Dejene, Seyoum (2002) The Role of the Private Health Sector in Tuberculosis Control in Jijiga Town, Eastern Ethiopia. Masters thesis, Addis Ababa University.
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Abstract
Tuberculosis is a major public health problem globally with eight million cases and two million deaths annually. In Ethiopia, tuberculosis has also been considered a major public health problem as far back as 40 years ago. The situation is worse in the study area due to low health service coverage and due to higher prevalence of tuberculosis. Tuberculosis has been declared to be a global epidemic and there is an increasing global and local effort to control tuberculosis. Despite all the effort, only less than half the annually estimated cases are reported by health authorities to the WHO. This could be due to poor coverage or and due to poor reporting from the private sector. Due to favorable health policy, which encourages private delivery and financing of health services, there is ongoing development of the private health sector in the country and in the study area. However, there is a gap in the knowledge as to the role of the private health sector in delivery of public health related services including tuberculosis control. An institution based cross-sectional study was carried out in public and private health facilities in Jijiga Town. Both quantitative and qualitative methods were used in this study to assess the role of the private health sector in tuberculosis control. A total of 533 tuberculosis suspects and 215 tuberculosis patients attending the DOTS clinics or TB laboratories in Jijiga Town during the study period were interviewed. Structured checklist was used to collect the necessary data from the private and public health institutions in the town and focus group discussions were also conducted with important stakeholders in tuberculosis control. It was found that 34% of the study subjects opted for a private provider on their first consultation for their current illness, while 62% turned to public facilities. This study also revealed a significant patient delay among smear positive pulmonary tuberculosis cases before starting anti-TB treatment. It was found that 51% of the patients were delayed by four or more months before they present themselves to a health facility, the mean patient delay being 5.7 months.It was also shown that provider delay of 4-6 months, and not being screened on the first visit among PTB+ were significantly associated higher likelihood of turning to a private provider (adjusted OR=10.44, 95% CI=(1.17, 93.36) and Adjusted OR=21.25, 95% CI=(6.30,71.70)) respectively. The focus group participants indicated that poorly equipped private health facilities, which were unable to process sputum examination for tuberculosis suspects, re-examining the sputum of patients who had already had this examination in the private sector, and poor referral between the public and private sectors were some of the reasons for delay of diagnosis and treatment of tuberculosis patients. It was also found that majority of the private clinics in Jijiga were unlicensed and owned by health workers who were self employed in the private sector on part-time basis. Though most of the private clinics lack the basic requirements for tuberculosis control, significant number of patients visited them, more than twice those visited the public, including tuberculosis suspects. Both the public and the private sectors should be better organized and equipped to strengthen tuberculosis control in the study area. The private sector, being the choice of many patients should not be neglected and better used as a partner in tuberculosis control after strengthening appropriate supervision and regulation by the public sector. The involvement of the private sector in tuberculosis control, under the prevailing poor regulation and poor quality and availability of the basic requirements for tuberculosis control should be limited to early identification and referring of TB suspects.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 29 Nov 2018 10:27 |
| Last Modified: | 29 Nov 2018 10:27 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7990 |
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