Background

In the Public-Private Mix for Tuberculosis (PPM-TB) project, Nepal CRS Company played a significant role in enhancing the involvement of private healthcare providers in the detection, diagnosis, treatment, and reporting of tuberculosis (TB) cases. The key aspects of CRS’s role in the PPM-TB project included:

1. Engagement of Private Sector Providers: CRS worked to integrate private sector pharmacies, clinics, and hospitals into the national TB control program. This involved identifying and engaging private providers to screen, diagnose, and refer suspected TB cases to appropriate health facilities.
2. Capacity Building: CRS provided training and technical support to private healthcare providers, enhancing their knowledge of TB symptoms, diagnosis, treatment protocols, and case management. This helped improve the quality of TB services provided in the private sector and ensured compliance with national guidelines.
3. Referral Systems: CRS facilitated the development of referral networks between private providers and public health facilities, ensuring that suspected TB cases detected in the private sector were properly referred to public health centers for confirmation and treatment. This strengthened the coordination between private and public healthcare systems in TB management.
4. Treatment and Follow-Up: CRS supported private providers in delivering TB treatment and following up with patients to ensure adherence to prescribed drug regimens. This played a critical role in improving treatment outcomes and reducing the risk of drug-resistant TB.
5. Data Reporting and Integration: CRS assisted private providers in recording and reporting TB cases through the national health information system. By encouraging private sector participation in TB surveillance, CRS helped ensure that more TB cases were identified, treated, and reported, contributing to national TB control efforts.
6. Awareness and Demand Creation: Through behavior change communication (BCC) strategies, CRS worked to raise awareness about TB symptoms, prevention, and the importance of seeking treatment. This was particularly important for increasing the detection of TB cases within communities that might not normally access public healthcare services.

By integrating private healthcare providers into the TB control framework, CRS significantly contributed to increasing the reach and effectiveness of TB services in Nepal, ensuring a broader and more inclusive approach to TB diagnosis and treatment through the PPM-TB project.

Possible Severe Bacterial Infection (PSBI)

In the Possible Severe Bacterial Infection (PSBI) project, Nepal CRS Company played an essential role in strengthening the healthcare system for the management of neonatal and child health in line with national guidelines. The project aimed to improve the treatment of neonatal infections through private sector engagement. The key roles of CRS in the PSBI project included:

1. Adherence to National Protocols: CRS ensured that private healthcare providers adhered to Nepal’s Integrated Management of Neonatal and Childhood Illnesses (IMNCI) protocols for the treatment of possible severe bacterial infections in newborns. This was critical in standardizing care across private facilities and ensuring alignment with national health policies.
2. Capacity Building of Private Sector Providers: CRS provided training to private sector healthcare providers, such as pharmacies and clinics, to correctly identify and manage neonatal infections. This training aimed to improve providers’ understanding of PSBI symptoms and management, emphasizing the importance of following proper protocols.
3. Referral System Strengthening: One of the major objectives of the PSBI project was to discourage the use of antibiotics by private sector service providers and instead ensure that severe cases were referred to public sector referral hospitals for advanced treatment. CRS played a key role in strengthening referral linkages between private healthcare providers and public health facilities to ensure newborns received appropriate care.
4. Coordination with Public Sector: CRS helped to facilitate a smooth coordination between private sector health facilities and the public health system. This strengthened the collaboration and referral mechanism, ensuring timely treatment for newborns with severe bacterial infections.
5. Awareness and Behavior Change: Through community outreach and provider engagement, CRS worked on raising awareness about the dangers of inappropriate antibiotic use and the need to refer severe cases to higher-level care. The project also promoted health-seeking behavior among families and caregivers to ensure timely access to quality healthcare for newborns.

By focusing on provider capacity building, strengthening the referral system, and promoting adherence to national protocols, CRS played a pivotal role in enhancing the quality of neonatal care and management of PSBI cases in the private healthcare sector in Nepal. This approach aimed to reduce neonatal mortality and improve overall child health outcomes.

Major Stakeholders

The major stakeholders include pharmacies, hospitals, private practitioners and the urban volunteers. Apart from them, other concerned stakeholders include NTCC, Provincial health directorate, and TB focal persons, Mayors, chief of health offices and health coordinators.

Major Activities

The project activities can be categorized as:

• TB case diagnosis from Pharmacies (350 Medical Shops)

The project establishes a patient-referral mechanism from pharmacies and links them for TB detection. The project also aims to identify presumptive cases and refer them to the appropriate site as soon as possible by linking pharmacies to ultimately increase case notification.

• TB Case Diagnosis from Urban Volunteers (350 Volunteer)

Similar to the above activity, the project links urban volunteers and establishes referral mechanisms from them so that presumptive TB cases from the community can also be linked and treated promptly.

• Find Cases Actively, Separate temporarily and Treat effectively (FAST) & institution Pay for Performance Approach: (25 Hospitals) 

Here the project links hospitals for FAST strategy and looks for presumptive TB cases. First, we screen for presumptive TB cases, separate them and then provide them with appropriate and prompt treatment. Apart from screening for passive cases, Outreach Workers (OWs) will also look for referred cases by pharmacies and urban volunteers so that they can be screened and provided with prompt treatment.

• Pay for Performance for private practitioners (20 Doctors)

Similarly, the project engages the private practitioners that are outside of NTP but are treating TB patients through their clinics or hospitals, so that we can identify the missing cases and bring them into our national reporting system.