A qualitative study exploring perspectives and practices of district TB officers and frontline TB workers implementing public-private mix for TB control in India

Abstract

The bottom-up perspective of policy implementation process recognizes that policy implementers play a vital role, are capable of re-shaping policy during implementation, and that studying their behaviour is important. Public Private Mix (PPM) has been a core component of the Revised National TB Control Programme in India. The programme encourages District TB Officers and Frontline TB Workers to actively involve NGOs and Private Practitioners to improve the quality of frontline service delivery. The paper reports the findings from an empirical study on the perspectives and practices of public sector actors towards implementation of the PPM-TB strategy in India. This study was conducted within a district in a southern state of India and utilised qualitative methodologies - observations, informal interactions and 26 in-depth interviews with public sector actors. Drawing on Lipsky and Bourdieu's theoretical insights, results reveal the behavioural practices and deepen our contextual understanding of the complex process of social relationships operating at the policy implementation level. These qualitative insights can help policy makers and programme managers to design strategies towards strengthening public-private relationships in order to minimize the policy-practice gaps in elimination of TB.