Fostering Directly Observed Treatment in Tuberculosis: A Program Manager’s Perspective

Global Tuberculosis (TB) report (2013) has revealed that an estimated 8.6 million people developed TB of which, India accounts for almost 26% of the cases. These estimates clearly suggest that the country’s efforts to achieve Millennium Development Goal 6 by 2015 have not delivered the desired output. In India, the TB prevention and control activities are supervised and implemented under the Revised National TB Control Program (RNTCP), which recognizes that implementation of a good quality Directly Observed Treatment with Short course chemotherapy (DOTS) is the first priority for TB control. Directly Observed Treatment (DOT) is the key element in DOTS strategy, in which a DOT provider insures and supports the patients in consuming their drugs throughout the course of treatment. In order to meet the country’s vision to achieve universal access of TB care, the RNTCP has launched a “treatment adherence scheme” (public-private partnership scheme). Further, an evidence-based integrated strategy should be formulated for addressing the identified barriers which advocates universal administration of DOT. To conclude, DOT in RNTCP insures long-term adherence to the treatment, with right drugs in right doses, at right intervals and thus plays an indispensable role in improving the outcome indicators of the program and the quality of life in patients

Community monitoring: A strategy to watch out for

India’s National Rural Health Mission (NRHM) was launched in 2005 on a nationwide scale with a vision to provide universal access to equitable, affordable and quality health care. In particular, it aims to meet the health needs of the poor and vulnerable in mostly rural areas, such as women, children and the elderly. The Mission is distinguished by in-built flexible mechanisms, so that local needs and priorities can be identified and addressed and local initiatives promoted. Central to these mechanisms is the role of community ownership and participation in management, which is seen as an important prerequisite within the NRHM. This article explores the development and use of community-based monitoring (CBM), which involves drawing in, activating, motivating and capacity building so that the community and its representatives can directly give feedback about the functioning of public health services, including input to improving planning of those services. The focus of this monitoring process is mainly on ‘fact finding’ and ‘learning lessons for improvement' rather than on ‘fault finding’. This article describes the objectives and stages of CBM and also discusses its current status and challenges. The most important reasons for the success of CBM are strong civil society engagement, the involvement of public health personnel as well as the community as principal stakeholders, adequate geographic representation and the crucial role played by the Monitoring and Planning Committees. Community-based monitoring of health services is a key strategy of the NRHM to ensure that services reach those for whom they are intended. This framework is consistent with the ‘Right to Health Care’ approach since it places health rights of the community at the centre of the process. It also seeks to address gaps in the implementation of various programs, thereby enhancing transparency down to the grassroots level. Keywords: Community, community mobilisation, community monitoring, community ownership and participation in management, health care, public healt

Mainstreaming of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy with the health care delivery system in India

AbstractIndia has a population of 1.21 billion people and there is a high degree of socio-cultural, linguistic, and demographic heterogeneity. There is a limited number of health care professionals, especially doctors, per head of population. The National Rural Health Mission has decided to mainstream the Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system of indigenous medicine to help meet the challenge of this shortage of health care professionals and to strengthen the delivery system of the health care service. Multiple interventions have been implemented to ensure a systematic merger; however, the anticipated results have not been achieved as a result of multiple challenges and barriers. To ensure the accessibility and availability of health care services to all, policy-makers need to implement strategies to facilitate the mainstreaming of the AYUSH system and to support this system with stringent monitoring mechanisms

Assessment of Environment friendly behaviour among medical students in Tamil Nadu- A cross-sectional study

Introduction The world today faces significant environmental challenges which have been directly or indirectly due to actions of mankind. A pro-active, environmental-friendly behaviour from individuals, communities and policy-makers to protect and prevent further degradation of environment is an immediate need. Materials & Methods: This descriptive, cross-sectional study was conducted among second and third year students of a medical college in Tamil Nadu during the period July to August 2016 using a selfadministered questionnaire to assess the individual behaviour and family practices. Kaiser-Meyer-Olkin (KMO) and Barlett’s test were used to assess sampling adequacy. The responses were expressed as frequencies and percentages. Results: A total of 210 students participated in the study. Individual eco-friendly practices with Likert-type responses were coded for a maximum of 60. Among the total 210 participants, 22.8%, 74.8% and 2.4% achieved high, medium and low scores respectively. The mean score was 35.23 with standard deviation (SD) 6.698. Assessing family practices, for a maximum score of 9, the mean score was 3.7 (SD 1.5). Conclusion: The self-reported behaviour varied between domains. Participants had better practices related to energy-efficiency at home compared to waste reduction, recycling and transport behaviour suggesting the role of other socioeconomic determinants. The relatively poor scores among medical students and their families, a specific population with adequate exposure to environmental education suggest need for more effective measures to inculcate eco-friendly behaviou

Exploring the dimensions of doctor-patient relationship in clinical practice in hospital settings

The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinant

Fostering directly observed treatment in tuberculosis: a program manager’s perspective

Global Tuberculosis (TB) report (2013) has revealed that an estimated 8.6 million people developed TB of which, India accounts for almost 26% of the cases. These estimates clearly suggest that the country’s efforts to achieve Millennium Development Goal 6 by 2015 have not delivered the desired output. In India, the TB prevention and control activities are supervised and implemented under the Revised National TB Control Program (RNTCP), which recognizes that implementation of a good quality Directly Observed Treatment with Short course chemotherapy (DOTS) is the first priority for TB control. Directly Observed Treatment (DOT) is the key element in DOTS strategy, in which a DOT provider insures and supports the patients in consuming their drugs throughout the course of treatment. In order to meet the country’s vision to achieve universal access of TB care, the RNTCP has launched a “treatment adherence scheme” (public-private partnership scheme). Further, an evidence-based integrated strategy should be formulated for addressing the identified barriers which advocates universal administration of DOT. To conclude, DOT in RNTCP insures long-term adherence to the treatment, with right drugs in right doses, at right intervals and thus plays an indispensable role in improving the outcome indicators of the program and the quality of life in patient

Exploring the Dimensions of Doctor-Patient Relationship in Clinical Practice in Hospital Settings

The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants

Preventing the Emergence of Ebola Disease in Unaffected Countries: Necessity of Preparedness

The outbreak of Ebola disease in West-African nations have come as a wake-up call for the international health agencies and the public health authorities of the affected nations as well (1). This outbreak has shown to the world that even a disease which is almost forty years old, and which was detected on at-least twenty different occasions in different nations and was successfully contained every time, can still create havoc to such an extent that eventually it had to be declared an international public health emergency (2,3). It has been realized that the existence of an effective public healthcare delivery system is a must to successfully counter the disease outbreaks, and is extremely difficult to develop such systems after the crisis has occurred, and absence of the same can allow even a less infectious disease (viz. moderately long incubation period, individuals being non-infectious during the incubation period, absence of airborne transmission – all factors which do not favor rapid transmission) to grow at an exponential rate (4,5)