Frontline workers in India’s tuberculosis (TB) elimination efforts: a street-level bureaucracy perspective

Difficult working conditions coupled with resource deficits hinder effective program implementation. However, supervisory leadership significantly shapes FWs' engagement with program objectives, highlighting its critical role in advancing TB elimination efforts. We recommend improving working conditions for TB health workers by addressing staff shortages, offering risk-based incentives such as paid leave, medical insurance, and nutritional support, and ensuring safer workplaces. Additionally, effective leadership training for District TB Officers, City TB Officers, and Medical Officers, along with recognition and capacity-building for frontline workers such as TB Health Visitors (TBHVs), is crucial.