Involving private sector pharmacies in tuberculosis care and control in countries with high tuberculosis burden

Abstract

Tuberculosis is a communicable bacterial disease. Although curable, globally two million people die and nine million new cases occur annually. Early detection and diagnosis reduce transmission and optimise patient health outcomes. Cambodia, a country with high tuberculosis burden, implements an innovative public/private mix Referral Program referring symptomatic clients from private pharmacies to public sector clinics for timely care. Using Cambodia’s Referral Program as a case study, the aim of research was to investigate the role of private pharmacies in tuberculosis control. To gain insight into contextual issues qualitative research comprised in-depth interviews with Referral Program stakeholders at strategic level and focus group discussions with pharmacy-based referral providers at operational level. Quantitative research comprised an interview survey with pharmacy-based providers to investigate referral-associated factors and providers’ clinical responses to symptomatic clients. Strong stakeholder collaboration contributed to successful Program management. Strategic refocus was considered essential to ensure sustainability. Referral was associated with pharmacies’ commitment to the Program. However, referral was negatively associated with compliance with protocols perceived to adversely impact client relationships. Cambodia’s Referral Program provided a promising model for involving pharmacies in tuberculosis control. Building sustainable capacity within pharmacy-based partnerships will be essential in making significant contribution to tuberculosis control.