Assuring health coverage for all in India

Patel, Vikram; Parikh, Rachana; Nandraj, Sunil; Balasubramaniam, Priya; Narayan, Kavita; Paul, Vinod K.; Kumar, Alok; Chatterjee, Mary; Reddy, K. Srinath

doi:10.1016/s0140-6736(15)00955-1

Cited by 238 publications

(202 citation statements)

References 43 publications

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“…Referral mechanisms are paper-based, and feedback on results to the referring physicians is suboptimal. 9 Communicating test results is vital for the next course of action for the patient.…”

Section: Methodsmentioning

confidence: 99%

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Using mHealth to enhance TB referrals in a tribal district of India

Chadha¹,

Trivedi²,

Nagaraja

et al. 2017

public health action

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Mobile health (mHealth), i.e., the use of portable electronic devices with software applications to provide health services and manage patient information, 1 has the potential to transform health service delivery worldwide. 2 mHealth has a crucial role to play in health care systems, as it can improve communication and enhance the integration of health care processes. 3 Low-and middle-income countries have extensive cellular networks, and the majority of the population has mobile phones. 2 Tuberculosis (TB) remains a major public health problem in India, accounting for 23% of the global TB burden. 4 Despite case-finding efforts by the Revised National TB Control Programme (RNTCP), the country is believed to have up to one third of the estimated three million TB cases that remain unnotified worldwide. 4 Nearly 50% of TB patients are treated in the private sector, where health care providers include specialist physicians as well as unqualified providers. 5 The RNTCP has various schemes for non-governmental organisations and private practitioners (PPs) that allow private health care providers to sign an official memorandum of understanding with the Government to provide RNTCP services, for which PPs are offered incentives. 6,7 However, the involvement of PPs in these schemes is not optimal due to the complicated procedures involved and the RNTCP's delay in providing incentives; furthermore, much of the focus is on allopathic doctors and their health facilities, which are generally located in urban and semi-urban areas. In rural areas, public health services are difficult to access, as the facilities are often located far from the inhabitants and there is poor transport connectivity. In addition, health care personnel capable of providing these services are sometimes lacking at these facilities; similar problems are observed across the country. There are very few qualified private health care providers in rural areas. 8,9 The first point of contact for any kind of ailment are health care providers who often lack formal training or are trained in alternative medicine. 5,10 Nearly 72% of health care in rural areas is provided by the private sector, and nearly 81% of the doctors are unqualified. 11 The provider-to-patient ratio in India is 1:2000. 12 Until now, the RNTCP had not attempted to involve unqualified health care providers/rural health care providers (RHCPs) in TB care, although they are responsible for the management of a significant number of presumptive TB cases and TB patients. These practitioners play an important role in TB control. As the first point of contact for the majority of the rural population, they can be trained to identify presumptive TB cases early and refer them to diagnostic and treatment services, thus preventing delays. They can also be effective providers of directly observed therapy (DOT), as they have earned the confidence and trust of the community they serve. Global efforts have been made to involve all stakeholders in general, but do not specifically address the role of unqualifie...

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Section: Methodsmentioning

confidence: 99%

“…There are very few qualified private health care providers in rural areas. 8,9 The first point of contact for any kind of ailment are health care providers who often lack formal training or are trained in alternative medicine. 5,10 Nearly 72% of health care in rural areas is provided by the private sector, and nearly 81% of the doctors are unqualified.…”

mentioning

confidence: 99%

Using mHealth to enhance TB referrals in a tribal district of India

Chadha¹,

Trivedi²,

Nagaraja

et al. 2017

public health action

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“…Caste system, gender and socioeconomic status have a significant influence on health, life expectancy, and other important although less conventional health determinants such as urbanization, poor access to water and sanitation, food insecurity, environmental degradation, social stratification and income inequality (Patel et al, 2015). The caste system emerged as a factor that influenced children’s access to relief and support after the floods.…”

Section: Discussionmentioning

confidence: 99%

Children in the 2015 South Indian floods: community members’ views

Krishna

Ronan

Alisic

2018

European Journal of Psychotraumatology

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Little is known about children’s experiences and involvement in disaster preparation and recovery, in particular in low- and middle-income countries. Eliciting community members’ perspectives on the 2015 floods in Tamil Nadu, India, may generate useful insights for improving services in low-resource settings. This qualitative study aimed to understand how children in Chennai experienced the floods, as reported by the adults in their community, and to explore children’s involvement in disaster preparedness, response and recovery efforts as reported from the adults’ perspective. We conducted in-depth, semi-structured interviews (N = 48) with family members (n = 36), and with staff of non-governmental organizations (NGOs) (n = 12) who actively participated in relief and recovery efforts. We also conducted two focus group discussions (n = 14) with NGO staff about a year after the 2015 South Indian floods in Chennai, India. Six broad themes regarding children’s experiences and behaviours during and after the floods emerged: (1) unexpectedness of the floods; (2) children’s safety – barriers and facilitators; (3) parents’ reactions – helplessness, fear and pride; (4) children’s reactions – helping hands, fun and fear; (5) barriers to a return to ‘normal’; and (6) a determination to be prepared for next time. Children and families were deeply impacted by the floods, in part owing to a lack of preparation, as perceived by the study participants. It was also clear from the data analysis that caste and socioeconomic status played an important role in the families’ ability to evacuate safely. Helplessness on the part of the parents was apparent, as was children’s concern over recurrence of the flood. Similarly, gender appeared to affect child safety, recovery and other outcomes such as continued education. Priorities for future efforts involve the development and evaluation of child-centred education about flood awareness, child participation and safety.

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“…This program alone remains insufficient to meet the needs of the large Indian population in rural areas, and the work of ASHAs has for the most part been limited to maternal and child health. 4 In view of the poor distribution of human resources for health in India's rural, tribal, and hill areas, the Christian Medical College (CMC) in Vellore, India, sought to enhance efforts to respond to the high burden of largely preventable and often easily treatable diseases by establishing the community lay-leaders health training certificate (CLHTC) course in 2011. [4][5][6] The CLHTC course trains lay leaders with the knowledge, skills, and attitudes to serve their local villages and schools with health promotion, health education, and basic health care.…”

Section: Introductionmentioning

confidence: 99%

“…4 In view of the poor distribution of human resources for health in India's rural, tribal, and hill areas, the Christian Medical College (CMC) in Vellore, India, sought to enhance efforts to respond to the high burden of largely preventable and often easily treatable diseases by establishing the community lay-leaders health training certificate (CLHTC) course in 2011. [4][5][6] The CLHTC course trains lay leaders with the knowledge, skills, and attitudes to serve their local villages and schools with health promotion, health education, and basic health care. The course takes an intentionally holistic approach to health and wellbeing by addressing spiritual, emotional, and social, as well as physical aspects of health.…”

Section: Introductionmentioning

confidence: 99%

Impacts of community lay-leader health worker training and practice (Uttarakhand, India)

Butcher¹,

Grills²

2017

han-j-cjgh

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This study investigated the impacts of the Community Lay-Leaders Health Training Certificate course on trainees and their communities in the state of Uttarakhand, North India. A suite of semi-structured interviews and focus group discussions were conducted among course stakeholders and graduates, respectively, and textual data was added to the data set. Thematic analysis of the results revealed four themes, including: (1) the effectiveness of course design and delivery, together with the key role of the coordinating facilitator; (2) the match between graduates' practices, the providing institution's objectives and general expectations of community health workers; (3) the strengthening of the health system through skills multiplication, collaboration with existing authorities, and advocacy for higher quality in professional practice; and (4) the need for ongoing support and training post-graduation. The findings are consistent with literature concerning community health workers' roles and challenges, although some potentially unique outcomes were noted with respect to the pastoral support provided to trainees and the pro-active transfer of graduates' knowledge and skills to fellow villagers.

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Assuring health coverage for all in India

Cited by 238 publications

References 43 publications

Using mHealth to enhance TB referrals in a tribal district of India

Using mHealth to enhance TB referrals in a tribal district of India

Children in the 2015 South Indian floods: community members’ views

Impacts of community lay-leader health worker training and practice (Uttarakhand, India)

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