by iphindia | Nov 23, 2015 | Blog, Internship, Latest Updates
Although we are already back in the Netherlands for one and a half week, I am still not totally used to it: Dutch food, no honking on the road and a lot of rain instead of the Indian sun. When people ask what the most impressive thing I have done was, it is difficult to choose between the many things we have done and we have learned. How can people really understand the culture and the Indian life, while they have not experienced it themselves? Watching back the pictures we have made while visiting the hospitals, the ASHA meeting, the tuberculosis centrum, the field visits and the Adivishi people, makes me realise that we were really blessed to have had this opportunity to see all those things. The most striking thing for me was the seeming discrepancy: on one hand the ‘hopelessness’ of the Indian healthcare, visible in the unhygienic operating theatres, the non-availability of doctors in the rural areas, and the lack of knowledge among the local population and on the other hand the hopefulness with the great opportunities that India is facing in among others the technology.
While a lot of people are motivated to work for the health of the population, the structure of the healthcare system, the corruption and the disbelief in the public care seems to work against. The inequality between private and public hospitals is large, the role of culture, which has especially been visualised during the visit at the Adivashi population, is huge and the role of political decisions is to a great extent determinative. Solving the distribution problem it not as simple as it sounds. For me, it became clear why most people in the population as well as physician give preference to the private sector. Providing a solution is not just solving one problem, is it a step-by-step process of convince physicians about the importance of working in rural areas, it is a challenge of deliver good quality care within a given budget, it is providing the right equipment, it is creating opportunities for doctors to develop themselves, it is starting with good medical education, it is providing the right information at the right time..
Besides the good insights into the Indian health care system and the problems they’re facing, my visit at the Institute of Public Health contributed to a new insight in seeing problems and solutions. Although a lot of problems seems to be insoluble, giving up is the most undesirable. Reaching your goal may take a lot of years (it took 25 years to establish the Adivashi hospital), but we never have to give up on a dream just because of the time it will take to accomplish it. The time will pass anyway. So, changing the Indian healthcare system and providing health care to every citizen in India is definitely possible!.
Esther Boudewijns 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.
by iphindia | Nov 23, 2015 | Blog, Latest Updates
Dr. Arun Jithendra, Dr. Praveen Aivalli and Dr. Samantha Lobbo, attended a four day regional course on Good Health Research Practice (GHRP) by the Regional Training Center, Universitas Gadjah Mada, Yogyakarta, Indonesia from July 27th – 30th, 2015.
The regional course on Good Health Research Practice was jointly organized by the TDR, (the Special program for Research and Training in Tropical diseases) and Regional Training Center Universitas Gadjah Mada, Indonesia. The course had participants with diverse backgrounds from countries such as Bangladesh, Nepal, Indonesia and India. The facilitators for the course were Varalakshmi Elango and Patricia Henley from TDR; Yodi Mahendradhata and Riris Andono Ahmad from Regional Training Center, Universitas Gadjah Mada (UGM).
The aim of the course was to guide the participants towards having a standardized research protocol that could be used in newer avenues of public health research like implementation research. The course was spread over 4 days with modules comprising of lectures, discussions and group activities. The following topics were covered as the part of the course:
- Principles of research ethics and quality
- Study planning and management
- Informed consent
- Tools for data collection
- Tools for study conduct and quality assurance
- Study sites and study team
- Organization breakdown structure and Delegation log
- Study site checklist
- Data management
- Quality system
- Evaluating the research
- Reporting and Dissemination
The uniqueness of the course lay in the fact that each team were asked to bring their own research protocol. Each group went through each topic of the course viewing it through the lens of their own research protocol. This led to an enriching experience of self-reflection, identifying gaps if any, discuss solution to plug these gaps which we could then implement in our respective projects. The lectures were made interactive by case vignettes during each session which encouraged to bring about different viewpoints that further enhanced the understanding of each topic. Presentations of each protocol helped us understand the varying contexts in which each team was working and helped us realize that there is no single fit solution for even similar problems that could exist in different contexts. Overall the course was a good first step to start looking towards developing standards in newer areas of public health research which could potentially improve the quality of the research being carried out.
by iphindia | Nov 17, 2015 | Blog, Latest Updates
According 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.
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
by iphindia | Nov 2, 2015 | Blog, Education, Internship, Latest Updates
During 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.
by iphindia | Nov 2, 2015 | Blog, Education, ePHM-Advance, Latest Updates
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).
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.
by iphindia | Oct 25, 2015 | Blog, Education, ePHM-Advance
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.
Similarly 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.
