Abstract

Objective: To assess the quality (regarding resources and appropriateness) of tuberculosis(TB) care provided at public and private health facilities in a rural district where directly observed treatment short-course (DOTS) strategy had been implemented.

Study Design: A cross-sectional study

Place and Duration of Study: Public and private health facilities in the district Thatta, province of Sindh, from January to December, 2004.

Material and Methods: All private clinics run by doctors having basic qualification of Bachelor of Medicine, Bachelor of Surgery (MBBS); and in public health sector only DOTS centers were included in the study. Total sample size of 63 was estimated, consists of 21 public and 42 private health facilities. Characteristics of health facilities and health care providers were assessed. Appropriateness of TB care was measured according to National TB control Program (NTP) Pakistan and World Health Organization (WHO) guidelines.

Results: Out of total 63, all 16 diagnostic center level facilities (11 public and 05 private) in the district were selected and remaining 47 were treatment centers (10 public and 37 private). Overall, 63.5% of health facilities had adequate waiting area, while in 30% spitting bins were placed. Functioning weighing scales were available at 65% and about 50% had registration system for TB patients. At diagnostic centers 62.5% laboratory In-charges were managing sputum smear slides properly. Only 32.7% of physicians managing TB cases were trained on DOTS.

Conclusion: Our study reflects lack of Logistics, supplies, sanitary conditions; and inappropriate TB case management in most of the health facilities especially in private clinics. Training of health care providers on DOTS, involvement of private sector, and implementation of regulatory measures were needed.

Keywords: tuberculosis, quality of care, public-private providers, health facility survey.