Cardiovascular disease risk factors – Assignment Help

Introduction

Cardiovascular disease. The community health programs can be defined generally as health education and health treatment plans for local communities typically focusing on individuals living under socioeconomically compromised conditions. Mostly these people do not have access to the health insurance and coverage services. Besides being non-profit in nature, these community health programs seek their funding via specialized departments which can both be government and non-government organizations as well as different donation sources (1).

Community health workers

The marginalized communities of a country often lack not only in proper health care services but also there is not total access to the ones already available due to hindrance posed by various factors. Therefore, most of the initiatives of the health care for such freeze out communities hold the incorporation of community health worker (CHW) programs as their integral parts. Also, many of the developing countries have CHW programs implemented in large scales across all their areas. The credit for such wide applicability of the CHW programs lies in their success in the presence of applicable selection, pertinent trainings and subsequently the relevant continuing support. However, apart from the considerable successes in such plan, an observable failure has also been evident in the past mainly due to the reasons of poor planning and unworkable applications ­(2).

Role of community health workers

The unique role of community health workers lies in their duty of addressing not only the health inequalities of a community but also identifying the contribution of socioeconomic drivers towards the development of a disease. The term ‘community health workers’ hold in it very broad category of jobs according to their relevant roles and titles. Some of the typical examples of their roles are community health promoter, community health advocate and community asthma educator. Of these, the last one is a specific title reflecting the services of a health worker in a particular area of health training or knowledge (3).

The success of a community health program lies in well designed and implemented platforms to carry out the respective community health interventions. The best conducted of these functional tasks are those in which there exists a cooperative partnership among the community members, the politicians and various public health professionals. Another aim of these effective partnerships include the collection and sharing of the local health data so as not only to answer the questions being raised by a community but also solve the associated arising problems in an efficient way. Moreover, the actions designed to be taken for a community are also guided by the community members themselves resulting in a type of implementation and feedback cycle helping to make the community health platforms better (4).

Brief history

The deployment of community health workers dates back to 1970a where they were first introduced to accomplish healthcare of mother and child health via management of infectious diseases with limited workforce and access to the baseline health services. Also, they were principally introduced in the low income countries first. However, many developing countries then followed the deployment of the community health workers especially to their remote and rural areas such as villages located at the peripheries of the cities. Moreover, the need of community health workers for such marginalized and disadvantaged communities lies not only in improving the health education of the populations but also for overall community development (5).

Community health worker program in India

The National Rural Health Mission (NRHM) first introduced the India’s community health program in 2005 by the name of Accredited Social Health Activist (ASHA). It primarily is composed of the female health squads with the primary goal of the promotion of professional birth attendance mainly by the collaboration of an Anganwadi worker and an auxiliary nurse midwife (ANM). The major goal of this activist is to cover 1000 individuals by actively reaching out to the population. Also, the activist is meant to obtain compensations based on the service and performance to facilitate immunization, escort and referral services to achieve institutional deliverables (6).

 

 

Tuberculosis and its prevalence

Mycobacterium tuberculosis, neither a gram positive nor a gram negative bacterium, is the causative agent of a lung disease known as tuberculosis (TB). About 1/3 of the world’s population is getting infected with this disease with the infection risk determined by various factors such as bacterial infectiousness, immune system of the host, and contact nearness. The most important and common source of infection is via aid droplets released by patients of pulmonary tuberculosis. When another, health individual, inhales these droplets contacting the infectious agents in them, an infection can occur if the immune system does not fight off these pathogens entering into the body (7).

Talking about the prevalence of TB around the world, it has been found to be affecting nearly 10 million people worldwide as per 2018 report. However, this number is 2% less than that of the year 2017 and overall decrease in the number of reported TB patient has been found to be 1.6% per annum since 2000. An initiative from the World Health Organization (WHO) by the name of ‘The End Tuberculosis Strategy’ now aims to achieve both a reduction in the incidence of TB as well as in the absolute number of deaths cause by it by a target of about 20% and 35%, respectively. Also, the main themes to target in this plan are: initiation of TB preventive treatments; drug resistance of the pathogen; and the con-incidence of HIV and thus the simultaneous management of both the diseases (8).

India holds the highest load of not only TB incidence in its population but also of multidrug resistance (MDR). Although a decline is generally suggested by the TB epidemic available data, however the proportion of new reported cases are still on the rise. Hence, the percentages of global prevalence, new case incidences and deaths due to TB are 24%, 21%, and 23% respectively, accounted by India alone. Considering this magnitude of the disease load, a plan to eradicate TB by the end of 2025 has been proposed in the Union Budget meeting 2017-2018 by the Government of India. Moreover, since the residence of 72.2% of Indian population is in rural areas where practice of health workers is limited to 40.8 only, achieving the goals of TB control becomes quite challenging in these areas. Furthermore, the situation gets exacerbated due to socioeconomic conditions of such populations too (9, 10).

Mitanin program running in Chhattisgarh for TB control and management

In a country with 29 states and 7 union territories – India – the one state coming under one of the most underprivileged states is known by the name of Chhattisgarh. It is also known by the substandard detection rates of tuberculosis (TB). Also, the detection rate of the Chhattisgarh state was around 55% of the total anticipated smear-positive cases as per 2014 report according to the Revised National Tuberculosis Control Program (RNTCP). However, this detection rate was low as compared to the expectation by RNTCP. Although the number of Designated Microscopy Centers (DMCs) in the state was adequate, this tailback was explained by the failure to bring along all the suspect cases to the respective health facility for sputum examination. Moreover, there were also poorer detection rates for re-treatment and smear-negative cases by 30% and 40%, respectively. Again, this was lower than the estimated cases. This led to an indication of a gap existing between clinical protocols and their due implementation. Therefore, it led to the proposition of the hypothesis that the community health workers of Chhattisgarh, locally and commonly known as Mitanins, could hold the potential to improve TB detection rates (11).

The broad objectives of the Mitanin program include: public health education and awareness about different health issues present in a community; an efficient utilization of already available and existent health care services for public; initiation of collective actions for health and health related developmental sectors at community level; on the spot relief provision for public health issues; organizing female taskforces for the formation of a process for health actions with the integration of women empowerment in it; and sensitization of local panchayats for their better understanding as well as enhancing capacities in the implementation of the community health plans and programs (12).

Apart from the main objectives of the Mitanin’s programs, its foundation also lies on the seven pillars or principles which are crucially important for the success of this program. These are: female gender of the community health workers; an adequately planned selection and mobilization process, even at habitation level, to ensure the community wise selection; incorporation of continuous training and support activities to be carried out throughout the programs rather than being a one-time event of the program; lack of financial payments, especially during the first year, and limitation of incentives afterwards with the maintenance of the program as  being community based in nature; the role for curative care must be supplementary in spite of central care; an appropriate connection with analogous initiatives for public health strengthening; and fitting partnerships with state civil societies for program management at all levels (12).

Talking about the infrastructure of Chhattisgarh in relevance to the TB control program, the total number of tuberculosis units and designated microscopy centers are 62 and 287, respectively, supposed to cover a total population of 27 million people distributed in 16 districts as well as tribal populations. Quite interestingly, tribal population of Chhattisgarh constitute about 34% of the total population. To cope with the TB management of Chhattisgarh, the community health workers alias Mitanins were first trained for detection of the signs of TB for the screening of whole population. The main job after training and education of the Mitanins was to carry out door-to-door screening of population to find suspected TB cases. After the identification, the cases are directed and referred to the closest designated microscopy center for the proper examination of the sputum. Moreover, tracing of child contacts from the confirmed TB cases was also included as a job part of the Mitanins. These children are then also undergo confirmations for TB infections via district hospitals (11).

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Program in India

The ‘Health for All’ initiative has been defined formally in 1978 by the Declaration of Alma-Ata. According to this, one of the main challenges of this platform included a workable expansion of the successful small programs of community health workers so as to achieve the same impact at a larger scale especially at national levels. This thought was put forward by the program developers under the assumption that the success which has been achieved at the smaller levels could also be replicated at a larger level. However, there are certain limitation of the implementation of a project at a broader level due to which these ideas could be unsuccessful at a wider scale. Therefore, the discussion in the rest of this report is focused mainly on one such program – the Village Health Guide (VHG) program – with reasons and pitfall of its failure as well as the suggestions for its improvements (15-18).

Much success was observed in early programs of community health workers (CHW) in India. In wake of this success, Indian government launched another program during 1977 by the name of Village Health Guides. This constituted a national level community health workers scheme for the provision of basic health care, preventive strategies and promotion of curative care especially designed for the rural population of the country. Despite the promising origins of its smaller projects, the overall project got abandoned due to failure in delivery of if its defined impacts on the society. The existence and integration of such programs into national health programs has been intensely endorsed by both the World Health Assembly as well as World Health Organization on the basis of extensively available experiences and evidences. However, there is not much published literature about this village health program despite its pioneering nature as being a health program of national level (18).

The inspiration for the VHG had been drawn from the proletarian projects with the aim to deliver the same impact, however on a larger scale. Although this VHG program has been launched for 40 years from now, due to the collapse of this scheme it has become imperative to have a detailed examination of the factors which led to its failure. Another reason for the critical assessment of these reasons is the fact the local community health programs are being continuously emerging and evolving around the world. Talking about the historical background of the VHG system, its emergence was based on the large scale ignorance of the inhabitants of the rural areas. The reasons for these health illiteracies included the meagre attention given to the services of rural health by the British colonial rule and also this rule was mainly to provide health services to the bureaucratic and military personnel. As a result, the percentage of the Indian population having proper medical care access was only 10% (18, 19).

The suggested improvisations in the VHG program which could lead to the success of the program include the following:

• The slow expansion of the said program according to the focused and well-planned groundwork of the scheme so as to make enough room available for the iterative learning through experiences as well as adaptive measures’ integration within the system;
• Early and frequent identification of the problems with the proper addressing of their solutions and their implementations;
• Improving the communications at both local, state and government levels so as to reduce confusions among the PHCs, VHGs, respective communities and the political personals involved in the scheme;
• Deployment of the community supervisors over their own VHGs instead of community leaders from select groups thus reducing the limitations arising from these distorted selections of the program leaders;
• A proper and effective training of the respective PHCs so as to transfer the appropriate skills to the community health workers and carry out a successful supervision of them;
• Proper maintenance of the supervision of the VHGs by the community health workers instead of delegation to the PHCs;
• Maintaining the appropriate and provision of required medicines and other health services to keep the programs running positively; and
• Changing the perception of the VHG workers as community educators and advocates rather than as government workers and let them stand alone as parts of separate organizations.

Although CHW programs serve as prevailing tools for the representation and problem addressing of the socioeconomically compromised and underserved populations, however one should not be fooled into thinking that they can prove to be magic bullets. In view of the analysis of the VHG program in India, it becomes apparent that a government willingness to carry out a long-term commitment to such programs is inevitable to the success of such plans. Also, a lasting impact can only be made by the true investments by the political leaders combined with the veracious guiding principles of the plan.

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References

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