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RURAL HEALTH CARE PROVIDERS – BUILDING CAPACITIES AND BEYOND Liver foundation, west bengal www.liver-foundation.in.

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Presentation on theme: "RURAL HEALTH CARE PROVIDERS – BUILDING CAPACITIES AND BEYOND Liver foundation, west bengal www.liver-foundation.in."— Presentation transcript:

1 RURAL HEALTH CARE PROVIDERS – BUILDING CAPACITIES AND BEYOND Liver foundation, west bengal

2 THE RECIPE 1. RELEVANCE AND PHIOLOSOPHY 2. THE PROCESS 3. IS IT USEFUL AND IMPACTING ? 4. ISSUES AHEAD

3 INFORMAL RURAL HEALTH CARE PROVIDERS Legitimate, Legislated & Regulated Unregulated, Heterogenous behavior & Content Indian Health Care OP/IP

4 Decision Makers Clinical service: o Paramedics o Nurses Public Health Service: o MPHW o ASHA o Nurses DOCTORS Professional bodies Corporate houses Public sector Hospitals Formal Sector Politician Urban Urban + Rural Civil servant Informal Sector Rural o Candle in darkness o Individualistic o Non-institutionalised o Instance o Social accountability Urban & Peri-urban o Institutional o Modernised o Non-institutionalised

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6 Self-employed Informal provider. Educated unemployed Youths. Lacks scientific understanding And approach.  Empirical “craft” Earning motive. Good / Bad.  Copy of the existing system. RHCP

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9 RHCP orientation Unregulated  Positive attribute  Negative attribute Regulated Net societal benefit Community participation. Community competition. Community vigilance. Community intervention.

10 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

11 INITIATION ENRICHMENT CONSOLIDATION CONTINUATION Theory: Disease oriented Adverse effect of drug & Practice Legitimacy & Regulation Theory & Clinical: Life saving care Public Health Programmes 2/3 Months : Exam RURAL HEALTH CARE PROVIDER [RHCP] Capacity building : CURRICULUM & PLAN

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13 THE WAY WE HAD GONE… SELECTION OF TRAINEES INITIAL ORIENTATION STRUCTURED CAPACITY BUILDING EXERCISE EXAMINATIONS CONTINUED ORIENTATION AND APPLICATION

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22 Training & execution: Overall participation 3 months o Certification o Integration o Main stream public health programme 75% 50% 25% Percentage of participation 100% 6 months 9 months 12 months 2 years 4 years 7 years DOTS COPD Metabolic Health

23 Good practice is retained over time K 75% 50% 25% Percentage of participation AP End of Training Loss of contact Knowledge Attitude Practice K AP Knowledge Attitude Practice 5 years after training Exposure

24 IMPACT ASSESSMENT Case Control design –RANDOMISED Simulated patients and Vignets RHCPs included Liver Foundation, West Bengal Department of Economics, MIT & J PAL ISERRD, New Delhi

25 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

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28 Attempts at Integration & Focused activities :  DOTs Defaulter retrieval  Leprosy Care: Detection & Retrieval  Large scale Metabolic Health Awareness and action project

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30 A PROPOSED INTEGRATIVE MODEL. HWANMAW TD RHCP SHG Panchayet Awareness generation Hepatitis /metabolic health/ immunization / safe motherhood Antenatal checks. Detection of high risk pregnancy. Action - NCD s

31 Lessons learnt

32 Rural Health Care Provides Need Competence ?? Performance ↑ Incentives ↑ Social status Regulate Integrate Utilize  Lifesaving curative care in “Darkness”  Candle of Public Health Messages Individual System

33 FUNDING : Bristol Myers’ Squibb Foundation, USA National Rural Health Mission, Government of West Bengal


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