Development of Public Private Mix (PPM) TB DOTS in Tabriz, Iran

Private health care providers (PPs) considered a major gateway to the health services for TB (Tuberculosis) patients. However, TB management practices by PPs is inadequate. National TB program need to collaborate with private health care providers. This paper is aimed to provide a comprehensive management program for public private mix (PPM) in TB DOTS (directly observed treatment short course) for effective case management of TB patients and reporting through a proper referral and information system in Tabriz, Iran. Mixed quantitative and qualitative methods in 5 stages have been used including: 1) Cross sectional study of current TB situation in Tabriz, Iran and a comparative study of various PPM TB DOTS programs worldwide. 2,3) Stakeholder analysis and SWOT (Strengths, weaknesses, opportunities and threats) analysis using qualitative directed content analysis method 4) Adaptation of WHO’s recommended tools for PPM TB DOTS to local situation 5) Development of action plan using eight steps in leading change method. 3.4% of new TB cases have been detected by public health network system and 96.6% by other health care providers. New smear positive case finding in Tabriz and East Azerbaijan province, Iran was 25% and 28.5% respectively. Treatment success rate in Tabriz and East Azerbaijan province, Iran was 94.8% and 87% respectively. All PPM DOTS findings showed that this program can significantly accelerate case finding while maintaining high cure rates. Cure rate in TB patients whom have been found in Tabriz, Iran is favorable, but case detection rate is less than expected. It is necessary to involve PPs with more sensitivity in case detection and more alliance with national TB program in treatment and patient follow up. Regarding improving case detection rate, promoting patient satisfaction, providing more accessibility and affordability the mentioned program would be an effective approach in management of TB control program.