Health and TB systems resilience and pandemic preparedness: Insights from a cross-country analysis of data from policymakers in India, Indonesia, and Nigeria

Abstract

AbstractIntroductionThe 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 policymakers’ 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 lessons learned for pandemic preparedness with respect to TB service delivery.MethodsFrom May – November 2021, thirty-three interviews were conducted with key policymakers 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 learned for pandemic preparedness with respect to TB. Data were analyzed thematically using a hybrid inductive-deductive approach, informed by Haldane et al.’s (2021) Determinants of Health Systems Resilience Framework.ResultsPolicymakers 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.ConclusionCountries implemented varied measures to support TB service delivery during the COVID-19 pandemic. This study presents lessons learned 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.