RURAL HEALTH CARE PROVIDERS – BUILDING CAPACITIES AND BEYOND

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

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

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

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

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

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

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

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

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

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

24. IMPACT ASSESSMENT Department of Economics, MIT & J PAL ISERRD , New Delhi Liver Foundation, West Bengal Case Control design –RANDOMISED Simulated patients and Vignets 2013- 2014 350 RHCPs included

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

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

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

31. Lessons learnt

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

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