CDHC – It’s Feasibility and Effectiveness in Addressing Gender Issues in Public Health System with Special Reference to TB

Abstract

Primary healthcare is for most people, it is both their first point of contact with the healthcare system and their most frequently used health service. The concept of primary healthcare was laid down by the recommendations of the Bhore Committee (1946). During the  last 6 decades of independence, the government of India adopted three-way approaches to accomplish  improvement in primary healthcare services, infrastructure, and related healthcare indices viz., five year plans, formation of different health committees and formulation of National Health Policies (NHP) from time to time to render advice on organization of health care programme. Still, many challenges are ahead to achieve health for all. Particularly gender-sensitive services were not discussed until National Health Bill, 2015. Hence, intervention research was undertaken in PHCs to understand the feasibility of bringing women as a forum to make existing public health system gender-sensitive.

In order to address the issues concerned with any targeted sections of the population, voices of the concerned must be heard. This intervention study adopting mixed-method design using qualitative and quantitative methods was conducted in two phases following a sequential approach in two districts namely Tiruvallur and Madurai Tamilnadu. In the situational analysis phase, FGD, IDI, KII and personal interaction were used to get to know the status of women and health-seeking behaviour in the intervention settings and to identify members for a community forum called CFTBC. Among 378 respondents 70% (266 had expressed willingness to be part of a community forum. Among those who expressed willingness initially, 59 were shortlisted, but at the end 31 alone could continue to take part in the community forum. The community forum members had organized regular monthly meetings in PHC to discuss various issues both general and gender-specific needs in the PHC and arrived at a series of resolutions. stakeholders meeting with health authorities were also organized to promote interaction between them.

Feasibility and effectiveness of this study were evaluated on four horizons viz., (i) Establishing a community-driven health forum, (ii) Addressing barriers in health care seeking, (iii) Care Receivers Satisfaction and (iv) support offered to TB case finding and case holding at the PHC. Establishing and counting on the community forum members proved to be possible as forum members could attend 60 monthly meetings. Secondly, in the forum meetings, the members could identify a range of gender-sensitive issues, discuss and make them come true. Some of the needs raised in the meetings were raised and addressed in public health system viz., 1) Separate toilet facility 2) Separate injection room and 3) Drinking water. Activities of community forum could also result in improved care receivers satisfaction level in the areas such as;

1. Satisfaction at registration (pre-84.2% post 87.5%) and at injection room (pre-45.3% post 88%),other areas like
2. Satisfaction about basic facility (pre-51.1% post 80.5%), satisfaction about working hours (pre-78.9% post 85.5%) and satisfaction about health / disease / treatment-related queries (pre-84.7% post 90%) had better outcome as impact of CFTBCs.

Therefore, it is suggested that community forum essentially consists of community women can be incorporated in a public health system that will enable less stigmatized, gender-sensitive health care services to ensure early TB identification and treatment provision. In order to facilitate this, trained professional social workers with skills in human relations, communication skills and sensitive to the needs of women may be appointed at each PHC. Trained professional social workers can mobilize forum members and facilitate coordination between healthcare providers and community forum members. A certain quantum of funds may be allocated to each PHC to conduct meetings at regular interval and offered some sort of compensation to members at least to meet expenses on the day of the meeting.

• A specific place or room may be earmarked in the PHC for the community forum to meet.
• The researchers strongly recommend that RNTCP may initiate women-led community forum in every treatment unit that will ensure achievement of the honourable Prime Ministers revelation of the governments National Strategic Plan for Tuberculosis (TB) Elimination 2017-25.

Further, in order to devise further strategies, larger studies may be taken up at a regional level /across states in India.