Private sector health care providers, the first point of contact for 50-70 percent of patients with tuberculosis (TB) symptoms in India, are delivering a wide range of largely inadequate care to these patients according to a study published this week in PLOS Medicine. Credit: CDC, Amanda Mills
Private sector health care providers, the first point of contact for 50-70% of patients with tuberculosis (TB) symptoms in India, are delivering a wide range of largely inadequate care to these patients according to a study published this week in PLOS Medicine. Researchers Ada Kwan, Ben Daniels, Jishnu Das (World Bank, Washington DC, United States), Madhukar Pai (McGill University, Montreal, Canada) and colleagues utilized 24 standardized patients (SPs) – actors trained to portray 4 different tuberculosis case scenarios during unannounced visits—to assess management and quality outcomes of private care for TB in the Indian cities of Patna and Mumbai.
The researchers analyzed 2,602 SP-provider interactions across 473 Patna providers and 730 Mumbai providers and found that providers managed SP cases according to national and international standards in only 949 interactions (35% after weighting for city-representative interpretation; 95% CI 32%-37%). Allopathic providers with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher were more likely to correctly manage cases than non-MBBS providers (odds ratio 2.80; 95% CI 2.05-3.82; p < 0.0001). However, within each qualification stratum, there was a wide range of observed quality and multiple treatment protocols. The researchers also found that providers stick to their often erroneous protocols, repeating their own observed actions 75% of the time. Providers were also more likely to manage a case correctly when they were presented with more diagnostic information.
The authors note that SPs cannot account for the broader mix of patients a provider sees or assess how a provider might manage a patient in subsequent visits. Neither are there data from the public sector to which this care can be compared. Nevertheless, these results indicate that improving TB management among urban India’s private health sector should be a priority for India’s TB elimination strategy.