Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh.

Background: In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis.
Methods and Findings: The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres' operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area.
Conclusion: The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b's screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.
Competing Interests: Jacob Creswell is an employee and received support from Stop TB Partnership in terms of salary during the project period. He was responsible for funding the interventions and their initial design, and contributed in the manuscript as senior author. Robert Stevens is an independent monitoring and evaluation expert employed by STOP TB Partnership. Md. Shamiul Islam and Rupali Sisir Banu are National Tuberculosis Control Program (NTP) staff. Besides the mentioned, all other listed co-authors either were/are staff of icddr,b working in the project and received salaries from the project fund, or working in other projects and received salaries from their respective project funds. This does not alter our adherence to PLOS ONE policies on sharing data and materials. None of the other authors have competing interests to declare.