Thailand - Stop TB Partnership

epresented in policymaking processes; these groups are most likely to lack higher education,
political access, and allies in policymaking circles. People struggling to stick to a
demanding treatment regimen are more likely to be focused on survival (while they are ill)
and putting the experience behind them (after they are cured) rather than policy debates. Yet
involving people living in the communities most affected by TB—especially those who have
successfully completed treatment—is crucial to the development of more effective public
outreach programs and to improving the quality and accessibility of services overall. Given
the marginalization often faced by the people and communities most affected by TB, governments
and international donors must take an active role in encouraging and supporting
partnerships with community-based organizations to reach these groups more effectively.
Public-private collaboration
Management of TB patients in private practice is not of acceptable quality.
. . . [D]ifferent anti-TB regimens are prescribed depending on the
experience of the private provider and on the patient’s purchasing power.
—Report of Third Joint International TB DOTS/ HIV/AIDS Monitoring
Mission to Nigeria 42
Many people with TB symptoms turn first to private practitioners in their communities, even
in areas theoretically “covered” by governmental DOTS programs. People seek services from
private providers because they lack knowledge about or sufficient access to free treatment,
or because they are looking for better service than they expect to receive at publicly managed
clinics. TB treatment regimens in private facilities are often based upon an individual’s purchasing
power rather than on national guidelines for TB treatment. In Nigeria, for example,
rather than relying solely on smear tests, private providers use chest x-rays to diagnose TB
in people who can pay for this service. Widespread reliance on private providers who are not
collaborating with the government also has a negative impact on the accuracy of official TB
case recording and reporting and the likelihood of treatment default.
While those who can afford it often seek treatment from licensed private medical
doctors, large numbers of TB patients seek treatment from a range of other, less qualified
private providers, including traditional healers, pharmacists, and unlicensed doctors, few of
whom can be counted on to follow NTP guidelines. A recent study in Bangladesh found that
up to 70 percent of poor TB patients had consulted traditional healers, homeopathic providers,
or allopathic doctors before seeking out DOTS services; 43 because these private providers
charge fees for TB services, patients are more likely to appear for treatment only when
they have enough money to buy drugs, or drop out entirely when their money runs out.
Defaulting on treatment increases patients’ risk of developing (and spreading) MDR-TB.
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TB POLICY IN THAILAND