CONTEXT

PATH has completed more than three decades in India and is recognized as a valuable partner in improving health and saving lives through innovation, creativity and collaborations with local partners. PATH’s current role in India focuses on bringing technical know-how for improving health and then helping to apply these results in communities across the country. PATH supports the national and state Governments by improving communications, strengthening laboratories, infection control, partnerships and surveillance of TB and Multi-drug-resistant (MDR) TB in the private sector.

As part of the Mumbai Mission for TB Control and with support from our donors, PATH established the Private Provider Interface Agency (PPIA) to improve quality of diagnosis and treatment in the private sector. PPIA strengthens the capacity of private providers serving in slums to ensure early, accurate diagnosis of TB, effective case management and successful treatment for patients, thereby providing universal access to quality services.

THE FIRST STEP

PPIA’s objective is to form a network of existing private providers including formal and informal doctors, chemists, laboratories, and hospitals, and align TB diagnosis and treatment as per the Standards of TB Care in India. The model is built towards patient subsidies to encourage informal providers to diagnose TB early and refer TB cases to a formal provider at a hub hospital for appropriate treatment.

PPIA’S ONE-STOP SHOP

Under PPIA, services offered to patients include a free digital chest X-ray and a free drug sensitivity test in form of a GeneXpert through a voucher mechanism. Specialized care is provided through an engaged hospital with an in-house Chest/MD (consultant) at a hub hospital. Once the patient has been diagnosed with TB, free anti-TB drugs are provided at a private chemist through electronic vouchers. A contact centre runs the e-drug voucher mechanism and supports the field health workers in facilitating patient treatment adherence.

Patients receive regular reminder text messages and phone calls for treatment adherence. Drug refill schedules are maintained for each patient and tracked to ensure compliance. A comprehensive Information, Communication, and Technology (ICT) platform enables patient lifecycle management, electronic reimbursements to service providers and insights for program management.

 

MAPPING AND ENGAGING

Initially, PATH with some help from local NGOs, Maharashtra Janavikas Kendra and ALERT-India conducted a mapping of the private providers to establish a list of the private providers in Mumbai classified by areas or districts. Based on provider location and patient load, certain providers were prioritized for further engagement in a particular geographical area.

 

 

Field officers, with experience as medical representatives, visited doctors and pitched PPIA services. Once the provider joined the PPIA network, he/she got access to TB diagnostic and treatment subsidies for his/her patients. NGOs and contact centers enable patients to continue treatment and track patients on a regular basis. NGOs reimburse the service providers (laboratories and chemists) on a monthly basis for providing subsidized/free services.

 

LET’S TALK NUMBERS (UPDATED AS OF FEBRUARY 2017)

PPIA Mumbai started its operations in the last week of August 2014 and is currently operational in 670 hub centers in 24 wards of Mumbai.

Provider Engagement

TB Case Detection and Patients put on Treatment

Patients Completed Treatment

Value of Diagnostic and Drug Subsidies Disbursed

SUSTAINABILITY AND GROWTH

In order to make this service-delivery model sustainable, PPIA has now started integrating with the public sector, leveraging public sector services for patients seeking care in the private sector, providing technical support to the Municipal Corporation of Greater Mumbai (MCGM) to manage these activities at scale and building capacity of the public sector health staff to implement public sector Public Private Mix (PPM) schemes in letter and spirit.

With support from our donors, PATH is also collaborating with the state Governments in Maharashtra and Gujarat for a pilot of E-Nikshay, which will involve training and capacity building of the public sector and private sector providers for implantation of E-Nikshay across sectors in different states.

With support from USAID, under the Challenge TB initiative, PATH facilitates the early diagnosis of HIV in TB patients from the private sector through free HIV testing via the rapid diagnostic test (RDT). All the diagnosed TB cases in the private sector are counselled under the project and referred further to a private HIV testing facility. There are follow ups with RDT positive TB patients at ICTCs. This initiative has also improved the absorption of National AIDS Control Organisation PPM schemes and HIV testing and reporting in the private sector.

With support from CDC, PATH is providing support for early diagnosis of MDR TB to patients seeking care in the private sector. By building an appropriate linking mechanism, PATH connects patients to the public sector for timely treatment initiation and subsequent follow up.

THE HUMAN CONNECT

Four-time TB survivor Abdul Jabbar Khalil Shaikh (50 years) with his wife and two daughters runs a small sewing workshop in Govandi, a suburban neighborhood in eastern Mumbai. Not once, not twice, but after surviving TB four times, Abdul is determined to make the most of his life, and promises to spread the word for PPIA if he comes across anyone who shows symptoms of TB.

“The constant support of the program, not only financially but also emotionally with the help of the field staff made sure that I don’t give up on my health for a single minute. I am thankful today, that I had the courage to fight TB and will be able to see my children live their dreams” says Abdul (Photo Credit – Sachi Aggarwal/PATH)

 

The personal connection with a trained and supportive community worker helps patients complete what is still known to be a very difficult treatment regimen. The stigma attached to the diseases and the constant ups and downs of life often put patients in a bad place. Here, our field worker Vishal Giri checks in with patient Azam and gives him hope to keep fighting. (Photo Credit – Tom Furtwangler/PATH)

 

PPIA field officer Ajit Bhatt left a career in medical sales to work creating referral networks in this innovative urban TB program. He works with PPIA networked doctors, laboratories, chemists and patients, problem-solving and trouble-shooting every step of the way.

“I used to travel 20 days a month,” he says. Dharavi slum, shown behind him, is his territory in a job that gives him enormous satisfaction—and lets him go home every night. (Photo Credit – Tom Furtwangler/PATH)

For more information on PATH’s PPIA program please visit: http://www.path.org/publications/detail.php?i=2584