Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria
Introduction The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the priv...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/1/e016180.full |
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| author | Madhukar Pai Poshan Thapa Charity Oga-Omenka Angelina Sassi Vijayashree Yellappa Petra Heitkamp Bony Wiem Lestari Surbhi Sheokand Nathaly Aguilera Vasquez Laura Jane Brubacher Bolanle Olusola-Faleye Joel Shyam Klinton |
| author_facet | Madhukar Pai Poshan Thapa Charity Oga-Omenka Angelina Sassi Vijayashree Yellappa Petra Heitkamp Bony Wiem Lestari Surbhi Sheokand Nathaly Aguilera Vasquez Laura Jane Brubacher Bolanle Olusola-Faleye Joel Shyam Klinton |
| author_sort | Madhukar Pai |
| collection | DOAJ |
| description | Introduction The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the private health sector. The objectives of this study were to (1) explore policy-makers’ perspectives on the impact of the COVID-19 pandemic on private sector TB service delivery in India, Indonesia and Nigeria and (2) identify cross-cutting insights for pandemic preparedness with respect to TB service delivery.Methods From May to November 2021, 33 interviews were conducted with key policy-makers involved in health service administration, TB service delivery and/or the COVID-19 response in India, Indonesia and Nigeria (n=11 in each country). Interviews focused on the impact of COVID-19 on TB services and lessons learnt for pandemic preparedness with respect to TB in each study context. Data were analysed thematically using a hybrid inductive-deductive approach, informed by Haldane et al’s Determinants of Health Systems Resilience Framework.Results Policy-makers highlighted the crucial role of intersectoral collaboration, effective governance, innovative financing strategies, health workforce reallocation and technological advancements such as virtual consultations and mHealth in strengthening TB service delivery amid the COVID-19 pandemic. India relied on patient–provider support agencies to implement a joint strategy for TB care across sectors and states. Indonesia engaged networks of private provider professional associations to facilitate coordination of the COVID-19 response. Nigeria implemented a pandemic policy for public–private referral for the continuity of TB care.Conclusions Countries implemented varied measures to support TB service delivery during the COVID-19 pandemic. This study presents insights from three countries (India, Indonesia and Nigeria) that together offer a ‘menu’ of possibilities for supporting pandemic preparedness with respect to TB care vis-à-vis strengthening health systems resilience. |
| format | Article |
| id | doaj-art-cbe3d3024cc843bc94b5215e8a95fb3f |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-cbe3d3024cc843bc94b5215e8a95fb3f2025-01-22T05:10:09ZengBMJ Publishing GroupBMJ Global Health2059-79082025-01-0110110.1136/bmjgh-2024-016180Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and NigeriaMadhukar Pai0Poshan Thapa1Charity Oga-Omenka2Angelina Sassi3Vijayashree Yellappa4Petra Heitkamp5Bony Wiem Lestari6Surbhi Sheokand7Nathaly Aguilera Vasquez8Laura Jane Brubacher9Bolanle Olusola-Faleye10Joel Shyam Klinton11Research Institute of the McGill University Health Centre, McGill University, Montreal, Québec, CanadaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaSchool of Public Health Sciences, University of Waterloo, Waterloo, Ontario, CanadaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaResearch Institute of the McGill University Health Centre, McGill University, Montreal, Québec, CanadaResearch Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, IndonesiaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaSchool of Public Health Sciences, University of Waterloo, Waterloo, Ontario, CanadaSustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, NigeriaTB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, CanadaIntroduction The COVID-19 pandemic was an unprecedented challenge to health systems worldwide and had a severe impact on tuberculosis (TB) case notifications and service delivery. India, Indonesia and Nigeria are high TB-burden countries where the majority of initial care-seeking happens in the private health sector. The objectives of this study were to (1) explore policy-makers’ perspectives on the impact of the COVID-19 pandemic on private sector TB service delivery in India, Indonesia and Nigeria and (2) identify cross-cutting insights for pandemic preparedness with respect to TB service delivery.Methods From May to November 2021, 33 interviews were conducted with key policy-makers involved in health service administration, TB service delivery and/or the COVID-19 response in India, Indonesia and Nigeria (n=11 in each country). Interviews focused on the impact of COVID-19 on TB services and lessons learnt for pandemic preparedness with respect to TB in each study context. Data were analysed thematically using a hybrid inductive-deductive approach, informed by Haldane et al’s Determinants of Health Systems Resilience Framework.Results Policy-makers highlighted the crucial role of intersectoral collaboration, effective governance, innovative financing strategies, health workforce reallocation and technological advancements such as virtual consultations and mHealth in strengthening TB service delivery amid the COVID-19 pandemic. India relied on patient–provider support agencies to implement a joint strategy for TB care across sectors and states. Indonesia engaged networks of private provider professional associations to facilitate coordination of the COVID-19 response. Nigeria implemented a pandemic policy for public–private referral for the continuity of TB care.Conclusions Countries implemented varied measures to support TB service delivery during the COVID-19 pandemic. This study presents insights from three countries (India, Indonesia and Nigeria) that together offer a ‘menu’ of possibilities for supporting pandemic preparedness with respect to TB care vis-à-vis strengthening health systems resilience.https://gh.bmj.com/content/10/1/e016180.full |
| spellingShingle | Madhukar Pai Poshan Thapa Charity Oga-Omenka Angelina Sassi Vijayashree Yellappa Petra Heitkamp Bony Wiem Lestari Surbhi Sheokand Nathaly Aguilera Vasquez Laura Jane Brubacher Bolanle Olusola-Faleye Joel Shyam Klinton Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria BMJ Global Health |
| title | Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria |
| title_full | Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria |
| title_fullStr | Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria |
| title_full_unstemmed | Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria |
| title_short | Health and tuberculosis systems resilience, the role of the private sector and pandemic preparedness: insights from a cross-country qualitative study with policy-makers in India, Indonesia and Nigeria |
| title_sort | health and tuberculosis systems resilience the role of the private sector and pandemic preparedness insights from a cross country qualitative study with policy makers in india indonesia and nigeria |
| url | https://gh.bmj.com/content/10/1/e016180.full |
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