Private sector engagement for tuberculosis elimination: India’s journey from pilots to national scale-up (2012–2021)

Tuberculosis (TB) is a leading cause of illness and death worldwide. India accounts for 26 percent of the world’s TB burden; hence, the significance of India’s role in achieving the global elimination of TB cannot be overstated. India has a mixed health care system comprising a vertical program-oriented public health care system and a fragmented private health care system, which drives out-of-pocket expenditures by households. Approximately 80 percent of TB patients start their diagnostic and treatment journey in the private sector, and nearly 50 percent continue their treatment there. Thus, private sector engagement (PSE) is an essential intervention for the Indian context. PSE is an important pathway for the government of India to achieve national TB targets. Since the mid-1990s, the National Tuberculosis Elimination Program (NTEP) has been implementing various PSE activities, in some cases with support from development partners. Most early PSE projects and interventions yielded poor-to-mixed results and did not impact the quality of private sector care. From 2012, NTEP began to scale up innovative approaches with support from development partners. Encouraging results from the pilots were instrumental in convincing policy makers and program managers to transition and integrate financing for newer PSE models into India’s domestic budgets. The program has successfully transitioned and institutionalized various PSE models. This working paper examines and documents early experiences and lessons from India’s TB PSE journey. While it is still too early to evaluate the impact of the transition, the story of how India transitioned from pilots to national scale-up holds lessons for other health programs and countries with similar TB burdens.