The Private Sector in TB Programs

This chapter by Mukund Uplekar describes drawing on his many years leading the World Health Organization’s work to guide private sector engagement with national TB programs around the world. Developing country governments and global agencies have responded to TB’s resurgence as a serious health threat with stepped-up resources and attention to control programs. Initially, donor-supported TB programs sought to reach patients primarily through public facilities. Where most TB sufferers were seeking private care, the results were disappointing.Based on considerable evidence that private engagement can accelerate TB control, global health organizations now advocate engaging private practitioners, and some countries have taken important steps in this direction. Programs which pursue engagement frequently succeed, for example, in improving private providers’ practices. Still, the magnitude of the effort falls short of the private sector’s potential contribution to TB control. A number of countries with a high TB burden are unlikely to achieve the desired reductions in TB cases without expanding the engagement of private providers. Donors and technical agencies may accelerate progress by refining this dimension of TB program strategy in countries where private providers play a large role in the healthcare provision system.