When the public healthcare system fails to care for their citizens adequately, these patients often turn to the private sector. These private providers are doctors and pharmacists that are not employed by the government, oftentimes do not adhere to government guidelines and provide their services and products for a fee (and profit) to the patients. However, the private provider option poses significant problem that has not only aided the persistence of the disease, but also has considerably contributed to the development of the dangerous, drug-resistant forms of TB.
In a study in Vietnam, for example, it was determined that for 70% of TB cases the private sector represents the first point of contact and that 40% of TB patients are treated exclusively by the private sector. The problem here is that often very different and usually inadequate and inappropriate treatments and medications are prescribed by doctors and pharmacists, which may exacerbate the risk and development of drug resistance.
Ultimately, it may even happen that these doctors shamelessly take advantage of the ignorance and disease illiteracy of the vulnerable patients. These patients, who are already weakened financially, may be asked to have expensive MRI and CT scans performed or they are prescribed ineffective medicines.
As before, we are looking for partner organizations that have an active role in strengthening the private sector either through cooperation or through training in the fight against tuberculosis. View the following link for a video report that was produced in collaboration between Operation ASHA and ABC News illustrating this very problem.
However, the fault does not lie entirely with the doctors in the private sector. From lack of knowledge about the potential consequences patients in developing countries often also tend to buy drugs and antibiotics from the pharmacy and thus to spare to visit the doctor in the hope of a simple infection. Often there is another, more dangerous reason for the self-diagnosis and self-treatment.
The lack of education about the disease often results in a strong stigma and discrimination against TB patients from the community and society itself. This stigma frequently compels patients to keep their illness secret and spare their family the shame of being associated with a TB patient. Read more about discrimination and stigma related to TB patients in developing countries in the next section.