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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
this scheme. 13
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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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