CHAPTER I - SOCIOLOGICAL APPROACH TO HEALTH CARE & TB CONTROL <<Back
 
a) Sociological considerations
 
016
AU : Mahler H
TI : A social revolution in public health.
SO : WHO CHRONICLE 1976, 30, 475-480.
DT : Per
AB :

The article is an adaptation of a speech made by Dr. Mahler, Director-General of WHO on Sept. 8, 1976 in Kampala, Uganda and on 11th October in Karachi, Pakistan. The main focus of the speech is the need for a social revolution in public health to attain an acceptable level of health uniformly distributed throughout the world's population. The meaning of a social revolution in this context is to take a new approach to the solution of community health problems. Four key factors to adopt when taking this new approach are described in detail: 1) determination of social health goals, 2) identification of the health technologies that subserve the stated goals, 3) selection of sound and affordable health technologies and, 4) manifestation of the political will to determine health policies and appropriate health care systems. It is suggested that these four factors could also serve as a guide for collaboration between Member States, both within and between Regions and certain measures to meet the social challenge in implementation of the policies are offered.

KEYWORDS: SOCIAL COST; SOCIAL PLANNING; TECHNOLOGY; SOCIAL CHANGE; GLOBAL.
 

  b) Socio-Cultural, Socio-Economic & Demographic Aspects  
 
057
AU : Rajeswari R, Balasubramanian R, Muniyandi M, Geetharamani S, Thresa X & Venkatesan P
TI : Socio-economic impact of tuberculosis on patients and family in India
SO : INT J TB & LUNG DIS 1999, 3, 869-877
DT : Per
AB :

This study was undertaken to quantify the socio-economic impact of TB on patients and their families from the costs incurred by patients in rural and urban areas.

An interview schedule prepared from 17 focus group discussions was used to collect socio-economic demographic characteristics, employment, income particulars, expenditure on illness and effects on children from newly detected sputum-positive pulmonary TB patients. The direct and indirect costs included money spent on diagnosis, drugs, investigations, travel and loss of wages. Total costs were projected for the entire 6 months of treatment.

The results showed that the study population consisted of 304 patients (government health care 202, non governmental organization 77, private practitioner 25), 120 of whom were females. Mean direct cost was Rs.2052/-, indirect Rs.3934/-, and total cost was Rs.5986/- ($171 US). The mean number of work days lost was 83 and mean debts totaled Rs.2079/-. Both rural and urban female patients faced rejection by their families (15%). Eleven per cent of schoolchildren discontinued their studies; an additional 8% took up employment to support their family.

It was concluded that the total costs and particularly indirect costs due to TB, were relatively high. The average period of loss of wages was 3 months. Care giving activities of female patients decreased significantly, and a fifth of schoolchildren discontinued their studies.

KEY WORDS: SOCIO-ECONOMICS, SOCIAL COST; WOMEN; INDIA
 

 
  CHAPTER II - HEALTH SERVICES  
 
a) Health Policy, Delivery of Health Services & Health Care
 
093
AU : Ruderman AP
TI : Health programmes and new directions in social and economic development.
SO : BULL IUAT 1974, 49, 50-56.
DT : Per
AB :

The changes in the place of health programmes in the international development process, over time, has meant that the role of health has come full circle, today. The paper describes this changing role of health, from the classic imperative of the medical practitioner to heal the sick and comfort the afflicted through a period when the justification for spending money on health programmes had to be sought in their contribution to economic development to the current period, in the 70’s, when once again, health programmes can be justified without recourse to economic arguments. To support this view, several figures, presenting data on the comparative savings from BCG and standard TB treatment in Burma (in the 60s) and the prevalence of TB in the Indian labour force (in the early 60s) are illustrated to show how they might convince development economists to provide money for the TB health programme.

KEYWORDS: HEALTH SERVICES; SOCIAL COST; HEALTH CARE; CANADA.

111
TI : Forum on Demand and supply of drugs (this title is constructed by the indexer for identifying the article as the information is without title).
SO : INDIAN J TB 1993, 40, 172-173.
DT : Per
AB :

Keeping the list of drugs available in the market to the bare essentials, reducing practices (such as hosting of conferences, advertising, peddling of samples and literature, etc.) which add huge overheads to the cost of production of drugs, rational drug prescription policies and consumer awareness as well as education are the essential ingredients which can ensure availability of low priced drugs.

KEYWORDS: SOCIAL COST; HEALTH POLICY; INDIA.
 

  d) Health Economics  
 
165
AU : Nagpaul DR & Vishwanath MK
TI : Economics of health.
SO : Tuberculosis and Chest Diseases Workers Conference, 22nd, Hyderabad, India, 3-6 Feb 1967, p. 277-300.
DT : CP
AB :

Health has been defined as the state of perfect physical, social and mental well-being which is somewhat of an abstract definition. In this paper, economics of health is measured through economics of sickness. Because sickness is experienced, it can be measured and it inflicts physical, social and economic sufferings. In a community, economic prosperity is directly dependent on quantum of sickness and its prevention by health services. A sociological enquiry into the part played by disease in the socio-economic development of society was made by carrying out a study in two village population groups. The Social Investigators of NTI made deep, probing questions to elicit presence of symptoms, action taken by them, money spent on treatment and the loss of wages. In the first study, observation-participation technique was adopted. The investigators lived in the village for four months. In the second study, 20% households of those 22 villages which participated earlier in an epidemiological survey conducted by NTI, were interviewed.

Findings of the two studies are combined and presented. Illnesses were classified into major and minor on the basis of clinical severity and the duration of symptoms. In both the studies, 60% of all persons were asymptomatic during 2 months prior to the interview. About 18% had one minor illness, 13% had major illness and only 3% had one major and one minor illness. The quantum of multiple disease (3 or more) occurring in one person was less than 2%. Only 20% of living man-days were spent as sick man-days. The average annual loss on account of health reasons per family has been estimated to be Rs.90/- and Rs.15/- per capita. The overall economic loss due to sickness, direct and indirect amounted to 3% of the per capita income in the poorer groups of villages and 6% in the economically more favourably placed villages. The material available here strongly suggests that the sizes of households will not have much influence over the sickness in the community. Another significant feature of this study was the phenomenon of substitution within the family whenever the wage earner could not go to work. The evidence examined in this paper suggests that the actual economic loss is only 1/3rd of the calculated loss. It also suggests that the overall cost of sickness to the individuals and family is far less than what is normally calculated and is influenced by the money available in the household.

KEYWORDS: HEALTH ECONOMICS; SOCIAL COST; INDIA.

167
AU : Sen AS & Basu RN
TI : Economics of health-the cost of tuberculosis.
SO : INDIAN J TB 1972, 19, 144-158.
DT : Per
AB :

In a study of the cost of TB in India, a direct cost of Rs. 29.68 crores annually has been estimated. The morbidity and mortality losses have been quantified taking into account the urban and rural population separately. The data on mortality in rural areas is very meager and is not available according to age and sex. This, and the expected working life for premature mortality have been calculated by the application of statistical methods. The morbidity loss has been estimated at Rs. 288.4 crores and the mortality losses at Rs. 420.41 crores at 4 percent deduction and Rs. 304.96 crores at 10 percent deduction.

KEYWORDS: HEALTH ECONOMICS; SOCIAL COST; SOCIAL WELFARE; INDIA.
 

 
     CHAPTER IV - TREATMENT BEHAVIOUR OF TB PATIENTS  
 
b) Measures to Improve Treatment Adherence
 
263
AU : Dick J & Lombard C
TI : Shared vision - a health education project designed to enhance adherence to anti-tuberculosis treatment
SO : INT J TB & LUNG DIS 1997, 1, 181-86
DT : Per
AB :

Two adjacent Cape Town Local Authority health clinics in Cape Town, South Africa, were selected. Clinic A was designated the "intervention clinic" and Clinic B the ‘control clinic’. To asses whether the combined strategy of a patient-centred interview plus the issuing of a patient education booklet would have the effect of increasing the adherence of notified pulmonary TB patients to prescribed treatment.

A controlled intervention study was implemented using a cohort of the first 60 consecutive patients notified with pulmonary TB at both Clinic A and Clinic B; the patient cohort thus consisted of 120 patients. The risk of patient non-adherence to anti-TB treatment was significantly reduced at the intervention clinic compared to the control clinic.

The results of this study indicate the need for further operational research to assist health providers in developing standardised protocols of health education to enhance adherence to treatment in patients who require protracted treatment regimens.

KEY WORDS: SOCIAL COST; COMPLIANCE; HEALTH EDUCATION; AFRICA.
 

 
     CHAPTER V - SOCIAL SERVICE & REHABILITATION  
 
 
270
AU : Mani JT
TI : The work of care and after care committees.
SO : All India TB Conference, 2nd, New Delhi, India, 20-23 Nov 1939 p. 159-164.
DT : CP
AB :

The paper briefly outlines the care and after care work obtained in Bangalore and compared it with schemes elsewhere. Provisions were made to help needy patients with diet and special medicines. It was felt that this was the best that could be done for these patients in the absence of sufficient hospital accommodation. It was suggested that suitable employment be found not only for the arrested case but also for the sputum positive good chronic. For care of infants, institutional separation was adopted in Bangalore as familial boarding out may not work satisfactorily. Preventoria (open air schools) for older children was not feasible due to lack of sufficient finances. It was concluded that, in India, since medical work was state-managed, State aid should be forthcoming for TB, failing which, the TB work in the country would come to a halt.

KEYWORDS: SOCIAL COST; SOCIAL WELFARE; REHABILITATION; INDIA.

TB is no stigma

274
AU : Vasudeva Rao K
TI : Rehabilitation of tuberculosis ex-patients.
SO : Tuberculosis Workers Conference, 7th, Bombay, India, 23-25 Nov 1949, p. 196-204.
DT : CP
AB :

The problem of rehabilitation of TB patients is not confined to medicine alone. The co-operation of other fields, psychology, sociology and economics must combine with medicine to obtain tangible, positive results. Sir Pendrill Varrier-Jones’s idea to bring work to the patient has had a salutary effect and is now recognised as the main method of rehabilitation. The most vulnerable period during which relapses occur are the first two years after the TB patient’s discharge. Hence, all patients discharged from institutions should be looked after for a further period of 2-3 years while making the patients feel they are being trained in some occupation. Colonisation or establishment of settlements for ex-patients serves this purpose. The advantages of colonisation are presented. The two main factors to be considered in rehabilitation after discharge are: 1) General principles with regard to the patient (which focus on the need to address the psychological fear and needs of the patient) and, 2) General principles with regard to the industries (which highlight the need for industry to be built around a worker) and taking various steps to protect the well-being, both physical and emotional, of the ex-patients. Making the services of ex-patients available for outside jobs and using machinery to the fullest extent in industries would resolve some criticisms leveled at settlements.

KEYWORDS: REHABILITATION; SOCIAL WELFARE; SOCIAL COST; INDIA.
 
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