Defining the Role of the Private Sector in Treatment
TB treatment is widely understood to be a public sector responsibility. However, our research found that in some countries the volume of TB drugs sold in the private sector is equal to or greater than the volume sold in the public sector.
The study explored the private sector landscape of 10 high-burden countries (that collectively account for 60% of the global TB burden) and found that the private sector treatment landscape in these countries is largely unregulated and fragmented. For example, the study detected 111 different first-line TB drug dosages and combinations, compared to the 14 deemed necessary by the Stop TB Partnership’s Global Drug Facility.
Drug misuse by the private sector could be responsible for many treatment failures and for escalating the emergence of multidrug-resistant TB (MDR-TB), which is further worsening the TB epidemic.
Other key findings in the 10 high burden countries revealed that:
- At least a third of all private sector dosages of first-line TB drugs fall outside of national and international treatment recommendations
- The public and private sectors are both major channels of treatment for TB patients. Nearly equal amounts of TB drugs are dispensed in the public and private sectors (enough to treat 67 percent vs. 66 percent of estimated incidence, respectively). The size of the private sector for TB drugs varies between countries, but has been steady within most countries over the past 5 years.
- Four of the biggest high-burden countries – India, Indonesia, Pakistan, and Philippines – had particularly large private sectors. Enough TB drugs are sold in their private sectors to treat all, or nearly all, incident TB cases with a full TB drug regimen. This is without even considering the 60 to 80 percent coverage by the public sector.
- Few patients receive MDR-TB treatment in the public sector—and the data reveal that the private sector was not stepping in to fill the gap. Private sector sales had the capacity to cover only ~1-10% of MDR-TB patients (or 0%, in three study countries) with a full regimen. However, with new, rapid diagnostics becoming available, this market may expand rapidly.
This research indicates that the private sector will need to ensure proper usage of new TB regimens to prevent the development of resistance against both existing and new TB drugs. In countries with large private TB drug markets, creating links between the public and private sectors through public-private mix programs could help to reach more patients with high quality TB treatment. This research highlights the need to substantially expand these efforts in preparation for the introduction of new TB drug regimens.