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In Almaty, Kazakhstan’s largest metropolis, successful steps are being taken to resolve a persistent national problem; the cavernous divide between the public and private sector on TB treatment.  The country is in a transitional phase towards a national health insurance. Reimbursed by the government, an increasing number of private clinics are giving primary health care under the “guaranteed volume of free medical care” (GVFMC) to the catchment population in the same way as the public primary care centers.  But TB and HIV care remained firmly in the hands of the public sector, with private providers being very reluctant to deal with symptomatic TB and HIV patients due to policy and regulations on TB and HIV. With growing amounts of people preferring to use private clinics, there is a gap in the services provided by private primary health care under the GVFMC to patients in need of TB and HIV diagnostic and treatment services.

KNCV and Dutch NGO AFEW have been working with the Almaty TB program as part of the DGIS project funded by the Dutch Directorate-General for International Cooperation to strengthen the collaboration between public and non-state actors and build an intervention model for further expansion. While AFEW Kazakhstan works with local NGOs to improve access to TB/HIV care for key populations, the local KNCV team is focusing on building bridges between the public and private sector in Almaty. The process initiated with a qualitative survey last year in June, to explore the current practices and opportunities for collaboration with the private providers. Results were shared and discussed in a public private workshop with relevant stakeholder such as local health authorities, TB program staff, private clinics and NGOs. The results of the discussion were captured and translated into a Public Private Collaboration Plan, which was adopted in the beginning of this year.

Although this initial progress appeared to be slow, with only two out of fifteen private primary health care clinics in Almaty participating at first. Yet, through hard work and dedication, at least two-thirds of private clinics were represented at the latest meeting on April 12th of this year. Furthermore, the meeting was attended by a good number of representatives of relevant local institutions from the public sector, providing a genuine platform for dialogue between previously entrenched parties.

Participants highlighted the lack of capacity to do laboratory TB testing at private facilities, the difficulties for private clinics to provide observed treatment and support, the pertinent need to update technical TB and HIV knowledge and clarify policy and regulations. Furthermore, it was revealed that already more than a tenth of all TB cases in Almaty were being diagnosed in private facilities, further highlighting the need for a clear referral system for TB patients. The dialogue has shown that all parties understood the severity of the situation. The Almaty city’s healthcare department and TB services have shown their readiness to start, together with the KNCV team, to assist private clinics, engaged in the GVMC, to create appropriate conditions for the provision of quality TB care.

KNCV and partners are proud to see this collaboration has resulted in a solid list of predefined next steps and a brighter future for collaboration on TB care between the public and private sector in Almaty.

Image: A private doctor sees a patient with high blood pressure