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