"Is there a difference in treatment outcome of tuberculosis patients: Rural Healthcare Providers versus Community Health Workers?"

INTRODUCTION: Rural healthcare providers (RHCPs) are the first point of contact for majority of patients in rural parts of India. A total of 75 RHCPs were trained and engaged in Hazaribagh to identify presumptive tuberculosis (TB) patients (PrTBPs) and refer them for diagnosis. Patients diagnosed with TB were initiated on directly observed treatment short course (DOTS) under the programme. Based on patients' choice, the treatment providers were either RHCPs or community health workers (CHWs). In this paper, we aim to compare the treatment outcomes of TB patients who received DOTS from RHCPs with CHWs. METHOD: This is a retrospective cohort study using secondary data routinely collected through project and Revised National TB Control Programme. RESULTS: Over the period of 24 months, 57 RHCPs continued to be engaged with project and a total of 382 referrals were made out of which 72 (19%) were diagnosed with TB. Based on choice made, 40 (55%) of TB patients chose RHCPs and 32 (45%) CHWs as their treatment provider. The mean successful treatment completion rate was 87% in the RHCP group compared with 81% for CHWs (P value 0.464). The percentages of unsuccessful outcomes were similar for both groups. CONCLUSIONS: Our study demonstrates the process to engage RHCPs in TB prevention and care. The study highlights community preference for RHCPs as DOT provider who can produce similar TB treatment success rates as that of CHWs identified by programme.

Research to policy on defining accessibility of public health facilities to ensure universal health coverage.

BACKGROUND: The mandate to ensure the availability of doctors under Universal Health Coverage has been one of the most difficult issues to address in India. It is believed that the geographic location of health facilities has influenced the availability of doctors in rural areas, which may have resulted in long-standing vacancies. There was a need to classify facilities based on location and access, to propose policies and strategies. The classification was arrived through a consultative process, which led to ambiguity. AIM: The aim of this study is to develop a criteria to identify health facilities based on location considering accessibility indicators. SETTINGS AND DESIGN: A cross-sectional operational research was conducted during 2010-2011 to collect data for public-health facilities above subcenters and below district hospitals across India. MATERIALS AND METHODS: Data was collected for geographic, environmental, housing, and vacancy status of doctors; for which scores were assigned for each health facility. RESULTS: A total of 20,528 (76%) were included for analysis out of 26,876 health facilities. Following application of criteria, 3,011 (11%) facilities were identified as eligible; of these, 1%, 3%, and 7% facilities were identified as inaccessible, most-difficult, and difficult facilities, respectively. The consultative meetings with state governments resulted in agreement on the criteria adopted. CONCLUSION: The study demonstrated more robust criteria to define access to health care facilities by applying composite scoring methods, which was validated through a consultative process with key stakeholders. The study results were applied to incentivize doctors serving in difficult areas in a move to address human resource gaps in rural areas and ensure universal health coverage.