with NTP. When asked as to what would they do if NTP decides to provide
free anti-TB drugs for their patients, 72% offered to pass on these drugs to
their patients without any service charges and 24% said they would charge a
nominal fee to meet their expenses. Only 4% said that they would decline the
drug supply.
There are evident problems
in entrusting management of TB patients to PPs. 80% of them do not maintain any
record of patients under their treatment and all of them do not have any system
to trace a defaulting patient. When further probed some of them said they were
ready to maintain records but could not suggest any satisfactory means to trace
defaulters, consistent with program requirements..
64% of those interviewed
said that they would like to receive information about NTP by ordinary mail.
Only 16% of them have access to internet and preferred information via internet/
e-mail.
To
summarize, our study indicates that PPs are getting a significant number of
fresh PTB cases and these are not being reported to NTP. The opportunities for
them to acquire information about NTP guidelines hardly exist in the field and
some of these are pharmaceutical industry driven. Most PPs are willing to
cooperate with NTP but there are obvious problems in this regard. Most PPs
wish to receive information about NTP guidelines by post.
The managers of NTP will have
to come out with effective communication strategies. A beginning could be made
by making available a written document on the lines of CDCs Core Curriculum on
TB.
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Survey Co-Ordinator |
Dr. Dinesh Kumar |
|
Director Health and Development Initiative - India |
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Click here for the - Survey of Private Practitioners from Philippines