ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇಂದ್ರ ಮತ್ತು ಸಮುದಾಯಗಳ ನಡುವೆ ಅತ್ಯಂತ ಬಾಹ್ಯ ಮತ್ತು ಜನರ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬಧಿಸಿದ ಮೊದಲ ಆರೋಗ್ಯ ಸಂಪರ್ಕ ಕೇಂದ್ರವೆಂದರೆ ಅದು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ. ಪ್ರತಿ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಕ್ಕೆ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದಲ್ಲಿ ೫೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕಾಗಿದ್ದು ಹಾಗೂ ಗುಡ್ಡಗಾಡು ಪ್ರದೇಶದಲ್ಲಿ ೩೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕು ಎಂಬುದು ನಿಯಮವಿದೆ ಆದರೆ ಪ್ರಸ್ತುತವಾಗಿ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದ ಕೆಲವು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಗಳಲ್ಲಿ ೭೦೦೦ ಕಿಂತ ಹೆಚ್ಚು ಹಾಗು ೨೦೦೦ ಕಡಿಮೆ ಜನಸಂಖ್ಯೆ ಕೂಡ ಹೊಂದಿವೆ, ಪ್ರಸ್ತುತವಾಗಿ ಭಾರತದಲ್ಲಿ ೧,೪೫,೨೭೨ ಆರೋಗ್ಯ ಉಪ-ಕೇಂದ್ರಗಳು ಕಾರ್ಯನಿರ್ವಹಣೆಯಲ್ಲಿವೆ. ಪ್ರತಿಯೊಂದು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರದಲ್ಲಿ ಕಿರಿಯ ಮಹಿಳಾ ಆರೋಗ್ಯ ಸಹಾಯಕಿ (ಕಿ.ಮ.ಆ.ಸ) ಮತ್ತು ಕಿರಿಯ ಪುರುಷ ಆರೋಗ್ಯ ಸಹಾಯಕ (ಕಿ.ಪು.ಆ.ಸ) ಎಂಬ ಸಿಬ್ಬಂದಿಗಳ ಮೂಲಕ ಈ ಕೆಳಗಿನ ಸೇವೆಗಳನ್ನು ಒದಗಿಸಲಾಗುತ್ತಿದೆ. ಉಪಕೇಂದ್ರದಲ್ಲಿ ದೊರುಕುವ ಮುಖ್ಯ ಸೇವೆಗಳು ಎಂದರೆ; ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಆರೋಗ್ಯ ಕಾಳಜಿ ಅವರ ಪೌಷ್ಟಿಕತೆಯ ಬಗ್ಗೆ ಪೋಷಣೆ, ಮಕ್ಕಳಿಗೆ ಮಾರಕ ರೋಗ-ನಿರೋಧಕ ಲಸಿಕೆ ನೀಡಿಕೆ, ಅತಿಸಾರ ನಿಯಂತ್ರಣ, ಸಂಪರ್ಕ ರೋಗಗಳ ಬಗ್ಗೆ ಜನರಿಗೆ ಅರಿವು ಮೂಡಿಸುವುದು ಮತ್ತು ಅವಗಳ ನಿಯಂತ್ರಣ ಹಾಗೂ ಪರಸ್ಪರ ಸಂವಹನ ಮುಖಾಂತರ ವರ್ತನೆ ಬದಲಾವಣೆ. ಪುರುಷ, ಮಹಿಳೆ ಮತ್ತು ಮಕ್ಕಳಿಗೆ ಅವಶ್ಯಕ ಆರೋಗ್ಯ ಬೇಡಿಕೆಗಳಿಗೆ ಬೇಕಾದ ಚಿಕ್ಕವ್ಯಾದಿಗಳಿಗೆ ಮೂಲ ಹಾಗು ತುರ್ತು ಔಷಧಿಗಳು ಕೂಡ ಲಭ್ಯವಿರುತ್ತವೆ.
ಆರೋಗ್ಯ ಇಲಾಖೆಯ ಅಡಿಯಲ್ಲಿ ಯಾವುದೇ ಹೊಸ ಕಾರ್ಯಕ್ರಮಗಳನ್ನು ಪರಿಚಯ ಮಾಡಿ, ಆ ಕಾರ್ಯಕ್ರಮ ಯಶಸ್ವಿಯಾಗಿ ಅನುಷ್ಟಾನವಾಗಬೇಕಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಹಾಗೂ ಅದರ ಕಿ.ಮ.ಆ.ಸ ಪಾತ್ರ ಬಹಳ ಮುಖ್ಯ ಹಾಗೂ ಅವಶ್ಯಕ. ಈಗಾಗಲೆ ಆರೋಗ್ಯ ಇಲಾಖೆಯಿಂದ ಹಲವಾರು ಕಾರ್ಯಕ್ರಮಗಳು ಅನುಷ್ಟಾನವಾಗಿ ಕೆಲವು ಯಶಸ್ವಿ ಹಂತದಲ್ಲಿದ್ದರೆ ಇನ್ನು ಕೇಲವು ಕಾರ್ಯಕ್ರಮಗಳು ಗುಣಾತ್ಮಕವಾಗಿ ಯಶಸ್ವಿಹಂತದಲ್ಲಿಲದಿದ್ದರು ಕು೦ಟುತ್ತಾ ಸಾಗಿವೆ. ಇದಕ್ಕೆ ಕಾರಣ ಏನು ಎಂದು ನೋಡುತ್ತಾ ಹೋದರೆ ಆರೋಗ್ಯ ಕಾರ್ಯಕ್ಷೇತ್ರದ ಮೂಲಮಟ್ಟವಾದ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರ ಹಾಗೂ ಕಿ.ಮ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಹಲವಾರು ಸಮಸ್ಯೆಗಳು ಪರೋಕ್ಷವಾಗಿ ಈ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನ ಗುಣಾತ್ಮಕತೆಯಲ್ಲಿ ಕಡಿಮೆ ಆಗಿರುವುದಕ್ಕೆ ಕಾರಣ ಕಂಡುಬರುತ್ತದೆ
ಹಾಗಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಮತ್ತು ಅದರ ಕಿ.ಮಾ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳಾದರು ಏನು? ನಮ್ಮ ಕಾರ್ಯಕೇತ್ರ ಭೇಟಿ ಸಂರ್ದಭದಲ್ಲಿ ಕೆಲವು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಕಿ.ಮಾ.ಆ.ಸ ನಮ್ಮೊಡನೆ ಹಂಚಿಕೊಂಡಿರುವ ಕೆಲವು ಸಮಸ್ಯೆಗಳುನ್ನು ಇಲ್ಲಿ ಪ್ರಸ್ತಾಪಿಸಾಲು ಇಚ್ಚಿಸುತ್ತೇನೆ; ವರದಿ ತಯ್ಯಾರಿ ಮತ್ತು ರೆಜಿಸ್ಟರ ಬರೆಯುವದು, ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ (ರಾಷ್ತ್ರೀಯ ಗ್ರಾಮೀಣ ಆರೋಗ್ಯ ಅಭಿಯಾನ) ಬರುವುದಕಿ೦ಥ ಮುಂಚೆ ೧೬ ರಷ್ಟು ರೆಜಿಸ್ಟರಗಳು ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ಬರೆಯುತ್ತಾ ಬಂದಿದ್ದು ಈಗ ಇವುಗಳ ಸಂಖ್ಯೆ ಹೆಚ್ಚಾಗಿದೆ. ದಿನಗಳ ಪೂರ್ತಿ ಹಳ್ಳಿಗಳ ಮತ್ತು ಮನೆ ಭೇಟಿ ಮಾಡಿ ಮರಳಿ ಮನೆಗೆ ಬಂದು ೧೬ ಕಿಂತ ಹೆಚ್ಚಿನ ರೆಜಿಸ್ಟರಗಳ ನಿರ್ವಹಣೆ ಮಾಡುವುದು ತುಂಬಾ ಕಷ್ಟ. ಅಲ್ಲದೆ ವಿವಿಧ ಕಾರ್ಯಕ್ರಮದ ಮೇಲಿನ ಅಧಿಕಾರಗಳು ಪ್ರತಿತಿಂಗಳು ಒಂದಲ್ಲಾ ಒಂದು ವರದಿ ಸ್ವರೂಪದಲ್ಲಿ ಹೊಸ ಬದಲಾವಣೆ ಮಾಡಿ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವಂತೆ ಕೇಳುತ್ತಾರೆ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವದು, ಅದರಲ್ಲಿ ಹೊಸ ಸ್ವರೂಪದ ವರದಿ ಸಲ್ಲಿಸುವುದು ತುಂಬಾ ಕಷ್ಟದಕೆಲಸ.
ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಬಂದನಂತರ ಪ್ರತಿ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಗಳಿಗೆ ರೂ: ೧೦,೦೦೦ ಮುಕ್ತ ನಿಧಿ ನೀಡುತ್ತಿದ್ದು, ಆ ಹಣವನ್ನು ಉಪ ಕೇಂದ್ರಗಳ ಸಣ್ಣ-ಪುಟ್ಟ ದುರಸ್ತಿ. ಅನಿರೀಕ್ಷಿತ ಅವಶ್ಯಕ ಘಟನೆಗಳಿಗೆ ಮತ್ತು ತಕ್ಷಣದ/ತುರ್ತು ಔಷಧಿ ವೆಚ್ಚವನ್ನು ಪೂರೈಸಲು ಹಾಗೂ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ಬೇಕಾಗುವ ಸಣ್ಣ-ಪುಟ್ಟ ಸಲಕರಣೆಗಳ ಖರೀದಿಗೆ ಈ ಹಣದಿಂದ ವೆಚ್ಚಮಾಡಬಹುದು. ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಅಡಿಯಲ್ಲಿ ಪ್ರತಿ ಉಪ ಕೇಂದ್ರಗಳಿಗೆ ರೂ ೧೦,೦೦೦ ನೀಡಿರುವದು ತು೦ಬಾ ಸಂತೋಷದ ವಿಷಯ ಆದರೆ ಈ ಹಣದಲ್ಲಿ ಯಾವುದೇ ಹಣ ವೆಚ್ಚ ಮಾಡಬೇಕಾದ್ದಲ್ಲಿ, ವೆಚ್ಚಮಾಡಬೇಕಾದ ಚೆಕ್ ಮೇಲೆ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಸಹಿ ಇರಲೇಬೇಕು, ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ತಮ್ಮ ವೃತ್ತಿಗೆ ಸಂಬ೦ದಿಸಿದ ಎಷ್ಟೋ ಮುಖ್ಯ ಕೆಲಸಗಳನ್ನು ಬದಿಗಿಟ್ಟು ಈ ಒಂದು ಸಹಿಗಾಗಿ ಮೂರ ರಿಂದ ನಾಲ್ಕು ಬಾರಿ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಮನೆಗೆ ಅಲೆದಾಡಬೇಕಾಗುತದೆ, ಈ ಒಂದು ಓಡಾಟದಲ್ಲಿ ತಮ್ಮ ಅಮುಲ್ಲ್ಯವಾದ ಸಮಯ ವ್ಯಯವಾಗುತ್ತಿದೆ ಎಂಬುದು ಕಿ.ಮ್. ಆ. ಸಹಾಯಕಿಯರ ಅಭಿಪ್ರಾಯ.
ಎಂ,ಸಿ,ಟಿ,ಎಸ್(ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಟ್ರ್ಯಾಕಿಂಗ್ ವ್ಯವಸ್ಥೆ) ಮತ್ತು ಎಚ್,ಎಮ,ಆಯ್,ಎಸ್ (ಆರೋಗ್ಯ ನಿರ್ವಹಣಾ ಮಾಹಿತಿ ವ್ಯವಸ್ಥೆ) ಗಳನ್ನೂ ಪರಿಚಯಿಸಿ ಸುಮಾರು ೩-೪ ವರ್ಷಗಳು ಕಳೆದರೂ ಕೂಡಾ ಇವಗಳು ಇನ್ನು ಮುಖ್ಯವಾಹಿನಿಗೆ ಬರುತ್ತಿಲ್ಲಾ ಏಕೆ ಎಂದು ಕಾರಣ ಹುಡುಕುತ್ತಾ ಹೋದರೆ; ಕೆಲವು ಕಿ.ಪು.ಆ.ಸಹಾಯಕಿಯರು ಇನ್ನು ಸಮುದಾಯ ಆಧಾರಿತ (Community based) ಅಥವಾ ಸೌಲಭ್ಯ ಆಧಾರಿತ (Facility based) ಕೇಂದ್ರಗಳ ವರದಿ ವ್ಯವಸ್ಥೆಯ ಅರಿತುಕೊಳ್ಳುವ ಗೊಂದಲದಲ್ಲಿ ಕೆಲವರು ಇದ್ದರೆ ಇನ್ನು ಕೆಲವರು ಎಂ,ಸಿ,ಟಿ,ಎಸ್ ಅಂತಹ ತಂತ್ರಜ್ಞಾನಕ್ಕೆ ಮೊಬೈಲ ಮೊಲಕ ವರದಿ ಸಲ್ಲಿಸವುದರಲ್ಲಿ ಪರದಾಡುತ್ತಿದ್ದಾರೆ, ಹಳೆ ತೆಲಮಾರಿನ ಕೆಲವು ಕಿ.ಮ.ಸಹಾಯಕಿಯರು ಕಾರ್ಯಕ್ಷೇತ್ರ ಭೇಟಿ ಮತ್ತು ಮನೆಯ ಬೇಟಿ, ಆಪ್ತಾಸಮಾಲೋಚನೆ ಹಾಗು ಹೆರಿಗೆ ಮಾಡುವದು, ಇತ್ಯಾದಿ. ಹೀಗೆ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬದಿಸಿದ ಇತರೆ ಚಟುವಟಿಕೆಗಳಲ್ಲಿ ನೈಪುಣ್ಯತೆ ಹೊಂದಿದ್ದು, ಆದರೆ ಎಂ.ಸಿ.ಟಿ.ಎಸ್ ಅಂತಾ ಹೊಸ ತಂತ್ರಜ್ಞಾನಕವನ್ನೂ ತಿಳಿದುಕೊಳ್ಳಲು ಹಾಗು ಅದಕ್ಕೆ ಸಂಬ೦ಧಿಸಿದ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಪದೆ-ಪದೆ ಇನ್ನೊಬ್ಬರಿಂದ ಸಹಾಯ ಕೇಳುವುದು ಪ್ರತಿ ಕಿ.ಮ.ಸಹಾಯಕಿಯರಿಗೆ ಮುಜುಗರದ ಸಂಗತಿಯಾಗಿದೆ.
ತಾಯಿ ಮತ್ತು ಶಿಶು ಮರಣ ಸಂಭವಿಸಿದಾಗ ಕಿ.ಮ.ಸ ಮನೆಗೆ ಹೋಗಿ ವಿವರವಾಗಿ ವಿಚಾರಣೆ ನಡೆಸಿ ಮೇಲಾಧಿಕಾರಿಗಳಿಗೆ ವರದಿ ಮಾಡಬೇಕಾಗಿರುವುದು ಕಿ.ಮ.ಸ ಕರ್ತವ್ಯ. ಆದರೆ ವಿಚಾರಣೆ ನಡಸಲು ಪದೆ-ಪದೆ ಅವರ ಮನೆಗೆ ಹೋದಾಗ, ಆ ಕುಟ೦ಬದ ಸದಸ್ಯರು ಹಾಗು ನೆರೆಯ ಜನರು ಕಿ.ಮ.ಸಹಾಯಕಿಯರನ್ನು ತಪ್ಪಾಗಿ ಭಾವಿಸುತ್ತಾರೆ. ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಗೆ ಸರಕಾರದಿಂದ ಹೆಚ್ಚಿನ ದುಡ್ಡು ಸಿಗಬಹುದು, ಆದರೆ ಆ ದುಡ್ಡುನ್ನು ಫಲಾನುಭವಿಗಳಿಗೆ ಕೊಡುತ್ತಿಲ್ಲಾ ಎಂದು ಸಂಶಯ ವ್ಯೆಕ್ತಪಡಿತ್ತಾರೆ. ಕಿ.ಮ.ಸಹಾಯಕಿಯು ಕ್ಷೇತ್ರದಲ್ಲಿ ತಮ್ಮ ಕರ್ತವ್ಯಗಳನ್ನು ಸರಿಯಾಗಿ ಮಾಡಿದ್ದರೂ ಸಹ ಯಾವುದೋ ಕಾರಣಾಂತರಗಳಿಂದ ಯಾವಾಗಲಾದರೂ ತಾಯಿ ಅಥವಾ ಶಿಶುಮಣರವಾದಾಗ, ಇಲಾಖೆಯ ಮೇಲಾಧಿಕಾರಿಗಳು ನಡೆಸುವ ತಾಯಿ ಹಾಗು ಶಿಶು ಮರಣದ ವಿಚಾರಣೆ (Maternal & Infant death Audit ) ಸಂದರ್ಭದಲ್ಲಿ ತಪ್ಪು ಎಲ್ಲಿ ನಡೆದಿದೆ? ಯಾರಿಂದ ನಡೆದಿದೆ? ಯಾತಗೋಸ್ಕರ ನಡೆದಿದೆ? ಎಂಬುದು ವಿಚಾರಿಸದೆ ಎಲ್ಲವು ಕಿ. ಮ. ಆ. ಸಹಾಯಾಕಿಯರದೆ ತಪ್ಪಿನಿಂದಲೆ ಯಾಗಿದೆ ಎಂದು ಅಪರಾಧಿ ಸ್ಥಾನದಲ್ಲಿ ನಿಲ್ಲಿಸಿ ಜನರ ಮುಂದೆ ನಿಂದಿಸುತ್ತಾರೆ. ಎಷ್ಟೋ ವರ್ಷಗಳಿಂದ ಕಿ.ಮ.ಆ.ಸ ಆರೋಗ್ಯ ಇಲಾಖೆಯಲ್ಲಿ ಸಾಕಷ್ಟು ಸೇವೆ ನೀಡುತ್ತಾ ಬಂದಿದ್ದರೂ ಆ ಸೇವೆಗೆ ಕೂಡ ಪರಿಗಣನೆ ಕೊಡದೆ, ಯಾರೋ ಮಾಡಿದ ತಪ್ಪಿನಿಂದಾಗಿ ಕಿ.ಮ.ಆ.ಸ. ನಿಂದನೆಗೆ ಒಳಗಾಗಭೇಕಾದ ಸಂದರ್ಭ ಉಂಟಾಗಿದೆ ಇದರಿಂದ ಬಹಳ ದುಃಖವಾಗುತ್ತದೆ ಎಂಬದು ಒಬ್ಬ ಹಿರಿಯ ಆರೋಗ್ಯ ಮಹಿಳಾ ಸಹಾಯಾಕಿಯ ದುಃಖದ ಮಾತುಗಳು.
ಈ ಎಲ್ಲಾ ಸಮಸ್ಯಗಳಿಗೆ ಪರಿಹಾರವಿಲ್ಲವೇ? ಯಾವ ರೀತಿಯಾಗಿ ಈ ಸಮಸ್ಯೆಗಳಿಗೆ ಪರಿಹರಿಸಿ ಪ್ರತಿ ಕಿ.ಮ.ಆ,ಸ ವೃತ್ತಿಯಲ್ಲಿ ಗುಣಾತ್ಮಕತೆ ಕಾಯ್ದುಕೊಳ್ಳಲು ಹಾಗು ಪ್ರೇರಣೆಯುತವಾಗಿ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಹೇಗೆ ಸಹಕಾರ ನೀಡಬಹುದು: ಎಲ್ಲಾ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ನಿಯಮದ ಪ್ರಕಾರ ಸಮಾನ ಜನಸಂಖ್ಯೆಯ ಹಂಚಿಕೆ ಅಥವಾ ಪುನಃಸ್ಸಂಘಟನೆ, ಪ್ರೇರಣೆ ಆಧಾರಿತವಾದ ಮೇಲ್ವಿಚಾರಣೆ, ವಿವಿದ ಕಾರ್ಯಕ್ರಮಗಳಿಗೆ ತಕ್ಕ೦ತೆ ನಿಯತ ಹಾಗು ಚೈತನ್ಯದಾಯಕ ಗುಣಮಟ್ಟದ ತರಬೇತಿ, ಪ್ರಸ್ತುತ ಸಲ್ಲಿಸುತ್ತಿರುವ ವರದಿ ಪದ್ದತಿಯಲ್ಲಿ ಬದಲಾವಣೆ, ಉತ್ತಮ ಕಾರ್ಯನಿರತ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯನ್ನು ಗುರ್ತಿಸಿ ವಾರ್ಷಿಕವಾಗಿ ತಾಲೂಕು ಮತ್ತು ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇ೦ದ್ರಮಟ್ಟದಲ್ಲಿ ಸನ್ಮಾನಿಸುವುದರ ಮುಖಾ೦ತರ, ಪ್ರಸ್ತುತವಾಗಿ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯರು ಎದುರಿಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳು ಪರಿಹರಿಸಿ, ಅರೋಗ್ಯ ಕಾರ್ಯಕ್ರಮಗಳು ಯಶಸ್ವಿಗೆ ವಿಷೇಶವಾಗಿ ಗುಣಾತ್ಮಕ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನಕ್ಕೆ ನಾ೦ದಿಹಾಡಬಹುದು.

Amrutha, a faculty at IPH facilitated a session on ‘National AIDS Control Program’ on 26^th of March 2012 for the Block Program Mangers

The session started with an activity in which participants were given questions related to HIV & AIDS to ponder over. The discussion that followed bought the understanding that participants had about HIV/AIDS, associated misconceptions and attitude towards the issue. Further to this discussion the facilitator elaborated on HIV and AIDS, its causes, symptoms, diagnosis, stages, transmission of infection, difference between HIV, AIDS and sexually transmitted diseases, methods of prevention and available treatment and care. The session then focused on the National AIDS Control Program, elaborating on its evolution, objectives, strategies and activities under it. The session ended with a discussion on the role of BPM under the program

 Revanna Siddeswara, the District Program Manager of Tumkur facilitated a session on ‘Check list for BPM Field Visit’ on 20^th of March 2012 for the Block Program Mangers

The session started with a brief on NRHM and organizational structure in health system. Then the role of BPM according to their terms of reference was discussed in detail. This was followed by a role play where one group representing the BPM had to interact with the PHC staff, represented by another group and collect relevant data, check registers and further guide the PHC staff on particular issues. The role play brought to light many issues related to the completeness of information collected under various national programs and issues related to interpersonal communication of the BPM in successfully getting such information. These issues were then discussed by the group. The session concluded with the facilitator presenting the check list that could be used as a guiding document for BPM on any field visit.

Second National Conference on bringing Evidence into Public Health Policy (EPHP 2012)

Location: Bangalore, India.

Conference dates: 5^th and 6^th of October 2012.

Abstract submission dates: Abstract submission opens on April 21, 2012 and closes on June 15, 2012.

Organisers: Institute of Public Health, Bangalore, India; Institute of Tropical Medicine, Antwerp, Belgium.

The main objectives of the conference are

• Disseminate the concepts of Universal Health Coverage (UHC) and Health Systems (HS) in the Indian context.
• Disseminate and review the evidence of research and implementation experiences of health systems strengthening at the National and State Level.

Provide a platform to bring together policy makers, practitioners and researchers to reflect on issues related to Health Systems and Universal Health Coverage

For any queries, contact ephp@iphindia.org

To submit your abstract – click here 

The Urban health project ofInstitute of public health has begun working in KG Halli since 2009. When we came to the area, our first action was mapping all the health facilities in ward no 30. As we did the mapping we found two government facilities in the area. One was the urban health center which comes under BBMP and mainly focuses on the RCH Preventive programs and the RNTCP.  Another one was the Primary health center, which is under the Karnataka state and family welfare wing. Interestingly these two physical structures share a common wall but one had to jump it informally to get to the other side. Psychologically this wall could not be crossed, as the health centre staffs are answerable to different bodies- state and corporation.

As the days moved on we noticed that near the PHC, new big posh buildings were being built. Somewhere in 2009, we heard news that this PHC had been upgraded into a CHC- Community health center. Months later, one of the new buildings started being used. As patients had been lining up in long queues in the hot sun, particularly during the Chikangunya epidemic, and the existing PHC size  was insufficient, an interim agreement had been reached. Without the official inauguration, one building would be used for examining outpatients.
Meanwhile the posting of doctors remained frequent and unpredictable. For a while there was a string of specialists and rumor was that it would be a functioning trauma centre. Happily this idea was thought through and discarded and for much of the two years -2010 and 2011, a senior administrator with four interns managed the outpatient care, in the newly inaugurated, well lit OP building.
However, an operation theater had been constructed and we waited with bated breath to see how it would be put to use. For some time we had been campaigning for a sorely needed maternity center for the area. It appears that our prayers were heard, because, finally they posted a senior lady doctor in charge. However a team was still necessary and they had only one staff nurse on board.

Once the gynecologist Dr. Mangalagowri had taken then charge, things moved faster. She also realized the need, but the final hold up was in hiring the ‘D’ group staff.
We also put in a word with local Councilor to push for hiring the necessary staff, but unfortunately our councilor also remained unsuccessful.

The fully provided-for labor room should lose this new and unused look soon!”

At last, on 15th march 2012 we had news that the labor ward action is in action. The Community health center has now become a 24×7 health service. Now the community can access the maternity facility without any time limit. Dr. Mangalagowri said within a month two deliveries have been conducted and requested the urban health team to spread this news across ward.

On 20th march 2012, the  youth center in KG halli, Bangalore which IPH has been instrumental in starting began on a happy note. The program was inaugurated   by councillor Ms.Shaina Taj (ward No.30), special invitees – Dr. Aftab Ahmed, Dr Trupti Kulkarni, Mr.Rayappa, Health Inspector, BBMP.

The participants were Sangha members, School teachers, BBMP officials, Link workers from the Urban health centre  and some local youth.

This youth centre was started as part of the urban health project initiative where we would like to provide basic computer training for free of charge, for the school dropout youths in the area with aim to empower them to seek jobs.

Another activity which we plan to do in the youth centre is Library, which is open for public use. In the long run we hope to empower some of the young people in the area and encourage them to widen their horizons.

Within a few days we find that the place is bustling with the sounds of shy young people who wish to read, and for the first time in their lives have a place down the road they can go to in order to enjoy a book.

The World Conference on Tobacco Or Health (WCTOH) is one of the important, and well-attended conferences on tobacco control that happens every three years. The last one was held in Mumbai in 2009. This time, the 15th WCTOH was in Singapore from 20-24 March 2012. I reached Singapore on night of 20^th and so missed the opening ceremony, where Dr. Margaret Chan –Director General of WHO- delivered the keynote lecture.

During this conference it became apparent that the tobacco industry, which has been known to derail and oppose governments’ regulatory moves in a rather covert ways (using front groups), is now becoming aggressive showing its grim face.

On 21st, the conference started with the focus on “tobacco industry interference”. Probably first time in the history of WCTOH, the plenary started with health ministers (and secretaries) of four countries (Turkey, Uruguay, Australia and Norway), who shared their experiences and commitment to fight BIG tobacco. Dr. Margaret Chan chaired the session. These four countries are facing intimidation from tobacco industry in form of litigation by BIG tobacco against government’s regulatory moves. In Australia industry also funded a strong media campaign terming Australian government as “nanny state” to intimidate government of their proposed move of ‘plain packaging’. Yes, Australia remained in limelight receiving appreciation and support from all the corners for government’s bold move of tabling the bill for plain packaging. If all goes well (and they are already facing litigation from industry, and dispute from a few countries under WTO dispute settlement mechanism), by December all the cigarette packages will be without any imagery in a plain brown color with the pictorial health warning occupying 90% of surface area. This is the first time in the world that any government has proposed this. Dr. Chan was very explicit and vocal in expressing her support to Australia and other countries in opposing the tobacco industry.

Other key highlights of the conference included a shift in the thinking from ‘tobacco control’ to ‘ending the game’ – creating tobacco free world. Few sessions only focused about ‘end game scenarios’. This topic, though marked a shift in the thinking, created a debate with a few countries already having plans to wipe out tobacco, while others calling for caution and pragmatic thinking.

There was unequivocal expression to put tobacco control in broader development agenda, in line with what was agreed at the recent high-level summit of UN on NCDs.  There was a call to expand the focus of research and advocacy to situate tobacco control in areas such as gender equity, poverty, trade and intellectual property rights, socio-cultural norms, NCDs and globalization.

There was much debate about lack of policy coherence between health and trade agreements (or between WHO, WTO and other international organizations). On one hand, this was seen as expression of lack of policy coherence at national level, suggesting the need to develop harmony between health and finance/trade ministries and having representation of health ministry at trade policy negotiations. On the other hand people felt that such coherence may not be desirable all the time and it may in fact work at odds with achievement of public health objectives citing that FCTC might not have been as strong as it is today if there was inclusion of trade/finance stakeholders in the process.

Litigation, as tobacco control strategy, received lots of attention for both; it’s potential to fight industry and bring sweeping advances in tobacco control policies, but also for its abuse by industry to intimidate governments causing unnecessary delay and fatigue. Also the need for the WHO to provide legal support to member countries and create a platform where governments can share their experiences of litigation was expressed.

As part of the conference, very prestigious ‘Luther Terry Awards’ (named after the former US Surgeon General for his landmark report on tobacco control), were given away by the American Cancer Society to individuals and organizations in categories of research, advocacy, community service, and distinguished career. Awardees included Dr. Mira Aghi, one of the few women tobacco control advocates for her contribution to community service. Also Mike Bloomberg, the mayor of the New York, gave Bloomberg Awards to NGOs for their excellent work in each of the six tobacco control strategies (MPOWER strategies by WHO).

The declaration on behalf of delegates participating in the 15^th WCTOH was prepared through email consultation (two months in advance of the conference) and through a session in the conference. This declaration, apart from acknowledging the burden of tobacco use and the nature of the tobacco industry, set certain goals to be achieved by 2015. The declaration was read out in the closing ceremony on 24^th March. The next WCTOH would be held in Abu Dhabi in 2015.

Look out the WCTOH website to download video/slides of presentations (will take some time).

Mahesh Kadammanavar, faculty at IPH facilitated the session on ‘National Program on Control of Blindness’ (NPCB) on 12^th of March 2012 for the Block Program Mangers

The first half of the session covered information about visual impairment, types, disease burden specific to India, major cause, of visual impairment in children and adults, and factors affecting the prevalence of visual impairment in India. The NPCB, its history, goals, objectives, strategies, activities under the program, calculation of prevalence rate were then discussed. The facilitator disseminated information on current activities happening under the program in Tumkur district, local NGOs involved and current statistics pertaining to blindness. This was followed by an activity in which the participants were given 2 case studies to work upon. The discussion that followed the activity brought our many practical suggestions on the role of BPM in checking blindness register during field visits, identifying under-reporting, guiding ANMs in this regard, role of immunization in preventing blindness in children and the importance of networking with local NGOs

The facilitator gave an elaborate description of the clinical features, epidemiology, causes and treatment of Leprosy. Then the focus shifted to the objectives, strategies, activities, implementers and administrators under the program. Dr. Pallaya Mohiddim, District Leprosy Officer, Tumkur, joined the session along with the senior non-medical supervisor, Mr. Chikkaboriah and briefed the participants on the current status of the NLEP in Tumkur. The District Leprosy Officer elaborated on how BPM could actively participate and support the program. The senior non-medical supervisor gave a brief account on detecting leprosy cases, encouraging patients to seek treatment and ensuring medicine compliance. The presence of the District Leprosy Officer and the senior Non-medical Supervisor bough weightage to the program making it practical and allowing interaction with actual implementer of the program in Tumkur district.

” We are as lost as our fellow surgeons in hitting the right plane,

in public health….Or are we knife shy?”

The opportunity to investigate this question of the preventive/curative divide in the health services of our country has presented itself, and I thought why not use the technological tool of the moment and ‘google’ it?  And this is what came up on typing ‘preventive/curative divide’

The Cambridge social history of Britain 1750-1950, Volume 3 (click here)

Amazing how the root of the issue came to light at the click of the button! For those who don’t want to go to the link, the fact that our public health services are conceptually distinct from our medical services go back to our colonial past when the industrial revolution, and subsequent urbanisation resulted in epidemics. A pragmatic approach to preventing disease by sanitary measures in populations (Remember John Snow?) evolved , as opposed to the treatment of the individual patient. Over time, the latter became the dominant power in the practice of medicine, and the split between the preventive and curative approaches widened steadily in the early part of the twentieth century. These approaches, along with much else were probably exported to our nation at the time of independence. They took root, despite opposition and reflection and even infiltrated medical education. And until today we are unravelling the skeins in the way our health services are planned, run and held accountable.

Strangely the next thing the google list threw up was an article from a colleague Beyond Tb- Public Health

And for those who prefer the shortcut, Dr. Devadasan talks about the artificial divide between prevention and cure, when he looked at a visit to a doctor from the point of view of the adivasi patient. Simply stated, there is no preventive or curative role, rather a simple desire to be healed.

So what does the adivasi patient see that the doctor does not? A mind uncluttered with ideas that divide will deal with treatment of  the present illness as well as information on immunisation for the baby. Every interaction between the health service and community is optimised. But if the health service is fractured by its very structure, this is difficult, if not impossible.

So what have we on the ground ?

• A doctor who manages the RCH programme, but has neither the infrastructure nor support (including drugs and lab services) to handle an epilepsy or a juvenile diabetic.
• A busy hospital OPD for paediatrics, with personnel who have no time to ask the mother if she would like to delay the next pregnancy.
• A group of ANMs fumbling with denominators for immunisation data, because the HMIS is not streamlined.
• Overburdened tertiary services, because people just don’t know where to go?

I wonder when a concept can be recognised for what it is……. an idea that may be changed even after 60 years of doing things in a particular way. Or is it like the Emperor’s new clothes where we are too afraid to face the truth and all the work that might entail?

For those who are interested in how a concept can grow a life of its own,click here 

-Prevention vs Cure- which takes precedence?

And finally, a ray of hope?

Consultation on History of Health Care in India: The Past in the Present Morarji Desai National Institute of Yoga, Dept of AYUSH in collaboration with WHO Country Office for India – click here