Public-private partnership in TB: Spotlight interview with Vijayashree Yellappa

Interview with Vijayshree Yellappa, by Angela Chen

Dr Vijayashree Yellappa, a SSHIFTB contributor, is a medical doctor in India, specialized in Public Health, HIV medicine and  public-private partnerships for TB care. We had the privilege of sitting down with Dr. Yellappa to discuss her perspectives on social science solutions to the TB epidemic.

Angela Chen: Could you describe your current positions and roles?

Dr. Yellappa: As with many researchers, there is no “typical day”. I wear several hats right now. First, as a Fellow with NITI Aayog, the premier think tank of India. Secondly, as a chair of the TB-PPM Learning Network executive committee in India, and third, as a researcher working in several institutions on public-private-partnerships in TB care and Primary Health care.

Angela Chen: What was your career journey? How did you become involved in social science research in the TB field?

Dr. Yellappa: I began my career as a medical officer in a primary health center and complemented my studies with a Master in Public Health from National University of Singapore. When I joined the World Health Organization as Medical consultant for the National TB Control Programme in India, I noticed that a majority of patients were seeking care from private practitioners even though public centers have free testing available to them. I realized that unless we include the private sector, we won’t move forward in addressing the TB epidemic. In the public health context of India, working at the intersection between the private and public sector, I noticed the impact that the different philosophies and worldviews had on the way the two sectors interacted. Driven by curiosity, I pursued a PhD at the Institute of Tropical Medicine in Belgium (2013-17) to better understand how to effectively engage the private sector in the National TB Programme.

Angela Chen: What do you value most about social science research?

Dr Yellappa: As a doctor, you look at each patient as a case that can be diagnosed and treated from a bio medical perspective. It was only after I started reading more social science research and engaging in research projects driven by qualitative methods, particularly when I worked on a project looking at the barriers of point of care tests, did I begin to appreciate patients’ complex journeys in healthcare within the larger societal context. My worldview changed, as a doctor and as a person, and I was able to be a more empathetic practitioner when I also considered the patient’s perspective. My PhD project led me to explore qualitatively how TB patients cope with the long duration of TB treatment. I explored how difficult it is for patients to complete their TB treatment while also considering the associated familial and societal pressures.

Angela Chen: Could you highlight a few challenges you face as a social science TB researcher?

Dr. Yellappa: For so long, TB has been regarded as a biomedical disease needing only quantitative data research, which provides the quantum of the problems. Like many other researchers, I believe that qualitative data plays a role in explaining why the quantitative numbers are the way they are and how it can be improved. Another barrier is the challenges oftentimes associated with getting ethical clearance for research projects. Qualitative research often involves interviews that may be on sensitive topics that risk re-traumatizing participants, for example interviewing family members about maternal deaths. Despite these challenges, qualitative research is important in bringing greater context to this epidemic and to move forward on policies that will fill gaps in service delivery.

Angela Chen: What would you say about the future of social science TB work in India?

Dr. Yellappa: Looking into the future, I’m hopeful. Medical education in India is being revamped to include subjects of ethics and I hope that there will soon be a social science curriculum. The time must come for medical graduates to look at illness from a social science lens. This will allow them to understand health in a broader scope, beyond a biomedical perspective.