The shifting landscape of private healthcare providers before and during the COVID-19 pandemic: Lessons to strengthen the private sectors engagement for future pandemic and tuberculosis care.

IntroductionCOVID-19 pandemic changed many aspects of healthcare services and deliveries, including among private healthcare providers (i.e., private healthcare facilities [HCFs] and private practitioners [PPs]). We aimed to compare the spatial distribution of private providers and describe changes in characteristics and services offered during and before the COVID-19 pandemic, and explore the tuberculosis (TB) and COVID-19-related services offered by the private sector in Bandung, Indonesia.MethodsA cross-sectional study with historical comparison was conducted in 36 randomly selected community health centers areas (locally referred to as Puskesmas) in Bandung, Indonesia, during the COVID-19 pandemic from 5th April 2021 - 27th December 2021. Data pertaining to before the COVID-19 pandemic was abstracted from a similar survey conducted in 2017 (i.e., INSTEP study). We obtained latitude and longitude coordinates of private healthcare providers and then compared the geographical spread with data collected for INSTEP study. We also compared characteristics of, and services provided by private healthcare providers interviewed during the COVID-19 pandemic with those previously interviewed for INSTEP study. Differences were summarized using descriptive and bivariate analyses.ResultsFrom April-December 2021, we surveyed 367 private HCFs and interviewed 637 PPs. Compared to INSTEP study data, the number of operating HCFs was reduced by 3% during the COVID-19 pandemic (401 vs. 412 before COVID-19), although we observed increases in laboratory service (37.8% increase), x-ray service (66.7% increase), and pharmacy (18.1% increase). Among a subset of private HCFs managing patients with respiratory tract infection symptoms, a quarter (60/235, 25.3%) indicated that they had to close their facilities in response to the emerging situation during the COVID-19 pandemic. For PPs, the number of practicing PPs was reduced by 7% during the COVID-19 pandemic (872 vs. 936 before COVID-19). Interestingly, the number of practicing PPs encountering patients with TB disease increased during the COVID-19 pandemic (42.9% vs. 35.7% before COVID-19, p = 0.008).ConclusionThis study confirmed that the COVID-19 pandemic adversely impacted health care service deliveries in private sectors, largely marked by closures and shortened business hours. However, the increased service capacities (laboratory and pharmacy), as well as significant increase in the number of patients cared for TB disease by PPs during the COVID-19 pandemic, made a more compelling case to further the implementation of public-private mix model for TB care in Indonesia

Introduction

We perceive teachers to be agents of change who are characterised by high selfesteem as well as by cultural and professional identity. Likewise, we suppose teachers possess solid knowledge of their teaching fields and abilities to identify problems as well as to provide solutions to them within particular educational contexts. For those reasons, and in order to help teachers strengthen their professional knowledge, the programmes offered to English teachers in the Foreign Languages Department of the Universidad Nacional de Colombia since 1995 have included three main components: language development, methodological updating and classroom research. The first two components respond to the trainees’ manifested needs to maintain or improve competence in using and teaching the target language, whereas the last one attempts to foster innovation

Pre-treatment direct costs for people with tuberculosis during the COVID-19 pandemic in different healthcare settings in Bandung, Indonesia.

The tuberculosis (TB) program was massively disrupted due to the COVID-19 pandemic, which may have impacted on an increase in costs for people with TB (PWTB) and their households. We aimed to quantify the pre-treatment out-of-pocket costs and the factors associated with these costs from patients' perspective during the COVID-19 pandemic in Bandung, Indonesia. Adults with pulmonary TB were interviewed using a structured questionnaire for this cross-sectional study recruiting from 7 hospitals, 59 private practitioners, and 10 community health centers (CHCs) between July 2021 to February 2022. Costs in rupiah were converted into US dollars and presented as a median and interquartile range (IQR). Factors associated with costs were identified using quantile regression. A total of 252 participants were recruited. The median total pre-treatment cost was $35.45 (IQR 17.69-67.62). The highest median cost was experienced by participants from private hospitals ($54.51, IQR 29.48-98.47). The rapid antigen and PCR for SARS-CoV-2 emerged as additional medical costs among 26% of participants recruited in private hospitals. Visiting ≥  6 providers before diagnosis ($38.40 versus$26.20, p <  0.001), presenting first at a private hospital ($50.68, p <  0.05) and private practitioners ($34.97, p <  0.05), and being diagnosed in the private health sector ($39.98 versus$20.30, p <  0.05) were significantly associated with higher pre-treatment costs. PWTB experienced substantial out-of-pocket costs in the process of diagnosis during the COVID-19 pandemic despite free TB diagnosis and treatment. Early detection and identification play an important role in reducing pre-diagnostic TB costs

Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria—A mixed methods study

Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts.</jats:p

Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria-A mixed methods study.

Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts

Portable logger to measure CO₂ concentration, temperature and humidity.

<p>An internal view of the portable personal CO₂ logger incorporated a COZIR Ambient 0–1% transducer (Gas Sensing Solutions Ltd., Glasgow, United Kingdom), GPS sensor, independent power supply and USB interface. Unit dimensions were length 10 cm, width 6 cm and depth 2.5 cm.</p

COVID-19 policies and tuberculosis services in private health sectors of India, Indonesia, and Nigeria

Introduction: The COVID-19 pandemic created unprecedented challenges in the field of global health. Nigeria, Indonesia and India are three high tuberculosis (TB) burden countries with large private health sectors. Both TB and the private health sector faced challenges in these countries because of COVID-19. This study aimed to compare the COVID-19 control measures and policies in the provision of TB care services and gain insights from policymakers on how the pandemic affected the provision of TB services in the private healthcare sector, how each country adapted, and identify lessons learned for health system preparedness. Methods: Qualitative, in-depth interviews were conducted among a purposive sample of 11 national and sub-national policymakers in each country. Thematic content analysis was conducted on the data collected using an adapted WHO Health Equity Policy Framework. Results: Results revealed three policy dimensions under costs, access, and quality. Under healthcare costs, policymakers highlighted resource allocation and diversion of TB resources to COVID response, and increased operational costs for private provider. Under healthcare access, key themes included reduced TB case detection due to fear of COVID-19, disrupted diagnostic services, and adaptations such as extended medicine supplies and tele-consultations. Under healthcare quality, themes included compromised TB diagnostic accuracy due to similar respiratory symptoms with COVID-19, and strain on laboratory infrastructure due to competing demands from both diseases. Policymakers across the three countries pointed to the need for strengthening private–public partnerships (PPP) for healthcare service delivery and continued private sector investment to facilitate the continuity of TB care within a pandemic context. Conclusion: The results of this study provide an overview of the impact of the pandemic from the perspective of private facilities and policymakers in Nigeria, Indonesia and India, which can inform future policy and ways forward in strengthening PPP for healthcare service delivery in high TB burden countries

Quantification of Shared Air: A Social and Environmental Determinant of Airborne Disease Transmission - Figure 3

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106622#pone-0106622-g003" target="_blank"><b>Figure 3 A</b></a>: Ambient parts per million of CO₂ recorded at minute intervals by the logging device carried by a subject during a 24-hour period. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106622#pone-0106622-g003" target="_blank"><b>Figure 3 B</b></a>: Litres per minute of rebreathed air with additional allocation to specific locations. Litres per minute of rebreathed air were calculated for a 24-hour period (transformation from ambient CO₂ levels in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106622#pone-0106622-g002" target="_blank">Figure 2A</a>) and additionally allocated to specific locations using diary and GPS information. The volume of rebreathed shared air is represented by the area under the curve for each location visited and the daily rebreathed volume is the sum of all volumes at all locations visited.</p

Daily volumes of rebreathed air in the pilot study and the adolescent study.

<p>Pilot study (left bar) shows median, inter-quartile ranges and maximum and minimum daily volumes of rebreathed air from others for 17 adults providing 29 daily records. Adolescent study (right bar) shows median, inter-quartile ranges and maximum and minimum daily volumes of rebreathed air of 108 daily records from 63 adolescents living in a high TB prevalence township. N.B. A single outlier value of 550 litres per day for the adolescent study is not shown as it exceeds the maximal value of the ordinate scale.</p