by iphindia | Jul 21, 2016 | Latest Updates, Uncategorized
Can Bengaluru Survive? Our priorities are all wrong :- IPH Staff quoted in The Times of India
Dr. Aneesha Ahluwalia, Training officer at IPH was quoted in Times of India and Bangalore Mirror. The article titled ‘Can Bengaluru survive?- our priorities all gone wrong’ was the third part in the series on Bengaluru’s indicators based on IISC report. The article focused on the social indicators and it’s relation with the sustainability of the city. Dr. Aneesha contributed towards the public health aspects especially the migration issue.
GOVT VS PRIVATE
Basic facilities in the city, Kurup said, are stretched out too thin because of unplanned growth. “Over the last two decades, Bengaluru’s economy has undergone a significant transformation, with service industry playing a major role in economic development.Our planning always comes after the problem and this is a dangerous approach,“ she says.
Health services have become expensive.Government services are not able to match the demand, nor are they efficient. So people are forced to look at private services. What planners need to look at is creating urban neighbourhoods beyond the city, so that people are not forced to migrate to Bengaluru for basic facilities, which the city anyway lacks, said Kurup.
Aneesha Ahluwalia, health expert from the city-based Institute of Public Health, pointed at a common concern for most cities: migration.“Bengaluru also faced such a sudden inflow of migrants due to the economic boom. The city grew tremendously in terms of population, but the infrastructure did not grow in the same proportion. The IISc report says that more than half of the population (58.7 per cent) lives in rented houses, indicating that a majority of them are not locals. The private sector on the other hand is highly unregulated, specially the private practitioners. There is no regulation on pricing or quality, among others,“ she said.
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 | May 14, 2015 | Blog, Urban Health Action
This article originally appeared on BMJ Blogs on April 24, 2015 under the same title.
This blog is my reflection on regular field visits as part of the urban health action research project that I am currently working on. The field site for the project is a very poor neighbourhood of Bengaluru called K.G.Halli. This neighbourhood has families who earn their living as daily wageworkers to a few upper middle class families.
Let me give a brief overview of the project. It is an action research project which aims to improve access to quality healthcare especially for people with chronic conditions among the urban poor. As a project initiative, we identified three ladies from the same community and trained in providing awareness sessions for chronic conditions. These community health assistants have been working in the neighbourhood since 2009. They go door to door to deliver awareness sessions on diabetes and hypertension, to inform patients what the preventive measures are that the patient and the family can adopt on a daily basis, how diet plays an important role in managing their conditions, and the importance of regular medical check ups. These ladies are an important interface between the community and healthcare providers. Over the years they have become the “go-to” people to seek advice.
Recently I accompanied these ladies for their regular home visits. As they were walking in the lanes, familiar faces greeted them, some asked them to come and join them for a cup of coffee. These were greetings on one end of the spectrum, on the contrary we had to knock on an average of 20- 25 houses and then there would be one patient or a family who would greet us. A few passers by whom we met on the way had curious questionable looks on their faces, and a few even said: “There is no patient in the family.”
Some responses I found were very startling and some of the interesting ones, which did capture my attention, were:
“I already have the disease, how will this awareness bring about a change?”
“ I do not have a ration card, that is more important to me, awareness is not.”
“ Why don’t you give us money?”
“ It is your job as a doctor to find cure and medicines, it is not the responsibility of the patient to make any dietary changes.”
“ Why are you scaring me after me being diagnosed with the disease? I do not need this information.”
“Do you have to meet certain targets? How many houses do you have to visit like these in a day?”
Another experience cited by the health assistants was, “we are educated people, we do not need your information: you would be better off educating the poor people.”
These reactions from the community, which I worked in for almost two years, made me realize that I was wearing blinkers as a young researcher and a medical doctor. It made me realize that the training in research or medical school did not give me any skills to understand these reactions or even think which other strategy I could use to communicate effectively and motivate people.
They sought a completely different path to find out about or understand their disease. Most of the patients that we visited asked us “why aren’t you carrying a glucometer to let me know if my blood sugar levels are under control.” The patients just wanted a figurative number, which is simpler for them to understand and to reassure them that their disease is under control. They would rather not listen to the “science” but to an immediate solution to their problem.
Their voices echoed completely different priorities, such as ration cards, cheaper sources of medicines, or jobs. Another question which came to my mind was whether my chosen strategy of conducting door-to-door awareness sessions was indeed the best strategy for the community or for the researcher?
The comfort of science and research were no longer my allies in solving my dilemma, reiterating the steps to actually listen to the community and understand their priorities better than going with my priorities as a researcher. How can a young researcher like me help them in securing a ration card of any other welfare schemes? Maybe there were unexplored pathways to find a common ground which has a possibility to solve some demands of the community as well as bring in about motivation in the community for adopting a healthier lifestyle.
Written by – Mrunalini Gowda, Research Officer at the Institute of Public Health, Bengaluru.
