Leveraging e-Pharmacy to Improve the Quality of TB Care in the Private Sector
Leveraging e-Pharmacy to Improve the Quality of TB Care in the Private Sector
Year: August 2022
Collaborators: William J Clinton Foundation (WJCF), the India-based affiliate of Clinton Health Access Initiative (CHAI)
Team: Sarang Deo, Ashish Sachdeva, Pratima Jandhyala, Samriddhi S. Gupte
Background
India bears the largest burden of TB in the world, accounting for over 28% cases. While the public sector offers structured care under NTEP, the private sector remains the first point of contact for 50-80% of the patients. Through Patient Provider Support Agency (PPSA) model under Joint Effort for Elimination of TB (JEET), the government aims to address these key inefficiencies in TB care cascade and build program management capacity by i) integration of private sector in TB care, ii) facilitating access to NTEP approved TB diagnostics iii) nationwide access to free early treatment via private sector. JEET engages agencies at the district level to engage and work closely with the patients, private clinics, providers, and NTEP to facilitate end-to-end services.
William J. Clinton Foundation (WJCF), under JEET, implemented two pilot programmes with TATA-1mg from July 2020 to June 2022 under the PPSA framework. TATA-1mg is a for-profit organization specializing in e-pharmacy services. One of the models included Drug delivery partnership only while the other included Service and Drug delivery via TATA-1mg in addition to standard PPSA services in both. The key differences between TATA-1mg pilots and other PPSA models are (i) payment structure and (ii) services provided by the implementation agency. Although PPSAs models have been evaluated in the past, these differences necessitate another evaluation of these specific care delivery models.
About the Study
The study aimed to evaluate the impact of engaging a for-profit organisation on quality, quantity and cost of TB care under the PPSA model in India. The evaluation included the following services: a) notification of patients, b) uptake of CBNAAT (Xpert testing), c) uptake of free Fixed Dose Combination Drugs (FDCs), and d) Telephonic/doorstep counselling.
Methodology
The study used a mixed methods approach. The study design consisted of three methodologies.
- Secondary Programmatic Data Analysis: We obtained programmatic data from WJCF to study the impact of the pilots on quantity and quality of services, and on patient outcomes, relative to JEET 1.0 programme.
- Primary Qualitative Research: We conducted in-depth interviews with patients, service providers, and TATA-1mg or PPSA staff to capture their experiences and understand their behaviours with respect to accessing of services under these pilots.
- Programmatic Cost Analysis: We used an activity-based costing approach to evaluate the per-case cost for TATA-1mg pilot in comparison to standard JEET-PPSAs.
Outcomes
- In the Drug Delivery Pilot (providing doorstep medication delivery along with monthly reminder calls in addition to the regular PPSA services), increased adherence, improved treatment outcomes and better patient satisfaction were observed.
- In the Service and Drug Delivery Pilot (Involving TATA-1mg taking care of all service deliveries end-to-end except for patient enrolments, requiring minimal PPSA staff on ground), a limited-service uptake was observed.
- This highlights the importance of public service staff involvement in the success of interventions.
- As far as costing is concerned, the PPSA model was found to cost less. The difference in cost effectiveness can be attributed to varying geographies, differences in models or incentives or exposure time. A refinement in approach to boost the success of such collaborations is necessary.