Brubacher Laura Jane, Yellappa Vijayashree, Lestari Bony Wiem, Heitkamp Petra, Aguilera Vasquez Nathaly, Sassi Angelina, Olusola-Faleye Bolanle, Thapa Poshan, Shyam Klinton Joel, Sheokand Surbhi, Pai Madhukar, Oga-Omenka Charity
School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
TB PPM Learning Network, McGill International TB Centre, McGill University, Montreal, Québec, Canada.
BMJ Glob Health. 2025 Jan 20;10(1):e016180. doi: 10.1136/bmjgh-2024-016180.
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.
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 's Determinants of Health Systems Resilience Framework.
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.
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.
新冠疫情对全球卫生系统构成了前所未有的挑战，对结核病（TB）病例通报和服务提供产生了严重影响。印度、印度尼西亚和尼日利亚是结核病高负担国家，大多数结核病初诊患者在私立卫生部门就诊。本研究的目的是：（1）探讨政策制定者对新冠疫情对印度、印度尼西亚和尼日利亚私立部门结核病服务提供影响的看法；（2）确定结核病服务提供方面大流行防范的交叉见解。
2021年5月至11月，对印度、印度尼西亚和尼日利亚参与卫生服务管理、结核病服务提供和/或新冠应对的关键政策制定者进行了33次访谈（每个国家11人）。访谈重点关注新冠疫情对结核病服务的影响以及在每个研究背景下结核病大流行防范的经验教训。采用混合归纳-演绎方法对数据进行主题分析，以霍尔丹的卫生系统恢复力决定因素框架为依据。
政策制定者强调了部门间协作、有效治理、创新融资策略、卫生人力重新分配以及虚拟咨询和移动健康等技术进步在新冠疫情期间加强结核病服务提供方面的关键作用。印度依靠患者-提供者支持机构实施跨部门和跨州的结核病联合护理战略。印度尼西亚利用私立提供者专业协会网络促进新冠应对的协调。尼日利亚实施了公私转诊大流行政策，以确保结核病护理的连续性。
各国在新冠疫情期间采取了不同措施来支持结核病服务提供。本研究展示了来自三个国家（印度、印度尼西亚和尼日利亚）的见解，共同提供了一份关于支持结核病护理大流行防范以加强卫生系统恢复力的可能性“菜单”。
