Barriers and facilitators to tuberculosis service access for patients in Bajhang, Nepal: a qualitative study based on focus groups with patients, screening camp visitors, community volunteers and medical doctors.

Abstract

Background: Efforts to achieve global tuberculosis (TB) targets, especially in lower- and middle-income countries, such as Nepal, require urgent attention. Challenges persist, including TB-related social stigma and catastrophic costs incurred by affected households. Socioeconomically vulnerable individuals, particularly those residing in rural, mountainous and remote areas, face limited access to TB care. To explore the barriers and facilitators to accessing TB care, this study was conducted in Bajhang, one of the most underdeveloped and socioeconomically vulnerable districts in Sudurpaschim Province of far-western Nepal.

Methods: Focus group discussions (FGDs) were held with TB patients, TB camp visitors, community mobilizers and medical doctors.

Results: Thirty-five barriers and 21 facilitators were identified by thematic analysis of the eight FGDs. Key barriers included economic burdens, social stigma leading to concealment and isolation, limited resources in local healthcare and geographical inaccessibility. Notable facilitators included TB volunteer programs, screening camps, economic support, and awareness campaigns.

Conclusions: Prioritizing actions should target early care cascade stages and address individual, community, infrastructure, and health policy levels.