BackgroundThe Government of India, made TB notification by private healthcare providers mandatory from May 2012 onwards. The National TB Programme developed a case based web based online reporting mechanism called NIKSHAY. However, the notification by private providers has been very low. We conducted the present study to determine the awareness, practice and anticipated enablers related to TB notification among private practitioners in Mysore city during 2014.MethodsA cross-sectional study was conducted among private practitioners of Mysore city in south India. The private practitioners in the city were identified and 258 representative practitioners using probability proportional to size were interviewed using semi-structured questionnaire.ResultsAmong the 258 study participants, only 155 (60%) respondents agreed to a detailed interview. Among those interviewed, 141 (91%) were aware that TB is a notifiable disease; however 127 (82%) of them were not aware of process of notification and NIKSHAY. Only one in six practitioners was registered in NIKSHAY, while one in three practitioners are notifying without registration. The practitioners expected certain enablers from the programme like free drugs, training to notify in NIKSHAY and timely feedback. 74 (47%) opined that notification should be backed by legal punitive measures.ConclusionThe programme should develop innovative strategies that provide enablers, address concerns of practitioners while having simple mechanisms for TB notification. The programme should strengthen its inherent capacity to monitor TB notification.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1943-z) contains supplementary material, which is available to authorized users.

Mobile health (mHealth), i.e., the use of portable electronic devices with software applications to provide health services and manage patient information, 1 has the potential to transform health service delivery worldwide. 2 mHealth has a crucial role to play in health care systems, as it can improve communication and enhance the integration of health care processes. 3 Low-and middle-income countries have extensive cellular networks, and the majority of the population has mobile phones. 2 Tuberculosis (TB) remains a major public health problem in India, accounting for 23% of the global TB burden. 4 Despite case-finding efforts by the Revised National TB Control Programme (RNTCP), the country is believed to have up to one third of the estimated three million TB cases that remain unnotified worldwide. 4 Nearly 50% of TB patients are treated in the private sector, where health care providers include specialist physicians as well as unqualified providers. 5 The RNTCP has various schemes for non-governmental organisations and private practitioners (PPs) that allow private health care providers to sign an official memorandum of understanding with the Government to provide RNTCP services, for which PPs are offered incentives. 6,7 However, the involvement of PPs in these schemes is not optimal due to the complicated procedures involved and the RNTCP's delay in providing incentives; furthermore, much of the focus is on allopathic doctors and their health facilities, which are generally located in urban and semi-urban areas. In rural areas, public health services are difficult to access, as the facilities are often located far from the inhabitants and there is poor transport connectivity. In addition, health care personnel capable of providing these services are sometimes lacking at these facilities; similar problems are observed across the country. There are very few qualified private health care providers in rural areas. 8,9 The first point of contact for any kind of ailment are health care providers who often lack formal training or are trained in alternative medicine. 5,10 Nearly 72% of health care in rural areas is provided by the private sector, and nearly 81% of the doctors are unqualified. 11 The provider-to-patient ratio in India is 1:2000. 12 Until now, the RNTCP had not attempted to involve unqualified health care providers/rural health care providers (RHCPs) in TB care, although they are responsible for the management of a significant number of presumptive TB cases and TB patients. These practitioners play an important role in TB control. As the first point of contact for the majority of the rural population, they can be trained to identify presumptive TB cases early and refer them to diagnostic and treatment services, thus preventing delays. They can also be effective providers of directly observed therapy (DOT), as they have earned the confidence and trust of the community they serve. Global efforts have been made to involve all stakeholders in general, but do not specifically address the role of unqualifie...

Background Weak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries. Methodology The present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care. Results A total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities. Conclusion There is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.

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