India Study Identifies Essential Functions for Tuberculosis Private Sector Care Transition

A comprehensive mixed-methods evaluation of private sector engagement for tuberculosis care in India has established that maintaining dedicated field cadres and hub-and-spoke delivery architectures is critical to sustaining care delivery, even as health systems shift from internationally backed initiatives to domestic financing. The study, published in BMC Health Services Research by lead author Ridhima Sodhi and colleagues including Pranati Das, Manoj Singh, Raghuram Rao, Harkesh Dabas, Shamim Mannan, and Mohammed A. Yassin, examined the implementation trajectory of the Joint Effort for Elimination of Tuberculosis—one of India’s largest public-private mix initiatives—alongside its subsequent transition toward domestically financed operational models. The investigators reported that while structured engagement substantially enhanced notification and clinical metrics, the shift to domestic funding mechanisms introduced pronounced implementation variability across state jurisdictions.

The operational scope of the investigation is rooted in the substantial epidemiological scale of tuberculosis within the country, as India accounts for more than a quarter of the global tuberculosis burden. Because a large proportion of patients seeking medical care for tuberculosis turn to private healthcare providers, establishing structured public-private mix approaches represents an essential priority for health systems. Such mechanisms are designed to support timely clinical diagnosis, rapid treatment initiation, and sustained treatment completion among individuals treated outside the public sector. The authors underscored that understanding the practical implementation experiences gained during the Joint Effort for Elimination of Tuberculosis and through the subsequent financing transition has become exceptionally urgent and relevant, particularly against the broader international backdrop of declining donor financing for tuberculosis programs.

To examine these complex program dynamics and structural transitions, the research team conducted a rigorous mixed-methods investigation combining a hybrid thematic framework, descriptive quantitative analysis, and a structured review of published evidence and official program documentation. The qualitative dimension of the research centered on 41 key informant interviews carried out across eight distinct Indian states as well as with national administrative teams. By triangulating observations from these qualitative interviews with quantitative datasets and documentary evidence, the researchers systematically analyzed programmatic governance, operational adaptations, and the systemic challenges encountered as external donor structures gave way to domestic health-system administration.

In the quantitative analysis, the researchers scrutinized historical trends in tuberculosis notifications, diagnostic utilization, treatment outcomes, and patient benefit transfers. These empirical evaluations drew upon longitudinal data compiled from the official India TB Reports spanning 2017 through 2024, coupled with Global Fund program data recorded between 2018 and 2022. The resulting quantitative evidence demonstrated substantial increases in private-sector tuberculosis notifications alongside measurable improvements across diagnostic and treatment indicators during the active period of the Joint Effort for Elimination of Tuberculosis, highlighting the direct clinical and reporting benefits achieved under structured public-private coordination.

The findings revealed, however, that the subsequent transition to domestic financing generated notable operational frictions and increased implementation variability across participating areas. Among the primary challenges documented following this fiscal transition were reductions in dedicated human resources, procedural delays in procurement and financial disbursements, the adoption of output-based reimbursement models, and the inconsistent execution of routine patient-support functions. Despite the organizational strains introduced by these institutional changes, stakeholder testimonies consistently highlighted the indispensable contributions of local government staff, whose sustained operational engagement helped preserve basic program continuity across local healthcare jurisdictions.

Key informants from national and state levels identified specific structural elements that proved indispensable during the initiative, singling out the hub-and-spoke architectural design and dedicated field cadres as core components of effective public-private mix models, despite their significant human-resource requirements. Stakeholders specifically identified a defined cluster of essential functions that must be preserved under future public-private mix models, including active notification support, sample transportation mechanisms, dedicated counseling for treatment adherence and adverse drug reactions, and stable commodity supplies underpinned by predictable and reliable financing streams.

Synthesizing these observations, the authors concluded that public-private mix and private provider support agency transitions under domestic financing can be successfully adapted to diverse local health-system contexts and requirements, provided that policymakers identify and safeguard an irreducible minimum set of core functions. Central to this recommendation is ensuring that the time, effort, and responsibilities of frontline health workers are appropriately compensated, especially as evolving program requirements demand greater engagement. The researchers noted that these implementation lessons offer actionable insights not only for Indian health authorities but also for other low- and middle-income countries that are currently navigating fiscal transitions toward domestic financing amid diminishing international assistance.

Subject of Research: Public-private mix engagement for tuberculosis care in India

Article Title: Private sector engagement for tuberculosis care in India: lessons from JEET and the transition to domestic financing

Article References: Sodhi, R., Das, P., Singh, M., Rao, R., Dabas, H., Mannan, S., & Yassin, M. A. (2026). Private sector engagement for tuberculosis care in India: lessons from JEET and the transition to domestic financing. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15966-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15966-1

Keywords: tuberculosis, India, public-private mix, JEET initiative, domestic financing, private sector engagement, TB notifications, diagnostic utilisation, treatment outcomes, patient benefit transfers, frontline health workers, hub-and-spoke architecture, Global Fund, India TB Reports, key informant interviews, health services research, low- and middle-income countries, adverse drug reaction counselling