by iphindia | Apr 21, 2016 | Blog, Latest Updates
The art of data collection in health system research: Lessons learned from the field.
Data collection is the most important aspect any research endeavour. Poor quality of the data will have impact on the results of the research study.Therefore it is vital for the researchers to adopt appropriate data collection methods to ensure quality data.Here is a blog by Meena Putturaj which highlights the practicalities of data collection in health systems research based on the field experiences.
Data collection is a crucial aspect of any research project. Depending on the nature and scope of the research question, collecting quality data requires considerable investment of time and resources. Indeed, any research endeavour is handicapped without the relevant data.
During a recent health systems research project, I had to collect a lot of information from government agencies, which turned out to be no cake walk. There were occasions when I had to wait for hours at a time to collect documents, to meet officials, and to conduct interviews. Those waiting periods gave me sufficient time to observe and reflect on the functioning of some of the government agencies in India.
Health systems research often requires data from, and cooperation by, the state sector authorities. So, as a rule of thumb, the health systems researchers work closely with government officials and will require data from them, the interpretation of which might reflect negatively upon those state sector authorities. This can, I think, make some officials and other employees feel that they are being cross examined or interrogated when researchers go to collect data from them. The various situations that I’ve been in while collecting data from government officials have enabled me to develop skills to deal with this tension and the struggle of getting relevant data. The following strategies have worked well for me while trying to obtain data:
To read more about “The art of data collection in health system research” : Click here
by iphindia | Mar 16, 2016 | ATM, Blog, Latest Updates
Dr Praveenkumar Aivalli blog titled, ” What I learnt from my first health system research project ” published in BioMed Central
Starting my first research project
Back in 2013, I just stepped out of my university after getting my Master of Public Health degree, in no time I was given an excellent opportunity to work on a World Health Organization (WHO) funded health system research project in one of the reputed public health research institutes in Bangalore. It was the first research project of my public health career and as a new bee, I was buzzing with excitement and enthusiasm about the study.
The project was on improving NCD (Non Communicable Diseases) care at primary health centers in one of the districts in south India. It was a quasi experimental study trying to understand the impact of health system interventions through a baseline and end line household and facility surveys.
For better coordination, exposure and learning, I was placed in the study district. Having completed most of my education in the country, it was not that difficult for me to understand our country’s health system.
We visited more than 1000 families to get data on NCD care at the rural level, health seeking behaviors of NCD patients and their out pocket expenditures for NCD care.
The theoretical explanations from classrooms started fitting in its notches when I got exposed to the field during the early days of the project. I got the hang of the project fairly quickly and began preparing for the baseline survey in the year of 2013.
We visited more than 1000 families to get data on NCD care at the rural level, health seeking behaviors of NCD patients and their out pocket expenditures for NCD care. We also visited primary health centers and private pharmacies in the area to collect information on medicine availability.
To read more about Dr Praveenkumar Aivalli blog Click here
by iphindia | Mar 3, 2016 | Blog, Latest Updates
Rashtriya Swasthya Bima Yojna (RSBY) is a health insurance scheme, implemented by the Ministry of Labour and Employment, Government of India. The objective of this scheme is to provide protection to families below poverty line (BPL), against illnesses which involve hospitalisation. Currently, it covers beneficiaries’ families up to Rs 30,000 for most of the diseases that require hospitalization. In a BPL family, up to five members are eligible to get enrolled in the scheme and the government pays the premium of this policy to the insurance company. Each enrolled member of the scheme gets a biometric enabled smart card (SC), in which the basic personal details, photographs and thumb impression are stored. Beneficiaries need to present this smart card at the empanelled hospital to avail cashless treatment. As per the guidelines of the scheme, the smart card is issued at the time of enrolment itself, so that the beneficiary can start availing the benefit of the scheme immediately after the enrolment.
RSBY has been implemented in the state of Karnataka from 2009 and as per the official estimates, about 59% of BPL families have been enrolled in the scheme. I got an opportunity to witness an RSBY enrollment camp and in this blog, I would like to share my experience of interacting with the personnel involved in the camp. Once the camp started, the computer operator started taking photos and thumb impressions of the beneficiaries, but I noticed he was not providing the SC and Empaneled Hospital List (EHL) to them. Upon enquiring with the computer operator and his higher authority as to why the beneficiaries were not being given the SC and EHL, I instantly received a response that there was some technical issue. I pursued the matter further, to which the computer operator replied that the EHL was out of stock and that “if the cards were printed and provided at the time of enrolment they will not able to enrol more people thus not being able to reach the day’s target’’. He went on and clarified that due to this, they enroll the eligible people first, and will distribute the printed card along with list of hospital empanelled under the scheme after 10 days to beneficiaries through ASHA. His answer did not convince me completely, but I had no option other than to wait and see if the beneficiaries received their cards.
After a month of enrollment, I checked with few ASHAs if the SCs have arrived, to which they replied that neither had they received any cards nor any documents. The whole incident surprised me! I continued to keep in touch with the ASHAs and enquire if they had received any of the cards. After three months, I found out that the cards were given to the ASHAs but they were less in number when compared to the enrolled beneficiaries. As per the list, the number of beneficiaries enrolled were 648 but only 500 cards were provided. Later, when I asked the ASHAs if they had distributed the cards, they said that they had not. They went on to tell me that as per the contract between ASHAs and Third Party Administrator , the ASHAs should get an incentive of Rs.7 per card; since they did not receive this incentive from the agency, they kept the cards with them instead of distributing them to the beneficiaries.
This is not an isolated episode. Studies have shown issues with enrollment and card disbursement as major factors affecting the utilization of the scheme. Poor awareness of the scheme in the community is another major issue, which needs to be addressed. All these experiences show that monitoring activities of the scheme needs to be strengthened. The enrolment camps are great platforms for creating awareness about the scheme. Sound IEC activities along with good governance of the scheme will go a long way in improving access to healthcare for the poor.
Santosh M Sogal is Research Officer at Institute of Public Health, Bengaluru, shares his experiences and views on RSBY, the national insurance scheme of India.
Disclaimer: IPH blogs provide a platform for staffs 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.
by iphindia | Jan 21, 2016 | Blog, Education, ePHM-Advance, Latest Updates
Application of the peer learning principles in the field of education has a long history. Lot of research has been done by psychologists, sociologists and educators on this and results have been positive. Peer learning has been seen as an effective methodology for gain deeper understanding of the concepts by formal or informal interaction among the peers. Peer learning promotes active participation among students and gives them a space to re-enforce their own learning. Since, the students share common educational or professional backgrounds, it creates interest in the topic. It also gives students a platform to build their communication, presentation and teaching skills.
We at IPH, used one of the aspects of peer learning principles, for our e-learning course in Public Health Management (ePHM). Based on their performance in the course, we selected the top ten students of 2015 batch. We invited them to take classroom sessions for their peers. The theme of the classroom session was – “One Challenge – One Public Health Management Principle”. The students had to talk about one challenge they faced at their workplace and how they applied one public health management principle to overcome the same. The objective of this exercise was to give an opportunity to the students to share their experiences from the field with the fellow students and at the same time give them a feel of how we record our online classrooms.
The response from the invited students was amazing. The students who were based in Bengaluru visited our office and recorded a session with us. Others who were residing outside Bengaluru had a hangout or Skype session with us and recorded the classroom. The students took sessions on different topics like community participation, systems thinking, leadership and development, breast feeding and health systems dynamics framework. We converted their sessions into online classrooms and uploaded it on our online platform, Moodle for sharing with their peers.
It was very interesting to see how the students, who are busy professionals also, took out time and prepared Powerpoint presentations and recorded sessions with us. Our next step is to understand from students how they benefited from this learning methodology. Since, this is the era of experimentation, we would love to step ahead and explore other peer learning methodologies in our courses for enhanced learning experience!
You can catch a glimpse of the peer classroom sessions
by clicking on the image:
Dr.Aneesha Ahluwalia is Training Officer at Institute of Public Health, Bengaluru and tutor for the ePHM course.
by iphindia | Jan 8, 2016 | Blog, Education, ePHM-Advance, Latest Updates, Short Course
Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” ICD-10,WHO, 1994.
It has been said that being pregnant and giving birth to a child is a joyous moment in a woman’s life. However where I come from, the prospect of dying during childbirth is an imminent threat that looms over every pregnant woman’s mind. It does not help that in India, even today, a large number of women deliver at home, with much higher figures in rural and remote areas.
When a woman dies during childbirth, she leaves behind more than a motherless child. The family is at risk of disintegration as a ripple effect. “Studies in developing countries indicate that the risk of death for children under five years doubles or even triples if their mother dies. Motherless children are likely to get less healthcare and education as they grow up. Girls, in particular, suffer because they are forced to drop out of school to look after their younger siblings. Maternal death is thus, almost inevitably, a double tragedy.”
For many maternal mortality is a particularly sensitive indicator of inequality. It is considered as a litmus test of the status of women, their access to healthcare, and the adequacy of the health care system in responding to their needs.
Jharkhand is one of the most underperforming states of the country. The maternal mortality ratio (MMR) in the state is much higher than the national average. In recent years there has been a drop in the MMR of the state of about 44%.
However there is still a long way to go. According to the third National Health and Family Survey in Jharkhand one could clearly see a gap in the health seeking behaviour among the women in different social groups during the antenatal care period. [5] More than a third of the marginalized groups do not have a single antenatal check-up during their pregnancy. Although more than half of women from the urban areas visit some type of healthcare facility (public, private, or trust) for delivery, in rural areas the percentage is only about 10 percent. This gap is also visible during the post natal care period. In rural areas in more than 80% of cases no pregnant women receives postnatal care services. This signifies that a major portion of the women do not undergo any type of postnatal check up, a period when the mortality rates are high.
When compared to other states in India, Jharkhand is amongst the ten worst performing states. Comparison with states which have a better MMR shows that a large number of deliveries in the better states are conducted by skilled birth attendants. This is not the case in Jharkhand. In addition to poor medical care, before, during, and after pregnancy, several factors play an important role in this situation. Low importance is given to women including reproductive care, and unfair customary practices which deprive pregnant women, lactating mothers, and infants of nutrition and food are prevalent in many areas of Jharkhand.
The definition above for maternal death is universally accepted and used for statistical enumeration. However more often than not the faces behind these numbers are forgotten. The agony women face during labour gets lost behind a big pile of paperwork. States like Jharkhand still suffer from problems that are not only due to medical methods.
Although at a national level we are improving in terms of the MMR and other maternal health indicators there are still states that are severely lagging behind. There are key equity issues such as social, economical, and geographical backgrounds that play important roles in maternal deaths. To nationally bring a change with respect to maternal deaths, the need of the hour is to help these low performing states improve and perform on par with other developed states.
Sharat Panday 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.
by iphindia | Jan 7, 2016 | Blog, Education, ePHM-Advance, Latest Updates
According to the 2011 census, approximately 400m of India’s 1.21bn population are “internal migrants.” These migrant communities in Indian cities constitute a large proportion of people living in urban slums.
Some of them have migrated from rural to urban settings as an entire family, others as parents, and some as individuals (the head of the household, for example). Some have become urban residents working in the construction industry, and they migrate back to their origin (homes) seasonally for agricultural work. Some migrate to escape civil conflict or domestic violence.
All face tremendous pressure to earn higher wages, as income opportunities in rural areas are very limited. Consequently, rapid urbanization in India has resulted in a high concentration of migrants in city slums.
Migrants are one of the most vulnerable groups in society, living in extreme poverty with low living standards; a lack of suitable housing, electricity, drinking water, sanitation, and cooking fuel; and without access to nutritious food, education, and healthcare.
Many migrant families will either have no identity documents, or government identity documents that are registered just to their place of origin. This means that without permanent residence in their current place of living, they’re not entitled to the services offered by state welfare schemes.
Because their families are living a nomadic life, children will often not have completed full immunisation or received health check-ups, increasing the risk of child mortality.
Two pregnant women I spoke to while visiting a slum in Bangalore say they didn’t receive regular antenatal and postnatal care. Indeed, many migrant women have home births (often because of a belief in following family tradition), which can adversely affect health outcomes for both mothers and babies, even if the local health centre is within walking distance.
If India is serious about achieving universal health coverage, it has to reach out to different parts of its population, including those on the move. The urban migrant community and their ability to access healthcare needs particular focus here.
Healthcare programmes should prioritise gathering data on these communities, which will result in the inclusion of many such migrant families and their children in government services. We need targeted health interventions and outreach efforts, which take into account the vulnerability of migrant women and children.
Nilanjan Bhor 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.
The art of data collection in health system research: Lessons learned from the field.
After a month of enrollment, I checked with few ASHAs if the SCs have arrived, to which they replied that neither had they received any cards nor any documents. The whole incident surprised me! I continued to keep in touch with the ASHAs and enquire if they had received any of the cards. After three months, I found out that the cards were given to the ASHAs but they were less in number when compared to the enrolled beneficiaries. As per the list, the number of beneficiaries enrolled were 648 but only 500 cards were provided. Later, when I asked the ASHAs if they had distributed the cards, they said that they had not. They went on to tell me that as per the contract between ASHAs and Third Party Administrator , the ASHAs should get an incentive of Rs.7 per card; since they did not receive this incentive from the agency, they kept the cards with them instead of distributing them to the beneficiaries. 
The response from the invited students was amazing. The students who were based in Bengaluru visited our office and recorded a session with us. Others who were residing outside Bengaluru had a hangout or Skype session with us and recorded the classroom. The students took sessions on different topics like community participation, systems thinking, leadership and development, breast feeding and health systems dynamics framework. We converted their sessions into online classrooms and uploaded it on our online platform, Moodle for sharing with their peers.
