Challenges in Engaging the Private Sector for Ensuring Standards of TB Care: A Case Study from Delhi, India

Abstract

Introduction: Despite many efforts by the National TB Elimination Program (NTEP), ensuring standards of TB care for people with TB have not been really converted into routine practice in the private sector of the state of Delhi. The current study aims at documenting the challenges faced by the Delhi state to partner with formal private healthcare delivery providers for ensuring quality TB care. Methods: A case study approach was adopted to understand the case through a primary descriptive exploration. A scoping review of nine research studies and analysis of data from various TB annual reports from 2015 to 2024 and project reports were performed. 23 In-depth interviews with private providers, policy makers, and program staff were conducted. The grounded theory approach was used to generate a single theory of the case itself that explains it. Results: With limited human resources and their managerial capacity, NTEP found it difficult to reach out to the fragmented multitude of private healthcare providers. Private sector had various concerns to engage with NTEP including breach in the confidentiality of the clients and cumbersome documentation process. TB care indicators improved in terms of quality service delivery from the private sector when a third-party agency was engaged by NTEP; however, the same started declining with the project closure. Poor stakeholder interests, lack of mutual trust, lack of sustained interaction between the sectors, and lack of a system for co-ordination were major challenges leading to poor sustainability beyond the project duration. Conclusion: A proactive effort by the public sector with a strategic policy direction for private sector engagement, understanding and addressing the concerns of the private sector and gaining their trust, capacity building of NTEP staff to deal with private sector, making the documentation process simple, and creating a platform for dialog between sectors can enhance further engagement.