The article discusses the role Public Private Mix in treatment of Tuberculosis in current scenario especially in a country like India.

Accountability is a fundamental principal of TB control.

In many countries, significant proportion of patients with TB first consult Private health practitioners.

Characteristics of poor management of TB patients in private sector:

1. Diagnosis by chest xray without smear examination.
2. Overuse of unnecessary and expensive tests.
3. Under treatment.
4. Over treatment.
5. No supervision.
6. No follow up of late patients.
7. Inappropriate monitoring of treatment by Chest Xray.
8. Inadequate treatment records.
9. No reporting.

There is no one means to achieve coordination between public and private sectors in all countries. The various approaches to strengthening the coordination between public and private sectors include the following:

1. Competition:

Well organised out patient chemotherapy, especially if provided free of charge, will attract asymptomatic cases from far and wide.

2. Exclusion:

-Exclude the private sector.
-Ban over the counter sale of anti tubercular drugs.

3. Contracting:
Public sector can contract TB control services to private groups.

4. Engagements:

-Actively engage private sector in TB care.
-In many countries, public health programmes & professional groups such as National Chest Societies, collaborate to establish standards of care that apply to both public and private sectors & revise medical colleges curricula to reflect these consensus standards.
-The following services should be made free:
*Lab services
*transportation of specimens
*referral to public sector
*free medications

5. Reporting:

Include making compulsory the following:
-Active surveillance of laboratories.
-Reporting of bacteriologiocaly confirmed patients.
-Monitoring of these patients.

Role of NGOs:

1. Educate private practitioners to adopt RNTCP (Diagnostic & treatment policies, treatment referral).
2. Provide diagnostic & treatment services to which private patients can be referred.
3. Provision of outreach workers in community for follow up of late patients.
4. Assisting in recording and reporting of cases.
5. Act as links with Chest Physicians, Paramedics, etc.

Government has recently introduces a 5 pronged programme for involvement of NGOs in RNTCP which includes the following 5 levels:

level 1: Outreach services, Education
level 2: DOT treatment
level 3: Hospital services
level 4: Microscopy centres
level 5: Model treatment services/centres

This carries a great relevance in today's scenario when we are striving hard to fight against Tuberculosis.

The take home message is involvement of all in providing health care services in tuberculosis.