Assessment of monitoring and online payment system (Asha Soft) in Rajasthan using benefit evaluation (BE) framework

Context

e-Health programs are implemented assuming that e-health/digital health can prove beneficial but pieces of evidence for assessing the actual benefits of e-health programs are lacking.

Aims

To utilize the benefit evaluation (BE) framework to assess Asha Soft, which is an online payment and performance monitoring system initiative taken by Rajasthan.

Settings and Design

BE of Asha Soft in Rajasthan.

Methods and Materials

BE of ASHA Soft was done using scoping review with consultation exercise. The rationale behind using this methodological framework is to contextualize knowledge of the current state of understanding within BE framework practice contexts. The themes used for data compilation and analysis were based on three broad dimensions of BE framework namely, health information technology quality, use, and net benefits.

Results

The state of Rajasthan has been the first in the country to start an online system of payment and monitoring of ASHA workers, through Asha Soft. It has administrative and supportive functions. Its simple and easy to use graphical user interference helps users to make accurate data entries and obtain desired monitoring and analytical reports. It has attributed to the availability of data on various parameters which help decision-maker to decide about the performance of ASHA worker and has brought a positive impact on the work performance of ASHAs. This online payment and monitoring mechanism has argumented motivational level and intention of use. The program has optimally utilized available human resources and no apparent monetary cost was involved in developing this software.

Conclusions

This scoping study using the BE framework has provided evidence on the potential benefits of Asha Soft adoption in Rajasthan. It is recommended that future in-depth assessment of other e-health initiatives could be undertaken to guide the decision making.

Study on the perception of Swachh Bharat Abhiyan and attitude towards cleanliness among the residents of urban Jodhpur

Context:

Swachh Bharat Abhiyan (SBA) is an ambitious project and has been successful in bringing a difference at the facility and infrastructure level, and the objectives of this programme can be achieved if people are aware of this mission and basic sanitation and waste management practices.

Aims:

To assess awareness and perception of SBA and attitude towards cleanliness among the residents of urban Jodhpur.

Settings and Design:

A cross-sectional survey was done in the largest mixed-income housing society of Jodhpur.

Methods and Materials:

A semi-structured questionnaire was designed for data collection. Sample size was 400. Participants aged above 18 years were included in the study.

Statistical Analysis Used:

Descriptive and inferential statistical analysis was done using Epi Info Version 7.1. The data were evaluated using Chi-square test and P < 0.05 was considered statistically significant.

Results:

Mean age of female participants were 30.02 ± 11.34 years and male participants were 34.92 ± 13.10 years. Mean perception about SBA for being able to communicate the importance of cleanliness was 4.8, i.e. lying between strongly agree and agree. No significant association was observed between educational status and attitude towards cleanliness (P < 0.005). A significant association was seen between gender and knowledge about SBA in terms of correctly mentioning the duration of the SBA programme (P > 0.005).

Conclusions:

Existing knowledge about SBA and perception towards cleanliness among participants were positive but still there is need of programmes and strategies that help in bringing positive behaviour among group of people who are reluctant towards adopting proper cleanliness, sanitation and hygiene practices.

Overview of e-Health initiatives in Rajasthan: An exploratory study

Background:

Government of Rajasthan has undertaken a series of e-Health initiatives, especially under various programs of National Health Mission in the past few years. There is a paucity of studies which document and provide appraisal of these initiatives in Rajasthan.

Aim:

To document ongoing e-Health Initiatives based on technologies and approaches used, coverage by the region and population, services provided and scope.

Materials and Methods:

Primary data collection in form of key-informant interviews while secondary data collection in form of internet-based search of peer and non-peer reviewed literature was conducted to achieve the study objectives. Appropriate documents, records, and reports were reviewed to ensure that all necessary information was obtained.

Results:

A total of 13 e-Health initiatives were included in the study. The e-Health programs were classified with the use of WHO's classification of Digital Health Interventions v1.0. Most of the initiatives perceived in the study were found to be beneficial to the community, covering the entire population targeted. Supporting agencies, technologies used, and challenges faced during the implementation were identified and documented. Lack of trained manpower, technical and software glitches and deficiency of awareness activities were few obstacles that were found consistent across all user groups.

Conclusions:

The overview from this study augmented the knowledge about further scopes and sustainability of these initiatives. Deploying dedicated professionals may improve the functioning of these initiatives. Since e-Health interventions significantly influence healthcare systems, further scale-up of such studies with appropriate evaluation should be planned to guide policy decisions.

Homeotic regeneration of eye in amphibian tadpoles and its enhancement by vitamin A

After removal of both the lateral eyes of external gill stage tadpoles of the toad Bufo melanostictus, the pineal organ gets transformed into a median eye. This type of transformation occurs in tadpoles of both control and vitamin A treated groups. However, vitamin A increases the likelihood of homeotic regeneration (57% in the control group and 71% in the vitamin A treated group). Histological studies showed that the newly transformed median eye developed from the pineal organ. The pineal eye so developed possessed all components of a normal eye such as a retina, sensory cells and lens.

Health-promoting school in India: Approaches and challenges

Interventions early in life are the need of the hour when it comes to controlling the rising incidence of communicable and non-communicable diseases (NCDs) globally. WHO has issued guidelines towards health promotional initiatives at schools as a part of Global School Health Initiative, and the Government of India has directed many policies and programs to integrate health deep within the school activities. School Health Promotion is an international need with programmes implementing across continents due to numerous documented benefits, to not just the individuals but to the community and country as a whole. Simple teachings like hand hygiene have shown to reduce the incidence diarrhea by more than 50% amongst children (a major cause of mortality in India), thus raising an urgent need of developing a model for health promotion at schools that is replicable, sustainable, and can be modified to the local needs as well. Though the existent programmes have a few documented challenges, a multisectorial involvement of government agencies, educational boards, and health sector along with the school is the way forward to address those challenges and covert the theory of health promoting schools (HPS) into a well-established fact. It presents a scope for the various established and newly emerging Schools of Public Health in the country to come forward and collaborate with these multiple sectors. These collaborations can be the only way to ensure sustainability and incorporation of health promotion into the core academic structure of schools in a diverse and highly populous country like India.

Developing a health-promoting school using Knowledge to Action framework

BACKGROUND

There is a lack of organized effort in the arena of school health promotion, which has been recognized as an effective approach to combat the growing incidence of communicable and noncommunicable diseases. With this view, a study was conducted to develop comprehensive and replicable model for health promotion in schools.

MATERIALS AND METHODS

The Knowledge to Action (KTA) framework recognized by the World Health Organization as an implementational framework was used in an implementation study in a school of urban Jodhpur to assess the challenges and gaps associated with health promotion interventions in the school. Baseline regarding knowledge application and practices was gathered using interviews with school staff, parents, and group interaction with students. Knowledge synthesis was done by a thorough search of available literature and the gathered baseline. Resource mapping was carried out using checklists developed from knowledge synthesis. Tailor-made tools were constructed for knowledge implementation for each component of the action cycle. Knowledge of facts related to health behaviors among students was evaluated using pre- and postquestionnaires and practical application of knowledge was assessed using a checklist of 28 indicators on a 5-point Likert scale. Values of tests were gathered and compared with test values 3 and 6 months after the implementation of tailored interventions using descriptive and inferential statistics.

RESULTS

Increase in correct answers by students (42% to 96%) and average response for indicators on the Likert scale (3.23-4.86) was seen on repeated interventions over 6 months. Tobacco consumption by school staff reduced by 20% and an increase in willingness among teachers was observed on follow-up interviews.

CONCLUSION

The study thus developed a model for health promotion in a school with the help of the KTA framework using tailored interventions that could further be evolved in other setups based on local needs and available resources.

Perception of caregivers on ITNs utilisation and its effectiveness among children under 5 years of age in Chikwawa district, Malawi

BACKGROUND

In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017-2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers' perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them.

METHODS

This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children's caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran's formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively.

RESULTS

The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment.

CONCLUSION

The study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

Competence-Based Assessment of Biomedical Equipment Management and Maintenance System (e-Upkaran) Using Benefit Evaluation Framework

Introduction To establish a centralized inventory management system for the efficient functioning of all healthcare facilities, e-Upkaran (equipment management and maintenance system) was launched in 2015 in the state of Rajasthan. This study is conducted to assess the functioning of e-Upkaran in Rajasthan. Methods The assessment of the e-Upkaran system for primary and secondary healthcare centers was carried out using a systematic review of the literature and a multi-indicator stakeholder questionnaire. The benefits evaluation framework focused on the system quality, information and service quality, use and user satisfaction, and net benefits utilized for the assessment. A review of the literature was done to highlight the importance of computerized medical equipment management and maintenance systems and appraise the challenges and benefits associated with such systems as compared to the traditional pen-paper register. Information was gathered based on available documents, field observation, and data obtained from specific hospital staff, including the bioengineers and other users of e-Upkaran. Results The finding of this study suggests that e-Upkaran efficiently improves documentation, reporting, maintenance, and management of medical equipment. It is more efficient than the traditional paper-pen system. It is designed to minimize downtime and maintain equipment in good operating condition and has potential benefits in terms of improving information quality, use, and net benefit. The cost of service ratio is within the benchmark value. This system has also considerably reduced out-of-pocket expenditure. Computer proficiency and the workload of other e-health programs pose a challenge in the implementation of this program. Conclusion The e-Upkaran system is competent in terms of improving information quality, use, and net benefit. Other Indian states could also adopt this system to improve their biomedical equipment management and maintenance system.

The "third eye"-- a new concept of trans-differentiation of pineal gland into median eye in amphibian tadpoles of Bufo melanostictus

Median third eye was found to develop from transplanted pineal gland of external gill stage tadpoles in the recipient 5 toe stage tadpoles of Bufo melanostictus. Pineal gland along with a bit part of brain tissue of the donor external gill stage tadpole was cut out and transplanted into a pit made between two lateral eyes of 5 toe stage recipient tadpoles. Half of the operated tadpoles were treated with vitamin A (15 IU/ml.) for 15 days. Median "third eye" was found to develop in the both untreated and vitamin A treated tadpoles. However, vitamin A increased the percentage of the development of median eyes. Morphological and histological study revealed that newly transformed median eyes were similar to that of normal functional eyes. A stalk like structure developed which connects the median eye to the brain. The median third eye could not develop when pineal gland of 5 toe stage mature tadpole was transplanted into the tadpole of the same age.

Challenges, Barriers, and Good Practices in the Implementation of Rashtriya Bal Swasthya Karyakram in Jodhpur, India

Introduction The Rashtriya Bal Swasthya Karyakram of the Government of India subsumes the existing school health program to provide care and treatment to children below 18 years through screening and early interventions. Benefitting an estimated 270 million children for 30 preidentified conditions is a step toward “health for all.” Although the program is running since 2013, due to paucity of studies particularly in Thar desert region and its associated challenges, this study was planned to assess challenges and good practices in the implementation of RBSK in Jodhpur.

Objectives To assess the challenges, barriers, and good practices in the implementation of RBSK among the mobile health team (MHT) in Jodhpur, Rajasthan.

Methods A community based descriptive cross-sectional study in all 11 medical blocks of Jodhpur district, with purposive sampling to invite all members of MHT to participate in the study as grassroot workers was planned. A pretested, semistructured questionnaire was processed using SPSS for quantitative component and in-depth interviews were reported using qualifiers for qualitative observations.

Results As much as 74.1% (n = 40) of the staff perceived the trainings to be sufficient for daily work needs but needed more sessions for birth defects (33.3%) and development delays (29.6%). As much as 96.3% (n = 52) of the staff considered salaries to be low and 55.5% were dissatisfied with the jobs. However, 70.4% found targets to be achievable and 76% found the work environment helpful. Taboos and superstitions in community, harsh climate, dual workload on pharmacists as data operators, and noninclusion of AYUSH medicines for AYUSH medical officers (MOs) were few of the challenges, while good practices such as fully equipped MHTs, readily available vehicles, information education communication (IEC) materials, and treatment coverage under Bhamashah Bima Yojana (BSBY) were also observed.

Conclusion Many good practices were observed during the study which can be adopted by other states for better implementations elsewhere. Certain challenges such as belief in quackery, superstitions and taboos could be minimized by conducting rapport-building meetings with community stakeholders. Feedback and regular trainings of MHT staff can further increase the success manifold.

A Scoping review of challenges, scope and assessment approaches of teledentistry: an Indian perspective

Context: In India, COVID-19 pandemic has limited the utilization and access to dental services owing to the risk of infections transmission. In this context, tele-dentistry could be useful but there is paucity of literature which provides guidance on the scope and challenges for using tele-dentistry in India. Aims: To identify challenges, scope and assessment approaches of tele-dentistry from an Indian perspective. Settings and Design: Scoping Review. Methods and Material: Scoping review was conducted using the Arksey and O’Malley framework. Databases were searched in July from April to August 2020. Studies concerning challenges and scope of tele-dentistry in India were included. Additionally, literature about assessment approaches used for tele-dentistry programs were also reviewed Results: A total of 64 studies were reviewed, out of which 26 articles were included in the final review. Scoping review reveled that tele-dentistry can act as a seamless tool for diagnosing, training and screening. Few studies suggested the relevance of smartphone technology for specialist consultations and proper diagnosis. Majority of studies revealed shortage of basic infrastructure as a major challenge for tele-dentistry in India. Assessment studies were mainly focused on economic perspective and cost-effectiveness of the programs. Conclusions: This review provide guidance for using tele-dentistry in India. It is also reflected that there is a need for further research about the assessment of tele-dentistry in terms of safety, clinical outcomes, and patient perception.

736Low Birth weight in new born, anaemia in pregnancy in Fluoride endemic areas of Rajasthan

Background

Rajasthan has been documenting severe anaemia in pregnancy, resulting in low birth weight. Current study was planned to explore potential linkages between exposure to fluoride, anaemia in pregnancy and low birth weight in infant.

Methods

Antenatal mothers from one fluoride endemic district (FD) and one non-fluoride endemic district (NFD) of western Rajasthan were recruited and followed up till delivery. Data included socio-demographic, lifestyle, diet, medication history. Lab Investigations included Hb, Urinary Fluoride.

Results

Out of total 1401 women, mean age of women from FD were 23.87 (+ 3.8) yrs and from NFD were 25.53(+ 3.82) yrs. Mean fluoride values in the urine samples of pregnant females were found to be 2.06 (0.0 to 14.4 mg/L) in FD and 1.43 (0.00 to 12.7 mg/L) in NFD. Mean fluoride values in water samples were 0.72 (0.0 to 3.80 mg/L) in FD and 0.21 (0.0 to 2.69 mg/L) in NFD. Mean weight of newborn from FD were 2.92 (+ 0.47) yrs and from NFD were 2.94 (+ 0.56) kg. 22% Newborn in FD and 18% in NFD had low birth weight.

Conclusions

Infants born in Fluoride endemic area have lower birth weight as compared to non-Fluoride endemic area. Antenatal women in Fluoride endemic areas are more anaemic.

Key messages

Fluoride endemicity is an important factor to be considered while addressing Anaemia in pregnancy and Low Birth Weight Babies in Western Rajasthan, India.

Approaches to Assess E-Health Programs: A Scoping Review

CONTEXT

With the increasing trend of adopting e-Health technologies, the need for evidence for assessing e-Health technologies has become crucial. The appraisal of the e-Health program is important as this could provide guidance on further e-Health investment and adoption.

AIMS

The aim of the study was to provide an articulated body of literature on the current state of knowledge about the assessment of e-Health interventions.

SETTINGS AND DESIGN

Scoping review was conducted based on the framework provided by Arksey and O'Malley (2005) and considering enhancements proposed by Peters et al. (2015).

SUBJECTS AND METHODS

We searched the electronic databases and available gray literature from inception until the last week of October 2019. PRISMA flowchart for the study selection process was used to guide reporting. Data extraction included information on study design, authors, year of study, country, and key findings in terms of approaches used for assessment of e-Health programs. Data were compiled and summarized narratively.

RESULTS

Searches were performed between October and December 2019. Seventy-one relevant papers published between the years until the last week of October 2019 were reviewed and analyzed. After considering all the eligibility criteria, 15 papers were included. We identified 15 approaches for assessing e-Health programs, which were summarized and tabulated.

CONCLUSIONS

This review showed that available literature on the assessment of e-Health programs is heterogeneous in terms of the methodology used. e-Health interventions are highly contextual; therefore; the phase of maturity and objective of the assessment should be considered while carrying out the assessment of e-Health programs.

Economic analysis of ASHA-soft programme (online payment and monitoring system) in Jodhpur, Rajasthan

Context:

The Government of India under a performance-based payment scheme is providing remuneration as per the activities completed by the Accredited Social Health Activists (ASHA) health workers. Each state in India has a differentperformance-based payment system for ASHAs. The state of Rajasthan developed the ASHA-Soft system in 2014 for providing incentives to ASHAs.

Aims:

This study is planned to analyze the performance of ASHA-Soft considering the economic aspects as there is a paucity of studies in this context.

Settings and Design:

This study was conducted in Jodhpur, Rajasthan.

Methods and Material:

Economic analysis of ASHA-Soft program was performed based on Incentive paid to ASHA workers; Number of beneficiaries; Overall contribution of ASHAs in the health services; and unit cost per health service under ASHA-Soft program. Data of five financial years, that is, from the inception of ASHA-Soft was analyzed.

Results:

Consolidated incentive for maternal health, child health, and Immunization services provided to ASHAs through ASHA-Soft in the year 2015--16 was $96794.22, $35348.32, and $49016.83 which increased to $200285.00, $116320.52, and $101686.48 in the year 2019—20, respectively. Family planning and national program services were provided to 6,259 and 4,061 beneficiaries, respectively, in the year 2015--16 which markedly increased to 16,360 and 9,552 in the year 2019--20. Unit-cost of service provided by ASHAs in the National Programme ($1.13) was the lowest and for Family Planning Services ($5.71) were the highest.

Conclusions:

ASHA-Soft program seems a potential program to attract ASHA workers for delivering health care services. The findings of this study could assist policymakers in guiding further decision-making.

Study of anaemia in pregnancy and low birth weight in fluoride endemic area of Western Rajasthan: a cohort study

Background

Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes' destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child's vulnerability to the risk of childhood diseases and chances of existence.

Methods

This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan.

Results

Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur.

Conclusions

Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area's most common indigenous food practices.