FAMILY & HEALTH CARE EDUCATION AND TRAINING


IMPLEMENTATION OF IMPROVING PRIMARY HEALTH CARE AND HEALTH EDUCATION IN RURAL INDIA

The objective is to improve and enhance the services offered by Primary Health Centers (PHCs & TC) in the rural communities of India. We propose to do this by applying novel solutions that take advantage of developments in harnessing solar power, computers, and information technology. Our strategy is to use technology to provide effective early medical intervention, deliver expert health care, and minimize the inconvenience caused to patients and health-workers from poor logistics and long travel time. An equally important role of PHCs & TC is to provide health education emphasizing family planning, hygiene, sanitation, and prevention of communicable diseases. A final step in this process will happen through video consulting and examination, a technology we anticipate becoming available in rural areas as soon as possible.

OVERVIEW

The long-term goal of the Indian government and international funding agencies has been to provide health care to rural communities through PHCs & TC.  However, even with large funding, these centers have not been successful for a variety of reasons that include lack of decent facilities, equipment for performing even simple laboratory tests, etc. Even more important is a social reality: there just are not enough trained and qualified doctors to adequately serve the entire urban and rural populations of India even if we could provide financial incentives for them to work in rural areas. Since we believe that the dearth of doctors willing to practice in rural areas and their reluctance to travel to, let alone live in, remote areas will continue to exist for a long time to come, we have incorporated this reality into our planning from the start as described in this proposal. Our plan, therefore, is to increase the effectiveness of doctors who are willing to work in rural areas by a large factor.  This can be accomplished by reducing the need for doctors in the initial screening of patients, and by allocating one physician for every five PHCs & TC. simultaneously; we plan to make working at PHCs & TC more attractive and satisfying.

The result of non-functioning PHCs & TC has been that, in many cases, diseases are not diagnosed in their early stages nor treated. The rural population has to often travel to urban areas when they can no longer bear the suffering caused by the disease, thus increasing the load on hospitals in urban areas and ending up with serious complications that, in many cases, could have easily been treated at their early stages. The need to rectify this problem has become critical especially given the fact that more than 650 million people live in rural areas across the country with poor awareness of health issues. This ignorance, coupled with the increased mobility between rural and urban areas, has led to an explosive increase in the spread of diseases like HIV/AIDS and Hepatitis B and C.
At this primary level, PHCs & TC will play two equally important roles: First, diagnosis of diseases based on symptoms and simple laboratory tests, and their treatment either at the centers or through referral.  Second, health education leading to family planning, better hygiene and sanitation, and prevention of communicable diseases, especially sexually transmitted diseases.
The government has shown keen interest in finding private partners to revitalize the PHCs & TC. To this end The AIISMD, in collaboration with the Government of U.P, has Proposing to initiate a pilot project involving one PHC covering some 85,000 people in the District.

HEALTH EDUCATION AND DISEASE PREVENTION

Rural India faces many very serious problems. Notable amongst them are potable water, emerging pandemics, population control, good hygiene and sanitation practices, basic education, and simple techniques for improving their crops and lives. One cannot expect to upgrade the people's health without simultaneously making an impact on these issues, and vice versa. We will, therefore, train and empower the staff at the PHCs & TC to spread awareness on some of these issues, build trust within the community, and to take a holistic approach to health care.
Using the telephone link to the central facility, relevant training and educational material and specific health instructions will be periodically transmitted to the computers at all PHCs & TC, and the status of various educational programs will be monitored.

COMMUNITY INVOLVEMENT

For the PHCs & TC to be effective, people have to believe that the PHCs & TC are there to serve them and to provide value.  To facilitate this we plan to involve the local population in the operation and in the community outreach programs.  We also plan to encourage cultural activities, self-help programs, and health education through the PHCs & TC. The monitoring role of The AIIMSD evaluates the performance of PHCs & TC and to provide guidance.

SUPPORT AND TRAINING CENTERS

Ongoing Support and Training of PHC personnel are the responsibility of the Support and Training Centers established for every 50 PHCs & TC. Support activities consist of recruiting PHC staff, set-up of facilities, supply of medicine, maintenance/repair of hardware, coordination of transportation, interaction with local community, etc. Field coordinators and computer technicians carry out most of these activities.  Arrangements with doctors and hospitals/clinics in the nearby areas will be made for handling referrals from PHCs & TC.  Involvement of local NGOs will be encouraged.
Support activities will be coordinated and made efficient through on-line communications, tracking procedures/systems, pre-maintenance, periodic status review meetings, and other techniques.  The goal is to ensure that PHCs & TC are fully operational at all times to serve the community.
Training of PHC staff covers the following areas: (a) administration of PHCs & TC, (b)use of  system, (c) conducting laboratory tests, (d) proper understanding of the cultural and social norms of the area, and (e) how to carry out health education. Comprehensive training for the above will be conducted at the Support and Training Centers, which will be followed by on-site training at the PHCs & TC under the supervision of physicians and field coordinators. Training materials and User Guides will be supplied.
Using the feedback we receive from the PHCs & TC , illustrative examples of good communication with patients and the community will be developed in an audiovisual format, and will be included in the training.
Training to provide health education will be an integral part of the program. We will supplement this by initiating an active program to attract visiting physicians, social scientists, and public health officials. Their recommendations will be incorporated where appropriate, and additional training and educational materials will be developed with their assistance.

HEALTH EDUCATION AND COMMUNITY ACTIVITES

Initially we concentrate on the following community health education related activities:

  1. Training of local women as midwives to reduce risks during childbirth.
  2. Instruct women on pre and post-natal care and early childhood development.
  3. Provide information on family planning and birth control.
  4. Give instructions on simple practices that improve hygiene and sanitation.
  5. Provide instructions on how to make drinking water safe.
  6. Provide information on how to reduce the risk of communicable diseases.

An educational course on health and hygiene, emerging pandemics (TB, malaria, Hepatitis B, Hepatitis C, sexually transmitted diseases, and HIV), addictions (alcohol, tobacco, drugs), abuses (emotional, physical, sexual), and environmental concerns (air and water pollution) has already been developed in Microsoft PowerPoint. Over time we propose to convert this into a modular multimedia format. Offering health education, and learning how to communicate the message in a simple manner will be an integral part of the training for the entire staff. It will be available at each PHC so that the staff can refresh their understanding as needed.
A second important way in which we propose to deliver these instructions is to develop homegrown video demonstrations. These will be recorded using local people who hold the respect of the communities, and using local situations to provide better identification with the problems and the solutions. These videos will be duplicated for distribution and the local PHC staff will be trained to further explain and demonstrate the procedures so as to make their adoption easier.
Instructions will also be offered to the community at the time of visit to the PHCs & TC.  We plan to use the computer at the PHCs & TC and possibly a television with a video player to continually provide this information while patients/families wait for their checkup.
Local community centers and village meetings are other forums for presenting the information.  NGOs and social workers will be provided the necessary tools, like the homegrown videos, to enable them to educate the rural population on health issues. The field coordinators will organize the above activities with the assistance of local NGOs and community leaders.