Institute of Tropical Medicine, Antwerp shares a short video about the work that IPH does to improve the health systems in India. In this video, various faculty members share their insights about their work.
It was estimated that nearly one million new cases of cancers will have been diagnosed in India by 2015, of which 0.67 million people are expected to die of conditions related to cancer. Cancer of the mouth and lungs in men, and cervix and breast cancer in women account for more than half of all cancer deaths in India.
Various health system weaknesses contribute to this state of cancer morbidity and mortality in India. In most cases the disease is diagnosed at a late stage when the effectiveness of known treatment options is low. Even if cancer is identified at an early stage, 50% of patients stop visiting hospitals after two or three cycles of chemotherapy due to the high cost of treatment. People still lack faith in cancer treatment options possibly due to very few early diagnoses and prevention stories making the news in India, especially in rural areas. There is a strong notion that even after spending huge amounts of money on treatment, the chances of survival are low. For example, consider a patient who is supposed to take Aromycin tablets every day. The cost of each tablet is approximately INR 800 (This is the equivalent of USD $12. In a largely poor country like India, daily wages are often less than half of this amount). So the monthly expenditure for a single medication alone (leaving aside other medications and fees for visiting a doctor) could be as high as INR 24000 (nearly USD $400) per month. In general cancer patients sometimes require three to 12 or more chemotherapy sessions, which can be a huge economic burden to an average Indian family.
Chemotherapy to treat cancer is out of reach for many Indians. It is not always covered under insurance which is a question of deep concern to many. As the new government at the centre in India is reassessing our country’s health policy, I feel we should evolve better strategies for improving coverage of cancer in insurance policies. Even better would be if the government itself would provide better financing arrangements for those who cannot afford the prohibitive treatment costs. The government ought to engage pro-actively with pharmaceutical companies, software companies, corporate hospitals, and universities to ensure that they contribute more to improving public health. This can happen through better governance, appropriate regulation, and partnerships with all sectors. In a country such as India, where cancer care is available, it is a pity if we cannot make it affordable and accessible to a large part of our population.
Harish Chandra Rodda 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 swine flu epidemic caused by a new strain of the influenza A (H1N1) virus became a public health problem in India in 2014 for the second time in the last decade. In 2009, it was categorised as a pandemic by the Indian government and all public health centres were advised to take strict measures to control it and prevent its recurrence in the future. However, in 2014 when it recurred, our public health system was unprepared.
India was one of many countries in the world that was affected by the pandemic in 2009.With 1178 deaths and more than 12,000 positive cases, the Indian health system struggled to cope with the impact. In comparison to 2009, in 2014 the total number of laboratory confirmed cases crossed the 33,000 mark and more than 2000 people died. Following 2009, the government had suggested compulsory preventive measures, which included vaccination. On enquiry, however, both the government and private hospitals did not have the vaccines in stock during the second epidemic. All the hospitals were out of stock due to the sudden increase in demand.
We conducted a study of 400 doctors, 120 nurses, and 400 people from the general population who were interviewed in the states of Delhi, Gujarat, Rajasthan, and Maharashtra, which were the areas worst affected by the epidemic. The interview questions covered topics aimed at assessing people’s knowledge of the symptoms of swine flu, the mode of infection, high risk groups, prevention, and immunization including the correct use of masks and tests.
80% of those interviewed had not even heard about the disease. When asked we got a broad range of answers on what the word “swine flu” means, ranging from the common cold to HIV/AIDS, which showed the sheer lack of knowledge about the condition. The data collected from doctors revealed that only 77.2% of doctors and only 71.4% of the nurses had knowledge about how to identify swine flu suspects.
Even simple questions such as asking about the correct way of wearing protective masks, which was advised by the government as a preventive measure revealed that close to 75% doctors, 74% nurses, and 89.25% of the general population were not able to answer it correctly.
As a nascent public health researcher, it was an eye opener. It helped me to understand the level of the seriousness of both the government and the private health sector when it comes to public health issues.
During this study, we observed that doctors do not always keep sufficiently up to date about new medicines and vaccinations available in the market, with 34.8% doctors unaware about high-risk groups while only 4% knew about the prevalence rate about this disease.
In my opinion this is just a manifestation of a deeper issue. On one hand high population density, especially in cities make us extremely susceptible to outbreaks and the spread of infectious diseases. On the other hand, severe unpreparedness makes it extremely difficult to curb the spread once such an event occurs. With a large and unregulated private sector where more than 70% of the population access healthcare, public health problems remain neglected. There is an overall lack of knowledge of the importance of being prepared for an event such as this. Even in public health systems, a lack of adequate infrastructure, insufficient resource supply, and inadequate monitoring leave us easily prone to such attacks.
The only way to address these issues is to spread awareness from the primary level and to make public health a part of general education. In addition to this, understanding the needs of the population, being prepared for such outbreaks with an effective public health system, and having regular audits to ensure preparedness, including following international guidelines, is essential to ensure that history doesn’t repeat itself when it comes to infections like swine flu.
Anu Sharma 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.
IPH faculty Dr. Vijayashree Yellappa, attended judicial workshop; Tuberculosis, Human Rights and Law at Chicago University, Delhi Centre.
Despite the fact that tuberculosis (TB) is a curable disease, it is the leading cause of death worldwide in 2014. Recognising the urgency to tackle the problem, University of Chicago, Delhi Centre, organised a Judicial workshop titled- Tuberculosis, Human Rights and Law 19- 20 December 2015. Workshop comprised of judges and other legal professionals in order to familiarize the legal community in India and other Commonwealth jurisdictions with the legal and human rights issues associated with TB. Along with judges and lawyers, participants also included medical and public health experts, civil society, and people living with TB and former TB patients.
With a broad theme of ‘Equitable India: All for Health and Wellbeing’, the 3rd edition of EPHP will focus on three major thematic areas: ‘equity in health and healthcare’; ‘intersectoral action for health’; and ‘from better knowledge to improved policies and practice’. For details about EPHP 2016 and the thematic areas please see here. We are pleased to invite proposals from institutions/individuals for organized sessions as part of the EPHP 2016. We have limited space for upto six sessions that closely fit the thematic areas. These sessions will run concurrently with other planned sessions of the conference.
The proposal, written in MS Word format with no more than 1000 words, shall have following details:
The proposals shall be submitted via email to ephp@iphindia.org with ‘proposal for organized session at EPHP 2016’ in the subject line latest by January 20, 2015. For queries, write to ephp@iphindia.org or call 80-26421929.
2nd paper on POCT ( Point of Care Test) project, published in BMC Health Services Research
Dr. Vijayashree Yellappa , faculty of IPH, Bengaluru in collaborative work among IPH, Maastricht University, Netherlands, and Mac Gill University, Canada published second paper from the POCT (Point of Care Test) project.
Abstract
Background: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.
Methods:
The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.
Results:
Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.
Conclusion:
These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.
Link to read more about 2nd paper on POCT ( Point of Care Test) project, published in BMC Health Services Research : Click here
