Tuberculosis control in rural India: lessons from public-private collaboration.

SETTING: A rural tuberculosis (TB) Unit (population 350 794) in Pune district, Maharashtra State, India. OBJECTIVE: To develop a 'model' partnership between rural private medical practitioners (PMPs) and the Revised National Tuberculosis Control Programme (RNTCP). DESIGN: A partnership was developed between 100 PMPs in the study area and the district health and tuberculosis staff through facilitation by a non-governmental organisation (NGO). Participatory research methods were used to plan and implement the partnership. The process of creation and implementation of the partnership was analysed using quantitative and qualitative research methods. RESULTS: The partnership contributed to 30% of the cases detected in the TB Unit over a 5-month period. Six months after withdrawal of the NGO, referrals from the private sector to the RNTCP were continuing to a lesser extent, but there was a breakdown of the communication and documentation systems. CONCLUSION: The project highlights the importance of organisational and individual commitment to these partnerships, the key roles of the District Health Officer and the District Tuberculosis Officer in guiding and supporting these initiatives from the public sector, the potential role of process and outcome 'indicators' in monitoring partnerships and the important role of NGOs as intermediaries and facilitators.

Kaleidoscope: a 5-year action research project to develop nursing confidence in caring for patients with HIV disease in west India.

As the national epidemic of human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS) epidemic rapidly unfolds in India, nurses have to acquire new competencies in order to provide appropriate care to an increasing number of affected persons. In response, an Indo-British action research collaboration was initiated to build clinical confidence and facilitate relevant changes in nursing practice. During a 10-day educational programme, a change intervention was applied, culminating in the development of individual and partnership action plans focused on bringing about changes in nursing practice within well-defined fields of action. Following implementation of their action plans, participants were reassembled 12 months later for a follow-up workshop to discuss their progress and describe those factors that either helped or hindered them in achieving their objectives. They then developed new action plans for the next 12-month period. This article reports on the results from six cohorts (n = 160) in India who participated in this project between 1995 and 1999. Action plans were frequently focused on infection control, primary prevention, curriculum development in preregistration nursing programmes and in-service nursing education. The majority of participants reported significant achievements in realizing their action-plan objectives. Data analysis revealed that the change intervention itself, together with multidisciplinary support from colleagues, the senior status of the participant, and anticipating and attending the follow-up workshop, were all positively correlated with achievement. The lack of personal authority and resistance from managers were the two major factors negatively correlated with achievement. This method for facilitating changes in nursing practice has been successfully adapted and replicated by our group in other countries.