title: Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods.
abstract: OBJECTIVE
  In Bangladesh, private healthcare is common and popular, regardless of income or area of residence, making the private sector an important player in health service provision. Although the private sector offers a good range of health services, tuberculosis (TB) care in the private sector is poor. We conducted research in Dhaka, between 2004 and 2008, to develop and evaluate a public-private partnership (PPP) model to involve private medical practitioners (PMPs) within the National TB Control Programme (NTP)'s activities. Since 2008, this PPP model has been scaled up in two other big cities, Chittagong and Sylhet. This paper reports the results of this development, evaluation and scale-up.
  
  
  METHODS
  Mixed method, observational study design. We used NTP service statistics to compare the TB control outcomes between intervention and control areas. To capture detailed insights of PMPs and TB managers about the process and outcomes of the study, we conducted in-depth interviews, focus group discussions and workshops.
  
  
  METHODS
  Urban setting, piloted in four areas in Dhaka city; later scaled up in other areas of Dhaka and in two major cities.
  
  
  RESULTS
  The partnership with PMPs yielded significantly increased case finding of sputum smear-positive TB cases. Between 2004 and 2010, 703 participating PMPs referred 3959 sputum smear-positive TB cases to the designated Directly Observed Treatment, Short-course (DOTS) centres, contributing about 36% of all TB cases in the project areas. There was a steady increase in case notification rates in the project areas following implementation of the partnership.
  
  
  CONCLUSIONS
  The PPP model was highly effective in improving access and quality of TB care in urban settings.
authors.affiliation: Nuffield Centre for International Health and Development,  Leeds Institute of Health Sciences,  University of Leeds, Leeds,  UK.
authors.forename: Abu Naser
authors.initials: AN
authors.lastname: Zafar Ullah
authors.forename: Rumana
authors.initials: R
authors.lastname: Huque
authors.forename: Ashaque
authors.initials: A
authors.lastname: Husain
authors.forename: Salma
authors.initials: S
authors.lastname: Akter
authors.forename: Akramul
authors.initials: A
authors.lastname: Islam
authors.forename: James Nicholas
authors.initials: JN
authors.lastname: Newell