Quality of tuberculosis care provided in different models of public-private partnerships in South Africa.

SETTING: Free State, North West and Western Cape provinces, South Africa. OBJECTIVE: To evaluate quality of care for the treatment of tuberculosis (TB) provided in different public-private partnerships. DESIGN: Quality of care analysis comparing three different models of directly observed treatment (DOT) provision: purely public, public-private workplace partnership (PWP), and public non-governmental organisation (NGO) partnership (PNP). For each type of provision model, two sites were selected. Three dimensions of quality of TB care--structure, process and outcome--were assessed. RESULTS: The PWP sites had the highest score in all three aspects of quality of care. In terms of process quality, the sites achieved similar scores, reflecting a very good knowledge of the treatment guidelines for both private and public providers. Patients supervised in the public clinics generally had lower treatment completion rates than those supervised in the occupational health clinics in the workplace and in the community. CONCLUSION: Partnerships with community-based NGOs and employer-based medical services should be established when the government does not have the capacity to provide services. The capacity of the public sector to monitor the quality of care provided in the partnerships is therefore crucial.