Graduation Year

2015

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Global Health

Major Professor

Ricardo Izurieta, Ph.D.

Committee Member

Ismael Hoare, Ph.D.

Committee Member

John Petrila, Ph.D.

Keywords

GIS, Healthcare Provision, Social Franchising, Stigma, Tuberculosis

Abstract

TB care and prevention is led by the public sector, but many TB symptomatics first seek care in the private sector, highlighting the importance of engaging these facilities. This report examines basic TB epidemiology (such as the gap in case finding that could be addressed in part via private sector activities), health-seeking behaviors (HSB) and diagnostic delays, the size of the private sector, activities of professional societies, and financing. It examines the potential utility of integrating Voronoi tessellations as a GIS-based method for informing and improving Public-Private Mix (PPM) efforts throughout six states in Nigeria. Further, it explores a potential methodology for quantifying the theoretical number of individuals served by each private facility in order to better guide funding allocation to private providers who need it most. Standardized searches of academic papers obtained from PubMed, Google, and of key planning documents from National Tuberculosis Programs (NTPs) were conducted. In Nigeria, PPM is quickly becoming entrenched in healthcare, and Voronoi tessellations supplement these efforts by dividing private provider location data into meaningful and clear partitions. These tessellations were deficient in areas with high levels of clustering (dense urban sprawl), but are suited for examining private provider distribution in rural locations. The methodology of estimating populations through the polygons was too inaccurate to yield meaningful conclusions. Themes for PPM implementation include effective consolidation and representation of private sector providers, structured leadership from the NTP, and an understanding of HSBs.

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