rural health care providers – building capacities and beyond liver foundation, west bengal
TRANSCRIPT
RURAL HEALTH CARE PROVIDERS – BUILDING CAPACITIES AND BEYOND
Liver foundation , west bengal www.liver-foundation.in
THE RECIPE
1. RELEVANCE AND PHIOLOSOPHY
2. THE PROCESS
3. IS IT USEFUL AND IMPACTING ?
4. ISSUES AHEAD
Private Institutions
Ind
ivid
uals
NGO/Missionaries
INFORMAL RURAL HEALTH
CARE PROVIDERS
Legitimate, Legislated & Regulated Unregulated, Heterogenous behavior & Content
Indian Health Care
OP/IP
Decision Makers
Clinical service:
o Paramedicso Nurses
Public Health Service:
o MPHWo ASHAo Nurses
DOCTORS
Professional bodies Corporate
houses Public sector Hospitals
Formal Sector
Politician
Urban
Urban + Rural
Civil servant
Informal Sector
Rural
o Candle in darknesso Individualistico Non-institutionalisedo Instanceo Social accountability
Urban & Peri-urban
o Institutionalo Modernisedo Non-institutionalised
Informal Rural Health Care Provider
A person engaged in activities & practice in rural health care market and supply goods in professionalized biomedicine guided by supply-demand axis
No TrainingNo Certification
No LegitimacyNo Regulation
Self-employedInformal provider.
Educated unemployed Youths.
Lacks scientific understandingAnd approach.
Empirical “craft” Earning motive.
Good / Bad.
Copy of the existing system.
RHCP
Individual
• Heterogeneous – Formal education - Culture - Quality - Contact
• Craftsmanship – Inflated sense
System
• Intolerance• Lack of focused
measures • Regulation
Enrichment of community understanding
Cross-talk and learning with
community
Integrated action within Health System Vehicle for
Multiple Positive
Health Action & Messages
Capacity building of Rural Health Care Providers
[RHCPs]
RHCP orientation
Unregulated
Positive attribute
¯ Negative attribute
Regulated
Net societal benefit
Community participation.
Community competition.
Community vigilance.
Community intervention.
Objectives:
Convert a clan of “Self proclaimed, unqualified doctors” to a clan of enriched health care workers through educational, social and cultural inputs
To
Reduce Harm
Increase benefits
INITIATION ENRICHMENT CONSOLI
DATIONCONTINUATION
Theory:• Disease oriented
• Adverse effect of drug & Practice
• Legitimacy & Regulation
Theory & Clinical:Life saving care
Public Health Programmes2/3 M
onths : Exam
2/3 Months : Exam
2/3 Months : Exam
RURAL HEALTH CARE PROVIDER [RHCP] Capacity building : CURRICULUM & PLAN
6 -8 hrs / Wk 150 – 200 hrs 75:25
THE WAY WE HAD GONE…
SELECTION OF TRAINEES
INITIAL ORIENTATION
STRUCTURED CAPACITY BUILDING EXERCISE
EXAMINATIONS
CONTINUED ORIENTATION AND APPLICATION
MADHYAMIK UPTO H.S. GRADUATION POST GRADUATE HARDCORE0
10
20
30
40
50 42.5
20.37 21.92
1.24
13.86
EDUCATIONAL BACKGROUND
NO
OF
RHCP
12%
25%
24%7%
1%
31%
AGE CLASSIFICATION OF RHCPS (IN YRS)
<3031-4041-5051-60>60NO DATA
CLINIC HOME VISIT CLINIC & HOME VISIT
DID NOT PRACTICE
HARDCORE05
101520253035404550
47.88
19.4422.75
1.76
8.17
NATURE OF PRACTICE N
O O
F RH
CP
0 5 10 15 20 >20 HARDCORE0
5
10
15
20
25
30
2.48
21.51
25.75
14.17
9.62
4.76
20.06
PERCENTAGE (RHCP)/EXPERIENCE (YEARS)
NO
OF
RHCP
ANY TIME TWICE ONCE HARDCORE0
102030405060708090
84.8
6.210.1
8.79
AVAILABILITY OF RHCPs FOR TREATMENT
PRACTICE TIME IN A DAY
NO
OF
RHCP
BIKE OTHER HARDCORE05
101520253035404550
42.3%
49.84%
7.86%
MODE OF TRANSPORTATION OF RHCP
TRANSPORTATION
NO
OF
RHCP
YES NO NO ANSWER0
10
20
30
40
50
60 53.36
0.1
46.53
Was the training was useful? N
O O
F RH
CP
YES NO DID NOT ANSWER0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Opinion of RHCPs REGARDING NEED FOR CONTINUED TRAINING
Axis Title
NO
OF
RHCP
48%
4%
0%1%
47%
Proposed training schedule
ONCE IN A MONTHONCE IN TWO MONTHONCE IN THREE MONTHTWICE IN A YEARDID NOT ANSWER
1% 2% 8%
41%
48%
Training Module
THEORETICALPRACTICALPRACTICAL>THEORITICALBOTH DID NOT ANSWER
1%
84%
6%9%
incentive FOR training program
EARNKNOWLEDGERESPECTSELF CONFIDENCE
Training & execution: Overall participation
3 months
o Certificationo Integrationo Main stream public health programme
75%
50%
25%
Perc
enta
ge o
f par
ticip
ation 100%
6 months
9months
12 months
2 years
4years
7 years
DOTSCOPD Metabolic
Health
Good practice is retained over time
K
75%
50%
25%
Perc
enta
ge o
f par
ticip
ation
A P
End of Training
Loss of contactKn
owle
dge
Attitu
de
Prac
tice
K A PKn
owle
dge
Attitu
de
Prac
tice
5 years after training
Exposure
IMPACT ASSESSMENT
Case Control design –RANDOMISED Simulated patients and Vignets
2013- 2014 350 RHCPs included
Liver Foundation, West Bengal
Department of Economics, MIT & J PAL
ISERRD , New Delhi
ISSUES :
Are we really achieving ?? - In the ‘MICRO’ level
Health System Information – Impact for the consumers
Regulation - Accreditation – Certification - Would A Co-operative / Professional society help ?
INTEGRATION & UTILISATION
Replication & Amplification of Capacity Building Projects
Reduce mainstream sensitivity Research :- Academic & Policy
Public Health Programmes - Pilot
RHCP : Peripheral Metabolic Port
50 such
3 X 17 blocks
BP Machine, Glucometer, Anthropometry, Bicycle
Awareness Tool
Exercise Training
Central Port: Confirmation & Validation
Apex Port : Detail Analysis
Attempts at Integration & Focused activities :
DOTs Defaulter retrieval
Leprosy Care: Detection & Retrieval
Large scale Metabolic Health Awareness and action project
A PROPOSED INTEGRATIVE MODEL
.
HW ANM AW
TDRHCP
SHG
Panchayet
Awareness generation Hepatitis
/metabolic health/
immunization / safe
motherhood
Antenatal checks.
Detection of high risk
pregnancy.
Action - NCD s
Lessons learntIndividual capacity building – Transient vs Persistent Government intervention
Awareness & community action can be fostered
Their social stakes may increase
‘SYSTEM’ is still strategically ambivalent
Mainstream is maintaining an “INFORMED SILENCE”
Rural Health Care Provides
Need• Competence ??
• Performance
• ↑ Incentives
• ↑ Social status
• Regulate
• Integrate
• Utilize
Lifesaving curative care in “Darkness”
Candle of Public Health Messages
Indi
vidu
al System
FUNDING :
Bristol Myers’ Squibb Foundation , USA
National Rural Health Mission , Government of West Bengal