Change search
ReferencesLink to record
Permanent link

Direct link
Life of a partnership: the process of collaboration between public and private providers for tuberculosis control in Yogyakarta, Indonesia
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-1633-2179
(English)In: Article in journal (Refereed) Submitted
URN: urn:nbn:se:umu:diva-37601OAI: diva2:369338
Available from: 2010-11-10 Created: 2010-11-10 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Revisiting the choice: to involve hospitals in the partnership for tuberculosis control in Indonesia
Open this publication in new window or tab >>Revisiting the choice: to involve hospitals in the partnership for tuberculosis control in Indonesia
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tuberculosis (TB) is a major public health problem in many low- and middle-income countries, including Indonesia. To accelerate TB case detection, and to improve the quality of diagnosis and treatment provided by all providers, the Public-Private Mix for implementing Directly Observed Treatment Short-course (PPM DOTS) was introduced in 2000. However, previous studies on PPM DOTS have focused on private practitioners and there has been a scarcity of research on PPM DOTS in the hospital setting. This dissertation aims to capture the potential of the PPM DOTS strategy, and identify the barriers to its implementation in hospitals in Indonesia.

This dissertation is based on four separate but interrelated studies: 1. A costeffectiveness analysis, comparing incremental cost per additional number of TB cases successfully treated under three strategies of PPM DOTS in four provinces. 2. An evaluation of the access to TB services by a cross-sectional study among 62 hospitals, by estimating the proportion of TB cases receiving standardised diagnosis and treatment according to the DOTS strategy. The data were analysed using poststratification analysis. 3. The quality aspect was explored in a multiple-case study, including eight selected hospitals. The data were analysed using cross-case analysis. 4. The process of partnership was explored through a qualitative study. In-depth interviews were conducted with 33 informants, who were actors involved in PPM DOTS in hospitals in Yogyakarta province. Content analysis was applied to the qualitative data.

PPM DOTS in hospitals was shown to be a cost-effective intervention in this particular context. However, the quality of the implementation was commonly suboptimal. In addition, a substantial number of TB cases did not get standardised diagnosis and treatment as per the DOTS strategy. The process of creating partnership among hospitals and National TB Programme was shown to be complex and dynamic. Process factors, such as commitment to collaboration and interaction and trust among the actors, were shown to be important. The rapid scaling-up of PPM DOTS in hospitals at the national level in Indonesia should be revisited. Indeed, considering the importance of hospitals in TB control, the implementation should be continued and expanded. However, more attention needs to be given to process, context and governance.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2010. 56 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1383
tuberculosis, public-private partnership, formative evaluation, health service research, health system research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
urn:nbn:se:umu:diva-37894 (URN)978-91-7459-108-8 (ISBN)
Public defence
2010-12-10, Sal 135, Allmänmedicin, by 9 A, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Available from: 2010-11-19 Created: 2010-11-18 Last updated: 2015-04-29Bibliographically approved

Open Access in DiVA

No full text

Search in DiVA

By author/editor
Probandari, AriLindholm, LarsHurtig, Anna-Karin
By organisation
Epidemiology and Global Health

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 45 hits
ReferencesLink to record
Permanent link

Direct link