Public–private mix for tuberculosis in urban health systems in least-developed, low-income and lower–middle-income countries and territories: a systematic review

This CHORUS systematic review aimed to evaluate the impact of public–private mix (PPM) models for tuberculosis (TB) on health, process and system outcomes in urban health sectors in least-developed, low income and lower-middle income countries and territories. We adopted the WHO’s definition of PPM, which is a strategic partnership between national TB programmes and healthcare providers, both public and private, to deliver high-quality TB diagnosis and treatment.

Of the 57 included studies, the majority were from Southeast Asia (n=37). PPM models had overall positive results on TB treatment outcomes, access and coverage and value for money. They are linked with improved TB health workers’ skills and service delivery. Inconsistent implementation of national TB guidelines, uncoordinated referrals and lack of trust among partners were identified as areas of improvement. Evidence was lacking on the involvement of informal providers within PPM models.

This evidence indicates that PPM models can be effective and cost-effective for TB care in urban low- and middle-income countries contexts, particularly when levels of mistrust between public and private sectors are addressed through principles of equal partnership.

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Vidyasagaran AL, Teixeira de Siqueira Filha N, Kakchapati S, et alPublic–private mix for tuberculosis in urban health systems in least-developed, low-income and lower–middle-income countries and territories: a systematic review BMJ Open 2025;15:e093246. doi: 10.1136/bmjopen-2024-093246