Exploring current and potential roles of informal healthcare providers in tuberculosis care in West Bengal, India: a qualitative content analysis

Abstract India accounts for 27 percent of global Tuberculosis (TB) cases, the highest among the 30 high-burden countries. Despite growing evidence highlighting the significance and potential of Informal Healthcare Providers (IPs) in TB care, their role remains ambiguous in India’s TB policies and guidelines, in contrast to the well-defined roles of the formal private sector. Considering such gaps, this study explores the perspectives of IPs and Formal Providers (FPs) regarding IPs’ current and potential roles in TB care. The study was conducted in West Bengal, India. We adopted a qualitative approach and conducted in-depth interviews with 23 IPs and 11 FPs. The study data was analysed using a content analysis approach. The study’s findings identified four current roles of IPs in TB care, two of which were corroborated by FPs: 1) Passive case finding and referral and 2) Treatment supporter. As for potential roles, an alignment was observed between the two groups of providers for the majority of the roles (5/7 roles). However, both IPs and FPs expressed reservations about assigning IPs the roles of 1) Clinical evaluation of TB cases and 2) Initiation of treatment for confirmed TB patients. The findings highlight the active involvement of IPs in various TB care roles, acknowledged by FPs, and also demonstrate significant potential for their expanded engagement under the National TB Elimination Program (NTEP) of India.