OBJECTIVES : Globally, Pakistan ranks fifth in Tuberculosis (TB) case burden. It is estimated that 36% of the incident (562,000) TB cases in the country remain undetected/missed and initiate TB care from providers in private healthcare system who unfortunately, do not report TB cases to National TB Control Program (NTP) of Pakistan. In order to engage these private providers for reaching out missing TB cases, NTP cohesively launched an implementation trial of Public-Private Mix (PPM) model in 2014. The study aims to assess the contribution and relative treatment outcomes of cohesively implemented PPM approaches (private sector) used in all four provinces of Pakistan in comparison to non-PPM approach (public sector).

METHODS : A retrospective cross-sectional study of all forms TB (new and relapsed cases) patients notified in PPM and non-PPM models from July 2015 to June 2016.

RESULTS : PPM model was implemented in 92 districts in total and contributed 25% (81,016 TB cases) to the national TB case notification in comparison to non-PPM contribution. A very strong statistical evidence existed among compared PPM and non-PPM variables related to gender (p < 0.001), age group (p < 0.000) and province (p < 0.000). Among PPM approaches, General Practitioner and Non-Governmental-Organization facilities achieve the same outcomes as non-PPM, with treatment success of 94%-95%; private hospitals achieve 82% success because of a total of 14% not evaluated or lost; Parastatals are unable to follow more than half of cases, and therefore achieves a success rate of just 47%.

CONCLUSIONS : PPM model findings in Pakistan are considerably consistent with countries that have prioritized PPM for increasing trend (5-56%) in TB case notification to their national TB control programs. Different PPM approaches need to be scaled up in terms of PPM implemented districts, PPM coverage, PPM coverage efficiency and PPM coverage outcome in the Pakistani healthcare system in future.