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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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