Unlocking the potential of informal healthcare providers in tuberculosis care: insights from India

• Published in: BMJ global health Vol. 9; no. 2; p. e015212
• Main Authors: Thapa, Poshan, Narasimhan, Padmanesan, Beek, Kristen, Hall, John J, Jayasuriya, Rohan, Mukherjee, Partha Sarathi, Sheokand, Surbhi, Heitkamp, Petra, Shukla, Prachi, Klinton, Joel Shyam, Yellappa, Vijayshree, Mudgal, Nitin, Pai, Madhukar
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 26.02.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Antibiotics; COVID-19; Editorial; Global Health; Health systems; India; Medical referrals; Physicians; Primary care; Public Health; Qualifications; Qualitative research; Tuberculosis; Bangladesh; West Bengal India; India; Health systems; Public Health; Tuberculosis; Global Health; India
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2024-015212

The private health sector in India, which delivers approximately 87% (in some regions, particularly if underserved) of initial primary care, is diverse and largely unregulated, extending from small clinics to multispecialty hospitals and ranging from informal providers to highly qualified specialists.2 This poses significant challenges, as patients seeking care from this sector often experience delayed TB diagnoses and inappropriate treatments.3 Therefore, to enhance TB care access and quality, it is essential to involve all healthcare providers in the private sector, both formal and informal, within the framework of the Public-Private Mix, as recommended by India’s National Strategic Plan (NSP) for TB elimination (2017–2025). Significance of IPs in TB care The importance of IPs in TB care is rooted in their widespread presence and strong acceptance within communities, where they frequently serve as the initial point of contact for patients seeking healthcare.4 The prevalence of IPs in India’s health system landscape is evident from the WHO’s India Health Workforce Report.8 This report indicates a significant portion of those identified as allopathic doctors lack formal medical training: 31.4% have only secondary school education, and an even more notable, 57.3% do not possess medical qualifications. Complementing these results, our team’s scoping review has documented the positive impacts of involving IPs across multiple domains of TB care (from prevention and detection to treatment).25 Additionally, the value of training IPs has been highlighted by several studies, including a randomised controlled trial in India, which reported a 14.2% improvement in the correct management of various conditions by IPs.20 24 26 Given this evidence, it is clear that prioritising and integrating IPs in TB care programmes is not just beneficial but necessary for enhancing care outcomes. Block 1: enabling policies and appropriate care guidelines Clear policies are needed to guide IP engagement within National TB Programmes (NTPs), providing clarity on roles and expectations and facilitating the development of national guidelines, such as protocols for screening and referral of presumptive TB cases by IPs. [...]to ensure the responsible management of TB care at the community level, policies must be clearly outlined to restrict IPs from prescribing anti-TB medications.