6.3.2. Rationale

In most low- and middle-income countries, private providers are an important source of health care for the whole population. Typically, less poor people make more use of formal, qualified providers, while poor people often turn first to informal, unqualified providers. Private providers often account for 50–70% of care, especially outpatient primary care (175). In 7 of the 30 high TB burden countries, which also contribute to the largest proportion of TB incidence and missing TB cases, the private sector is the first point of contact for up to 75% of people seeking care (174, 176). In many high TB burden countries, especially those with a large private health sector, engagement of private providers has systematically increased, and there is a need to strengthen the engagement of all care providers, building on evidence from country experiences and initiatives that demonstrate increased case detection and good treatment outcomes through approaches that engage the private sector (175). Health care providers in the private sector may not be provided with information or trained in TB with up-todate guidance on TB diagnosis and treatment, including the use of child-friendly formulations, and children and adolescents managed in private facilities and services are often not notified to the NTP.

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