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

## TL;DR

This study explores the roles of informal healthcare providers in tuberculosis care in West Bengal, India, and finds they are actively involved and could play a bigger role.

## Contribution

The study identifies current and potential roles of informal healthcare providers in TB care and highlights their potential for expanded engagement.

## Key findings

- IPs currently serve as passive case finders and treatment supporters, roles acknowledged by NTEP-affiliated personnel.
- Most IPs and NTEP personnel agree on five potential future roles for IPs in TB care.
- Both groups are hesitant about IPs performing clinical evaluations or initiating TB treatment.

## 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 programs, in contrast to the well-defined roles of the formal private sector. Considering such gaps, this study explores the perspectives of IPs (specifically untrained allopathic practitioners, UAPs) and National TB Elimination Program (NTEP)-affiliated personnel 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 NTEP-affiliated personnel. 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 NTEP-affiliated personnel: 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 NTEP-affiliated personnel expressed reservations about assigning IPs the roles of 1) Clinical evaluation of people with TB and 2) Initiation of treatment for confirmed people with TB. The findings highlight the active involvement of IPs in various TB care roles, acknowledged by NTEP-affiliated personnel, and also demonstrate significant potential for their expanded engagement under the NTEP of India.