Table 1 Perceived positive and negative value drivers of the intervention

TB patients (n = 11)

• CHWs increase feelings of support and care through counselling

• Encouragement from CHWs increased self-efficacy and motivation to complete treatment

• Prevention of family or community from TB infection

• Anticipated and/or experienced isolation and stigma

“I had to try to follow the treatment. Luckily, I had the help from my healthcare worker. She encouraged me and helped me receive my medicine. In general, I was very happy and even went to hug her and said thank you. Without her, I don’t know what I would have done.” – Male, TB Patient, Painter

“I was afraid that people would avoid me since this is a communicative disease. Many people have knowledge about TB and are okay with it. But for people who do not know about TB, they are probably scared.”- Male, TB Patient, Silversmith

Site coordinators & CHWs (n = 9)

• Earlier disease detection

• More access to healthcare services

• Increased sense of personal satisfaction due to positive patient outcomes

• Creation of community and strengthened interpersonal relationships

• Lack of patient trust in the health care system

“My healthcare worker lit a flame in me, she encouraged us to place more heart in our jobs, we felt excitement in our work. We feel happy when working with patients and creating trust. I have worked for this for nearly twenty years, and I love my job.” – Female, Community Health Worker

“The most difficult thing is trust. For example, there was a case of a drug-resistant TB patient who had a positive result, but he did not believe that he suffered from TB. He did not agree to treatment even though the TB counsellor visited his house and a healthcare worker talked with him.” – Male, Community Health Worker

TB program

(n = 3)

• Direct support for ACF activities

• Strengthened collaborations between National and Provincial TB programs and local governments

• CHWs supported programs and increased collaboration

• Heavier workload and need for overtime support

“The force of community health workers has worked so far and I still highly appreciate them and consider them as the important bridge between the project, people with TB, clinics and units.” – Male, Head District TB Unit Officer 1

“It is not just that we work extra hours, but the intensity of screening will also be heavier. With the program, patients get chest x-rays and some days there may be up to 30. Therefore, there is more work to do.” – Male, Head District TB Unit Officer 2

Provincial and District Government

(n = 3)

• Direct support for ACF activities

• Broader community and household reach

• Ability to target high risk groups

• Fear and lack of trust of the government from patients

“Since the Proper Care program started, we are more active, we find cases actively at our unit. For example, each year, we detect about 100 TB patients, but the number of TB cases increased to 150 patients last year. – Male, District Health Center Director 1

“Our activities make people afraid of being taken advantage of due to the approach. For some difficult places, we have to invite leaders of the residential clusters. They will come along with us for safety reasons, moreover to avoid the negative exploitation of counsellors’ and health workers’ work.” – Male, District Health Center Director 2

Viet Nam TB Ecosystem

(n = 3)

• Increase in funding for TB

• Influence on domestic policy

• Improvement of corporate image and reputation

• Communicating project mission fit to corporations

“It really helped us to inform national policy. Back in the day, we didn’t really know what it’s like on the ground. Now, we have someone who really understands the details to help us make an impact. – Male, Organization Country Director

“One of our challenges was really to convince our management that the Proper Care project was worth investing in. There’s a pot of money that was available to us, and we were all competing for it” – Female, Organization Department Senior Director

Abbreviations: ACF: Active Case Finding, CHW: Community Health Worker, TB: Tuberculosis