OPERATIONS RESEARCH <<Back
 
A : Problem Definition
 
085
FEASIBILITY OF INVOLVEMENT OF THE MULTIPURPOSE WORKERS IN CASE-FINDING IN DISTRICT TUBERCULOSIS PROGRAMME
KS Aneja, NK Menon-, AK Chakraborty, K Srikantan & M Manjunath: Indian J TB, 1980, 27, 158-66.

At present, Case-finding activity of tuberculosis through the self reporting chest symptomatics attending Peripheral Health Institutions, is at a low ebb. With the introduction of Multi Purpose Workers (MPW) scheme, a machinery has emerged through which this activity could be augmented. An operational study was therefore undertaken in five Primary Health Centres (PHCs) of Chittoor district, Andhra Pradesh in June 1978.

The study has revealed that if the MPWs collect sputum smears from the symptomatics of the age group of 20 years and above during their routine visits to each household of the specified population allotted to them and despatch the smears to the PHC for examination, there is a possibility of augmenting the existing Case-finding activity by 4 5 times. An intensive training of 2 3 days for this purpose seems adequate. The average work load for a MPW would be preparation of one smear a day initially for a couple of months and thereafter as a routine one smear a week. In an average PHC, the work load for the microscopist would be to examine 10 to 12 slides a day initially, the load will then progressively decline and subsequently as a routine it will not be more than 3 4 slides a day. An additional microscopist would probably be needed at PHC laboratory for examination of sputum smears as well as to assist the existing microscopist who at present is primarily engaged in malaria work. Meticulous supervision and regular flow of supplies and equipment is however a 'must' for the success of the scheme.

KEY WORDS: HEALTH WORKER, CASE-FINDING, CONTROL PROGRAMME, PRIMARY HEALTH CARE.
 

  B : Programme Development  
 
105
A STUDY OF TUBERCULOSIS SERVICES AS A COMPONENT OF PRIMARY HEALTH CARE
Radha Narayan, A Jones, S Prabhakar & N Srikantaramu: Indian J TB 1983, 30, 69-73.

During last two decades, the health care delivery system has undergone several changes. The implementation of the concept of Primary Health Care and of the Multi Purpose Health Workers (MPWs) Scheme can be utilised to improve both Case-finding and case holding activities of the District Tuberculosis Programme. A study was undertaken by National Tuberculosis Institute (NTI) to obtain a profile of work of MPWs, observe their work on time and motion analogy and to ascertain output of tuberculosis services and other works. The study was carried out in a contiguous area of 6 PHCs of a district. The work of 16 MPWs was observed by a Social Investigator of NTI who accompanied them during a day's work; one month period was selected as reference period. 160 MPWs were asked to give details of their activities through self administered questionnaire and records of the six PHCs were studied in terms of output of the services.

On an average a MPW travelled 15 kms, spent 4 hours in the village, visited 70 homes; Of them, 25% were locked. The time spent on different activities during home visits were 34% for minor ailments, 26% on malaria, 12% on family welfare and 11% on tuberculosis. Profile of activities carried out on a randomised day were, 77.5% did not perform any anti tuberculosis activities. Those who did anti tuberculosis work identified 4 symptomatics, prepared two smears and followed up 13 patients. The highest performance was with regard to Family Welfare (68%) and treatment of ailments (64%). As per the opinion of MPWs tuberculosis was 7th, 8th and 9th rank, malaria was lst and 3rd and family welfare was 1st and 2nd. As per the actual output of work from the PHC records, anti malaria (70%) and minor treatment had the maximum performance and family welfare averaged, as only 35 of the eligible couples were registered. Findings suggest that tuberculosis was given lower priority in terms of all the three points i.e., actual performance, profile of work of MPW, actual day's work of MPW and diverse health activities among rural population. Integration of tuberculosis at periphery needs more important considerations.

KEY WORDS: CONTROL PROGRAMME, PRIMARY HEALTH CARE, HEALTH WORKER, INTEGRATION.

106
ACTIVE CASE-FINDING IN TUBERCULOSIS AS A COMPONENT OF PRIMARY HEALTH CARE
KS Aneja, P Chandrasekhar, MA Seetha, VC Shanmuganandan & GE Rupert Samuel: Indian J TB 1984, 31, 65-73.

Feasibility of introducing limited active case-finding in tuberculosis involving Multi-purpose Health Workers (HWs) to supplement the existing methodology of detecting the cases through chest symptomatics attending Peripheral Health Institutions (PHIs) on their own, was studied earlier with encouraging results. The present study was undertaken to understand the existing working system of HWs and within that the priority areas of input which may lead to better case yield.

The study revealed that the population available at any beat schedule of HWs was about 42% of the eligible population of age 20 years and above. Only 60-75% of the field days were utilized for routine multi-purpose duties. Of the total area, 25% to 40% remained uncovered. The effective tuberculosis work was done only on 5% of the beat schedule days and the work was not uniformly spread throughout the month. Even so, the contribution by HWs was twice the number of cases diagnosed at PHIs under study in one year. Had the HWs covered the entire area of their beat schedule, 80 against 26 cases would have been diagnosed. Moreover, there is possibility of detecting more cases among the elderly patients who normally do not attend their area health centres. However, the success depends upon meticulous supervision and regular flow of supplies.

KEY WORDS: HEALTH WORKER, PRIMARY HEALTH CARE, CONTROL PROGRAMME, CASE-FINDING, RURAL COMMUNITY.
 
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