DOI: 10.3886/e199007v1-147045
title: The shifting landscape of private healthcare providers before and during the COVID-19 pandemic and the potential impacts on tuberculosis care in Bandung, Indonesia

description: COVID-19
pandemic changed many aspects of healthcare services and deliveries, including among
private healthcare providers (i.e., private healthcare facilities [HCFs] and
private practitioners [PPs]). We aimed to compare the spatial distribution of private
providers and describe changes in characteristics and services offered during and
before the COVID-19 pandemic, and explore its potential impact on tuberculosis
care. We conducted a cross-sectional survey in 36 randomly
selected community health centers areas (locally referred to as Puskesmas) in Bandung, Indonesia, during the
COVID-19 pandemic from April – December 2021. Data pertaining to before the COVID-19
pandemic was abstracted from a similar survey conducted in 2017 (i.e., INSTEP
study). We obtained latitude and longitude coordinates
of private healthcare providers and then compared the geographical spread with
data collected for INSTEP study. We also compared characteristics of, and
services provided by private healthcare providers interviewed during the COVID-19
pandemic with those previously interviewed for INSTEP study. Differences were summarized
using descriptive
and bivariate analyses.
During the study period,
we surveyed 367 private HCFs and interviewed 637 PPs. Compared to INSTEP study data,
the number of operating HCFs was reduced by 3% during the COVID-19 pandemic (401
vs. 412 before COVID-19), although we
observed increases in laboratory service (37.8% increase), x-ray service (66.7%
increase), and pharmacy (18.1% increase). Among a subset of private HCFs
managing patients with respiratory tract infection symptoms, a quarter (60/235,
25.3%) indicated that they had to close their facilities in response to the emerging
situation during the COVID-19 pandemic. For PPs, the number of practicing PPs
was reduced by 7% during the COVID-19 pandemic (872 vs. 936 before COVID-19). Interestingly,
the number of practicing PPs encountering patients with TB disease increased during
the COVID-19 pandemic (42.9% vs. 35.7% before COVID-19, p=0.008). This study confirmed that
the COVID-19 pandemic adversely impacted health care service deliveries in private
sectors, largely marked by closures and shortened business hours. However, the
increased service capacities (laboratory and pharmacy), as well as significant
increase in the number of patients cared for TB disease by PPs during the COVID-19
pandemic, made a more compelling case to further the implementation of public-private
mix model for TB care in Indonesia.
description: We used convenience sampling method to select
individuals working in private healthcare facilities to be surveyed in the
present study. Clinic managers, clinic owners, doctor(s) in charge, general practitioners,
or other clinic staff were eligible to be interviewed for the mapping survey.
For the providers survey, eligible study participants included GPs and
specialists.
description: face-to-face interview; on-site questionnaire; paper and pencil interview (PAPI);