Managing Hypertension and Diabetes in Resource Poor Settings:- By Bheemaray V M

Managing Hypertension and Diabetes in Resource Poor Settings:- By Bheemaray V M

bheemaimgAccording to the Diabetes Atlas 2006, the number of people with diabetes in India is currently around 40.9 million and is expected to rise to 69.9 million by 2025. Similarly, 118 million people were estimated to have high blood pressure in the year 2000, which is expected to go up to 213 million in 2025.

To address this situation, the Indian government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) to 364 districts and Tumkur is one of them.Managing Hypertension and Diabetes in Resource Poor Settings:- By Bheemaray V M

I want to share my experience of working in Tumkur, one of the rural districts of Karnataka, as part of a research project aiming to strengthen care for hypertension and diabetes in two primary health centers (PHCs) with using available sources.

Link to Bheemaray V M blog’s on BMJ:- Click Here

Internship at the Institute of Public Health, Bangalore: By Hanna Schenck

Internship at the Institute of Public Health, Bangalore: By Hanna Schenck

Hanna MU-internDuring my summer of the year 2015, I had the great opportunity to visit the Institute of Public Health in Bangalore and to explore the Indian health system during a few days. During the first half of my internship, I was confronted with the great complexity of the problems in the Indian sector.

To begin with, I noticed that the government sector was truly avoided by the Indian population for several reasons. Some of them include a very bad coordination and communication within the government sector and the different ministries of health. I was shocked when noticing that two different ministries had built two health institutions next to each other without knowing it: one community health center and one primary health center, both lacking medical paraphernalia. Instead of coordinating and optimizing their human and financial resources to build one hospital, the government sector proved to be unproductive and non-transparent with regards to its actions.

Another striking element of the Indian health sector is the lack of cooperation and unity between the private and public sector. In most countries like the Netherlands, public and private sector work hands in hands and stimulate one another to provide quality healthcare. Talking to an employee of the Institute of Public Health working on a project to reduce the burdens of non-communicable diseases like hypertension and diabetes, allowed me to have a better insight of the relationship between private and public sector. I was told for example that the private sector would deliberately tell their patients that generic medicine from the government sector were not efficient, or even threatening to their health, which makes it inevitably difficult to imagine any form of collaboration between these two sectors of healthcare. Another example of hostility to collaboration between different actors of healthcare in India is the fact that private doctors refuse to use records or tools from other organizations or health providers, simply denying any other form of help.

My internship in Bangalore also taught me that health, and the importance one associates to it varies a lot depending on where you are. In Europe, health has become one of the biggest priorities, and people strive for good health in their everyday lives, whether trying to do some physical activity, to buy food with the least bad cholesterol or to take medicine with the slightest headache or feeling of pain. Health represents an important pillar in the European everyday life. In India however, I noticed that health does not come as a priority, because people still struggle for social recognition and acceptance. Having a social card to receive rice therefore becomes more of a priority than having adequate healthcare. This makes it difficult to implement any form of reform in the health sector that would be widely accepted by the population.

After seeing the intricacy of the health sector in India, one can be pushed to believe that one of the solutions to improving health would be to privatize the entire health sector to eliminate the competition, inequality and misbalance between the two sectors, and to guarantee quality healthcare. However, another lesson I learned is that the government sector does have necessary and beneficial influence on the healthcare. The government sector is the one sector genuinely interested in public good, and which always strive to help the entire population.

Furthermore, the government sector is the only sector that will provide preventive health care, which plays a pivotal role in overall health. This is due to the fact that preventive care is not remunerative and does not provide remuneration, making it worthless for the private sector to invest in.

During the second part of my visit, I was lucky enough to be able to discover the Adivasi community from Southern India and to get familiarized with a quite unique form of development based on empowerment and sustainability. During my visit of Gudalur, I learned a few essential lessons. One of the main conclusions I was able to draw from my visit is that development of a certain population can only be successful if it is population-based. External actors may of course come to teach and stimulate a community to develop itself, but the reins must be taken by the community. This allows to develop a feeling of responsibility from the population, of loyalty and thus of sustainability. If a community works together to reach certain objectives, it will also be able to enjoy the fruits of its labor, thus further encouraging it to carry on with a certain behavior. Only the people themselves are capable of clearly assessing the problems and thus are the only ones capable of coming with the solutions to certain issues. External help usually has the tendency to colonialize people and to render them dependent instead of empowering them. One of the teachers of the school of Gudalur, Ram, very righteously told us “We don’t look at the building, we look at the people. Buildings are ways by which you colonialize people” when referring to the simple architecture of the Adivasi hospital of Gudalur. All in all, this internship really made me reflect on the real nature of development: what really is development? Is development really the form we so often give it: material possession and financial wealth? Looking at the Adivasi community, I have learned that a feeling of community, of belonging and cultural identity can contribute so much to development, and that even minorities can achieve great progress without losing their integrity.

Following this experience, I have taken home some life lessons and made myself some objectives. As of September, I have joined the international organization Universities Allied for Equal Medicines, and joined in the battle to promote equal access to medicine. I was able to see that health as we see it in Europe is true luxury in comparison with India and realized how unequally the intrinsic right to health is distributed in the world. Besides this, I have decided to get involved with the refugees of Maastricht and want to participate in their integration within our society. Dr. Deva wisely advised us to always think of the minorities everywhere around us. Even in Maastricht, the Netherlands, thousands of individuals are forced to live in denial of their own identity, hoping to stay unnoticed in order to integrate the community. I am hoping to change this.

Hanna Schenck  from Maastricht University was an intern at Institute of Public Health, Bangalore, India.

Disclaimer: IPH blogs provide a platform for  interns to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.

ART centres in Uttarakhand: Some reflections from the field: By Supriya Chand

ART centres in Uttarakhand: Some reflections from the field: By Supriya Chand

Hivaids

One of the Millennium Development Goals (MDG) is to control the spread of HIV/AIDS. This puts a continuing concern on improving health services. Many projects are run by the government to address these concerns effectually. One such program is operation of ICTCs/STIs/ART centres in government hospitals. These centres have been successful in providing pre and post test counselling through trained counsellors to the individual/s coming for HIV screening. However, there are many challenges and barriers faced at bot  Institution (Hospitals and Health workers) and community level (community members).

supriya

Poor infrastructure and facilities

A standard approved size room is given to counsellors for their work. However, at some of the ICTCs/STIs the counsellors are facing troubles in carrying out their work in the given space. The problems range from room given at one far end of the building, electricity/store room being converted into counselling room, room given at first/higher floors, absence of proper waiting area outside the counseling room etc. This could be taken care if room is allotted after making sure it is easily accessible, comfortable as well as guards the privacy of visitor.

The counsellors at almost all the ICTCs/STIs have to bear the burden of administrative issues. These range from low salary amount, delayed salary payments, petty politics at the workplace (at some centres), absence/delayed supply of essential work material like Kits for STI counselling. These problems could result in burnout of counsellor. Hence the concerned authorities should maintain the SOP strictly so as to enable counsellors to do their work effectively. Apart from these, often the counsellors have deal with the interference and pressure from local authorities (local leader/s, group/s etc.) in their work.

In the state of Uttarakhand, in the areas at great altitude most of the ICTCs/STIs counsellors have less patient’s visits. This is mainly due to absence of specialist doctors and specialised services in the hospitals at these places. The provision of these would mean more patients visiting the centre.

Capacity building for counsellors

The minimum qualification for counsellor’s job is bachelor’s degree. Hence some counsellors are neither from psychology/sociology/social work background, nor received any training in counselling. Some of them lack even the basic skills of counselling. This could be addressed by making either the aforesaid subjects or a training/experience of counselling compulsory for applying for the post. The newly appointed counsellors should be allotted centres only once they have completed induction training. In Indian society HIV/AIDS is still considered to be a taboo issue. Though the counselors are trained, some of them have their own prejudice. Often they are not sensitive and have indifferent attitude towards the sero-positive individuals. This could lead to patients getting discouraged about coming for treatment. Hence, providing trainings to sensitize health workers is utmost importance for success.

Governance issues

The sero –positive patients could avail ART medicines from the Link ART centres. However, their number is less in Uttarakhand, so more number of such centres would be beneficial for community as this would provide access to necessary medicines to the concerned person without many troubles. Patient load is high at some centres, which results in limited counselling period so taking up significant points can make session effective. Additional workload like filling of many formats daily apart from report to be submitted to concerned authorities is another issue, which could be dealt promptly with following proper work plan.

Need for community care centres

Distance is one major problem, which restricts people from accessing the health facilities. Finance is another issue which requires attention. Most of the people are poor in terms of finance hence lack both money and time (since they could utilize that time for work) to visit the facilities until their health issue becomes dead serious. Promoting NGOs/local groups to work would help people like providing vehicle support for reaching health facility

The community care centre (CCC) for sero-positive patients is not present at local levels hence a sero-positive individual who is at Srinagar in the state has to come down to Dehradun to avail the service. Also availability of seats at such centre is another issue.

Improving awareness in the community

HIV/AIDS is still a taboo subject, so there is a hesitation among community members to seek help like visiting health facilities for fear of character judgement or being out casted from community. There is absence/lack of complete and correct information on the subject. This results in people believing in many myths and misconceptions and often not approaching health facility for timely treatment. All this could be successfully answered by sensitizing community on the subject. This could be done through awareness campaigns, street plays, informative wall paintings etc. Involvement of community head and Panchayat members would also prove to be fruitful.

Supriya Chand  was a  student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.

Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.

Right to clean air: By Ajeet Pal Singh

Right to clean air: By Ajeet Pal Singh

health programmes, public health internships, public health online, public health scholarships, public health management, doctor of public health, public health website, public health careers, careers in public health, public health organizations, bachelors in public health, public health centre, public health administration,public health advocacy,public health and education,public health and family welfare,public health and government,public health and health promotion,public health and mental health,public health and nutrition,public health and policy,public health and the government,public health application,public health as a course,public health books,public health building,public health care,public health careers,public health centre,public health centres,public health certificate,public health certificate online,public health certificate programs,public health certification,public health classes,public health college,public health colleges,public health course

The effects of air pollution on the lungs and heart are now widely appreciated, with more incriminating evidence of its role in cardiac disease.  Air quality is represented by the annual mean concentration of fine particulate matter: PM10 and PM2.5, referring to particles smaller than 10 or 2.5 microns. The Global Burden of Disease Study identified fine particulate matter (PM2.5) in outdoor air and household air pollution from use of solid fuels as the ninth and fourth leading risk factors, respectively, for disease worldwide, and the World Health Organization attributes one in every eight deaths to air pollution. This research stems from improved understanding of the role of air pollution in initiating systemic inflammation, a response that may affect multiple organ systems.

ajeetSimilarly a study conducted in India found that average pollution levels were up to eight times higher on city roads.They reported that the exposures that one experiences on and near roads can substantially exceed what one would measure at an official monitoring site.

There is growing evidence that air pollution is an important risk factor for an increasing number of common diseases; in a recent systematic analysis study, it was found that the increase in each of the common gaseous and particulate air pollutants were significantly associated with admission to hospital for stroke or stroke related mortality, with associations strongest for strokes on the same day as exposure.

Need for political will

To curb the problem of bad air quality, a strong political will is required. It is the lack on information and knowledge about air quality due to obsolete technology and limited number of monitoring stations, which often leads to a poor decision-making. Moreover, lax standards is a major impediment. So it is important to chalk out an effective plan for thorough monitoring fulfilling the minimum requirement of monitoring for at least 104 days in a year along with that an increase in the number of monitoring sites too. This is because effective air quality planning requires accurate data. Parameters like network design of monitoring sites, maintenance, calibration of equipment and quality audits of data should be given urgent attention. Capacity for autonomous air quality planning free from industry bias is something that is needed from state regulatory authorities. Monitoring is also important to formulate policies to control it, to create awareness and sensitise people to prepare them for hard decisions. Last but not the least, decision makers should come up with plans for proactive climate change preparedness. For example, instituting policies that make bicycle commuting more accessible and convenient will help to reduce carbon emissions, improve air quality, and decrease obesity rates by facilitating physical activity.

Health system preparedness

Health systems have a major role to play in dealing with the consequences of several diseases. For this, a trained and competent workforce is central to the success of health system. Medical care providers should be trained to recognise and manage emerging health threats that may be associated with climate change. Furthermore, respiratory health should be promoted through better prevention, detection, treatment and education efforts. Besides this, allocating a unit for respiratory illness with adequate resources in terms of medicines, masks, nebulizers, ventilators and so on is something that can help to deal with the load of patients coming in times of climate change with several respiratory problems.

Increasing the number of a specialised professional i.e Pulmonologists is something that should be thought about. Moreover, training sessions should be organized for all levels of healthcare providers – from paramedics to doctors –  to deal with patients on urgent basis. Timely referrals to higher health centre with effective transportation can also another issue that needs to be looked in to.

Measures that can be undertaken

1. Diesel vehicles which are more than 10 years old should not be permitted to ply, especially in cities

2. Tightening vehicle emissions standards to world-class levels and extensive adoption of cleaner fuels in passenger vehicles (CNG, low-sulfur diesel).

3. Cleaning up the high emitting trucks that ply at night, reducing urban burning of wood and wastes, reducing emissions from  diesel backup generators, and cleaning up rural industries such as brick kilns.

4.  Switch to polluting methods, whenever possible. For example, solar electricity is now price competitive with imported coal power in the Indian market.

Scope for public health involvement

Public health practitioners have a responsibility to effectively engage with policy makers about the need for proactive climate change preparedness .By providing a critical health perspective, public health professionals can communicate the significant health impact that are likely to occur if adequate preparedness measures are not adopted. Public health professionals can educate policymakers about the health benefits that will result from sound climate preparedness planning. Public health department and agencies should take help of communication tools tailored to community,and population which would have greater impact on community members. Few are as follows –

1. Use variety of media outreach strategies that would be effective for different age groups (like radio,local news,social media sites,etc.)

2. Have brochures and media outreach in multiple languages

3. Door to door outreach may be more effective for some communities

4. Use non-traditional outlets of education and outreach(like meals on wheels,celebrities, sporting events etc.)

Ajeet Pal Singh  was a  student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.

Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.

How secure is India’s National Food Security Act? : by Manoj Kumar

How secure is India’s National Food Security Act? : by Manoj Kumar

Screen Shot 2015-10-05 at 9.51.51 am

Screen Shot 2015-10-05 at 10.01.28 amRecently food security provisions in India has improved and not surprisingly the country is operating one of the largest food safety nets in the World. However regarding figures related to malnutrition particularly chronic malnutrition, the country is at very poor level. There are many challenges in implementation of food security schemes which hinders achieving desired outcomes of reducing malnutrition and the benefits reaching the actual poor.

Link to Manoj’s blog in Global Food Security….Click here