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Table 1 Key Documents from the WHO and Stop TB Partnership Websites

From: Engagement of the private pharmaceutical sector for TB control: rhetoric or reality?

Key documents Key messages related to engaging private-sector retail drug outlets Gaps
TB patients and private providers in India (1997) [44] Exclude anti-TB drugs from private channels. Prescriber-oriented education in private drug-distribution channels. Delegation of TB control responsibilities to non-governmental organizations. Public-private collaboration for the delivery of documented TB cures. No recommendation of engaging “drug retailers” despite documenting evidence of their TB drug dispensing practices.
Global Plan to Stop TB (2001–2005) [45] DOTS strategy implementation specified for private practitioners, non-governmental organizations, hospitals, clinics, prisons, industry, and military. No explicit mention of engaging private pharmacies.
Legislation and Regulation for TB Control (2001) [46] Create an effective partnership with private-sector physicians to implement national guidelines on TB control. Envisage the regulation of a drug supply for TB exclusively through the public health system. No mention of engaging private pharmacies.
Emerging policy framework for involving private practitioners (2001) [19] First WHO document to include “private pharmacists” as part of the formal definition of private providers to be engaged in TB control. Global assessment in 23 countries focused on private physicians. Captured evidence on patient health-seeking behavior in pharmacies and unrestricted availability of anti-TB drugs. Options for engagement prioritized only for physicians. Restriction on TB drug availability in the private sector specified without engagement of wholesalers and private pharmacies.
Improving TB Drug Management. Accelerating DOTS Expansion (2002) [47] In the context of analyzing TB drug management practices and to inform decision-making, recommendations were made to monitor private pharmacies or private clinics if they are an important source of anti-TB drugs. None
Expanded DOTS Framework (2002) [48] Involve private-sector health providers for case detection and DOTS implementation. No specification of private pharmacies as part of the private sector.
Expanding DOTS in a changing health system (2003) [49] Considerations on how best to ensure standardized, high-quality, affordable drugs through all providers, including private pharmacies, will be necessary. Engaging private pharmacies to ensure an uninterrupted supply of high-quality drugs was briefly considered in the context of the role of private providers. There was no mention of engaging private pharmacies from the perspective of patient case detection and referral.
PPM DOTS Practical Tool (2003) [50] “Pharmacists” was mentioned several times throughout the document, including considerations on how to engage them. A sample referral form for non-physicians was included to encourage adaptation and use depending on the local context. None
PPM Guidelines (2006) [51] The guideline clearly lists the importance of engaging pharmacists, drug shops and non-physicians so that the poor and vulnerable can receive appropriate care and referrals. Interventions include identifying persons suspected of having TB, collecting sputum samples, making referrals, notifying/recording cases, and supervising treatment. Pharmacy associations were listed among various PPM stakeholders for engagement at the national level. None
DOTS Expansion Working Group Strategic Plan (2006) [52] The term “PPM DOTS” has evolved to represent a comprehensive approach to involve all relevant health care providers in DOTS. PPM-DOTS targets a wide range of audiences as well as private health care providers not yet sufficiently linked to NTPs. Private pharmacies were included among a variety of private providers. None
Second Global Plan to Stop TB (2006) [53] Promotes the wider and more strategic use of existing strategies for TB control with an explicit mention of engaging “private pharmacies” and the “informal health sector” for introducing or scaling up PPM-DOTS. None
9th WHO STAG-TB Meeting (2009) [54] Special session on policy change for improved quality and rational use of anti-TB drugs. Recommended to schedule anti-TB drugs as restricted with special reporting requirements for pharmacies and prescribers. WHO must develop approaches to engage pharmaceutical companies, professional associations, and pharmacies to curb unethical practices and promote rational use of anti-TB drugs. None
PPM Scale up (2010) [55] Non-physicians and private pharmacies were included as part of a PPM task-mix strategy. Pharmacists may be able to identify persons with TB-like symptoms, collect sputum samples, refer suspects, notify or record cases, and supervise treatment. None
Third Global Plan to Stop TB (2011) [56] There is good evidence that PPM approaches can increase the percentage of people who are diagnosed and receive high-quality treatment by between one-quarter and one-third, with health care providers, such as pharmacists, traditional healers, and private practitioners, often serving as the first point of contact for people with TB symptoms. None
Role of pharmacists in TB care and control (2011) [57] The WHO/FIP joint statement recommended engaging pharmacists and national pharmacy associations in TB control. None
Engaging all providers for drug-resistant TB (DR-TB) (2015) [58] Non-physicians, such as private pharmacists, are currently engaging in PPM for TB care and control. They can be similarly engaged in patient-centered care for DR-TB, such as by providing DOTS and identifying and reporting side-effects of second-line drugs. Pharmacists can also provide education to family members on infection control and strategies to prevent and manage stigma. None