The Public-Private Mix for Directly Observed Treatment, Short Course (PPM-DOTS) programme has been hailed as a success story in international cooperation. However, the evidence emerging from a range of sources suggests that this confidence may be motivated more by a desire to eulogize participation by private providers per se rather than on evidence of impact in terms of the cases treated.
This review of literature has therefore been triggered by the need for a sober assessment of the progress of the strategy of PPM-DOTS to date, and queries the extent to which tuberculosis control is embedded in sustainable national tuberculosis control programmes.
Our concerns over PPM-DOTS relate to three factors:
Firstly, there is growing doubt about the stewardship role of the state in LICs to adequately supervise the private for-profit sector. There is evidence from some regions that the current arrangements further weaken what remains of the public health system.
Secondly, the nature of the private for-profit sector, which in most settings is highly diverse, requires a coherent national health system absent in many cases; this fragments tuberculosis control, and undermines the long-term sustainability of PPM-DOTS.
Thirdly, the complex nature of partnerships and the frequent lack of adequate public sector supervision are leading to a rise in multidrug resistance as reported from many regions.
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