Does Cash Incentive Effect TB Case Notification by Public Private Mix-General Practitioners Model in Pakistan?

Setting: Private healthcare providers including solo practitioners and laboratories enrolled with Public Private Mix General Practitioners model in Pakistan who were enrolled with the program and maintained participation during 2014 to 2016. Objective: To assess the change in case notification by private healthcare providers as well as effect on sputum smear positivity rate at private laboratories after introduction of incentives. Design: A comparative cross-sectional study based on routinely maintained National TB Control Program data collected before and after the introduction of incentives (2014 and 2016). Results: In 2016, TB case notification increased by 71% after cash incentives was introduced. Among the 618 private healthcare providers who enrolled and maintained participation in the Public Private Mix program, only 1% of the GPs contributed to 19% increase in case notification, whereas 27% GPs had reported a reduced number of cases compared to the pre-intervention period. After incentives, slide positivity rate for diagnostic declined by 1.9% and follow-up increased by 0.6%. Number of slides for diagnostic and follow-up testing increased by 82% and 72% respectively. Conclusion: Engaging the private healthcare sector, by providing cash incentives to private health care Provider’s is an effective strategy for providing a substantial increase in National TB case notification.