The need to furtheraugment the public health system to control tuberculosis – Authors' reply
Authors: Madhukar Pai, Prashant Yadav, Ravi Anupindi
Journal: The Lancet Global Health (2014)

We appreciate the response by Sharath Nagaraja and Ritesh Menezes to our Comment,1Pai M Yadav P Anupindi R Tuberculosis control needs a complete and patient-centric solution.Lancet Glob Health. 2014; 2: e189-e190Summary Full Text Full Text PDF Scopus (29) Google Scholar in which we had argued that patients with tuberculosis deserve a complete and patient-centric solution, irrespective of whether they seek care in the public or private health sector. Nagaraja and Menezes seem to have missed this key point and instead reframe the argument as public sector strengthening versus private sector engagement. They also make the erroneous claim that most of India's population is served by the public health system, when data suggest the converse.2The MAQARI teamMapping medical providers in rural India: four key trends. Centre for Policy Research, Delhi2011http://www.cprindia.org/sites/default/files/policy%20brief_1.pdfGoogle Scholar We should rise above this anachronistic public versus private care debate and focus on the orchestration of a solution for all patients with tuberculosis, making use of the best and most efficient mix for a specific context. Patients might not care who exactly is orchestrating the solution, where funds or drugs are sourced from, or which players are engaged, so long as they get quality care that is accessible and affordable. We do agree with Nagaraja and Menezes that the Revised National TB Control Programme (RNTCP) needs to be further strengthened and overall governmental expenditure on health must increase.3Laxminarayan R Nandi A Tuberculosis control in India: More bang for bucks than simply saving lives. International Growth Centre, New Delhi2013http://ideasforindia.in/article.aspx?article_id=147Google Scholar Indeed, if the Indian government were to fully fund the RNTCP to implement the National Strategic Plan, universal access could become a reality, not merely an aspirational goal.3Laxminarayan R Nandi A Tuberculosis control in India: More bang for bucks than simply saving lives. International Growth Centre, New Delhi2013http://ideasforindia.in/article.aspx?article_id=147Google Scholar RNTCP might also assume a stewardship role across public and private sectors and enable patient-centric solutions. However, we do not think tuberculosis can be controlled by strengthening of the public system alone because millions of people seek initial care for their symptoms from hundreds of thousands of chemists, informal providers, practitioners of alternative health systems, and qualified private doctors.4Kapoor SK Raman AV Sachdeva KS Satyanarayana S How did the TB patients reach DOTS services in Delhi? A study of patient treatment seeking behavior.PLoS One. 2012; 7: e42458Crossref PubMed Scopus (101) Google Scholar These providers outnumber the public sector workforce by a huge margin and seem to be preferred by most patients.2The MAQARI teamMapping medical providers in rural India: four key trends. Centre for Policy Research, Delhi2011http://www.cprindia.org/sites/default/files/policy%20brief_1.pdfGoogle Scholar Because early diagnosis is crucial for reduction of transmission, engagement of these first-contact providers is important. Other good reasons to engage the private sector, including improvement of the quality of tuberculosis care in line with Standards for Tuberculosis Care in India (STCI); improvement of case notifications; and establishment of linkages for private providers to refer patients to the RNTCP, exist.5Ratnavelu VK Pai M TB control: five key reasons to engage the private sector.http://www.thehindu.com/sci-tech/health/medicine-and-research/tb-control-five-key-reasons-to-engage-the-private-sector/article5805559.eceGoogle Scholar Even with greater resources, limitations restrict what the public sector can do, and we cannot wish the private sector away. But more importantly, no good reason exists to assume that the government needs to play a part in the finance of health care and its delivery. Indeed, the government's financing and regulation of health care might sometimes be more efficient and cost-effective than its provision of a service.6Preker AS Liu X Velenyi EV Baris E Public ends, private means: strategic purchasing of health services. World Bank, Washington2007Crossref Google Scholar Indeed, use of the private sector for public good widens the nature and scope of the public–private mix. Thus, engagement of all providers is a core element of the post-2015 Global Tuberculosis Strategy. MP serves on the editorial board of The Lancet Infectious Diseases. He serves as a consultant to the Bill and Melinda Gates Foundation (which did not fund or sponsor this work). PY and RA declare no competing interests. The need to further augment the public health system to control tuberculosisWe completely agree with Madhukar Pai and colleagues1 that a complete and patient-centric solution to tuberculosis control should be delivered with dignity and compassion. India's Revised National Tuberculosis Control Programme (RNTCP), which was recognised as one of the best-run tuberculosis control programmes in the world, has only been able to provide 27% of patients with multidrug-resistant tuberculosis with treatment, which is worrisome. Pai and colleagues vouch for patient-centric solutions for complete treatment. Full-Text PDF Open AccessTuberculosis control needs a complete and patient-centric solutionWhether it is mobile phone service or vacation travel, good businesses know that success depends on providing a complete and customer-centric solution. Should patients with tuberculosis not be offered a complete solution that is patient-centred? After all, millions are affected1 and a large market at the base-of-the-pyramid remains unserved. Full-Text PDF Open Access