PDF(Pubmed)
Abstract：
The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.
We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.
A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.
Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.
We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.
A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.
Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.
摘要：
公私混合（PPM）方法是一项战略举措，涉及所有私营和公共医疗保健提供者使用国际医疗保健标准与结核病作斗争。为了控制尼泊尔的结核病，PPM方法可能是一个里程碑。本研究旨在探讨尼泊尔结核病病例管理中公私混合方法的障碍。
■我们对20名参与者进行了重要的线人访谈，其中14人来自私人诊所，多诊所，以及使用PPM方法的医院，两个来自政府医院，四个来自政策制定者。所有数据都是录音的,转录，翻译成英文.采访的笔录是手工整理的,和主题产生并分类为1。TB病例检测,2.与患者相关的障碍，and3.与卫生系统相关的障碍。
■共有20名受访者参与了这项研究。PPM的障碍被确定为以下三个主题：(1)与结核病例检测相关的障碍，（2）与患者有关的障碍，(3)与卫生保健系统有关的障碍。PPM的实施受到以下子主题的挑战，包括工作人员更替，私营部门参与讲习班的比例低，缺乏培训，糟糕的记录和报告，联合监测和监督不足，经济利益差，缺乏协调和协作，以及非支持性结核病相关政策和战略。
■政府利益相关者可以通过在监测和监督中与私人合作发挥积极作用而受益匪浅。然后，与私营部门的共同努力可以使所有利益相关者遵循政府政策，案例发现中的实践和协议，持有和其他预防措施。未来的研究对于探索如何优化PPM至关重要。
■我们对20名参与者进行了重要的线人访谈，其中14人来自私人诊所，多诊所，以及使用PPM方法的医院，两个来自政府医院，四个来自政策制定者。所有数据都是录音的,转录，翻译成英文.采访的笔录是手工整理的,和主题产生并分类为1。TB病例检测,2.与患者相关的障碍，and3.与卫生系统相关的障碍。
■共有20名受访者参与了这项研究。PPM的障碍被确定为以下三个主题：(1)与结核病例检测相关的障碍，（2）与患者有关的障碍，(3)与卫生保健系统有关的障碍。PPM的实施受到以下子主题的挑战，包括工作人员更替，私营部门参与讲习班的比例低，缺乏培训，糟糕的记录和报告，联合监测和监督不足，经济利益差，缺乏协调和协作，以及非支持性结核病相关政策和战略。
■政府利益相关者可以通过在监测和监督中与私人合作发挥积极作用而受益匪浅。然后，与私营部门的共同努力可以使所有利益相关者遵循政府政策，案例发现中的实践和协议，持有和其他预防措施。未来的研究对于探索如何优化PPM至关重要。
