CHAPTER II - HEALTH SERVICES <<Back
 
b) Community Participation & Role of Voluntary Organizations
 
120
AU : Cariappa BM
TI : Tuberculosis in India-as seen by a layman.
SO : Tuberculosis and Chest Diseases Workers Conference, 17th, Cuttack, India, 31 Jan-3 Feb 1961, p. 93-97.
DT : CP
AB :

The focus of this paper is to make known the extensive incidence of TB in India in the early sixties. Various prevailing factors such as a lack of sufficient anti-TB clinics that are properly equipped and adequately staffed, unsatisfactory housing conditions and Government efforts to counter TB, non-availability of sufficient treatment drugs and lack of patients’ access to these drugs, have contributed to the high prevalence of TB. To overcome the huge problem, it is recommended that voluntary bodies and individuals should work, in addition to the Government, to strengthen the campaign against TB. Particularly, TB workers could help in strengthening voluntary TB Associations in the country, so that these Associations can really form the people’s movement against TB and fill the lack that exists at the moment between anti-TB schemes and the individual patient.

KEYWORDS: COMMUNITY PARTICIPATION; VOLUNTARY ORGANIZATION; INDIA.

123
AU : Banerji A, Shawndilay AK & Basu Chaudhuri SK
TI : Organised home treatment in a small community: preliminary report.
SO : INDIAN J CHEST DIS 1962, 4, 181-186.
DT : Per
AB :

One hundred twenty-five cases of pulmonary TB from residents of Vrindaban, UP, who attended the Out-Patient Department of the Shri Brij Sewa Samiti TB Sanatorium in May 1961, were reviewed to assess the value of an organised home treatment scheme. Observations regarding age, sex, stage, cavity and bacillary status and, socio-economic conditions of the patients were recorded. Results of treatment under ambulatory conditions were analysed. Cavity closure was observed in 12 out of 65 cavitary cases and there was sputum conversion in 26 out of 51 cases recorded positive originally. Some problems of organised home treatment, however remain and are indicated.

KEYWORDS: COMMUNITY PARTICIPATION; INDIA.

132
AU : Sen Gupta NC
TI : Community participation in the tuberculosis programme.
SO : BULL IUAT 1972, 47, 102-106.
DT : Per
AB :

Several reasons for the failure to achieve the expected results in TB control, globally, are presented and discussed in detail with reference to the three basic components of a TB programme- BCG vaccination, case-finding and treatment. They include the failure of decision-makers and administrators responsible for formulating and implementing NTPs to establish proper and realistic priorities reflected in the choice of control measures and the allocation of available resources to them. For instance, many developing countries have opted for an expensive screening method (mass chest radiography) rather than achieving effective results by provision of basic health facilities within easy reach of everyone and by using direct microscopy sputum examinations. Several countries have focussed on construction of sanatoria when out-patient treatment has been proven to be as effective as institutional treatment. The failure to bring the TB programme to the most peripheral regions and to apply it on a country-wide basis, the failure to orient the consumer sufficiently to the services offered, and several socio-economic and patient factors have contributed to limited success in anti-TB efforts. Given this background, a community participation programme can help increase the success rate of TB programmes by using volunteers in case-finding and in reducing treatment default rate as demonstrated in Ceylon (Sri Lanka) and Malaysia.

KEYWORDS: COMMUNITY PARTICIPATION; SRI LANKA.

139
AU : Spinosa AV, Bales V, Pesanti E & Hadler J
TI : Treatment of tuberculosis by community workers.
SO : BULL IUAT 1976, 51, 695-700.
DT : Per
AB :

A TB control project was undertaken in 1971 in South Western United States, in the reservation of the Navajo Indians (120,000 living in a vast, high, arid land). The specific problems in treating TB among the Navajo are described. The specific problem was that, despite efforts of medical personnel and available treatment facilities, only 25% of the active TB cases at home were taking their medications. The cause was found to be the inadequate number of trained personnel to do the necessary tasks to keep patients on medication. To achieve the project’s goal of increasing the percentage of patients at home, taking medication in one year, to 80%, job analyses were done to develop outlines of the duties, knowledge and skills required of TB workers, the case register clerks and the project Director, by interviewing the physicians, nurses and administrators working on the project. Subsequently, 4 weeks of training (carefully designed around the job requirements of the trainees) was given. An evaluation of the project indicated that 80% of active cases at home were on medication after a year and 96% in the fourth year. Only 4% of cases were lost to supervision, active cases in the hospital were down from 50% to 15%, hospital stay was down from 70 to 18 days, a quarter of active cases were on intermittent therapy, new case rates were down from 150 to 73 per 100,000. A subjective evaluation performed through the use of interviews and questionnaires revealed positive and negative feelings of the workers to different issues of TB work. The conclusions were that TB workers, recruited from the indigenous population and carefully trained, could greatly benefit a TB programme; such a project was best implemented by an objective-oriented approach focussing on the problem, cause, objective, solution and evaluation. These concepts could be successfully utilized in any TB programme, whether it be rural or urban, in a developed or developing nation.

KEYWORDS: COMMUNITY PARTICIPATION; SOCIO-ECONOMICS; USA.

142
AU : Trivedi SB
TI : Role of non-medical voluntary body in active case detection and case holding in tuberculosis control programme.
SO : Eastern Region Conference of IUAT, 15th, Lahore, Pakistan, 10-13 Dec, 1987, p. 403-405.
DT : CP
AB :

Community involvement in the TB control programme has always been considered to be a very important factor. The Rotary Club of Surendranagar District, Gujarat, was entrusted with the work of organising active case detection camps in the district. The case detection work was done by a mobile odelca unit and the laboratory team. The results were handed over to the Rotary Club. The Rotarian volunteers, with the help of the DTC, supervised the regularity of collection and consumption of treatment drugs. Fifteen(15) such camps were held for the chest symptomatics. A total of 5,648 mini X-rays were done and 5077 sputa were examined. A total of 1,395 radiologically active cases were detected. The involvement of volunteers significantly helped in: 1) Early and increased detection of cases, 2) Reducing the financial burden of the treatment by providing the needed drugs to all detected cases, 3) Increasing case holding by voluntarily contacting all the patients in the area, 4) Increasing the public’s awareness about the TB problem and helping in providing the necessary health education. This collaborative effort resulted in 78.3% of the cases completing the treatment. It was concluded that community involvement, as in this study, improved the performance of the TB control programme.

KEYWORDS: COMMUNITY PARTICIPATION; VOLUNTARY ORGANIZATION; CASE HOLDING; INDIA.
 

 
     CHAPTER III - ILLNESS PERCEPTION & UTILIZATION OF HEALTH FACILITIES  
 
a) Community Survey Based
 
192
AU : Hadley M & Mather D
TI : Community involvement in tuberculosis control : lessons from other health care programmes
SO : INTL J TB & LUNG DIS 2000, 4, 401-408
DT : Per
AB :

Decentralising TB control measures beyond health facilities by harnessing the contribution of the community could increase access to effective TB care. This review of community-based health care initiatives in developing countries gives examples of the lessons for community contribution to TB control learned from health care programmes. Sources of information were Medline and Popline databases and discussions with community health experts. Barriers to success in TB control stem from biomedical, social and political factors. Lessons are relevant to the issues of limited awareness of TB and the benefits of treatment, stigma, restricted access to drugs, case finding and motivation to continue treatment.

The experience of other programmes suggests potential for an expansion of both formal and informal community involvement in TB control. Informal community involvement includes delivery of messages to encourage TB suspects to come forward for treatment and established TB patients to continue treatment. A wide range of community members provide psychological and logistic support to patients to complete their treatment. Lessons from formal community involvement indicate that programmes should focus on ensuring that treatment is accessible. This activity could be combined with a variety of complementary activities: disseminating messages to increase awareness and promote adherence, tracing patients who interrupt treatment, recognising adverse effects, and case detection.

Programmes should generally take heed of existing political and cultural structures in planning community-based TB control programmes. Political support, the support of health professionals and the community are vital, and planning must involve or stem from the patients themselves.

KEY WORDS: COMMUNITY PARTICIPATION; DEVELOPING COUNTRIES; UK.
 
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