Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh

PLoS One. 2020 Nov 23;15(11):e0241437. doi: 10.1371/journal.pone.0241437. eCollection 2020.

Abstract

Background: In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis.

Methods and findings: The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres' operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area.

Conclusion: The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b's screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Algorithms
  • Bangladesh / epidemiology
  • Child
  • Cities
  • Geography
  • Humans
  • Mass Screening / economics*
  • Models, Economic*
  • Patient Care / economics*
  • Private Sector / economics
  • Referral and Consultation
  • Treatment Outcome
  • Tuberculosis / diagnosis*
  • Tuberculosis / economics*
  • Tuberculosis / epidemiology

Grants and funding

This research was made possible through the support of Global Affairs Canada through the Stop TB Partnership’s TB REACH initiative. (Grant no: STBP/TBREACH/GSA/W5-24),The Global Fund (Grant no: BGD-T-NTP-1405), and support for Challenge TB provided by the United States Agency for International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-14-00029. icddr,b is grateful to the Government of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. All funds were given to SB. JC, an employee of Stop TB Partnership’s TB REACH initiative, is the senior author of the manuscript and had role in preparation of the manuscript but had no role in the study design. The other funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Stop TB Partnership: http://www.stoptb.org/global/awards/tbreach/), The Global Fund: https://www.theglobalfund.org/en/ USAID: https://www.usaid.gov/bd Challenge TB: https://www.challengetb.org/.