. 2026 Jul 1;26:2402. doi: 10.1186/s12889-026-28272-6

Table 3.

Sub-themes and illustrative quotes under structural workforce fragility undermining service delivery

Sub-theme, n (% of participants)	Quotes
Lack of professional knowledge, experience, and responsibility, 11 (42.3%)	“The diagnostic techniques still need to be improved, especially for patients with negative cultures. Supervision has revealed that there are still instances of non-standard diagnoses or a lack of experience” (A6). “The sense of responsibility among the medical staff at our treatment facility is still insufficient. They tend to prioritize their own workload over the feelings of the patients” (A12).
Insufficient staffing and high work pressure, 9 (34.6%)	“There are not enough medical personnel and grassroots epidemic prevention workers. In the office, there are just one or two dedicated epidemic prevention staff responsible for the entire communicable disease work, including HIV and TB” (A1).
Low compensation, 6 (23.1%); High staff turnover, 3 (11.5%)	“There is no performance-based compensation in the tuberculosis outpatient and infectious disease departments. Because designated hospitals receive 70% of salaries while 30% come from performance, their year-end bonuses are lower compared to other departments. Staff turnover is frequent, and the risk of TB transmission is high, which makes them unwilling to stay in this department” (A5).

Sub-theme, n (% of participants)

Quotes

Lack of professional knowledge, experience, and responsibility, 11 (42.3%)

“The diagnostic techniques still need to be improved, especially for patients with negative cultures. Supervision has revealed that there are still instances of non-standard diagnoses or a lack of experience” (A6).

“The sense of responsibility among the medical staff at our treatment facility is still insufficient. They tend to prioritize their own workload over the feelings of the patients” (A12).

Insufficient staffing and high work pressure, 9 (34.6%)

“There are not enough medical personnel and grassroots epidemic prevention workers. In the office, there are just one or two dedicated epidemic prevention staff responsible for the entire communicable disease work, including HIV and TB” (A1).

Low compensation, 6 (23.1%);

High staff turnover, 3 (11.5%)

“There is no performance-based compensation in the tuberculosis outpatient and infectious disease departments. Because designated hospitals receive 70% of salaries while 30% come from performance, their year-end bonuses are lower compared to other departments. Staff turnover is frequent, and the risk of TB transmission is high, which makes them unwilling to stay in this department” (A5).