STEPS: A Solution for Ensuring Standards of TB Care for Patients Reaching Private Hospitals in India

Shibu Balakrishnan; Rakesh PS; Sunilkumar M; Bhavan Sankar; Rakesh Ramachandran; Ameer KA; Ramani Gopi; Prem Nair

doi:10.9745/GHSP-D-20-00449

Key Findings

The STEPS (System for TB Elimination in Private Sector) model demonstrated that a “patient-centric” strategy where private hospitals follow up their patients with TB for clinical actions and public health actions is feasible.
STEPS successfully addressed the gaps in the quality of care for patients seeking care in the private sector and ensured that services are aligned with the standards of TB care.
STEPS model helped the state government in establishing a good surveillance system for TB within private hospitals.

Key Implications

Policy makers may consider conceiving and implementing locally customized models based on the principles of STEPS for ensuring standards of care to TB patients seeking care from the private sector.
Donor agencies and intermediaries may consider developing low-cost sustainable solutions for private-sector engagement like STEPS where public program management and the private sector have equal roles and accountability.

ABSTRACT

Background:

In India, the private sector diagnoses and treats more patients with TB than the public sector. Gaps in the TB care cascade were observed more among the patients diagnosed in the private sector.

Concept:

The System for TB Elimination in Private Sector (STEPS) model evolved as a solution to address gaps in the quality of care for patients in the private sector by ensuring standards of TB care. STEPS has 3 components: a consortium of private hospitals, a coalition of all professional medical associations, and a STEPS center in each private hospital. STEPS centers act as a single window for notification, linkage for social welfare measures, contact investigation, chemoprophylaxis, direct benefit transfers, and treatment adherence support.

Intervention:

STEPS was piloted in 14 districts in the state of Kerala. All 14 districts formed consortiums of private hospital management for policy support and a coalition of professional medical associations for advocacy with doctors. STEPS centers were established in 318 private hospitals.

Results:

Notification to National TB Elimination Program from the private sector improved by 26% when compared to the previous year. Among the patients notified from the private sector, microbiologically confirmed cases increased by 81%, rifampicin resistance testing at baseline increased by 56%, and the percentage of those informed of their HIV status increased by 95%. The percentage of patients notified from the private sector with their treatment outcome reported improved from 39% (2018) to 99% (2019).

Conclusion:

The STEPS model demonstrated that a low-cost locally customized private sector engagement model is feasible and is beneficial to society. STEPS could be one of the major solutions for supporting patients reaching the private sector.

Received: August 1, 2020.
Accepted: March 31, 2021.
Published: June 30, 2021.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00449

View Full Text