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Abstract Background The Government of India, made TB notification by private healthcare providers mandatory from May 2012 onwards. The National TB Programme developed a case based web based online reporting mechanism called NIKSHAY. However, the notification by private providers has been very low. We conducted the present study to determine the awareness, practice and anticipated enablers related to TB notification among private practitioners in Mysore city during 2014. Methods A cross-sectional study was conducted among private practitioners of Mysore city in south India. The private practitioners in the city were identified and 258 representative practitioners using probability proportional to size were interviewed using semi-structured questionnaire. Results Among the 258 study participants, only 155 (60%) respondents agreed to a detailed interview. Among those interviewed, 141 (91%) were aware that TB is a notifiable disease; however 127 (82%) of them were not aware of process of notification and NIKSHAY. Only one in six practitioners was registered in NIKSHAY, while one in three practitioners are notifying without registration. The practitioners expected certain enablers from the programme like free drugs, training to notify in NIKSHAY and timely feedback. 74 (47%) opined that notification should be backed by legal punitive measures. Conclusion The programme should develop innovative strategies that provide enablers, address concerns of practitioners while having simple mechanisms for TB notification. The programme should strengthen its inherent capacity to monitor TB notification.

Jaya Prasad Tripathy1,2, Karuna D Sagili,1 Soundappan Kathirvel1,3, Archana Trivedi,1 Sharath Burugina Nagaraja,4 Om Prakash Bera1,5, Kiran Kumar Reddy,1 Srinath Satyanarayana1,2, Ashwani Khanna,6 Sarabjit S Chadha11Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, New Delhi, India; 2Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France; 3Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 4Department of Community Medicine, Employees State Insurance Corporation Medical College, Post Graduate Institute of Medical Sciences and Research, Bangalore, India; 5Bloomberg Data for Health Initiative, Vital Strategies, Mumbai, India; 6Department of Health and Family Welfare, Government of Delhi, New Delhi, IndiaBackground: Weak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries.Methodology: The present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care.Results: A total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities.Conclusion: There is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.Keywords: diabetes mellitus, primary care, screening, noncommunicable disease, mixed methods