Introduction to TB PPM by Nadim Reza, Bangladesh

1. Public Private Mix (PPM)
An Overview
Md. Nadim Reza
TB PPM Expert, Bangladesh
PhD Researcher, Mahidol University, Thailand
Email: nadim.rez@student.mahidol.edu

2. What is PPM ?
PPM is the involvement of all health care providers - public
and private as well as formal and informal - in the provision of TB
care, in line with International Standards for TB Care for
patients who have or are suspected of having tuberculosis.
Source: WHO

3. Why PPM ?
• In Bangladesh, 65% TB patients’ first visits are with private doctors.
• Failure to engage them can result in
 Delays in diagnosis and treatment
 Resulting in further TB transmission
 Poor quality diagnosis and treatment
 Leading to the development of multidrug-resistant TB
• Thus, the key PPM objective is to engage private care providers

4. PPM: Multiple Country Experience
Sl. Country PPM Engagement Sl. Country PPM Engagement
1 Nigeria Faith-based health
facilities
9 Indonesia Professional
bodies
2 Pakistan GPs 10 Cambodia Pharmacy
3 Afghanistan Private Hospitals 11 Philippines Hospital
4 Kenya Prisons
Bangladesh
NGOs (40 NGOs)
Informal Providers
SS (BRAC)
5 Tanzania Drug sellers
6 South Africa Worksite Health
Facilities (mines)
7 India Pathology labs
8 Myanmar GPs
Source: PPM Roadmap, 2019

5. PPM Structure
PPM encompasses diverse collaborative strategies such as,
Public- Private : Between NTP and the private sector
Public-Public : Between NTP and other public sector care providers
Private-Private : Between an NGO and the neighborhood private
providers’ collaboration

6. Public Private Mix (PPM): Mechanism
Government
(National/Local)
NTP
Public TB
Center/
NGOs
Private clinics/labs
Private Practitioners
Patients
Policy/Guidelines
Drug/Facilities
Registration
Coordination
o Advocacy/training
o Confirmed diagnosis
o Supervision
o Drug delivery
o Coordination
Referral
Report
Diagnosis
Treatment
Counselling
Diagnosis
Treatment
Management

7. NTPs and their
partners, in
collaboration with
the private sector,
must:
Supportive
regulatory &
policy
framework
ESTABLIS
H
Private
sector
dynamics to
engage
BUILD
Appropriate
PPM targets
SET
Appropriate
PPM Model
ADAPT
Political
commitmen
t & funding
ADVOCAT
E
Digital
technology
HARNES
S Funding to
engage all
care
providers
ALLOCAT
E Financial &
Non-
financial
incentives
DELIVER
Capacity
building of
key
stakeholder
s
PARTNE
R Progress &
build
accountabili
ty
MONITO
R
Source: PPM Roadmap, 2019

8. When PPM in needed?
• High utilization of the private sector and non-NTP
public sector
• Quality of care is poor in these facilities
• Low case detection
• Poor treatment outcomes
• Delay and high costs for patients.

9. Role of various sectors in TB case notification,
selected countries 2016
Source: PPM Roadmap, 2019

10. Four PPM actors & Key Sites
1. NTP
2. Other Public
3. Private for profit
4. Private for non-profit
o Medical College
Hospitals
o Specialized Hospitals
o Specialized
Institutions
o Development
Partners
o Implementing
Partners
o Professional
Association

11. Prospective PPM sites in Bangladesh
o Total Govt. health facilities: 2,258
o 106 medical colleges (Govt. : 36, Private : 70)
o 5,321 private hospitals and clinics; 9,529 private
diagnostic centers;
o Almost 125,000 registered physicians
o Govt Physicians: 25,594
o Estimated 500,000 non-graduate private providers
Source: PPM Assessment Report 2019; BMDC; DGHS Health Bulletin

12. ENGAGE
CITY
CORP
PP
UPHC
SDP
Non-TB
NGOs
CITY
CORP
Prof
Bodies
OTHER
STAKE
HOLDERS
inf-PP
Alternative
Medicine
Work
place
Other
Private
Govt. & Private
Hospitals, Med.
Collages, clinics,
diag. centers
TBDM
PPM in ACTB
JANAO
PPM
SERVICES
Linking
PPs to
NTP sites
EPTB
test
TBSTC
Others

13. Thank
You!