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ED 77.9007 :Decentralization and Governance Assignment (2)

Topic :Public Private Partnership

Social franchising of TB care through private GPsin Myanmar :An Assessment of Treatment Results ,

Access , Equity and Financial Protection

by Su Lai Mayst -113225

May , 2012

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Therefore , one potential strategy for improving access to good quality care is to

ensure that all relevant private providers become formally involved in national TB

control program by providing TB diagnosis and treatment free of charge or at

highly subsidized rates.

Several initiatives in Myanmar to involve private providers-Among them , PSI

(Population Services International (PSI ) ,under the brand Sun Quality Health is

one of the initiatives by coordination with National Tuberculosis Program (NTP).

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Objective

TB control efforts are conducted in social franchising scheme with

two poverty specific objectives

(1)to equitably reach the poor and vulnerable with quality treatment

(2) to minimize the social and economic toll of TB and TB care for the poor

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National

TB

programme(NTP)

PopulationService

International

(PSI )

General

practioners

clinics(GPclinics)

TB Patients

Functions of NTP

NTP get anti TBdrugs from Global

TB drugs facility

and provide to PSI

free of charge

Functions of PSI

-provide training course to GPs-provide anti TB drugs free of

charge

-making awareness of people about

TB disease and control measures

through communicable medias

--performing mystery client

surveys to ensure that providers

follow quality standard

--train and accredit selected

private laboratories for sputum

microscopy by coordination with

NTP

-Appointing Franchising officer

and conducting monthly follow -up

visits to GPs

Functions of GP

-Making TB diagnosis

-Prescribing drugs

according to national

guidelines

-Dispensing drugs free of

charge to patients

-Instituting laboratory

follow up investigations

-Maintaining an

individual patient record

-Reporting defaulters to the

franchising officer from

PSI

Findings from the coordination between Public (NTP)and Private ( GPs)

(a )Intervention

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Patients survey

253 patients who stay in 16 townships of Yangon with SQH clinics as well as in 11

townships in Yangon without any SQH clinics are interviewed about health seeking

behavior , living conditions ,experiences during treatment and cost before and after

treatment.

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NO Item number Percentage (% )

1 Patient category of

study area

Higher 83 32.80

lower 170 67.19

Total patient 253

2 Health seeking

behaviour

(Private )

SQH GP 93 36.76

Other private doctor 70 27.67

Drug shop 65 25.69

Traditional medicine 15 5.93

Total patients 243 96.05

3 Health seeking

behaviour (Public )

Hospital/ Primary

health care

6 2.37

NTP facility 1 0.4

Health assistant 3 1.19

Total patients 10 3.96

4 Treatment success

rate

Higher 78 93.98

Lower 142 83.53

Total success rate 220 86.95

(b )Analysis of the status of TB patients in the study areas

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NO Item number Percentage (% )

5 Borrow money

before the

treatment

Higher 22 26.5

lower 94 55.3

Total patient who borrowed 116 45.84

6 Borrow money

after the

treatment

Higher 14 17.3

Lower 62 38.3

Total patients who borrowed 76 30.3

7 Lost jobs Higher SES 7 8.6

Lower SES 52 32.1

Total patients who lost job 59 23.32

8 Stopped study Higher SES 2 2.5

Lower SES 1 0.6

Total patients who lost job 13 1.19

9 Divorced Higher SES 0 0

Lower SES 1 0.6

Total 1 0.39

10 Cost burden

(before

treatment)

Higher SES 26 % of annual income

Lower SES 57.8 % of annual income

Cost burden

(after treatment )

Higher SES 6.3% of annual income

Lower SES 11.3 % of annual income

(b )Analysis of the status of TB patients in the study areas(continued )

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(c )Benefits raised through social franchising scheme

Case notification

After launching SQH scheme , TB case notification rate increased noticeably in SQH clinics located

townships compared with that of the control townships .

Ensuring the quality of care

Social franchising of TB care contribute positively to public health by curing 87 % of all TB patients

successfully .

Reaching the poor

Social franchising scheme has managed well to reach the poor by enabling the poor to access the quality

treatment . 68 % of total TB patients are from lower SES group and 83 % of Lower SES group has been

cured successfully.

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Financial and social protection

Highly subsidized TB care delivered through a social franchise scheme in the private sector

in Myanmar help the poor reduce the heavy burden of costs of care for poor patients through

providing drugs and diagnostics services free of charge

Patients who turned directly to SQH GP avoid longer delay to treatment and so, they had

significantly lower cost burden (15 % ) than those who had sought care at other providers

first (30 % ).SQH franchises protect the patients from heavy additional financial burden.

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Comments on SQH Franchising scheme

Through the social franchise scheme, poor people benefits quality services

and equitable access likewise the patients of higher socio economic groups.

Therefore , this scheme could perform well equity and inclusiveness of poor people .

Overall, the social franchising approach conducted in Yangon is successful to some

extent with the achievements of reaching the poor , equity in access and good

treatment success rate . Therefore , public private partnership in the form of social

franchising meets the health care needs of the people especially poor people in the

study areas .(consensus oriented )

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(c ) Suggestion for the improving of Social franchising in TB control

of Myanmar

Social franchising scheme is very beneficial for TB patients because it supports the drugs in

free charge ,

Laboratory charge in free of charge ,and only low consultation fees has to pay the general

practioners .

Franchising of TB services also need to be publicly funded to be selfsustained if it is

aimed to reach the poor staying throughout the country and to be financially protected

because ,now these franchising scheme is mainly supported by the international funds and

therefore ,there is limitation in funding amounts and funding preiod is also limited.

Branding and marketing about TB disease and treatment need to be expanded until it make

aware the whole population because only one patient of the study area knows through the

communication media (TV spot )that treatment is freely available. 12


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More private providers need to be involved to serve the whole population of

contryso that it can covers the whole population of the country because the number

of the private clinics offering sun franchising scheme is few compared with the all

the general practitioner clinics all over the country

It should be considered that whether Franchising scheme will give equal access to

poor in every parts of Myanmar because there are fixed limitations of number of

patients for PSI trained GPs and the population of the areas is not the same from

one place to another.

It also need to consider about the sustainability of the social franchising clinics

because general practioners who participated in the social franchising scheme getonly consultation fees from the patients and it is very few in agreement form with

PSI (just 300 kyats (10 $) for one time of consultation .Therefore , there is no

incentive for the general practioners to pursue them in long term participating in

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References

Knut Lonnroth,Tin Aung,Win Maung ,Hans Kluge and MukundUplekar(2007) , Social franchising of TB care through private GPs

in Myanmar:as assesssment of treatment results,access,equity, and financial

protection,Health Policy and Planning ,22:156-166

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