Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background:Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities.Methods:Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed.Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance.Conclusion:The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed

Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted

Health impacts of extreme weather events – Cascading risks in a changing climate

Background: Extreme weather events represent one of the most tangible impacts of anthropogenic climate change. They have increased in number and severity and a further increase is expected. This is accompanied by direct and indirect negative consequences for human health. Methods: Flooding events, storms and droughts are analysed here for Germany from a systemic perspective on the basis of a comprehensive literature review. Cascading risks beyond the initial event are also taken into account in order to depict downstream consequences. Results: In addition to the immediate health burdens caused by extreme weather events, such as injuries, long-term consequences such as stress-related mental disorders occur. These stresses particularly affect certain vulnerable groups, e.g. older persons, children, pregnant women or first responders. Conclusions: A look at the cascading risks described in the international literature allows us to develop precautionary measures for adaptation to the consequences of climate change. Many adaptation measures protect against different risks at the same time. In addition to planning measures, these include, above all, increasing the population's ability to protect itself through knowledge and strengthening of social networks. This is part of a series of articles that constitute the German Status Report on Climate Change and Health 2023

Gesundheitliche Auswirkungen von Extremwetterereignissen – Risikokaskaden im anthropogenen Klimawandel

Hintergrund: Extremwetterereignisse stellen eine der greifbarsten Auswirkungen des anthropogenen Klimawandels dar. Sie haben in Zahl und Ausprägung zugenommen und eine weitere Zunahme wird erwartet. Damit gehen unmittelbare und mittelbare negative Folgen für die menschliche Gesundheit einher. Methode: Überschwemmungsereignisse, Stürme und Dürren werden hier für Deutschland aus systemischer Perspektive auf Basis einer umfassenden Literaturrecherche analysiert, wobei über das konkrete Schadensereignis hinausgehende Risikokaskaden in den Blick genommen werden, um auch nachgelagerte Folgen darzustellen. Ergebnisse: Neben den unmittelbaren gesundheitlichen Belastungen durch Extremwetterereignisse, wie Verletzungen, treten langfristige Folgen, wie psychische Belastungsstörungen, auf. Diese Belastungen betreffen bestimmte vulnerable Gruppen, z. B. ältere Menschen, Kinder, Schwangere oder Einsatzkräfte, in besonderem Maße. Schlussfolgerungen: Der Blick auf die in der internationalen Literatur beschriebenen Risikokaskaden erlaubt es, Vorsorgemaßnahmen für die Anpassung an die Folgen des Klimawandels zu entwickeln. Viele Anpassungsmaßnahmen schützen dabei vor unterschiedlichen Risiken gleichzeitig. Neben planerischen Maßnahmen ist dies vor allem auch die Erhöhung der Selbstschutzfähigkeit in der Bevölkerung durch Wissen und die Stärkung sozialer Netzwerke. Dieser Artikel ist Teil der Beitragsreihe zum Sachstandsbericht Klimawandel und Gesundheit 202

Gesundheitliche Auswirkungen von Extremwetterereignissen – Risikokaskaden im anthropogenen Klimawandel

Hintergrund: Extremwetterereignisse stellen eine der greifbarsten Auswirkungen des anthropogenen Klimawandels dar. Sie haben in Zahl und Ausprägung zugenommen und eine weitere Zunahme wird erwartet. Damit gehen unmittelbare und mittelbare negative Folgen für die menschliche Gesundheit einher. Methode: Überschwemmungsereignisse, Stürme und Dürren werden hier für Deutschland aus systemischer Perspektive auf Basis einer umfassenden Literaturrecherche analysiert, wobei über das konkrete Schadensereignis hinausgehende Risikokaskaden in den Blick genommen werden, um auch nachgelagerte Folgen darzustellen. Ergebnisse: Neben den unmittelbaren gesundheitlichen Belastungen durch Extremwetterereignisse, wie Verletzungen, treten langfristige Folgen, wie psychische Belastungsstörungen, auf. Diese Belastungen betreffen bestimmte vulnerable Gruppen, z. B. ältere Menschen, Kinder, Schwangere oder Einsatzkräfte, in besonderem Maße. Schlussfolgerungen: Der Blick auf die in der internationalen Literatur beschriebenen Risikokaskaden erlaubt es, Vorsorgemaßnahmen für die Anpassung an die Folgen des Klimawandels zu entwickeln. Viele Anpassungsmaßnahmen schützen dabei vor unterschiedlichen Risiken gleichzeitig. Neben planerischen Maßnahmen ist dies vor allem auch die Erhöhung der Selbstschutzfähigkeit in der Bevölkerung durch Wissen und die Stärkung sozialer Netzwerke. Dieser Artikel ist Teil der Beitragsreihe zum Sachstandsbericht Klimawandel und Gesundheit 202

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed

Living in two cultures - Transnational identities of Indian migrants in Germany

The question of migrant identities is a leitmotif of the research on transnationalism. This paper explores how Indian migrants in Germany describe their identities. Differing views will be portrayed: on the one hand positive self-perceptions, which are nurtured by living in two cultures; on the other hand the self-perceptions of transnational migrants, who perceive living transnationally as a burden. Further, it will be discussed how the relationship to the sending society develops with an increasing duration of stay in Germany. Also the cultural identity of different Indian migrant organisations in Germany will be described. Special interest is given to the analysis of transnational identities of second generation migrants. For this group the embedding in transnational familial and social networks poses a special challenge. The paper aims at substantiating the concept of hybrid identities by applying a differentiated analysis of the concrete case study