Engagement of the private pharmaceutical sector for TB control: rhetoric or reality?
Abstract
Background
Private-sector retail
drug outlets are often the first point of contact for common
health ailments, including tuberculosis (TB). Systematic reviews
on public-private mix (PPM) interventions for TB did not perform
in-depth reviews specifically on engaging retail drug outlets
and related stakeholders in the pharmaceutical sector. Our
objective was to better understand the extent to which the World
Health Organization’s (WHO) recommendation on engaging
retail drug outlets has been translated into programmatic
policy, strategy, and intervention in low- and middle-income
countries.
Methods
The study included a content
analysis of global-level documents from WHO and the Stop TB
Partnership in five phases. A country-level content analysis
from four data sources was performed. Global-level findings were
tabulated based on key messages related to engaging retail drug
outlets. Country-level findings were analyzed based on four
factors and tabulated. National strategic plans for TB control
from 14 countries with varying TB burdens and a strong private
sector were reviewed.
Results
33 global-level documents
and 77 full-text articles and Union World Lung Health conference
abstracts were included for review. Based on experience of
engaging retail drug outlets that has emerged since the
mid-2000s, in 2011 WHO and the International Pharmaceutical
Federation released a joint statement on promoting the
engagement of national pharmacy associations in partnership with
national TB programs. Only two of 14 countries’ national
strategic plans had explicit statements on the need to engage
their national pharmacy professional association. The success
rate of referrals from retail drug outlets who visited an
approved health facility for TB screening ranged from 48% in
Vietnam to 86% in Myanmar. Coverage of retail drug outlets
ranged from less than 5 to 9% of the universe of retail drug
outlets.
Conclusions
For WHO’s End TB
Strategy to be successful, scaling up retail drug outlets to
increase national coverage, at least in countries with a
thriving private sector, will be instrumental in accelerating
the early detection and referral of the 3 million missing TB
cases. The proposed PPM pharmacy model is applicable not only
for TB control but also to tackle the antimicrobial resistance
crisis in these countries.
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