Exploring Potential Barriers and Facilitators to Integrate Tuberculosis, Diabetes Mellitus, and Tobacco-Control Programs in India

BackgroundIntegrating Tuberculosis (TB), Diabetes Mellitus (DM), and Tobacco-Control (TC) programs in India presents a promising strategy to address the triple burden of these diseases. However, limited information exists regarding the feasibility and influencing factors of such integration. This study investigates potential barriers and facilitators to integrate TB, DM, and TC programs in Ambegaon Block of Pune District in Maharashtra and Ballabgarh Block of Faridabad District in Haryana states of India. MethodsQualitative in-depth interviews were conducted between Nov 2022 to March 2023 among health workers, program managers, and stakeholders involved in program implementation (n=32). Interview guide was based on World Health Organizations Health System Strengthening framework. Purposive sampling and snowball sampling were used to select participants. Rapid analysis of the data was done using the WHO HSS Framework. ResultsThere were barriers and facilitators for the integration of TB-DM-TC programs observed in India. The primary challenges for integration are at the level of service delivery which is largely attributed to inadequate implementation of all three programs and negligible involvement of private practitioners in the program implementation. Moreover, inadequate referral system, insufficient infrastructure, limited resources, a shortage of trained staff, and lack of essential drugs and equipment impeded the uptake and coverage of services. ConclusionThe results highlight the critical importance of addressing barriers and facilitators of implementation program in India to build a robust structure of managing the triple burden of TB, DM and tobacco control. The proposed strategies, such as sensitizing health system staff, implementing feedback and referral systems, and developing cross-program digital platforms offer a roadmap for policymakers and healthcare system managers. A multidimensional approach is vital for overcoming barriers and facilitating integration.