Unlocking the potential of informal healthcare providers in tuberculosis care: insights from India

In 2022, tuberculosis (TB) remained a major global health concern, second only to COVID-19 in mortality from a single infectious agent. Over 10 million people contract TB annually, with two-thirds of cases from eight high-burden countries. India alone accounted for 27% of the global burden, totalling an estimated 2.8 million cases.1 Notably, approximately 18% of these people were considered ‘missing’, either undiagnosed or not reported, because they were likely managed by the private sector, which serves the healthcare needs of about half of the patients with TB in the country. The private health sector in India, which delivers approximately 87% (in some regions, particularly if underserved) of initial primary care, is diverse and largely unregulated, extending from small clinics to multispecialty hospitals and ranging from informal providers to highly qualified specialists.2 This poses significant challenges, as patients seeking care from this sector often experience delayed TB diagnoses and inappropriate treatments.3 Therefore, to enhance TB care access and quality, it is essential to involve all healthcare providers in the private sector, both formal and informal, within the framework of the Public-Private Mix, as recommended by India’s National Strategic Plan (NSP) for TB elimination (2017–2025).