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Suseela RP, Shannawaz M. Engaging the Private Health Service Delivery Sector for TB Care in India-Miles to Go! Trop Med Infect Dis 2023; 8:tropicalmed8050265. [PMID: 37235313 DOI: 10.3390/tropicalmed8050265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
More than half of the people with TB in India seek care from the private sector, where suboptimal quality of care is a concern. Significant progress has been made over the last five years to expand the coverage and to involve more private sector providers in TB care under the National TB Elimination Program (NTEP) in India. The objective of this review is to describe the major efforts and the progress made with regard to the engagement of the 'for-profit' private health service delivery sector for TB care in India, to critically discuss this, and to suggest the way forward. We described the recent efforts by the NTEP for private sector engagement based on the literature, including strategy documents, guidelines, annual reports, evaluation studies, and critically looked at the strategies against the vision of partnership. The NTEP has taken a variety of approaches, including education, regulation, provision of cost-free TB services, incentives, and partnership schemes to engage the private sector. As a result of all these interventions, private sector contribution has increased substantially, including TB notification, follow-up, and treatment success. However, these still fall short of achieving the set targets. Strategies were focused more towards the purchase of services rather than creating sustainable partnerships. There are no major strategies to engage the diverse set of providers, including informal health care providers and chemists, who are the first point of contact for a significant number of people with TB. India needs an integrated private sector engagement policy focusing on ensuring standards of TB care for every citizen. The NTEP should adopt an approach specifically tailored to the various categories of providers. For meaningful inclusion of the private sector, it is also essential to build understanding and generate data intelligence for better decision making, strengthen the platforms for engagement, and expand the social insurance coverage.
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Affiliation(s)
- Rakesh P Suseela
- Amity Institute of Public Health, Amity University, Noida 201303, India
- The Union South East Asia Office, New Delhi 110016, India
| | - Mohd Shannawaz
- Amity Institute of Public Health, Amity University, Noida 201303, India
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Balakrishnan SK, Suseela RP, Mrithyunjayan S, Mathew ME, Varghese S, Chenayil S, Aloysius S, Prabhakaran T, Nair SA. Individuals' Vulnerability Based Active Surveillance for TB: Experiences from India. Trop Med Infect Dis 2022; 7:tropicalmed7120441. [PMID: 36548696 PMCID: PMC9781449 DOI: 10.3390/tropicalmed7120441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Community-based active TB case finding (ACF) has become an essential part of TB elimination efforts in high-burden settings. In settings such as the state of Kerala in India, which has reported an annual decline of 7.5% in the estimated TB incidence since 2015, if ACF is not well targeted, it may end up with a less-than-desired yield, the wastage of scarce resources, and the burdening of health systems. Program managers have recognized the need to optimize resources and workloads, while maximizing the yield, when implementing ACF. We developed and implemented the concept of 'individuals'-vulnerability-based active surveillance' as a substitute for the blanket approach for population/geography-based ACF for TB. Weighted scores, based on an estimate of relative risk, were assigned to reflect the TB vulnerabilities of individuals. Vulnerability data for 22,042,168 individuals were available to the primary healthcare team. Individuals with higher cumulative vulnerability scores were targeted for serial ACF from 2019 onwards. In 2018, when a population-based ACF was conducted, the number needed to screen to diagnose one microbiologically confirmed pulmonary TB case was 3772 and the number needed to test to obtain one microbiologically confirmed pulmonary TB case was 112. The corresponding figures in 2019 for individuals'-vulnerability-based ACF were 881 and 39, respectively. Individuals'-vulnerability-based active surveillance is proposed here as a practical solution to improve health system efficiency in settings where the population is relatively stationary, the TB disease burden is low, and the health system is strong.
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Affiliation(s)
- Shibu K. Balakrishnan
- World Health Organization Technical Support Network (NTEP), Thiruvananthapuram 695001, India
| | - Rakesh P. Suseela
- World Health Organization Technical Support Network (NTEP), Thiruvananthapuram 695001, India
- Correspondence:
| | - Sunilkumar Mrithyunjayan
- State TB Elimination Program, Kerala State Health Services Department, Directorate of Health Services, Thiruvananthapuram 695001, India
| | - Manu E. Mathew
- World Health Organization Technical Support Network (NTEP), Thiruvananthapuram 695001, India
| | - Suresh Varghese
- State TB Elimination Program, Kerala State Health Services Department, Directorate of Health Services, Thiruvananthapuram 695001, India
| | - Shubin Chenayil
- State TB Elimination Program, Kerala State Health Services Department, Directorate of Health Services, Thiruvananthapuram 695001, India
| | - Suja Aloysius
- State TB Elimination Program, Kerala State Health Services Department, Directorate of Health Services, Thiruvananthapuram 695001, India
| | - Twinkle Prabhakaran
- State TB Elimination Program, Kerala State Health Services Department, Directorate of Health Services, Thiruvananthapuram 695001, India
| | - Sreenivas A. Nair
- Country and Community Support for Impact, Stop TB Partnership Secretariat, 1218 Geneva, Switzerland
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P Suseela R, Ambika RB, Mohandas S, Menon JC, Numpelil M, K Vasudevan B, Ved R, Danaei G, Spiegelman D. Effectiveness of a community-based education and peer support led by women's self-help groups in improving the control of hypertension in urban slums of Kerala, India: a cluster randomised controlled pragmatic trial. BMJ Glob Health 2022; 7:bmjgh-2022-010296. [PMID: 36384950 PMCID: PMC9670931 DOI: 10.1136/bmjgh-2022-010296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to assess the effectiveness of a community-based education and peer support programme led by women's self-help group (SHG) members in reducing the mean systolic BP among people with hypertension in urban slums of Kochi city, Kerala, India. METHODS A cluster randomised controlled pragmatic trial was conducted where 20 slums were randomised to either the intervention or the control arms. In each slum, participants who had elevated BP (>140/90) or were on antihypertensive medications were recruited. The intervention was delivered through women's SHG members (1 per 20-30 households) who provided (1) assistance in daily hypertension management, (2) social and emotional support to encourage healthy behaviours and (3) referral to the primary healthcare system. Those in the control arm received standard of care. The primary outcome was change in mean systolic BP (SBP) after 6 months. RESULTS A total of 1952 participants were recruited-968 in the intervention arm and 984 in the control arm. Mean SBP was reduced by 6.26 mm Hg (SE 0.69) in the intervention arm compared with 2.16 mm Hg (SE 0.70) in the control arm; the net difference being 4.09 (95% CI 2.15 to 4.09), p<0.001. CONCLUSION This women's SHG members led community intervention was effective in reducing SBP among people with hypertension compared with those who received usual care, over 6 months in urban slums of Kerala, India. TRIAL REGISTRATION NUMBER CTRI/2019/12/022252.
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Affiliation(s)
- Rakesh P Suseela
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Renjini Balakrishnan Ambika
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sreelakshmi Mohandas
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jaideep C Menon
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Preventive Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidhyapeetham, Kochi, Kerala, India
| | | | - Beena K Vasudevan
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajani Ved
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- National Health Systems Resource Centre, New Delhi, India
| | - Goodarz Danaei
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Donna Spiegelman
- Department of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Centre for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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Menon J, Numpeli M, Kunjan SP, Karimbuvayilil BV, Sreedevi A, Panniyamakkal J, Suseela RP, Thachathodiyil R, Banerjee A. A Sustainable Community-Based Model of Noncommunicable Disease Risk Factor Surveillance (Shraddha-Jagrithi Project): Protocol for a Cohort Study. JMIR Res Protoc 2021; 10:e27299. [PMID: 34677141 PMCID: PMC8571687 DOI: 10.2196/27299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND India has a massive noncommunicable disease (NCD) burden, at an enormous cost to the individual, family, society, and health system at large, despite which prevention and surveillance are relatively neglected. If diagnosed early and treated adequately, risk factors for atherosclerotic cardiovascular disease would help decrease the mortality and morbidity burden. Surveillance for NCDs, creating awareness, positive lifestyle changes, and treatment are the proven measures known to prevent the progression of the disease. India is in a stage of rapid epidemiological transition, with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country in the future. A previous study done by the same investigators in a population of >100,000 revealed poor awareness, treatment of NCDs, and poor adherence to medicines in individuals with CVD. OBJECTIVE This study aimed at assessing a sustainable, community-based surveillance model for NCDs with corporate support fully embedded in the public health system. METHODS Frontline health workers will check all individuals in the target group (≥age 30 years) with further follow-up and treatment planned in a "spoke and hub" model using the public health system of primary health centers as spokes to the hubs of taluk or district hospitals. All data entry done by frontline health workers will be on a tablet PC, ensuring rapid acquisition and transfer of participant health details to primary health centers for further follow-up and treatment. RESULTS The model will be evaluated based on the utilization rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centers for risk stratification and care, and community-level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow-up treatment at no cost to the individual entirely through the tiered public health system of the state and country. CONCLUSIONS Surveillance for NCDs is an essential facet of health care presently lacking in India. Atherosclerotic cardiovascular disease has a long gestation period in progression to the symptomatic phase of the disease, during which timely preventive and lifestyle measures would help prevent disease progression if implemented. Unfortunately, several asymptomatic individuals have never tested their plasma glucose, serum lipid levels, or blood pressure and are unaware of their disease status. Our model, implemented through the public health system using frontline health workers, would ensure individuals aged≥30 years at risk of disease are identified, and necessary lifestyle modifications and treatments are given. In addition, the surveillance at the community level would help create a general awareness of NCDs and lead to healthier lifestyle habits. TRIAL REGISTRATION Clinical Trial Registry India CTRI/2018/07/014856; https://tinyurl.com/4saydnxf. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27299.
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Affiliation(s)
- Jaideep Menon
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | | | | | - Jeemon Panniyamakkal
- Sree Chitra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rakesh P Suseela
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rajesh Thachathodiyil
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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Kumar VS, Karuveettil V, Joseph J, Yeturu SK, Suseela RP, Janakiram C. Association of Dental Caries and Oral Health Impact Profile in 12-Year-Old School Children: A Cross-Sectional Study. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/35029.11984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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