Public-private mix for TB care and control: a toolkit

In order to meet the global TB control targets, the Stop TB Strategy of the World Health Organization (WHO) recommends systematic engagement of all care providers in TB care and control through public-private mix (PPM) approaches. This toolkit attempts to address the need and demand for more specific guidance to National Tuberculosis Control Programmes (NTPs) on working with diverse care providers based on country experiences. It is expected to help NTPs engage non-NTP careproviders to deliver services in line with national guidelines based on International Standards for Tuberculosis Care.

Care providers may be within the public sector (general and specialty hospitals; academic institutions; prison, military or railway health services; health insurance organisations, etc.), within the voluntary sector (nongovernmental organisations, community- based or faith-based organisations, etc.) and within the private and corporate sectors (formal and informal private practitioners including traditional healers and, pharmacies, and private and corporate hospitals and institutions).

The toolkit consists of 14 tools. The first seven tools outline basic aspects of PPM implementation, while the remaining seven tools address engagement of specific types of care providers. The tools are listed below:

• Rationale and generic approach: provides the rationale and generic approach for implementing PPM to engage all care providers in TB care and control, highlighting how PPM is beneficial to country programmes
• National situation assessment: describes how to undertake a national situation assessment before designing and implementing PPM for engaging all care providers in TB care and control in a country
• Operational guidelines: describes the process of developing country-specific operational guidelines on PPM, taking into consideration the tasks diverse care providers can undertake in a countrysetting
• Advocacy, communication and social mobilisation: describes the concept and suggests ways to implement advocacy, communication and social mobilisation (ACSM) activities in the context of PPM
• Monitoring and evaluation: describes the significance of monitoring and evaluation of PPM programmes in order to maintain the quality of care and suggests indicators to measure the contribution of collaborating care providers to TB care and control
• International Standards for Tuberculosis care: presents an overview of the International Standards for TB Care (ISTC) as a yardstick of quality of comprehensive TB case management that all care providers must adhere to
• Resources and budgeting: summarises the rationale and methods of planning, budgeting and resource mobilisation for PPM implementation
• Engaging private practitioners: outlines the need and practical steps of engaging frontline, individual care providers in TB care and control
• Engaging hospitals: presents a summary of involving hospitals in TB care describing key steps in facilitating internal coordination and networking with peripheral health centres
• Engaging nongovernmental organisations: elaborates on the different roles nongovernmental organisations can play in TB care and control and outline steps for their engagement
• Engaging workplaces: provides broad guidance on how businesses, in collaboration with NTPs and other partners, can initiate and implement TB and TB/HIV workplace programmes
• Engaging social security organisations: provides guidance on how social security organisations, health insurance schemes and NTPs can work together in strengthening TB care and control efforts
• Engagement for TB/HIV collaboration: describes steps for effective planning, preparation, implementation and monitoring of collaborative TB/HIV activities through the engagement of all care providers
• Engagement for programmatic management of drug-resistant TB: presents a framework for engagement of all care providers in Programmatic Management of drug-resistant TB (PMDT).