The second global meeting of the Health Inc project was held in Senegal between 9th and 11th November. This meeting was hosted by the Centre de Recherché sur les Politiques Sociales (CREPOS – Research Centre for Political and Social Science) in the capital city of Dakar. All partners of the Health Inc consortium attended this meeting. From IPH, the Health Inc team comprised of Dr.Devadasan N, Dr.Thriveni BS, and Dr.Tanya Seshadri.
The three day meeting began with presentation and discussion by ‘Experts by Experience’ in poverty and social exclusion from Belgium who provided insight into social exclusion from the point of view of those excluded. This enlightening start was followed by presentations from all partners regarding their localised research protocol along with challenges foreseen. While the previous meeting had allowed for discussions regarding health financing mechanisms across Ghana, Senegal, Maharashtra (India) and Karnataka (India), this time the focus was on the planning and implementation of research across the various sites. The challenge remains to develop a common skeletal protocol while allowing each team to develop protocols based on their specific context. The health financing schemes being used to study social exclusion in the African and Indian sites are National Health Insurance Scheme (NHIS, Ghana), Plan Sesame (Senegal) and Rashtriya Swasthya Bima Yojana (RSBY – Maharashtra and Karnataka).
This meeting was followed by a two day workshop for the junior researchers from the various institutes. The workshop had the group divided into country-based teams and each team worked on developing context-specific hypotheses and initiated work on the research tools.
The Urban Health Project in Bengaluru was envisaged as an intervention based creation of a model for public health in a large and expanding city, focusing on the needs of the poor. Initially planned as an exercise in co-ordination with other NGOs, it has moved to focusing primarily on a “field area” –KG Halli where direct intervention by IPH staff is taking place.
Given the rapid urbanisation and delay in the unrolling of the NUHM, much remains to be done in the area of urban health. Bengaluru with its rapidly expanded city precincts needs careful study and quick well planned interventions. With this background, IPH is carrying out an action research project in ward number 30, KG Halli, Bengaluru. Here the IPH team will work towards improving the quality of health care provided to the community of roughly 42,000 people, with a small part of notified slum in it.
Action taken to achieve it
The action research is based on a seemingly simple idea, that if the stakeholders – communities and both private and public health providers in a geographical area can be brought together to dialogue on a common “health platform”, they can work towards improving the quality of care in the area. What brings complexity to the situation is the multi layering of the “community” where class, language and religion play important roles in decision making processes. Additional factors include the complexity of the government health system, partially under the corporation and partly under the state services.
The overall ambition is to test strategies for improved access to quality care in a metropolis such as Bengaluru, emphasizing bottom up processes based on community empowerment. A key aspect of envisaged strategies is the creation of local health platforms involving community, providers and local authorities, to which health services would be answerable. Photos of Urban health
This project was implemented in collaboration with the Gramin Shikshan Charity Foundation (an NGO based in Hubli, Karnataka) across seven districts – three northern and four southern Karnataka districts. Project aim was to study effect of district level capacity building of law enforcement officials and tobacco control advocacy on implementation of selected provisions of national tobacco control legislation. Five districts, namely, Tumkur, Ramanagaram, Mysore, Dharwad & Gadag, were taken as intervention districts while two districts – Bengaluru rural and Haveri – were taken as control districts. In the course of one year, state and district level need assessment surveys as well as pre-compliance monitoring exercises were conducted in all seven districts highlighting the needs of district level law enforcement officials as well as the status of implementation of tobacco control law in these districts.
Exposure to on-screen (portrayal of tobacco use in media) tobacco use has been shown to be one of the factors influencing initiation of tobacco use by youth. Media rating system is one of the tool to reduce exposure of youth to on-screen tobacco use. There was a proposal by Central Board for Film Certification (film certification authority in India) to possibly rate films with portrayal of tobacco use as ‘A’ (only for adult viewing) films, in order to reduce its exposure to youth.
IPH carried out a study among youth in Karnataka (including students from metropolitan city, towns and villages) to assess awareness and enforcement of current media rating system. Study findings suggested poor re of viewership restrictions as prescribed by prevailing media rating system. Study also provided data on various aspects of tobacco use and its association with exposure to on-screen tobacco use among youth. This study was funded by the World Health Organisation (India). Publications from the study are in progress.
Following an initial exploratory and small study by IPH on tobacco use among pre-university students, a large-scale cross sectional study using a random sample of 19 pre-university colleges across the Bangalore city was planned for better and representative assessment.
Various aspects related to tobacco use including, prevalence of tobacco use, social perceptions of tobacco use/user, factors influencing initiation/continuation of tobacco use, implemettaion of relevant policies etc. were studied. This study was carried out under ISEC-SRTT visiting fellowship programme by Institute for Social & Economic Change, Bangalore. Publications from this study are in progress. A research brief was produced summatising the study findings and was distributed among city based pre-university colleges. Study findings were reported in several news reports.
Most studies on youth and tobacco use in India (including Global Youth Tobacco Surveys) focsues on high-school students (grades 8, 9 and 10). In Karnataka, pre-university education (grades 11, 12) is imparted through a seperate governmanet department and often in different settings than high-schools. This phase of life represents a transition of student from relatively more restricted school setting to liberal university setting. In order to understand tobacco use and related factors among pre-university students, IPH carried out an exploratory cross sectional study among 500 students of a purposely selected pre-university college in Bangalore city. Study provided findings on tobacco use prevalence, reasons for (non) use of tobacco by students, awareness on tobacco harms, information sources for such awareness etc.
Study findings were published in the National Medical Journal of India and were subsequently disseminated through mass media reports. For more details, please see relevant publications and news reports.