It’s all about Health: Public problems and Private Providers in Chennai

Chennai is seen as ‘India’s health capital’, with medical tourists travelling from Africa, the Middle-East and across Asia to receive high quality medical attention in one of the many gleaming specialist hospitals. Yet, in a country where tuberculosis claims nearly half a million lives a year, the city’s lower-income families primarily depend on local government hospitalsand smaller private healthcare clinics . Walking into Doctor Julian’s clinic reveals a waiting room filled with faces displaying a mixture of fear and relief, the same expressions you see in waiting rooms around the globe. The patients at the clinic are a representation of the diverse population of this multi-cultural lower income neighborhood. While, to some, ‘private healthcare’ might invoke images of fancy specialist hospitals, in India the private healthcare sector fulfills an immediate need to both rich and poor.

For over a quarter century, Doctor Julian’s clinic has provided healthcare services.. A consultation costs about $2,50, roughly half a day’s wages of a rikshaw driver, plumber or electrician and their families  all sitting patiently in the waiting room.  But in the sweltering heat of Southern India, life can be a struggle for many living in this crowded city. “To poor families we provide waivers for a free consultation” Doctor Julian says, understanding very well that patients often do not have the funds or time totravel to busy government hospitals. Health seeking behavior surveys clearly show that residents prefer to go to private providers for their primary care, but unfortunately   only  government provides  free tuberculosiscare. In order to mediate this problem KNCV supports REACH, a local organization of dedicated,competent health workers and with a long track record in community based TB care and working with the private sector. Funded by Eli Lilly, the collaborative ‘EQUIP’ project has actively worked to remove barriers of access to quality TB diagnosis and care with REACH as the interface agency between the private and public healthcare prividers .

By making the free TB diagnostic test, drugs and support available through patients’ private doctors, specialists in hospitals as well as family doctors in their clinics, the project has brought TB care to where potential patients need and want it most. “It was a blessing for me, because now I can provide treatment for TB” says Doctor Julian when asked about the moment he was approached and sensitized by the EQUIP project in 2016. The ‘EQUIP’ project first task was to ‘sensitize’ doctors to the options available to them, and provide participating doctors with free vouchers for quality TB diagnosis using state-of-the-art GeneXpert diagnostic machines. After private healthcare providers decide to participate, they can refer patients for their diagnostic test and prescribe free TB drugs. Meanwhile, the REACH team provides  additional counselling, home visits, contact investigation and nutritional support. This collaboration has proven effective for both patients and healthcare providers; “Now we can do follow-up together, I do the clinical and they do the rest” says Doctor Julian, beaming proudly.

Using an NGO in an interface role between the private and public sector has proven to be a successful  model, one that KNCV hopes to learn from and apply in other parts of the world. Through the REACH team’s home visits and continuous counselling, they have provided essential support to help patients through the long and intense regimen that is required to cure this dreadful disease. . The REACH team consists of dedicated and experienced health technicians that delicately guide patients through either the regular six month course, or the twenty-two months of treatment for drug resistant TB. REACH, through their personal touch, contribute to reducing (self) stigma, providing essential information and assisting patients to reduce  catastrophic costs due to loss of income..

“Everything comes through knowledge” Doctor Julian says. Patients need the information to minimize often self-imposed stigma, doctor’s need to be sensitized about TB and the available options to them, while contact investigation shines a light on the potential spread of tuberculosis in the community. By retaining their family doctor, patients have a trusted  source for asking questions and help with side-effects.

From the perspective of private healthcare providers, the project helps them heal and retain their patients and provides them with TB related information and pyschosocial support. When  curing a patient, that patient and their family trusts his/her doctor nd will keep coming back to the  clinic, providing an additional advantage for the private health providers

For KNCV, REACH and Eli Lilly, the project shows the importance of a Private-Public collaboration  when it comes to providing quality TB diagnosis and care for sensitive as well as drug resistant TB cases. As a neutral party between the two sectors, NGOs can provide a valuable service to both patients and private doctors , and facilitate access r to the latest diagnostic technology  such as GeneXpert testing which would otherwise not be available to lower-income families

The project provides an encouraging model for the provision of patient-centered TB services, which are valuable tools in understanding and combatting the TB epidemic.  By providing fast and high quality diagnosis, the project allows for the quick recognition and treatment for drug-resistant TB, which constitutes a growing problem in both India and around the world. The sustainability of the project is further evidenced in current efforts to integrate the developed  model into the local Free TB city collaborative initiative of the Chennai City corporation, REACH and other local partners funded by USAID and StopTBPartnership. . Through the work of KNCV and REACH, with the support of Eli Lilly, local communities can benefit from a sustainable and replicable model that provides the right diagnosis and the right treatmentfor TB patients. . In these ways, the EQUIP project fights the rise of drug-resistant TB through faster diagnosis, more effective quality treatment and limiting catastrophic costs for society’s most vulnerable and reduces the general suffering imposed by tuberculosis in India.

“They came to me, and I was very impressed. It’s the personal collaborative approach that makes it work!”

Dr. Thirupathi, SIMS Hospital Chennai

KNCV has been fighting TB since its establishment in 1903. Over the past 120 years, the organization has acquired indispensable knowledge and experience in the field of effective TB prevention and care, resulting in pre-elimination in the Netherlands and significant contributions to global evidence generation, policy development and TB program implementation worldwide.

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