Effectiveness of Treatment Outcomes of Public Private Mix Tuberculosis Control Program in Eastern Nigeria

Abstract

Effective tuberculosis treatment has been shown to have significant effect on the control of tuberculosis. Completion of treatment of active cases is therefore the most important priority of tuberculosis control programmes. Descriptive statistics with a retrospective cohort study design used to analyze secondary data set (2007-2010) of patients accessing TB-DOTS treatment in two facilities (Nnamdi Azikiwe University Teaching Hospital, NAUTH and Department of Health Services Tuberculosis and Leprosy  Control Unit Nnewi North Local Government Area (L.G.A.) Secretariat, DHSTLCU ) as public health facilities and other two facilities ( Immaculate Heart of Catholic Church Hospital, IHCCH  and Diocesan Anglican Communion Hospital, DACH) as private health facilities in Nnewi North L.G.A., Anambra State. Gender of patients were male: female 54%(1016 patients) : 46% (883 patients) and 53%(63 patients) : 47%(56 patients) in public and private health facilities respectively . Using WHO (1996) standards the health facilities adjudged as efficient were: in 2007, private facilities using the indicator  of treatment failure rate; private facilities using the indicator of death rate;  public facilities and private facilities using  the indicator of transfer-out rate ; public facilities using the indicator of  treatment completion rate. In 2008, effective health facilities were: private health facilities using the indicator of failure rate; public and private health facilities using the indicator of transfer-out rate; private facilities using the indicator of treatment completion rate. In 2009, effective health facilities were public and private health facilities using indicator of treatment failure rate; public and private health facilities using the indicator of death rate; public and private facilities using the indicator of transfer out; public and private facilities using the indicator of treatment completion rate. In 2010, effective health facilities were: private health facilities using the indicator of  cure rate; private facilities using the indicator of death rate ; public and private facilities using the indicator of transfer-out; public facilities using the indicator of treatment completion rate. In conclusion, private health facilities were more effective than public health facilities  by the several indicators over the four year period.  Future research is needful to use primary and secondary data sets in assessment of TB control program effectiveness; technical efficiency assessment using non-parametric statistics will assess the validity of assessing effectiveness using only the WHO standards; identify centre-specific factors associated with poor treatment outcome; institutionalizing a reward system for effective TB-DOTS facilities will engender healthy competition in the Public Private Mix for sustained effectiveness; the Monitoring and Evaluation tools especially the treatment card for data capture should be improved upon for comprehensiveness of patients socio-economic history.

Keywords: Tuberculosis, Effectiveness, Treatments Outcomes, Public Private Mix