Public and private providers' quality of care for tuberculosis patients inKampala, Uganda

SETTING: The role of the private sector in tuberculosis treatment in develo ping countries in sub-Saharan Africa is largely unknown. In recent years, m any fee-for-service clinics have opened up in Kampala, Uganda. Little is kn own about the tuberculosis caseload seen in private clinics or the standard of care provided to the patients. OBJECTIVE: To compare the appropriateness of tuberculosis care in private a nd public clinics, and the extent of the tuberculosis burden handled in the private sector. DESIGN: Cross-sectional survey in private and public clinics treating tuber culosis patients in Kampala, Uganda, during June to August 1999. MEASUREMEN TS: Clinics were evaluated for appropriateness of care. This was defined as provision of proper diagnosis (sputum smear microscopy as the primary mean s of diagnosis), treatment (short-course chemotherapy, with or without dire ctly observed therapy), outcome evaluation (smear microscopy at 6 or 7 mont hs) and case notification in accordance with the Uganda National Tuberculos is and Leprosy Programme. RESULTS: A total of 114 clinics (104 private, 10 public) were surveyed. For ty-one per cent of the private clinics saw three or more new tuberculosis p atients each month. None of the public or private clinics met all standards for appropriate tuberculosis care. Only 24% of all clinics adhered to WHO- recommended treatment guidelines. Public clinics, younger practitioners and practitioners with advanced degrees were most likely to provide appropriat e care for tuberculosis. CONCLUSION: The private sector cares for many tuberculosis cases in Kampala ; however, a new programme that offers continuing medical education is need ed to improve tuberculosis care and to increase awareness of national guide lines for tuberculosis care.