Unraveling the Suboptimal Tuberculosis Score in South Goa: A Qualitative Exploration of Reasons and Solutions

Background: The tuberculosis (TB) score, a composite score based on nine domains of TB care and management, optimally should be more than 80 points. However, in the South Goa district in Goa, India, the TB score has been consistently below this level. Improving the TB score would help improve program implementation. Objectives: The objective of the study was to identify reasons and solutions for sub-optimal TB score in South Goa. Materials and Methods: Through a sequential exploratory mixed methods study design, using the quantitative data from the “sub-national certification of progress towards TB free status” exercise conducted in India and qualitative data obtained from the National Tuberculosis Elimination Programme (NTEP) functionaries within the South Goa district, “Achievement Gap” in TB score, reasons and solutions were explored. Qualitative exploration was through key informant interviews and the nominal group technique. Manual coding and descriptive content analysis were done, followed by the development of codes and themes. Results: Weighted ranking of “achievement gap” identified five poorly performing TB domains. Reasons for suboptimal TB score were poor knowledge and awareness about TB and NTEP, Social factors, challenges in NTEP implementation at the level of diagnosis of TB and management of TB and various administrative issues. Solutions identified included training of health staff, awareness campaigns, recruitment of staff to vacant posts, an effective system for monitoring and supervision of NTEP implementation, resolving administrative issues, solving transportation issues and reduction of delays at various levels. Conclusion: Practical, simple local solutions could be generated from within the NTEP which are likely to be acceptable, easily implemented in a time-bound manner.