Leveraging e-pharmacy to improve the quality of TB care in the private sector

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 – 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 aims to evaluate the cost and efficacy of involving a for-profit organization (TATA-1mg) in TB care delivery under PPSA model by gauging:

  • Impact on uptake of TATA-1mg services compared to the existing PPSAs
  • Impact on quality of service delivery through TATA-1mg compared to existing PPSAs
  • Costing of TATA-1mg pilots

Methodology

Using mixed methods approach, the study will use:

  • Secondary datasets of the two pilots and other PPSA models
  • Primary qualitative interviews with patients and service providers

For costing analysis, activity-based costing techniques will be used.

Outcome

  • In the Drug Delivery Pilot that provided 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 that involved 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.