title: Balancing authority, deference and trust across the public-private divide in health care: tuberculosis health visitors in western Maharashtra, India.
abstract: While concepts such as 'partnership' are central to the terminology of private-public mix (PPM), little attention has been paid to how social relations are negotiated among the diverse actors responsible for implementing these inter-sectoral arrangements. India's Revised National Tuberculosis Control Programme (RNTCP) has used intermediary agents to facilitate the involvement of private providers in the expansion of Directly Observed Therapy, Short-Course (DOTS). We examine the roles of tuberculosis health visitors (TB HVs) in mediating working relationships among private providers, programme staff and patients that underpin a PPM-DOTS launched by the RNTCP in western Maharashtra. In addition to observations and informal interactions with the programme and participating health providers, researchers conducted in-depth interviews with senior programme officers and eight TB HVs. Framed by a political discourse of clinical governance, working relationships within the PPM are structured by the pluralistic context, social and professional hierarchies and paternalism of health care in India. TB HVs are at the nexus of these relationships, yet remain undervalued partly because accountability is measured through technical rather than social outcomes of the 'partnership'. Close attention to the dynamics of power relations in working practices within the health system can improve accountability and sustainability of partnerships.
authors.affiliation: a Institute for International Health & Development , Queen Margaret University , Edinburgh , Scotland.
authors.forename: Karina
authors.initials: K
authors.lastname: Kielmann
authors.forename: Vinita
authors.initials: V
authors.lastname: Datye
authors.forename: Anagha
authors.initials: A
authors.lastname: Pradhan
authors.forename: Sheela
authors.initials: S
authors.lastname: Rangan
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy / Q000379:methods* / Q000523:psychology; D005260:Female; D006302:Health Services Research; D006792:House Calls; D006801:Humans; D007194:India; D007400:Interprofessional Relations; D008297:Male; D011369:Professional-Patient Relations; D055818:Public-Private Sector Partnerships; D035502:Trust; D014376:Tuberculosis / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission
chemical_list: D000995:Antitubercular Agents
keywords: India; accountability; partnerships; private–public mix; tuberculosis control