Research Article: The Role of Private Health Sector for Tuberculosis Control in Debre Markos Town, Northwest Ethiopia

Date Published: January 28, 2018

Publisher: Hindawi

Author(s): Alemayehu Reta, Addis Simachew.


Tuberculosis has been declared to be a global epidemic. Despite all the effort, only less than half the annual estimated cases are reported by health authorities to the WHO. This could be due to poor reporting from the private sector. In Ethiopia, tuberculosis has also been a major public health problem. The aim of this study was to assess the role of the private health sector in tuberculosis control in Debre Markos.

An institution based cross-sectional descriptive study was carried out in private health facilities. A total of 260 tuberculosis suspects attending the private clinics were interviewed. Focus group discussion, checklist, and structured questionnaire were used.

Majority of the private clinics were less equipped, poorly regulated, and owned by health workers who were self-employed on a part-time basis. Provider delay of 4 and more months was significantly associated higher likelihood of turning to a private provider (OR = 2.70, 95% CI = (1.20, 6.08)).

There is significant delay among tuberculosis patients. Moreover, there is poor regulation of the private health sector by public health authorities. The involvement of the private sector in tuberculosis control should be limited to identification and refer to tuberculosis cases and suspects.

Partial Text

Tuberculosis remains one of the top 10 causes of death worldwide in 2015. The global plan, to achieve The End TB Strategy by 2020, set 4-5% per year decline rate of tuberculosis (TB) incidence, but 2015 report shows 1.5% between 2014 and 2015 [1]. In 2015, 6.1 million new TB cases were reported to World Health Organization (WHO) by national authorities [2].

Institutional based cross-sectional study was conducted to assess the role of private health sectors in TB control from February to March 2017. Around 378 participants (all TB cases or suspects who visited private health centers) were selected by using purposive sampling technique [13].

The majority of the subjects (61.9%) visited public health facilities while 34.6% visited private clinics and pharmacies (private providers) (Table 1).

This study revealed that a considerable proportion (34.6%) of the patients with TB or symptoms of TB in Debre Markos town had been in contact with a private health care provider either for screening or for anti-TB treatment initiation. There was also similar finding from a study conducted in Bahir Dar on health-seeking behavior of TB patients, which reported that 32.4% of TB suspects turned to the private sector during their first visit [14]. However, in the study conducted in Bahir Dar, unlike in the present study, significantly higher proportion of patients (12.9%) visited traditional healers, while in this study only 0.7% reported a visit to traditional healers. The possible explanation could be the difference in the study population. In the present study, the cases were new patients who were about to start anti-TB or on the investigation while the patients in the Bahir Dar study were already on treatment. In such a situation, the subjects in the present study would be more reluctant to reveal visit to traditional healers since they were on the way to be treated in the modern health care which could lead to more social desirability bias compared to those patients in Bahir Dar who were already on treatment who might be more willing to reveal their behavior long before starting their treatment.

Considerable numbers of tuberculosis patients visit the private health sector. There is significant provider delay before initiating treatment for TB patients especially for those patients who first visited the private provider. Underscreening of tuberculosis suspects that is more significant in the private sector compared to the public sector. There is a lack of appropriate coordination and collaboration between the private and public sectors in tuberculosis control. The majority of the private clinics in Debre Markos are unregulated and unsupervised and lack the necessary requirements for effective tuberculosis control like sputum microscopy, NTP manual, TB register, trained staff, and regular working hour.




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