Population Services International (PSI), a non-profit organization incorporated in 1970, combines entrepreneurial spirit with social mission to encourage healthy behavior worldwide.  Through its health social marketing programs in over 60 countries, PSI distributes affordable, accessible, and attractive health products.  PSI raises awareness of health problems and generates demand for the health products it provides through innovative and culturally sensitive communications.  PSI’s primary interventions concern: family planning, HIV/STI prevention, diarrheal disease, malaria, micro-nutrient deficiencies, waterborne illnesses, and tuberculosis.

PSI’s mission is to deliver affordable and accessible health products to low-income populations, and to produce and disseminate innovative, culturally appropriate behavior change communications.  PSI's social marketing approach is based on four core principles:

• To serve the poor, primarily by pricing products affordably and making them widely available 
• To achieve measurable health impact
• To provide products and services cost-effectively, primarily by working through an existing commercial infrastructure
• To strategically target consumers, vendors, and health care providers with communications and training programs that emphasize correct use of each product and service to promote healthy behavior

What Can PSI Do?
Innovative PSI programs can respond to the global TB epidemic by:

Improving the private sector’s ability to manage TB effectively through a “Social Franchising” approach, including training private health care providers as franchise members in TB diagnosis and treatment, and supporting DOTS supervision.  PSI can also over-brand the TB drugs/treatment and promote the use of improved TB services.  This approach has proven effective for PSI in Myanmar and Pakistan.

Implementing social marketing & communication campaigns designed to increase care seeking behaviors around TB, reduce stigma around DOTS treatment, and increase patients’ and providers’ belief that TB can be cured.  PSI has already had successful programs for TB communications in Kenya, Laos, Pakistan, Romania, and Myanmar.

What are PSI’s major successes in TB to date?

Myanmar
Myanmar was PSI’s first TB project, launched with PSI discretional funding.  Population Services International (PSI)/Myanmar introduced TB DOTS (Directly Observed Treatment, Short course) to low income communities through the Sun Quality Health (SQH) franchise network of private doctors in 2004. SQH members are licensed general practitioners (GPs) with pre-existing clinics serving low-income populations, who work full-time in their clinics and who demonstrate a positive attitude towards quality and equity in health care. The TB social franchise intervention is targeted towards low-income TB patients in the community at large, as well as those living among population sub-groups in Myanmar, such as migrants, people living with HIV, ethnic and religious minorities. The goal of the intervention is to contribute towards reductions in morbidity, mortality and transmission of tuberculosis (TB) in Myanmar.  The purpose of the intervention is to increase use of affordable, quality, private sector TB diagnosis and treatment services amongst the target populations in accordance with national and international guidelines.  To-date over 415 private SQH doctors have been trained by PSI/Myanmar in TB DOTS in 70 townships in 10 of Myanmar’s 14 states and divisions. In addition, 86 laboratories and their laboratory technicians have received training and accreditation from SQH.  SQH private doctors in Myanmar have tested over 35,000 clients, and registered more than 17,000 TB cases:  including registering approximately 8,000 smear positive TB cases.  They have achieved a treatment success rate of 83 % among new smear-positive cases.  Only 4 percent of clients have defaulted.  Today, SQH clinics contribute approximately 15% of the estimated case detection rate (CDR) in the states and divisions in which PSI works.  Research also indicates that 68% of TB patients who received DOTS through SQH clinics were from lower socio-economic groups.  The intervention has been subject to internal and external reviews and a paper has been drafted by the WHO and is in the process of being published entitled: Social Franchising of TB Care through Private GPs in Myanmar – an Assessment of Access, Quality of Care, Equity and Financial Protection.  The study found that the project is reaching the poor with quality TB services and increasing case detection rates in areas where the project is active.

Pakistan
GreenStar and PSI Pakistan launched their TB project in 2006.  PSI’s local partner, GreenStar trained over 1,010 providers in DOTS in 962 franchised clinics and contracted over 80 private laboratories to do sputum smear microscopy.  GreenStar also linked private labs in each site to government NTP quality assurance systems and training.  To date, more than 10,557 community based treatment supporters have been trained to monitor DOTS treatment on the ground.  Outreach activities have reached over 203,603 people and 9151 TB cases have been detected and are under treatment to date:  7,155 of them smear positive. GreenStar now contributes between 33% - 51% of all new of total new sputum smear positive TB cases in areas where they operate.  Today, GreenStar has an 80% treatment success rate for new sputum smear positive TB cases.

Kenya
PSI designed and executed a mass media campaign encouraging people with signs of tuberculosis to seek treatment and to educate the general community on the curability of TB, the availability of treatment at public health facilities in Kenya, and the dangers of untreated TB. The campaign reached over 72% of Kenyans and significantly raised knowledge levels about TB, while increasing knowledge of where to go to get diagnosed and treated.  The campaign was well liked, and was non-stigmatizing to those who had TB.