SEARCH

SEARCH BY CITATION

Keywords:

  • PPM DOTS;
  • TB control;
  • Global Fund grants
  • PPM;
  • DOTS;
  • lutte contre la tuberculose;
  • bourses du Fonds Mondial
  • DOTS;
  • Control TB;
  • Subvenciones Fondo Mundial

Summary

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References

Objectives  To map the extent and scope of public–private mix (PPM) interventions in tuberculosis (TB) control programmes supported by the Global Fund.

Methods  We reviewed the Global Fund’s official documents and data to analyse the distribution, characteristics and budgets of PPM approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. We supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report.

Results  Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with ‘for-profit’ private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus. Average and median spending on PPM within grants was 10% and 5% respectively, ranging from 0.03% to 69% of the total grant budget. In China, India, Nigeria and the Philippines, PPM contributed to detecting more than 25% TB cases while maintaining high treatment success rates.

Conclusion  In spite of evidence of cost-effectiveness, PPM constitutes only a modest part of overall TB control activities. Scaling up PPM across countries could contribute to expanding access to TB care, increasing case detection, improving treatment outcomes and help achieve the global TB control targets.

Financement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculose

Objectifs:  Evaluer l’étendue et la portée des interventions mixtes public-privé dans les programmes de lutte antituberculeuse soutenus par le Fonds Mondial.

Méthodes:  Nous avons examiné les documents officiels et données du Fonds Mondial afin d’analyser la répartition, les caractéristiques et les budgets des approches mixtes public-privé pour les financements pour la TB au sein du Fonds Mondial dans les pays bénéficiaires entre 2003 et 2008. Nous avons complété cette analyse avec des données sur la contribution du partenariat public-privé, sur la notification des cas de TB dans 14 pays, rapportée à l’OMS en 2009, pour la préparation du rapport mondial sur la lutte contre la TB.

Résultats:  58 projets dans des pays et multi-pays sur un total de 93 bénéficiaires de financement du Fonds Mondial pour la TB avaient des activités public-privé en 2008. Des partenariats avec le secteur privé«à but lucratif»étaient plus fréquents en Asie du sud tandis que la participation des services de santé de prison était courante en Europe de l’est et en Asie centrale. Au Moyen-Orient et en Afrique du nord, l’implication des organisations non gouvernementales semble être le focus. Les dépenses moyennes et médianes pour les activités mixtes public-privé au sein des financements étaient de 10% et 5% respectivement, allant de 0,03%à 69% du budget total du financement. En Chine, Inde, Nigéria et Philippines, le mélange public-privé a contribuéà la détection de plus de 25% des cas de TB tout en maintenant un taux élevé de succès du traitement.

Conclusion:  En dépit des preuves de rentabilité, les interventions mixtes public-privé ne constituent qu’une part modeste de l’ensemble des activités de lutte antituberculeuse. Déployer le partenariat public-privéà travers les pays pourrait contribuer àélargir l’accès aux soins pour la TB, augmenter la détection des cas, améliorer les résultats de traitement et contribuer à la réalisation des objectifs mondiaux de lutte contre la TB.

Financiación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis

Objetivos:  Realizar el mapa de la extensión y el alcance de las intervenciones público-privadas en programas de control de la TB financiados por el Fondo Mundial.

Métodos: Hemos revisado los documentos y datos oficiales del Fondo Mundial para analizar la distribución, características y presupuestos de las intervenciones público-privadas dentro de los países que han recibido subvenciones para la TB del Fondo Mundial entre el 2003 y el 2008. Hemos complementado este análisis con datos sobre la contribución de las intervenciones público-privadas a la notificación de casos de TB en 14 países, entregados a la OMS en el 2009 durante la preparación del informe global sobre el control de la TB.

Resultados: 58 de 93 países y receptores multinacionales de las ayudas del Fondo Mundial para la TB reportaron actividades público-privadas en el 2008. El compromiso con el sector privado 3”con ánimo de lucro” prevalecía en el sudeste Asiático, mientras que la participación de los servicios sanitarios penitenciarios era común en Europa del Este y Asia Central. En el medio oriente y el norte de África, lo más común parecía ser involucrar a las organizaciones no gubernamentales. El gasto promedio y la media de gasto de las subvenciones en la mezcla público-privada era del 10% y 5% respectivamente, con un rango de 0.03% al 69% del presupuesto total de la subvención. En China, India, Nigeria y las Filipinas, la mezcla público-privada contribuyó a detectar más del 25% de los casos de TB, manteniendo una tasa alta de éxito en el tratamiento.

Conclusión: A pesar de la evidencia de costo-efectividad, la mezcla público-privada constituye solo una parte modesta del conjunto de actividades de control de la TB. El llevar a escala las intervenciones público-privadas ayudaría a contribuir a expandir el acceso a los cuidados para la TB, a aumentar la detección de casos, a mejorar el tratamiento y a cumplir los objetivos globales de control de la TB.


Introduction

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References

According to the 2009 Global Tuberculosis Control Report of the World Health Organization (WHO), the acceleration in tuberculosis (TB) case detection rate achieved over the last decade now seems to be stagnating at a little over 60%. The global target of detecting 70% sputum smear-positive TB cases was not reached in 2005 and is unlikely to be achieved by the end of 2010 (WHO 2009a).

Globally, efforts to strengthen TB control have been concentrated largely within the public sector health services directly under the scope of National Tuberculosis Programmes (NTPs) (Uplekar 2003). In many countries, diverse care providers outside NTPs, which manage significant proportions of TB patients, are yet to be integrated into national TB control efforts. These comprise public sector care providers such as prison health services under ministries of interior, military health services under ministries of defence or social security organizations under the ministries of labour as well as for-profit and not-for-profit private sector care providers that include private practitioners, private hospitals, corporate health services and voluntary organizations. In some countries, the private sector has outgrown the public sector in health care provision. TB management practices of many non-NTP care providers have been shown to be uneven and cases detected by them are rarely notified (WHO 2001, 2006a ). However, studies show that engaging all relevant care providers through public–private mix (PPM) approaches helps to effectively harnesses available capacity in the country by NTPs to expand coverage, improve access to quality care and programme outcomes and reduce cost of care to patients (Dewan et al. 2006; Pantoja et al. 2009).

PPM for TB care and control implies public–private collaboration for delivery of TB services. It is a comprehensive approach to systematically involve all relevant health care providers in TB control and achieve national and global TB control targets. International Standards for TB Care (ISTC) offers an excellent tool to help standardize TB management practices of diverse care providers. In practice, countries have used the label PPM to denote ‘public–public mix’ when the NTP collaborates with other public sector care providers who have not traditionally been part of their network, including certain public hospitals or special health services under ministries other than the ministry of health, such as prison health services; and ‘public–private mix’ when the collaboration is between the NTP and private, voluntary or corporate sector care.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) – a major source of funding for NTPs – is a public–private partnership (http://www.theglobalfund.org). It provides around 63% of all international financing for tuberculosis control globally (WHO 2009b); which between 2002 and 2009 amounted to US$ 3.2 billion of approved funds. The Global Fund requires applicant countries to set up national level partnerships in the form of country coordination mechanism representing diverse stakeholders including civil society and people living with diseases. It finances grant implementation by public and private sectors in countries through a dual-track financing facility. However, to date, no studies have explored the extent to which PPM activities are financed by the Global Fund. While a number of country case studies show that global mechanisms have helped national and local TB programmes to establish and scale up PPM initiatives, the global scale of these activities is not known (WHO 2009b). Enormous untapped potential still remains in translating global and national level partnerships into large scale collaborations among providers for delivery of TB care at the grassroots. Realizing this potential is essential to meet and maintain TB control targets (Uplekar 2003; Stop TB Partnership, WHO 2006).

The purpose of this paper is to map the extent and the scope of PPM interventions in TB grants financed by the Global Fund. It is hoped that this will provide useful lessons for NTPs, international technical agencies and financiers of TB programmes globally.

Methods

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References

Two levels of analyses were applied: reviewing the evolution of support to PPM for TB care and control in Global Fund-supported TB grants as reflected in its official documents and mapping the distribution and characteristics of PPM initiatives within the Global Fund-supported programs. We supplemented this analysis with relevant data from 14 countries reported to WHO for the Global TB control report of 2010.

The official documents of the Global Fund include guidelines on submission of requests for funding as well as the monitoring and evaluation tool-kit, which provide grant recipients with an inventory of indicators to measure outputs of their activities (WHO 2006b). Applicants are required to submit a performance framework with the indicators and targets against which grant’s results are later measured (Katz et al. 2010). We reviewed all performance frameworks of all TB grants, and considered a grant to include a PPM activity if an indicator was classified as such within the performance framework or if any of the indicators measured provision of any TB service with or through a non-NTP entity such as the private sector, prison, municipality, faith-based organization, and non-governmental organizations (NGOs). The analysis of the distribution and characteristics of PPM initiatives within the Global Fund-supported programs, included measurement of (i) proportion of TB grants with PPM, in total, over time and their regional distribution; (ii) distribution of PPM implementers, categorized into prison health services, for-profit private sector, NGOs, others and unspecified, including changes in their composition over time and regional distribution; and (iii) the investment in PPM approaches as part of the overall funding in the TB grants studied and their regional distribution. Financing data were obtained from the Global Fund’s Enhanced Financial Reporting System (EFR) which tracks utilization of Global Fund investments by grant recipients. The EFR includes a category ‘PPM/ISTC’. Grants reporting financial data under this category were used to estimate the investment in PPM. The EFR data used in this study represented 80% of Global Fund TB investments disbursed by the end of 2008.

WHO publishes an annual report on global TB control. The purpose of the report is to provide an annual assessment of the global TB epidemic and the progress made in implementing the Stop TB Strategy. For the global TB report of 2010, countries were asked to provide the data on the number of cases reported by non-NTP providers in the public and private sectors in 2009. Data obtained from 14 countries – Angola, Cambodia, China, Ghana, India, Indonesia, Islamic Republic of Iran, Kazakhstan, Myanmar, Nepal, Nigeria, Pakistan, Philippines, and Tanzania – are presented here. All 14 countries had received Global Fund grants for scaling up PPM and 11 reported to be implementing PPM countrywide. It was not possible, however, to determine whether the outcomes of PPM interventions in terms of contributions of non-NTP care providers to TB case notification were attributable solely to the Global Fund grants.

Results

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References

Scope for PPM in Global Fund official documents

The Global Fund guidelines for submitting funding proposals promote collaborations among all relevant health care providers within countries to deliver health care services. The Global Fund supports existing and new innovative programmes both within and outside the health sector that promote public, private and non-governmental efforts. The Global Fund’s Technical Review Panel also considers PPM as an important attribute when assessing the technical quality of a proposal. The Monitoring and Evaluation toolkit developed by the Global Fund together with various partners includes indicators specific to PPM (Box 1).

Table Box 1.   Examples of indicators for ‘Engage all care providers’ component of stop TB strategy included in the Global Fund monitoring and evaluation framework
  1. Source: The Global Fund M&E Toolkit. Available at URL: http://www.theglobalfund.org/en/me/guidelines_tools/?lang=en#toolkit.

1. Private and Public health providers (different types) collaborating with the NTP (number and percentage)
2. New smear positive TB patients referred by a specific type of health care provider among the new smear positive TB patients reported to the national health authority (started on treatment in NTP) (number and percentage)
3. New smear positive TB patients managed/supervised by a specific type of health care provider among all TB patients reported to the national health authority (number and percentage)
4. New smear positive TB patients successfully treated (cured plus completed treatment) among the new smear positive TB patients managed/ treated by a specific type of health care provider (number and percentage)
5. Private and Public health providers (different types) collaborating with the NTP (number and percentage)
6. New smear positive TB patients referred by a specific type of health care provider among the new smear positive TB patients reported to the national health authority (started on treatment in NTP) (number and percentage)
7. New smear positive TB patients managed/supervised by a specific type of health care provider among all TB patients reported to the national health authority (number and percentage)
8. New smear positive TB patients successfully treated (cured plus completed treatment) among the new smear positive TB patients managed/ treated by a specific type of health care provider (number and percentage)

Distribution and characteristics of PPM initiatives

The number of countries with PPM activities within the active TB grants supported by the Global Fund increased from 13 in 2003, the first year of Global Fund disbursement for TB, to 58 in 2008. Figure 1 shows the incremental numbers of proposals with PPM components. The proportion of Global Fund grants with PPM activities was highest in Southeast Asia (82%) and lowest in Sub-Saharan Africa (52%) (Figure 2).

image

Figure 1.  Proportion and number of countries which received Global Fund support for PPM activities, by year. N, Number of countries with active TB grants that include PPM component and D, Number of countries with active TB grants.

Download figure to PowerPoint

image

Figure 2.  Number of countries with Global Fund support for PPM activities (proportion of the total number of active TB grants), by region and by year.

Download figure to PowerPoint

Figure 3 shows the types of care providers engaged in PPM. Between 2003 and 2008, while collaborations with NGOs and the for-profit private sector also increased, there was a sharp rise in NTPs engaging prison health services, predominantly in countries of Eastern Europe.

image

Figure 3.  Number of countries with Global Fund support for PPM activities (proportion of the total number of countries with Global Fund support for PPM activities), by implementer type and year.

Download figure to PowerPoint

Care providers involved in PPM varied by region (Table 1). Collaboration with the for-profit private sector was greater in South Asia and East Africa while collaboration with NGOs was common in North Africa, the Middle East and South Asia. Links with prison health services were present in other regions including Eastern Europe and Central Asia, Latin America and the Caribbean as well as West and Central Africa.

Table 1.   Distribution of PPM implementers within countries with Global Fund support for PPM as of end 2008, by region
Region (N)Percentage of countries with Global Fund-supported PPM
NGOsPrisonsPrivate sectorOtherNot specified
  1. N, Number of countries with Global Fund support for PPM activities, per region; Green cells – the regions with the highest proportion of countries with the specific PPM implementer.

East Asia and the Pacific (8)383825380
Eastern Europe and Central Asia (11)369118279
Latin America and the Caribbean (8)25630500
North Africa and the Middle East (8)6325382513
South Asia (6)5017671750
East Africa (5)04040020
Southern Africa (4)25005050
West and Central Africa (8)2563253813
All regions (58)3448263116

Finances allocated to PPM activities in TB Grants supported by the Global Fund

Analysis of budget and expenditure data showed that by 2008, US$ 38.3 million (4.4%) of TB funding in the budgets of Global Fund-supported grants was allocated to PPM. The expenditure for PPM activities as a proportion of total expenditure in TB grants amounted to 5.4%, higher than that initially budgeted; 99% of the funding budgeted for PPM activities was utilized, compared to 80% for the TB budget for all activities.

The median amount budgeted in Global Fund grants for PPM activities was 5% of total. However, this amount ranged from 0.03% to 69% of total, with Kyrgyzstan and Swaziland allocating over 50% of their funding to PPM. In most proposals this does not include cost of drugs and other consumables for the diagnosis and treatment of TB in the targeted health facilities, which falls under other budget headings.

For PPM activities, the investments in China, Indonesia and Ghana were $US 18.8 million, $US6.1 million and $US3.5 million, respectively. The top two regions with highest share of their budget allocated to PPM were East Asia and the Pacific and, West & Central Africa (10.4% [US$ 25.7 million] and 6.9% [US$ 4.6 million] respectively). While the share of the TB budget allocated to PPM in Eastern Europe & Central Asia, and Latin America & the Caribbean is lower than in other regions, both regions have many grants for collaboration with prison health services, which are not always reported as a part of PPM. The expenditure data are based on a budget-line that relates to PPM and ISTC yet excludes some grants which did not report on their expenditure.

Country data

The mix of health care providers and health seeking behaviour of TB patients varies by setting. In China, hospitals are often the first point of care (Ministry of Health of the People’s Republic of China 2002). In rural areas of Bangladesh (Salim et al. 2006) and Cambodia (National Center for TB & Leprosy Services Cambodia 2008), semi-formal ‘village doctors’ are the first level care providers. In India and Kenya, private practitioners are the first port of call for many patients with symptoms of TB (WHO 2006a).

Data compiled from 14 countries (including nine high-burden countries) and published in the Global TB Report of 2010 (WHO 2010) demonstrated the important contribution of PPM to case notifications, between a quarter and a third of all cases in five countries (Table 3). Expectedly, there has been considerable variation in PPM approaches and the provider groups targeted. This includes collaboration with pharmacies in Cambodia, private hospitals in Nigeria, public hospitals in China and Indonesia, and prison services in Kazakhstan.

Table 3.   Contribution of PPM to TB case notification in selected countries (Reference WHO, 2010)
CountryTypes of non-NTP care providers engagedCoverageNumber of cases notified per year1Contribution to total notifications (%)
  1. 1Data for 2009 except where specified.

AngolaDiverse public and private providersCountrywide4 59112
CambodiaPharmacies, private clinics and hospitalsCountrywide6 55017
ChinaGeneral public hospitalsCountrywide337 28637
GhanaDiverse public and private providersCountrywide2 12415%
IndiaDiverse public, private and NGO providers14 large cities (50 million population)12 45036 of new smear-positive cases
IndonesiaPublic and private hospitalsCountrywide38 36213
Islamic Republic of IranDiverse public and private providersCountrywide2 51425
KazakhstanPrison health servicesCountrywide1 5158
MyanmarPrivate practitioners through the professional medical association26 townships (6.4 million population)8 526 (2008)21
NepalDiverse public and private providersCountrywide2 5198
NigeriaPrivate clinics and hospitalsCountrywide29 41834
PakistanPrivate practitioners, NGOs and hospitalsCountrywide43 16214
PhilippinesPrivate clinics and hospitals30 million population3 99428% of new smear-positive cases
TanzaniaPrivate and NGO hospitalsCountrywide11 49219%

Discussion

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References

Evidence points to growth globally in the number and size of non-public sector health care providers in TB control, with a significant proportion of TB patients managed by them, albeit often with poor quality of care. But proactive engagement of them can yield substantial benefits for TB control. There is also a growing body of evidence, over the past decade, which indicates that in some countries PPM has helped improve programme performance by increasing case detection by 10% to 60% while maintaining the treatment success rates above 85% (Lönnroth et al. 2006). Importantly, in some settings, for-profit private providers engaged through PPM have been able to improve their treatment success rates from levels that are often below 50% to above the global target of 85 (Dewan et al. 2006).

Table 2.   Budgets and expenditures on PPM and ISTC, by region
RegionBudget (US$, 000s)Percentage of regional TB budget allocated to PPM activitiesExpenditure (US$ 000s)Percentage of regional TB expenditure allocated to PPM activities
East Africa3880.43660.4
East Asia and the Pacific25 68410.426 20012.8
Eastern Europe and Central Asia3 2951.93 7372.7
Latin America and the Caribbean3320.44430.6
Northern Africa and the Middle East3360.41650.3
South and West Asia2 3434.01 6833.7
Southern Africa1 3382.01 1942.8
West and Central Africa4 5986.93 9886.8
Entire portfolio38 3144.437 7765.4

The importance and the scope of PPM are not often reflected at a level commensurate with the evidence, in the TB proposals and budgets submitted by countries. More than a third of the countries with active TB grants do not have PPM as a component. While the number of countries with active TB grants has increased from 22 in 2003, to 93 in 2008, the proportion of countries with PPM has not increased in this period despite additional Global Fund support for PPM. Of particular concern is the relatively low proportion of countries in sub-Saharan Africa with PPM supported by the Global Fund. We further observed a relatively low engagement of both NGO and private health sectors, which are key for PPM expansion.

There are also concerns regarding the nature of PPM and the way in which countries plan for PPM. Judging upon the PPM-related indicators used by countries on which Global Fund-supported programs report, many focus merely on training of providers, without a clear strategy on how to establish effective and sustainable collaboration. Proposals submitted to the Global Fund often lack explicit mention of what enablers and incentives (financial or non-financial) will be used for private sector engagement, such as supply of anti-TB drugs free of charge to private practitioners on the condition that they follow DOTS principles for diagnosis and case management (Lönnroth et al. 2006). Larger health care institutions taking on more complex roles in TB control will normally require financial compensation mechanisms, such as contracting on a capitation or fee-for-service basis. These aspects are rarely highlighted in proposals. Similarly, the support structures for PPM, such as continuous supervision, monitoring and evaluation, are often inadequately described. Finally, in the reports submitted to the Global Fund there is often little information on the proportion of non-public health care providers involved and the percentage contribution by different providers (Katz et al. 2010; Komatsu et al. 2011). All this will require more ambitious and better designed PPM plans to expand the engagement of non-public sector institutions in TB control to scale up services and improve outcomes.

There is useful guidance available to countries on PPM, including a tool to undertake a national situation assessment to decide on the need and scope of PPM in a country (Stop TB Partnership 2007) (used successfully by at least a dozen countries), a PPM guidance document and a PPM toolkit that advises on different steps of implementing PPM in phases, and also steps to engage different types of providers (WHO 2006a). These documents also include a planning framework for PPM in Global Fund applications; this framework is further elaborated in the Stop TB Planning Matrix and Framework for Global Fund TB proposal preparation (WHO 2008). The Global Fund currently does not have specific guidance on PPM, however, clearer guidance in the future would enable greater uptake of PPM.

The current median budget allocation for PPM activities of 5% is probably sufficient for limited engagement however the scaling up of PPM initiatives, especially those involving financial incentives requires more investment. In addition a significant portion of the budget has been allocated to training activities. The Global Fund recommends that countries follow the Stop TB Strategy and the larger tranches of funding for TB approved in R8 and R9 should further contribute to PPM activities.

The study could have underestimated the PPM within TB grants supported by the Global Fund, as there are limited data on sub-recipients of Global Fund grants including activities implemented by NGOs and the private or corporate sector, many of which are of PPM nature. Further limitation is the categorization of PPM types. Global Fund data highlights the recent expansion of PPM to prisons, and has ample examples for PPM in NGOs and the private sector, but none in public health facilities that are not part of the NTP, due to the difficulty in identifying such facilities within grant indicators. A further problem is the categorization of an activity under PPM. For example, in many grants, DOTS implementation in prisons was not classified as PPM. This partially explains the relatively low share of the TB budget allocated to PPM in Eastern Europe & Central Asia and Latin America & the Caribbean. Finally, the Global Fund is not the only financier of PPM activities and there is a lack of sufficient information to estimate the contribution from other funding agencies. All these limitations require further in-depth case studies.

Wide implementation of PPM requires good collaboration between the public and other health sectors. Innovative mechanisms appropriate to the nature of the settings such as certification of provider and financial incentives should be put in place to ensure such cooperation. There are good examples from countries like India, where NTP tries to encourage and formalize PPM though initiatives that develop guidance documents to facilitate PPM partners to formally engage in PPM activities. We need robust case studies to illustrate further examples of good practice that has resulted in improved outcomes. Mechanisms aimed at providing appropriate incentives and providing online reporting tools to establish and sustain such collaborations are to be considered based on the relevance in specific settings.

PPM is cost-effective in diverse country settings (Floyd et al. 2006; Sinanovic & Kumaranayake 2006; Pantoja et al. 2009; Mahendradhata et al. 2010). A deeper analysis of PPM components of Global Fund country proposals and of the performance related to PPM could be of immense benefit not only to countries themselves but also to the technical and financial agencies supporting them. South-South learning opportunities should be encouraged and lessons learned from country cases more carefully harnessed and disseminated. Clearly, significant untapped potential still exists in scaling up PPM across countries, particularly in light of the increase in TB funding in recent years.

References

  1. Top of page
  2. SummaryFinancement du Fonds mondial des approches mixtes public-privé pour la prestation des soins de la tuberculoseFinanciación del Fondo Mundial de intervenciones público-privadas para la entrega de cuidados en tuberculosis
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. References