Dr.Vijayashree Yellappa, Faculty at IPH presented a study at 46th World Conference on Lung Health at Cape Town
( 2nd December – 6th December).
Title of the presentation: Retail Private Pharmacist’s referral practices and perceptions to collaborate with National Tuberculosis Programme (NTP): Qualitative Study, South India.
The study findings were part of a larger study conducted for World Bank in 2013 in Karnataka, India, to evaluate the Results based financing strategies for TB care.
Retail Private Pharmacist’s (RPP) knowledge and perceptions to collaborate with National Tuberculosis Programme (NTP): Qualitative Study, South India
Vijayashree Yellappa, Hima Bindu, Neethi V Rao, Devadasan Narayanan
Background: In India, RPPs are often first and repeated point of contact for patients. NTP is involving RPPs through Indian Pharmaceutical Association by training them to identify and refer chest symptomatics to NTP for TB diagnosis. We conducted this study to assess RPP’s (i) knowledge and referral practices (ii) stocking and dispensing of TB drugs (iii) kickbacks to providers.
Methods: Semi-structured interviews were conducted with 40 RPPs in Bangalore (urban=19) and Tumkur district (rural=21) during 2013 from Karnataka, India. RPPs were randomly selected from the register maintained with district drug controller.
Live interaction of Student-teacher are very essential for engagement of students, especially, in an e-learning environment. Online learning is most effective when courses are led by a live teacher and students can interact with that teacher in real-time. The mere presence and active involvement of an instructor motivates students and helps them navigate challenging content, inspiring them to improve their performance. During such interactions, instructors bring in knowledge beyond the curriculum. Keeping this in mind, we organized a live hangout session with Prashanth, our subject matter expert and students of ePHM 2015. The students and Prashanth discussed on various topics like systems thinking, national health programmes, private sector regulation, etc. Here is a video of their interaction.
Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India
Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource constrained settings. In order to generate such knowledge, we evaluated an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management.
We conducted a quasi-experimental study in a poor urban neighborhood in South India where four health facilities delivered the intervention and the four matched facilities served as control. Patients were surveyed before and after the six-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Of the patients who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines.
Doctors’ concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients’ perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. In conclusion, implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients’ and healthcare providers’ experiences and perceptions and how macro-level policies translate into practice within local health systems.
Link to know more about this paper reporting on a health service experiment in an urban slum: Click Here
Shortage of nurses and its impact on the Indian health care delivery system remains a major concern to this day. Adding to the above problem there is an undersupply of competent public health nurses who are willing to serve in the resource-limited community health care settings. The blog is a reflection on the current status of community health nursing education in India.
With a shortage of doctors, it is the nurses and other allied health professionals who run the show in many of the primary healthcare settings in India. Nurses make up a major proportion of the health workforce. In this context we need more and more nurses who are capable of addressing the diverse healthcare needs of society. There is a shift from hospital based curative care to community based preventive and rehabilitative care, and a greater focus on giving people control over their health. Therefore, we need nurses who are equipped with specialized knowledge and skills in public health to work in community healthcare settings.
But the reality shows a different picture. Currently in India, diplomas, undergraduate, postgraduate, and doctorate level courses are offered in nursing. There are also various specialities and sub specialities in nursing at a Masters level. Many nursing educational institutions even the reputed ones in India are contemplating stopping their Masters programmes in community health nursing since there are no takers. If this trend continues, there is a possibility that community health nursing will become extinct in the near future.
The honours programme of Maastricht University has a cooperation with the Institute of Public Health(IPH) in India. We, a group of 9 students, are doing a research for the Institute of Public Health about the human resources for health in India. We were invited by IPH at the end of our summer holiday and experienced the health care system for two weeks by ourselves. Our program consisted of several field visits in Tumkur and in Bangalore, and a visit to Gudalur, where a program for the Adivasi is made that contains their rights, education and health.
Our program started on Monday the 17th of August with an introduction about our program during our stay at the IPH. On Tuesday we went to Tumkur for two days. Here we visited the government/public health facilities: the sub centre, primary healthcare centre, community healthcare centre and the district hospital. We also visited the tuberculosis centre of Tumkur and a private hospital. Because our project is about the human resources for health in India we also focus on the distribution of the doctors in not only the rural and urban areas, but also in public and private settings. For us it was hard to imagine why doctors would prefer to work in the private sector. After visiting the different facilities (district/public hospital and private hospital) it was more clear to us why doctors choose to work in the private hospital, especially because we also had the opportunity to talk to doctors in both settings. Besides this, it was also hard for us to imagine why a lot of people visit the private sector instead of the public (which is for free).
After our visit, it is clear that the private sector is better and as long as patients have money to pay the private sector, they will go to the private. After Tumkur, we had a visit in a field office in Bangalore itself on Thursday. Here we saw another primary healthcare centre and a community healthcare centre. Unfortunately, we didn’t had the opportunity here to talk with healthcare workers in this field. On Friday we had debriefing day and we told Dr. Deva about the experiences we had during our first week. Also we gave a presentation about our work back home in Maastricht and updated Dr. Deva about our progress so far. On Sunday we left Bangalore to go to Gudalur. This was a different kind of experience, one that I didn’t expected to have during our stay at the IPH. In Gudalur a project for the Adivasi people was started about 25 years ago.
The incentive of this program was to give the Adivasi people their rights back: bring them back their land/forest and learn them about their rights and how to maintain their rights and their land. Adivasi are the poorest people of India, and giving them their land back didn’t solve all their problems The project extended, and included the strengthening of a wealthy health system and a good educational system. Nowadays the Adivasi have their own school, the best in the area, and an own hospital, which is also very good. The hospital and the school are managed by almost only Adivasi people. There are still a few persons from outside that help the Adivasi maintaining their community, but their goal is (as it was 25 years ago) to strengthen the Adivasi people to do this themselves. I really like the philosophy the people in Gudalur have and I think their approach of helping the Adivasi people is one that should be used more often and can be an example in other situations. I’ve learned a lot during those 2 weeks at the IPH and hope I will use these experiences in my later life when I myself operate as a doctor. It’s amazing to see what good work people do to make other people’s lives better and I really have a lot of respect for them.
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.
The Indian Council of Medical Research (ICMR), New Delhi is the apex body in India for the formulation, coordination and promotion of biomedical research. It is one of the oldest medical research bodies in the world. The council promotes biomedical research in the country through its research institutes and units, and provides grants/fellowships for different kinds of research activities. We feel proud to have such a pioneer organisation as ICMR to be a partner for EPHP 2016. ICMR will send delegates from their affiliate organisations and also provide scientific inputs for the conference. They will also help in facilitating thegovernment representation at the conference from both the centre and states.
unity health care settings. The blog is a reflection on the current status of community health nursing education in India.
octors in both settings. Besides this, it was also hard for us to imagine why a lot of people visit the private sector instead of the public (which is for free).
