Engagement of Informal Healthcare Providers in National Tuberculosis Elimination Program of India: A Multimethod Study

India accounts for an estimated 26% of total global Tuberculosis (TB) cases, the highest among the 30 high TB burden countries. The importance of engaging the private sector in TB care has long been endorsed in global TB policies and guidelines. However, the engagement gap is wide, particularly in relation to Informal Healthcare Providers (IPs), who are reported to be the first providers in care pathways for a significant proportion of TB patients. When compared to formal private providers (such as qualified private doctors and pharmacists), there is a non-prioritization of IPs in the National TB Elimination Program (NTEP) of India, a situation that could result from a lack of clarity concerning IPs’ roles in the National TB policies and guidelines. Such a gap with regards to IPs also prevails at the level of evidence, as limited studies have been conducted focusing on this group of providers. Therefore, this PhD project aims to achieve two primary research goals: 1) To examine IPs’ roles in TB care and 2) To explore factors influencing IPs’ engagement in the NTEP. The thesis includes five studies in a multimethod design; a scoping review on IPs’ role in TB care; two quantitative studies, the first focusing on IPs’ knowledge and the second on practices in TB care; and two qualitative studies exploring in-depth IPs’ roles in TB care, as well as the factors influencing their engagement in the NTEP of India. New empirical findings from this research include 1) Though information on IPs’ roles included in India’s TB policies and guidelines lacks clarity, IPs were found to be undertaking various TB care roles at the community level; 2) a number of potential roles for IPs in TB care were also discovered; and 3) finally, this study identifies various barriers and facilitators, including policy and system-level factors and some related to IPs’ service characteristics that can significantly influence this cadre’s engagement in the NTEP. The evidence generated through this research provides critical insight to clarify and effectively address IPs in India’s TB policies and programs. The findings provide clarity on IPs’ current roles in TB care and shed light on potential roles for IPs within the framework of NTEP. Furthermore, this study identifies various factors which can significantly influence the engagement of this cadre of workforce who are ubiquitously present in India’s health system and are highly accepted and trusted as primary care providers in the community.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2023

Author dc:creator

• Thapa, Poshan ; https://orcid.org/0000-0002-3333-1434

• informal healthcare providers
• tuberculosis
• primary care
• infectious disease
• India
• Public Private Mix in tuberculosis care
• Public Private Mix
• anzsrc-for: 4206 Public health

Statement dc:rights

• open access
• CC BY 4.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by/4.0/

Language dc:language

en

Identifier

https://doi.org/10.26190/unsworks/24803

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/101096