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.
by iphindia | Oct 14, 2015 | Blog, Education, Latest Updates
Dr N. Devadasan was invited by the ITM Antwerp to help coach their MPH students on local health systems. He was there for the whole month of Sept 2015.
It was a great learning opportunity as he was able to interact with health professionals from 25 different countries (4 continents).
by iphindia | Sep 17, 2015 | Blog, Education, ePHM-Advance, Latest Updates, Short Course
e-learning course on Public Health Management 2015
After successfully managing three consecutive batches for the online course in Public Health Management (e-PHM), we kick started the fourth batch on 19th of August 2015. This batch brings along with it 31 amazing students from diverse backgrounds working across the country and internationally as well!
For the first time, we have five participants from Universitas of Gadjah Mada, Yogyakarta who are working in the department of public health. The diverse work backgrounds of the participants include UNICEF, National Institute of Epidemiology, St.John’s Research Institute, Bangalore Baptist Hospital, Department of Environmental Science and various NGO
s like JANANI and SAATHI.
We also have participants who are pursuing their PG in the field of community medicine and hospital & healthcare management. The course consists of eight modules and each module consists of four units. Each unit will have one to two classrooms that is a PowerPoint presentation with audio recording and corresponding exercises. Each module ends with a final module test based on the content covered. The students are expected to complete these units and based on their completion we are presenting their progress. Based on the feedback provided, this new batch has new features to make the learning experience more interesting and fun. Keeping in mind the work backgrounds of our participants who have to travel constantly and have limited internet access, we have introduced a new feature called “Learn on the go”. This feature allows them to download MP3 versions of our classrooms and listen to them on the go! Out of 31 students, 30 have logged in and viewed our course. The number of students who have managed to complete Module – 1 are 19, which is about 61% of the total students.
We are currently in the process of identifying any challenges faced by the participants and address them as we move forward in the course. We look forward to providing a good learning experience to the participants!
by iphindia | Sep 2, 2015 | Blog, ePHM-Advance, Latest Updates, Short Course
In India, only 20% people with minor illness, and only 50% people with serious illness come to Government hospitals. Thus, there is a need to understand the reasons influencing health care seeking practices to generate demand for health programmes. Amongst rural and tribal communities in Madhya Pradesh, it has been generally noticed that the first point of contact for any illness is a private provider, many-a-times an untrained practitioner, since they are easily accessible. Literacy level is quite low in the state, particularly in rural and tribal communities, resulting in being unaware of the basic symptoms of Tuberculosis (TB) and availability of free treatment and diagnostics at Government health facilities. Some TB patients also discontinue treatment, due to lack of awareness. At times these people also get required medications from a local pharmacist, since they have low faith in Government health system and when condition worsens (both in terms of health as well as finances), they visit a Government health facility. Also these communities are generally dependent on daily labour, leading to delayed TB diagnosis and treatment, in fear of loss of wages. Alcoholism & tobacco use of all forms is predominant in these communities, thus affecting the treatment adherence.
Barriers & constrain
ts
With reference to the programme delivery, a number of barriers play a role in influencing health care seeking behaviour of rural and tribal communities of Madhya Pradesh, such as unavailability of health staff, poor accessibility due to distance, unavailability of medicines and other requirements, to name a few. A major proportion of rural and tribal communities are residing far off from the Government health facilities, and thus even if the PHC is open and there are health staff providing services round the clock, it is difficult for a sick person to reach the PHC.
Beliefs influencing TB health seeking behaviour
Rural people in India and tribal populations in particular, have their own beliefs and practices regarding health. Some tribal groups still believe that a disease is always caused by hostile spirits or by the breach of some taboo. They therefore seek remedies through magic and religious practices.
Amongst tribals in Madhya Pradesh, evil spirits are attributed to be the cause of TB. The belief that TB occurs due to supernatural powers lead to the concept of seeking relief through magic, keeping the allopathic medical practitioner as a last resort. There are also beliefs that they cannot get TB, hence leading to delayed treatment seeking.
Lessons learnt and way forward
To summarize, there are many reasons for people to go to a particular health provider. Most important reasons include awareness, money, distance and availability of staff. These factors play a role in creating demand for any health programme, particularly the Revised National TB Control Programme (RNTCP). Hence, there is a need to address the issues that influence TB health seeking behavior such as improving the availability of trained staff at health facilities, enhance level of awareness amongst the community about TB – IEC activities to be increased, regular patient provider meetings to ensure treatment adherence as well as improved faith in Government health system. Also in RNTCP, there is a scope for involvement of NGOs in the programme – since most of the rural and tribal habitations are quite interior, Sputum collection centres can be established through NGOs nearer to these communities.
Moumita Biswas 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.
