title: Intensified scale-up of public-private mix: a systems approach to tuberculosis care and control in India.
abstract: METHODS
  India's Revised National Tuberculosis Control Programme (RNTCP) implemented an intensified scale-up of public-private mix (PPM) DOTS covering 50 million population in 14 major cities.
  
  
  OBJECTIVE
  To describe the processes and outcomes of the systems approach adopted.
  
  
  METHODS
  National schemes for engagement with different providers were applied. Additional human resources were provided to assist with implementation. All health care providers were mapped, a concise training module and advocacy kit were developed, and sensitisation and training activities were conducted. National advocacy efforts complemented local initiatives. Data were captured in a PPM-focused surveillance system.
  
  
  RESULTS
  Intensified PPM resulted in a 12% increase in notification of new smear-positive pulmonary TB cases. Contribution to case notification by providers varied widely: health department 67%, medical colleges 16%, private practitioners 6%, non-government organisations 7%, and the rest 4%. Treatment success was above the 85% target for all sectors combined. Strong public sector implementation and differentiation of roles and responsibilities among providers played major roles. The lessons learnt have been used by the RNTCP to inform future policy development.
  
  
  CONCLUSIONS
  The systems approach to the intensified PPM scale-up used in the 14 cities was productive. However, many challenges and barriers to scale-up of PPM DOTS in India remain.
authors.affiliation: Office of the World Health Organization Representative to India, New Delhi, India. lal.sadasivan@theglobalfund.org
authors.forename: S S
authors.initials: SS
authors.lastname: Lal
authors.forename: S
authors.initials: S
authors.lastname: Sahu
authors.forename: F
authors.initials: F
authors.lastname: Wares
authors.forename: K
authors.initials: K
authors.lastname: Lönnroth
authors.forename: L S
authors.initials: LS
authors.lastname: Chauhan
authors.forename: M
authors.initials: M
authors.lastname: Uplekar
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated; D023801:Directly Observed Therapy; D018563:Disease Notification; D006801:Humans; D007194:India; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009313:National Health Programs / Q000458:organization & administration; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care; D055818:Public-Private Sector Partnerships / Q000458:organization & administration; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents