RT Journal Article SR Electronic T1 Facilitators and Barriers for Private Health Sector Engagement for TB Care in India: A Systematic Review and Meta-Synthesis of Qualitative Research JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2400034 DO 10.9745/GHSP-D-24-00034 VO 12 IS 4 A1 PS, Rakesh A1 Shannawaz, Mohd A1 Mathew, Manu E. A1 Sachdeva, Kuldeep Singh YR 2024 UL http://www.ghspjournal.org/content/12/4/e2400034.abstract AB Key FindingsDespite efforts by the National TB Elimination Program (NTEP) to engage the private sector in providing timely, high-quality TB care and services, private-sector engagement in India remains suboptimal.A meta-synthesis of qualitative findings from 19 studies included in the review found that although private-sector providers were committed to contributing to the fight against TB, they expressed several concerns that posed barriers to partnering with NTEP.Barriers to private-sector engagement included for-profit private-sector providers expressing concerns about losing business to NTEP, lack of coordination between sectors, concerns about patient confidentiality and privacy, and negative attitudes and lack of capacity of NTEP staff to deal with private-sector providers.Enablers for private-sector engagement included nonfinancial incentives like recognition, feedback, involvement in planning, and consideration as equal status in the public-private partnership.Key ImplicationsPolicymakers should address barriers to private-sector engagement in TB care and develop a comprehensive engagement strategy and uniform understanding among all stakeholders.District- and state-level program managers need to clearly understand the vision of private-sector engagement for TB care and support the private sector to achieve the same as equal partners in the fight against TB.Introduction:Private sector engagement is recognized as one of the most critical interventions to achieve the End TB goals in India. We conducted a systematic review and a meta-synthesis of qualitative studies to identify the barriers and facilitators for private sector engagement in TB care in India.Methods:A systematic search in electronic databases was done. We assessed the methodological limitations of individual studies, synthesized the evidence using thematic analysis, and assessed our confidence in each finding.Results:Of the 19 eligible articles included for the qualitative synthesis, 31.5% (6/19) were conducted in northern states of India. Included studies had details from 31 focus group discussions and 303 in-depth interviews conducted among various stakeholders. The synthesis revealed that barriers to engaging the private sector were lack of coordination mechanisms, lack of the National TB Elimination Program (NTEP) staff capacity to deal with the private sector, lack of private practitioners’ knowledge on various programmatic aspects, and perceived complexity of the data exchange mechanism. The private sector felt that NTEP was not sensitive to the patient’s confidentiality and demanded too much patient data. The private sector considered nonfinancial incentives like recognition, feedback, involving them in planning, and giving them equal status in partnership as powerful enablers for their engagement in TB care.Conclusion:Factors related to the context in which the engagement occurs, the architecture of the engagement, and interaction among the actors contribute to barriers to engaging the private sector for TB care in India. Strengthening policies to protect patient confidentiality, using behavior change communication to NTEP program managers, providing managerial and soft-skill training to NTEP staff, promoting nonfinancial incentives to private providers, establishing a coordination mechanism between the sectors, and simplifying the data exchange mechanisms need to be done to further strengthen the private-sector engagement.