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Table 1 Role & Responsibility of Actors within the PPM-TB Policy

From: Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory

Actors

Role & Responsibility

District TB Officers (DTOs)

• Key person in programme implementation, holding crucial responsibility for: identifying the partners; developing links with them; and maintaining sustainable partnerships.

• He or she also holds the responsibility of calling the District TB Control Society meetings on a quarterly basis and for inviting the partner NGOs to these meetings.

Frontline TB Workers (FTWs)

• Provide feedback to PPs referring TB suspects

If the patient doesn’t have TB, then the FTW gives that feedback to the referring PP;

If the patient is diagnosed with TB, the FTW then requests the referring PP to be a DOTS provider.

If the PP shows unwillingness, then in such cases the FTWs take consent from the referring PPs and place the patient’s box in another nearby DOTS centre. The FTW then counsels the patient that if he/she has any other problems, s/he should see the referring PP for any other side drugs other than TB medicines.

• Identify a DOTS provider depending on the patient’s willingness and convenience

A DOTS provider could be anyone, from a shop keeper to a qualified medical practitioner.

Once the patient shows stability in treatment, and if willing, then the field staff shifts his/her treatment box to a DOTS centre nearest to his/her house.

They further explain the DOTS provider that the patient’s need to be given drugs on alternate days.

• Follow up with DOTS providers

The FTW visits regularly to follow up on the case until treatment is completed.

The FTW then reports the successful completion of the treatment to the STS.

• Provide honorarium to DOTS providers

The FTW updates the STS about the DOTS providers’ supervision.

The STS prepares a list of all such PPs every quarter and sends it to the District TB office for release of the PP honorarium.

Within 3 to 6 months, the FTW receives a Cheque in hand, which he hands over to the DOTS providers in person and take their signatures on the vouchers to be returned back to the District TB office as a sign of proof.

Private Practitioners (PPs)

• The PP can get involved in a single activity or in multiple activities depending on his or her capacity, interest and the requirements of the programme.

Be a DOTS provider - the PPs are expected to ensure follow-up sputum collection and late patient retrieval, as well as to maintain RNTCP records for the patients and to permit on-site monitoring by RNTCP supervisory staff as per RNTCP guidelines.

Be a referring provider- refer TB suspects for diagnosis and treatment, irrespective of whether the client is diagnosed as having TB in private labs or not.

Be a DOTS provider, and refer TB suspects.

• Practitioners who support as DOTS providers receives an honorarium of Rs. 250 per case (US$ 3.9) that has been successfully completed, whereas, in the case of MDR, the amount goes up to Rs. 1000 per case (US$ 15.9) [54].

Non-Governmental Organisations (NGOs)

• NGOs play an important role in supporting the RNTCP by making treatment more accessible to TB patients through various strategies and programmes, including community-based DOTS.

• The RNTCP maintains a formal relationship with NGOs through signing a memorandum of understanding (MoU).

• As per the revised schemes for PP/NGO involvement, NGOs can opt for a single scheme or multiple schemes depending upon their experience and capacity.

The RNTCP pays on a quarterly-basis for the particular scheme that is opted for.

The duration of agreement is one year and is renewable.

The NGOs need to re-apply to the District TB Office for funding each year.

• The applications are made to the district TB offices, and are renewed only after being signed by the District Magistrate/Collector.