The Deputy Permanent Secretary in the Ministry of health (MOH), Shenaaz El-Halabi, has said that the drive towards more patient-centered care demands more meaningful engagement of the private sector, through public private partnerships, to accord more options to patients.
El-Halabi said that in Botswana, TB control has been largely been limited to the public sector.
“Some patients prefer and receive care from the private sector, beyond the radar of the National TB Program surveillance system,” she said, adding that, consequently, such patients do not get reported, with implications on the completeness of epidemiologic reports they produce each year.
El-Halabi said the current estimated case detection for TB of 71 percent might just be a reflection of such under-reporting by the private sector.
El-Halabi explained that in 2008, MoH did make provision to allow private practitioners to manage uncomplicated cases of tuberculosis. She said there was, however, no guiding framework to standardize practice, in alignment with national treatment protocols.
She further said that in 2012, close to 7000 cases of TB were reported across the country.
“Our TB burden per capita remains among the highest globally; with estimated incidence as high as 455 per 100 000 population in 2011, about 4 times the global equivalent. Notably, close to two thirds of such patients were co-infected with HIV. Clearly in our context, an integrated TB/HIV service delivery approach is non-negotiable” said El-Halabi.
She added that it is against this background, that in 2011, the Ministry of Health in collaboration with key stakeholders put together the 1st edition of the national TB/HIV policy framework, “our blue print to a more comprehensive TB/HIV collaborative response”.
She said it is pleasing to note that the proportion of TB patients who know their HIV status and co-infected patients receiving Cotrimoxazole prophylaxis have continued to inch towards universal access, and in 2012 were 87 percent and 91.4 percent, respectively.
El-Halabi said drug resistant forms of TB are emerging, complicating our response. She said each year, they confirm close to 100 new cases of multi drug resistant (MDR) TB, and over the years close to 10 cases of extensively drug resistant TB were confirmed, with one of such cases referred from the private sector. “Regrettably, most such cases are a consequence of lapses in routine service provision,” she said.
El-Halabi said tuberculosis remains the most important co-morbidity among people living with HIV, whose disproportionate burden presents a strain on public health infrastructure, demanding a more inclusive approach in service delivery, as espoused in the Global Stop TB Strategy.
“As a communicable disease, the management of TB within the context of a public private mix zooms focus on the delicate balance between making money, and paying attention to critical public health interventions. These include among others, initiating contact tracing and health education for infection prevention, as a holistic care package at no additional cost to the client,” El-Halabi said.
She also said that to ensure access to quality assured TB medicines to all patients in the private sector, the Ministry of Health through respective District Health Management Teams, will provide all TB drugs on a name to patient basis at no cost to the patient.
“We equally would not expect the care provider to sell such drugs to our clients in an effort to eliminate the cost of drugs as a barrier to treatment adherence, an essential game changer in averting drug resistance,” she said.
El-Halabi explained that consultation fees are wholly borne by the client and as such, ability to pay should be an important consideration when enrolling for TB care in the private sector.
She said treatment initiation for drug resistant TB is decentralized to 5 specialized centers across the country, namely Princess Marina, Sekgoma Memorial, Letsholathebe Memorial, Nyangabgwe Referral and Ghanzi Primary hospitals, with plans to open more sites in the coming years.