Exploring current and potential roles of informal healthcare providers in tuberculosis care in West Bengal, India: A qualitative content analysis

India accounts for 27 percent of global Tuberculosis (TB) cases, the highest among the 30 high-burden countries. Despite growing evidence highlighting the significance and potential of Informal Healthcare Providers (IPs) in TB care, their role remains ambiguous in India's TB policies and programs, in contrast to the well-defined roles of the formal private sector. Considering such gaps, this study explores the perspectives of IPs (specifically untrained allopathic practitioners, UAPs) and National TB Elimination Program (NTEP)-affiliated personnel regarding IPs' current and potential roles in TB care. The study was conducted in West Bengal, India. We adopted a qualitative approach and conducted in-depth interviews with 23 IPs and 11 NTEP-affiliated personnel. The study data was analysed using a content analysis approach. The study's findings identified four current roles of IPs in TB care, two of which were corroborated by NTEP-affiliated personnel: 1) Passive case finding and referral and 2) Treatment supporter. As for potential roles, an alignment was observed between the two groups of providers for the majority of the roles (5/7 roles). However, both IPs and NTEP-affiliated personnel expressed reservations about assigning IPs the roles of 1) Clinical evaluation of people with TB and 2) Initiation of treatment for confirmed people with TB. The findings highlight the active involvement of IPs in various TB care roles, acknowledged by NTEP-affiliated personnel, and also demonstrate significant potential for their expanded engagement under the NTEP of India.