Public-private health cooperation in tuberculosis prevention and control

(Baonghean) - The coordination between public and private health sectors in detecting, managing and treating tuberculosis patients has achieved many positive results in recent times, contributing to reducing the number of people with tuberculosis in the whole province. However, to further improve the quality of coordination activities, the active participation of relevant levels and sectors is needed, especially the role of heads of district, city and town health departments.

BMs. Ngo Thi Hoa, 80 years old, in Hamlet 6, Dien Hoa Commune, Dien Chau District, just discovered that she had tuberculosis about 10 days ago. Ms. Hoa said that her health was very good before, rarely sick. At the beginning of last month, she felt a cough and phlegm. She thought she had the flu so she went to the clinic to ask for medicine but it did not get better. Her child took her to Trang An General Clinic in Dien Chau Town for a health check. And after a preliminary examination of suspected tuberculosis, the clinic referred her to the District Medical Center for testing and treatment. The doctors here discovered that she had tuberculosis, gave her injections and gave her medicine to take home. Up to now, her health has stabilized, and her symptoms have decreased. Ms. Hoa shared: Knowing that tuberculosis is a dangerous and contagious disease, I followed the doctors' instructions: "Every day at 9am, I go to the clinic to get an injection, at 9am I take medicine, and I also take supplements. My tuberculosis was detected and treated early, and I follow hygiene at home, so the risk of transmission will be reduced."

It is very encouraging that Ms. Hoa discovered the disease early so that she could be treated promptly and prevent the spread of the disease. But what is commendable here is the positivity and sense of responsibility of Trang An General Clinic in helping patients and guiding them to the right doctor and the right medicine (currently, there are still many medical facilities that are not capable of treating the disease but still deliberately keep patients). Talking to Dr. Nguyen Ngoc Ly, head of this clinic, we learned that the clinic has actively implemented the project to strengthen public-private health cooperation to support the tuberculosis prevention strategy deployed by the health sector. In more than 1 year of operation, the clinic has detected and referred 10 patients with suspected tuberculosis to higher levels for testing and treatment. Through testing, 3 patients were positive.

The project to strengthen public-private health cooperation in tuberculosis prevention and control (funded by the US Agency for International Development) was implemented by Dien Chau district from 2011 to 2013; with the goal of increasing the rate of early detection of tuberculosis patients, limiting transmission, and not missing patients in the community. Accordingly, the supervisors participating in the program are staff from the Health Department and Dien Chau District Health Center, who have established a network to transfer suspected tuberculosis patients from pharmacies, private hospitals, private clinics and public hospitals to the tuberculosis prevention network. Select reputable pharmacies and clinics to participate in the program; conduct training and distribute documents to pharmacy and clinic staff on signs of tuberculosis; issue referral letters for patient transfer; regularly remind pharmacies and clinics that actively cooperate; reward pharmacies and clinics that actively prevent and control tuberculosis.

Propagating tuberculosis prevention and control for patients at Tay Phu Dien General Clinic.

Ms. Pham Thi Nga, owner of Nga Thang Pharmacy, Dien Chau Town, said: “This referral process is when people with signs of TB and high risk of TB come, the pharmacy, clinic, and hospital are responsible for referring them to the Provincial Tuberculosis Hospital and the district TB control team for examination and testing. The results of that patient will be clearly informed by the Provincial Tuberculosis Hospital and the TB control team to the pharmacy, clinic, and hospital. Those who do not have TB will return home, those who do will be treated. I think that pharmacies, clinics, and hospitals that can do this will enhance their reputation, and more patients will come. And when people with suspected TB are instructed like that, everyone will comply…”. In 3 years, 28 pharmacies, 9 clinics, 1 private hospital, and 1 public hospital in Dien Chau district have participated in this public-private health program. Thereby, 1,200 patients with suspected TB have been referred to higher levels for testing and treatment.

Dr. Nguyen Nhu Huynh, Head of the Dien Chau District Health Department, said: The results achieved by the public-private health cooperation program in tuberculosis prevention are very positive. Staff at pharmacies, clinics, and public hospitals have been trained in additional knowledge about tuberculosis; tuberculosis patients have received more attention from all levels, sectors, and the community. Initially, many pharmacies, clinics, and hospitals were still concerned about transferring patients, which would reduce their revenue, but gradually they have understood the long-term benefits of the program. Although the Project to Strengthen Public-Private Health Cooperation to Support the Tuberculosis Prevention Strategy in Nghe An ended in September 2013 (no more funding or propaganda materials), we still remind pharmacies, clinics, and private hospitals to maintain this network, and integrate tuberculosis prevention and control training into medical and pharmaceutical meetings.

Not only Dien Chau has implemented this project, but from 2011-2013, the whole province has had 8 districts, cities and towns in the province implementing the combination of public and private health care to prevent and control tuberculosis, including: Nghi Loc, Dien Chau, Quynh Luu, Thanh Chuong, Yen Thanh, Nam Dan, Cua Lo Town, Vinh City. Thereby, a network of 408 facilities has been established to refer tuberculosis patients; training for more than 1,000 staff of pharmacies, clinics and private hospitals, public hospitals outside tuberculosis; public and private health facilities have transferred 3,788 suspected tuberculosis patients, through testing, 762 patients were found to have AFB(+)... The project of combining public and private health care to prevent and control tuberculosis has brought about good results.

However, it must be said that, among the 8 participating units, not all units did as well as Dien Chau. According to specialist doctor I Thai Dinh Lam, Deputy Director of the Tuberculosis and Lung Disease Hospital, who directs the tuberculosis prevention and control work line of Nghe An province: There are some units that have not implemented the network well, the role of monitoring and urging of the Heads of Health Departments (non-public health management) has not been promoted, so the number of patients referred is not much, reporting and updating data is not regular and timely. Typical examples are Vinh City and Cua Lo Town... When the project ended (there was no more funding), the steering committee called down, some heads of health departments did not even pick up the phone, and did not respond to emails.

Doctor Thai Dinh Lam said: To continue the public-private health care program, on January 15, 2013, the Ministry of Health issued Circular 02 regulating the coordination between health facilities in tuberculosis management; and the Nghe An Department of Health issued Directive 95 requiring hospitals and health facilities in the province to strengthen coordination in detecting, managing and treating tuberculosis patients. Currently, Nghe An Tuberculosis and Lung Disease Hospital is continuing to implement public-private health care coordination, directing and supervising in the remaining districts in the area. However, to do this well, it is still necessary to have a sense of responsibility from health workers, especially the active participation of district, city and town health department heads in requesting, mobilizing and supervising pharmacies, clinics and private hospitals to participate in detecting and referring patients.

Thanh Chung