Private practitioner characteristics and their potential to contribute to tuberculosis management in Indonesia

Vollständiger Abstract

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Abstract Background Most tuberculosis (TB) patients first seek care through the private health sector; however, most private practitioners (PPs) are not linked to the National TB Program (NTP). We aimed to map, characterize, and assess the potential contribution of PPs to the Indonesian NTP, particularly for TB diagnosis and care. Methods This study was conducted between August 2017 and April 2018 in Bandung city, West Java, Indonesia. Trained enumerators surveyed 30 (of 73) randomly selected community health centers (CHCs) areas to identify the location of private health care facilities (HCFs) and recorded service characteristics, including physician’s qualifications and practice schedules. We also asked whether the PPs were managing patients with respiratory tract infection (RTI), ordering a TB diagnosis in the past three months, or treating TB patients at the time of interview. Results We identified 936 practicing PPs with each CHC areas having a median of 27 (IQR: 12–40). We successfully interviewed 674 (72.0%), 88.1% (594/674) of whom reported managing patients with RTI symptoms. Most PPs worked in clinics with multiple providers (78.6%; 530/674), and the remainder (21.4%; n = 144) in single-provider clinics. A small proportion of PPs practiced in HCFs equipped with an X-ray (10.1%) or laboratory (27.1%) facility, and 23.2% collaborated with the national health insurance system. Almost three-quarters (70.0%) practiced in a HCF with a pharmacy. A third (33.3%; 209/627) provided services after weekday office hours, and 28.3% (191/674) offered weekday and weekend clinics. Of the PPs managing RTI patients, 241 (40.6%) reported encountering TB patients, and 101 (17.0%) had TB patients under their treatment program at the time of the interview. Overall, PPs reported they had diagnosed 937 patients with TB in the past three months and that 354 TB patients were receiving treatment. Conclusions PPs have great potential to contribute to TB care because they are present in large numbers, are distributed throughout the city, and can provide services after regular office hours. Some PPs even worked in HCFs supported by X-rays, laboratories, and pharmacies. Ways to engage PPs optimally with the NTP should be sought.