TY - JOUR T1 - Scale and Ambition in the Engagement of Private Providers for Tuberculosis Care and Prevention JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 3 LP - 5 DO - 10.9745/GHSP-D-19-00074 VL - 7 IS - 1 AU - William A. Wells Y1 - 2019/03/22 UR - http://www.ghspjournal.org/content/7/1/3.abstract N2 - The tuberculosis (TB) community knows the importance of engaging private providers to reach critical TB targets, and knows how to engage successfully. The next challenge is to transition such efforts to government stewardship and financing in order to reach scale.See related article by Ananthakrishnan.Tuberculosis (TB) programs find themselves in an unusual position. They are the quintessential public health program, focused on an airborne public health threat with many externalities beyond an individual's health, thus justifying a substantial public investment. Yet globally, one of the largest pieces of unfinished business for these public programs is to engage with private health care providers.The reason is simple: TB is now largely concentrated in countries with large numbers of private health care providers. A recent landscape analysis of private provider engagement (PPE) in TB1 found that 7 of the highest TB burden countries (India, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, and Myanmar), which account for 57% of the global TB incidence and 63% of unreported (“missing”) TB cases,2 have dominant private sectors. In these countries, 75% (67%–84%) of initial care seeking is to private providers, and 61%–74% of total expenditure on health is private. Yet only 19% (5%–28%) of total TB notifications and 12% (1%–18%) of estimated TB incidence are notified by private for-profit TB providers.1When national TB programs are not fully engaging private providers, what happens to TB patients? Indonesia and Nigeria provide contrasting experiences. In Indonesia, only an estimated one-third of the non-notified TB patients are not diagnosed; the remaining two-thirds are diagnosed but not notified.3 They are thus inaccessible to public interventions that would improve the quality of the 6-month treatment, reduce the likelihood of developing multidrug-resistant TB, and ensure treatment completion … ER -