Private Sector Involvement in Tuberculosis Control in An Urban City of Western India– A Cross-Sectional Study


  • Khushboo Hadiya Government Medical College, Surat, India
  • Rahul Damor Medical College Baroda, Vadodara, India
  • Hiteshree Patel Government Medical College, Surat, India
  • Mohamed Anas Mohamed Faruk Patni Ras Al Khaimah College of Medical Sciences (RAKMHSU), Ras Al Khaimah, United Arab Emirates
  • Kavita Bodar Pacific Institute of Medical Science, Udaipur, India
  • JK Kosambiya Government Medical College, Surat, India



Cross sectional study, National Tuberculosis Elimination Program, Private practitioners, sputum smear microscopy


Background: In India, TB diagnosis and treatment practices among Private Practitioners (PPs) vary widely and are not properly regulated by the national TB program. Despite their irrational and inequitable practises, PPs remain an important and preferred primary care provider for many people. The study was done to with the objectives to describe different diagnosis and treatment practices of Tuberculosis among private practitioners and their involvement in National Tuberculosis Elimination Program (NTEP).

Material and Methods: A cross sectional study was performed among 303 PPs during October 2020 to March 2021 by using stratified random sampling to select private practitioners based on their speciality.

Results: Most preferred investigation was Chest X ray (45.2%) followed by sputum smear microscopy (29.7%). Only 71.3% PPs practiced the correct regimen for new cases of Pulmonary TB according to NTEP. More than half of the PPs had TB training (59.7%). Majority of the PPs (90.1%) were involved in NTEP mainly by referral of TB patients to local government centres for treatment purpose.

Conclusion: Preferred investigation for diagnosis of pulmonary TB was chest X-ray followed by sputum examination among PPs. The treatment regimen and duration of treatment varies among PPs as per their clinical judgement and practice.


Global tuberculosis report 2020 [Internet]. [cited 2024 Feb 18]. Available from:

Uplekar M, Pathania V, Raviglione M. Private practitioners and public health: weak links in tuberculosis control. Lancet [Internet]. 2001 Sep 15;358(9285):912-6. Doi: PMid:11567729

Satyanarayana S, Nair SA, Chadha SS, Shivashankar R, Sharma G, Yadav S, et al. From where are Tuberculosis patients accessing treatment in India? results from a cross-sectional community-based survey of 30 districts. PLoS One. 2011;6(9). Doi: PMid:21912669 PMCid:PMC3166304

Hazarika I. Role of Private Sector in Providing Tuberculosis Care: Evidence from a Population-based Survey in India. J Glob Infect Dis. 2011 Jan;3(1):19-24. Doi: PMid:21572604 PMCid:PMC3068573

Chauhan LS. Public-private mix DOTS in India. Bull World Health Organ. 2007 May;85(5):399. Doi: PMCid:PMC2636661

Sachdeva KS, Kumar A, Dewan P, Kumar A, Satyanarayana S. New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access "Reaching the un-reached." Indian J Med Res. 2012;135(5):690-4.

Bhat R. Regulation of the private health sector in India. International Journal of Health Planning Management. 1996;11(3):253-74. Doi:<253::AID-HPM435>3.0.CO;2-N

Fochsen G, Deshpande K, Diwan V, Mishra A, Diwan VK, Thorson A. Health care seeking among individuals with cough and tuberculosis: A population-based study from rural India. International Journal of Tuberculosis and Lung Diseases. 2006;10(9):995-1000.

Bharaswadkar S, Kanchar A, Thakur N, Shah S, Patnaik B, Click ES, Kumar AM, Dewan PK. Tuberculosis management practices of private practitioners in Pune municipal corporation, India. PLoS One. 2014 Jun 4;9(6):e97993. Doi: PMid:24897374 PMCid:PMC4045673

Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version., updated 2013/04/06, accessed 2024/02/12.

Grosse U. Attracting and retaining staff for TB work-role of governments: Experiences from India, 37th Union World Conference on Lung Health; J Tuberc Lung Dis.2006; 10(11):149. Available from:

Murrison LB, Ananthakrishnan R, Sukumar S, Augustine S, Krishnan N, Pai M, et al. How do urban indian private practitioners diagnose and treat tuberculosis? A cross-sectional study in Chennai. PLoS One. 2016;11(2):1-14. Doi: PMid:26901165 PMCid:PMC4762612

Datta K, Bhatnagar T, Murhekar M. Private practitioners' knowledge, attitude and practices about tuberculosis, Hooghly District, India. Indian Journal of Tuberculosis. 2010;57(4):199-206.

Prakash, M., Rajagopal, A., Vasudevan, K., Subramani, S. K., & Basu, M. Extent of Involvement of Private Practitioners in Public-Private Mix-Directly Observed Treatment Short Course (PPM-DOTS) for Tuberculosis Management in South Coastal India: A Mixed-Method Study. Medical Journal of Dr. D.Y. Patil University.2022,15(5), 713.

Baseline KAP Study Under RNTCP Project-CMS | PDF | Tuberculosis | Clinical Medicine. (n.d.). Scribd. Retrieved March 1, 2024, from

Vandan N, Ali M, Prasad R, Kuroiwa C. Assessment of doctors' knowledge regarding tuberculosis management in Lucknow, India: A public-private sector comparison. Public Health [Internet]. 2009;123(7):484-9. Doi: PMid:19560176

Greaves F, Ouyang H, Pefole M, MacCarthy S, Cash RA. Compliance with DOTS diagnosis and treatment recommendations by private practitioners in Kerala, India. International Journal of Tuberculosis and Lung Diseases. 2007;11(1):110-2.

Krishnan N, Ananthakrishnan R, Augustine S, Vijayalakshmi NK, Gopi PG, Kumaraswami V, Narayanan PR. Impact of advocacy on the tuberculosis management practices of private practitioners in Chennai City, India. Int J Tuberc Lung Dis. 2009 Jan;13(1):112-8. PMID: 19105888.

Das J, Hammer J. Location, location, location: residence, wealth, and the quality of medical care in Delhi, India. Health Aff (Millwood). 2007 May-Jun;26(3):w338-51. Doi: PMid:17389631

Stallworthy G, Dias HM, Pai M. Quality of tuberculosis care in the private health sector. J Clin Tuberc Other Mycobact Dis. 2020 Jun 13;20:100171. doi: 10.1016/j.jctube.2020.100171. Erratum in: J Clin Tuberc Other Mycobact Dis. 2021 Jun 03;24:100250. Doi: PMid:32642560 PMCid:PMC7332523

Vo LNQ, Codlin AJ, Huynh HB, Mai TDT, Forse RJ, Truong VV, Dang HMT, Nguyen BD, Nguyen LH, Nguyen TD, et al. Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City, Viet Nam. Tropical Medicine and Infectious Disease. 2020; 5(3):143. Doi: PMid:32937757 PMCid:PMC7558378

Chijioke-Akaniro O, Onyemaechi S, Kuye J, Ubochioma E, Omoniyi A, Urhioke O, Lawanson A, Ombeka VO, Hassan A, Asuke S, Anyaike C, Merle CS. Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study. BMJ Open. 2023 Sep 13;13(9):e069123. Doi: PMid:37709312

Kelamane S, Satyanarayana S, Nagaraja SB, et al. Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India. Drlica K, ed. Tuberculosis Research and Treatment. 2021;2021:9579167. Doi: PMid:34239728 PMCid:PMC8241510




How to Cite

Hadiya K, Damor R, Patel H, Patni MAMF, Bodar K, Kosambiya J. Private Sector Involvement in Tuberculosis Control in An Urban City of Western India– A Cross-Sectional Study. Natl J Community Med [Internet]. 2024 Apr. 1 [cited 2024 Apr. 22];15(04):276-82. Available from:



Original Research Articles