About

Tuberculosis (TB) is a communicable disease and has one of the highest disease burdens globally. India had the largest share of Tuberculosis (TB) as 26% in the global burden of TB in 2019. The National Strategic Plan (NSP) 2017-25 aims to eliminate TB from India by 2025. The public sector delivers standardized TB care through RNTCP, but the private sector is the first point of contact for healthcare for 50-80% of the patients.

Joint Effort for Elimination of Tuberculosis (JEET) aims to address inefficiencies in every step of the patient care cascade for TB and to build the program management capacity through (i) mapping and to prioritize of private sector healthcare providers, (ii) facilitating access to RNTCP approved affordable TB diagnostics, (iii) nation-wide access to early, appropriate, and free treatment for patients seeking TB care in the private sector. Patient Provider Support Agency (PPSA) is a model under JEET for the effective care management of TB patients seeking care in the private sector. JEET contracts agencies at the district level to engage and work closely with the patients, private clinics, providers, and NTEP to facilitate end-to-end services. The key differences between TATA-1mg pilots and other PPSA models are (i) payment structure and (ii) services provided by the implementation agency (table 1). Although PPSAs models have been evaluated in the past, these differences necessitate another evaluation of these specific care delivery models. 

The study aims to evaluate these models on the following objectives:
- Impact on uptake of the services of the TATA-1mg pilots vis-à-vis existing donor-funded PPSAs
- Impact on the quality-of-service delivery of the TATA-1mg pilots vis-à-vis existing donor-funded PPSAs 
- Costing of the TATA-1mg pilots

Methodology

The study will employ a mixed-methods evaluation. The quantitative exercise will be conducted in a retrospective setting using secondary datasets of these two pilots and other PPSA models. In addition, primary qualitative interviews will also be conducted with patients and service providers to capture their experiences and behavior in the pilot.

The performance of TATA-1mg pilot will be compared with other PPSA models using a synthetic control approach. Synthetic control will be created using secondary data on demographics and disease prevalence. We will use variables such as age-sex composition, income levels, rural/urban population, incidence, the prevalence of TB, etc. Any directly available information in the program data or indirect information from the other available data in the public domain can be taken for this purpose. Under this evaluation, we will use appropriate techniques for analysis based on the data we receive and variables of interest.

For the costing analysis, the activity-based costing (ABC) technique will be used to explore the cost-driving activities and time and resources consumed per unit of activity. The requisite information on costing analysis will be collected from WJCF through primary and secondary data collection methods.

Funder

William J. Clinton Foundation