Browsing by Author "Nair, VM"

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    Changing roles of grass root level workers in primary health care: an inter-district primary health centre based study from Kerala, India.
    (Health Policy and Planning, 2001) Nair, VM; Thankappan, KR; Sarma, PS; Vasan, RS
    OBJECTIVE: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA: DESIGN: Cross-sectional, community-based survey.PARTICIPANTS:We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members. RESULTS: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields. CONCLUSIONS: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive multipurpose benefits from the MPWS:
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    Changing roles of grass-root level health workers in Kerala, India
    (HEALTH POLICY AND PLANNING, 2001)
    Objective: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, India.Design: Cross-sectional, community-based survey.Participants: We selected three out of the 14 districts in Kerala. Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWs. Work sampling of M PWs was also performed to era mi ne the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members.Results: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWs. MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields.Conclusions: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWs.
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    Community Utilization of Subcentres in Primary Health Care-an Analysis of Determinants in Kerala
    (Indian Journal of Public Health, 2004) Nair, VM; Thankappan, KR; Vasan, RS; Sarma, PS
    The determinants of utilisation of subcentre services in a random sample of 247 subcentres from three out of 14 districts of Kerala were investigated. Physical verification of the facilities was done in a subset of 90 subcentres and household surveys of 750 households were performed in the service areas of those subcentres. About 30 per cent of the beneficiaries utilised services of the subcentres during the reference period. The relationship of selected predictor variables on utilisation of the services was found out. The district in which a subcentre was physically present was found to be the most important correlate of its utilisation.
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    Polio eradication - global initiative; strategy challenged in Kerala, India
    (JOURNAL OF PUBLIC HEALTH MEDICINE, 2002)
    The 'polio eradication initiative' launched by the World Health Assembly in 1988, although successfully implemented in several countries, could not achieve the goal of global eradication by the year 2000. It has components on strengthening routine immunization system, observance of National Immunization Days (NIDs) and strengthening of surveillance for Acute Flaccid Paralysis (AFP). Recently, this strategy was challenged in Kerala, India. Kerala has excellent health indicators compared with other Indian states. In 1999, Intensified Pulse Polio Immunization (IPPI) was introduced with four NIDs throughout India. More than 2000 doctors working under the Kerala Government challenged the strategy, demanding its redesign. Zero prevalence of polio for 2 years, near-complete coverage of children by the routine system, probable business interests of vaccine manufactures and suppliers, dubious interests of officials, and weakening of the routine system by concentrating more on NIDs were all cited as reasons for discontinuing current strategy. The authorities, citing the success stories of polio eradication by the global initiative in several countries, discard the allegations as baseless. They alleged that the medical officers who were on strike demanding higher pay and better conditions were using the 'polio issue' to win their strike. The incidence of two polio cases in Malappuram in northern Kerala during September 2000 has further complicated the issue. As the controversy continues it is felt that the 'eradication initiative' will have to be revisited.