TB Notification from Private Health Sector in Delhi, India: Challenges Encountered by Programme Personnel and Private Health Care Providers

Abstract

Objective To identify the challenges encountered by private health care providers (PHCP) to notify tuberculosis cases through a programme developed web-based portal mechanism called “NIKSHAY.” Study Design. It is a descriptive qualitative study conducted at two revised national tuberculosis control programme (RNTCP) districts of New Delhi. The study included in-depth interviews of PHCP registered with “NIKSHAY” and RNTCP programme personnel. Grounded theory was used to conceptualise the latent social patterns in implementation of tuberculosis case notification process and promptly identifying their challenges. Results The analysis resulted in identification of three broad themes: (a) system implementation by RNTCP: it emphasizes the TB notification process by the RNTCP programme personnel; (b) challenges faced by PHCP for TB notification with five different subthemes; and (c) perceived gaps and suggestions: to improvise the TB notification process for the private health sector. The challenges encountered by PHCP were mainly related to unsystematic planning and suboptimal implementation by programme personnel at the state and district level. The PHCP lacked clarity on the need for TB notification. Conclusion Implementation of TB notification among private health care providers requires systematic planning by the programme personnel. The process should be user-friendly with additional benefits to the patients.

Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study

“…The TBHV who currently fulfils this role in our context is probably overburdened with responsibilities in the absence of the ‘DOT centre medical officer,’ a functionary of the RNTCP. Reports from the private sector also indicate the need for additional human resources in the light of the volume of patients that they cater to 22. Identifying an additional ‘nodal officer’ for TB notification from among existing institutional personnel could optimise the use of existing resources for notification.…”

Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us

“…This study is particularly important in terms of its timing when there is a heightened political willingness around End TB in India by 2025 [62], when mandatory notification for TB (even for drugs dispensed) is being instituted [9]. Recommendations from this study hence have the potential to help bring improvements in TB control not just in the city of Mumbai, or the state of Maharashtra, but in the entire nation at large.…”

“…The Revised National TB Control Programme (RNTCP) in India is positioned within an existing medical system, which is pluralistic [5]. The programme faces a huge challenge of getting the vast private sector, the first point of contact for a majority of TB symptomatics [6, 7], to notify diagnosed TB cases and refer them to the RNTCP or manage them according to national guidelines [8, 9]. In a context, where the public sector is viewed negatively by the community due to its poor access, shortage of resources, and inefficient functioning, [10, 11] and the private sector which is more accessible and has a ubiquitous presence particularly in urban areas [12], patients move between the two sectors and different private providers in their quest for a cure [7].…”

Knowledge attitude and practice of paediatricians regarding tuberculosis case management in five major districts of Punjab state, India

“…The annual total of new TB cases increased globally to 6%, mostly due to a 29% increase in TB notifications in India. 10,11 To promote TB case notification, incentives are provided upon notification in the TB reporting software i.e. Nikshay through a smooth and programme integrated direct beneficiary transfer.…”