NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Thursday, March 26, 2015

Over the past 20 years, that rallying cry has gone from fantasy to imperative. Since the advent of the World Health Organization’s directly observed treatment strategy in 1995, more than 61 million people have been successfully treated for tuberculosis, and new TB cases and TB-related deaths are on the decline. Furthermore, countries have achieved the Millennium Development Goal of halting and reversing the TB epidemic by 2015. Thus, today, we have important successes to celebrate. Ending TB is within reach.

But it’s far from certain.

This year, 1.5 million people will die from TB and 9 million people will develop the disease. These numbers are staggering. As the global community pursues a bold vision of universal health coverage, in which all people are able to access the health services they need without suffering financial hardship, we must be even smarter in our efforts to ensure every TB patient has access to high-quality affordable TB care without incurring catastrophic costs.

To achieve UHC, we need a comprehensive approach to health systems — one that incorporates engagement of all public, private, voluntary and corporate care providers to deliver quality health services, supported by bold systems and social policies. Often, discussions of UHC focus on the public sector. This makes sense — the sector remains the backbone of health systems worldwide. Yet private, voluntary and corporate care providers play a critical role in providing patients with access to care. The TB community knows all too well that we ignore their role at our peril.

This year, an estimated 3 million people with TB will go untreated, or will be cared for in unregulated private sectors. It is likely that many of these people will receive treatment of uneven quality that both fails to cure the patient and potentially augments the problem of multidrug-resistant TB. Compounding this danger, out-of-pocket expenses in the private sector can lead to catastrophic patient costs and further impoverishment. Therefore, ensuring universal access to quality TB care requires that we engage all providers who care for people with TB.

The good news is that we have proven strategies to do just this. WHO has documented a host of successful approaches for engaging private hospitals, workplaces and private practitioners in the provision of high-quality TB care. One strategy particularly effective at engaging individual private practitioners is social franchising.

In this approach, based on commercial franchising techniques and employed by PSI since 2004, an intermediary agency engages existing private practitioners in a franchise network. As members of this network, practitioners are trained to adhere to quality guidelines and are provided ongoing supportive supervision. To ensure the use of quality diagnostics and treatments, franchised providers are often linked to national laboratories and provided supplies of TB drugs through the national program. In exchange, they agree to prenegotiated prices for standardized and quality-assured services. Franchise clinics operate under a common brand, which is promoted among patients to drive demand for high-quality TB care in the private sector. Today, initiatives in eight countries use this approach.