Table 4

Representative quotations on social and resource constraints that limit HCWs’ ability to effectively do their jobs

Constraint on healthcare workersRepresentative quotation
Having to work at multiple facilitiesQ26. Health visitor 1: We are covering more than one (facility) madam.
Health visitor 1: Four centres madam.
Health visitor 2: Two centres.
Health visitor 6: Six centres madam.
Health visitor 9: For this reason, we aren’t able to treat patients well. (Excerpt from a health visitor FGD)
Q27. General staff do not collect patient details properly. We (RNTCP staff) know that, if information is not collected properly, in the future the patient may become an initial defaulter (ie, PTLFU case). So we give great importance to recording patient details, but other staff do not. (Participant in a laboratory technician FGD)
High patient volume at certain facilitiesQ28. It is very difficult (to verify patient contact information) in big centres (ie, high-volume facilities) because they are regularly overcrowded with patients. (Participant in a senior treatment supervisor FGD)
Hierarchy in the health systemQ29. They call on me while I’m trying to do my work… They send someone to get me saying, ‘Call that RNTCP girl.’ (Participant in a health visitor FGD).
Lack of material support to track patientsQ30. Most villages do not have any buses… those of us who have two-wheelers make these visits (to track PTLFU cases), but we are not receiving any reimbursement for petrol costs. (Participant in a health visitor FGD)
Lack of material support to coordinate patient referralsQ31. Due to practical difficulties we never send this column (copy of the referral form). If I have to send this column (back to the DMC) then I need to spend money from my pocket for purchasing the envelope and paying the courier charge. (Participant in a senior treatment supervisor FGD)
  • DMC, designated microscopy centre; FGD, focus group discussion; HCW, healthcare worker; PTLFU, pretreatment loss to follow-up; RNTCP, Revised National TB Control Programme; TB, tuberculosis.