Welcome to the Dynamic Database of Indiaʼs Primary Health Care Landscape

Summary

The paper documents efforts initiated in building capacity of law enforcers and NGOs for effective implementation of tobacco control laws in the state of Bihar, and provides a multi-strategy model for tobacco control interventions for replication. The framework recognizes six steps to strengthen tobacco control efforts at subnational level, viz. needs assessment, capacity building of multisectoral stakeholders, formation of inter-departmental administrative committees, advocacy (upstream and downstream), monitoring and reporting mechanism for assessing enforcement of the Indian tobacco control law, and media engagement.

Outcomes/Observations

Provider/managerial outcomes: Capacity building and training of law enforcers and NGO personnel from the state on various provisions of COTPA and WHO-FCTC. Within 2 years after the first meeting of the State Tobacco Control Coordination Committee (STCCC), 7 capacity building workshops were held. A total of 196 law enforcers were sensitized on tobacco control laws and policies.

Summary

The paper assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP). This is a randomised controlled trial of male harmful drinkers defined by an Alcohol Use Disorders Identification Test (AUDIT) score of 12–19. Participants were randomly allocated by trained health assistants based at the primary health centres to enhanced usual care (EUC) alone or EUC combined with CAP. Primary outcomes were remission and mean daily alcohol consumed in the past 14 days, at 3 months.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): AUDIT score of less than 8 and mean daily alcohol consumption in the past 14 days immediately preceding the 3 month outcome assessment.

Summary

The aim of this study was to evaluate the effects of telemedicine on patients and medical specialists. This pilot study was conducted in two phases in a nodal Telemedicine Specialty Centre (TSC) in Apollo Hospital, Hyderabad. The first phase had a separate questionnaire for medical specialists from different branches of medicine. The second phase had questions for patients from the North-Eastern states of India. A cross‑sectional study was conducted among 122 participants on satisfaction in quality of service, cost‑effectiveness and problems encountered in healthcare provided by telemedicine.

Outcomes/Observations

Provider/managerial outcomes: All doctors were satisfied with the treatment given through TSC. Most doctors responded that they got desirable results on the diagnosis of the patient and an increase in patient’s inflow. Health and wellbeing outcomes (Individual level): 80% of patients were satisfied with treatment quality. Almost all participants found telemedicine cost‑effective and time convenient

Summary

The study conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The study was conducted over a period of 21 months. The primary outcomes included the number of women approaching PHCs for childbirth and 12 essential practices around the time of childbirth.

Outcomes/Observations

Provider/managerial outcomes: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs. Organisational outcomes: 22% increase in the number of women approaching PHCs for childbirth during the intervention period. Health and wellbeing outcomes (Individual level): No difference in rates of maternal or neonatal mortality or stillbirths between two periods.

Summary

The study aimed to evaluate the sustained effectiveness and the cost- effectiveness of the Healthy Activity Programme (HAP) over 12 months and to assess behavioural activation. The HAP is a contextually adapted brief psychological treatment based on behavioural activation that focuses on increasing patient activation levels in pleasurable or mastery activities, and comprises the following strategies: psychoeducation, behavioural assessment, activity monitoring, activity structuring and scheduling, activation of social networks, and problem solving

Outcomes/Observations

Health and wellbeing outcomes (Individual level): HAP participants maintained the gains they showed at the end of treatment through the 12-month period, with lower symptom severity scores than participants who received EUC (Enhanced usual care) alone and higher rates of remission; these effects were partly mediated by increased levels of behavioural activation reported at 3 months.

Summary

The paper aims to understand how community-level exposure to ASHA may affect an individual's health-seeking behaviours. The study evaluates the association between exposure to the ASHA programme and four key components along the continuum of care—at least one ANC visit, four or more ANC visits, presence of a skilled attendant at the time of birth and PNC for the mother or child within 48 hours of birth, and explore how exposure to ASHA may influence the number of services utilised along the continuum.

Outcomes/Observations

Provider/managerial outcomes: ASHA services had significantly higher reported use of ANC-1 and SBA. ANC-4 and PNC were the two services that were most frequently missed. No significant differences in the use of services across the different levels of exposure intensity. Unintended outcomes: Exposure to ASHA is strongly associated with the service initiation and continuation along the maternity continuum, but not completion of service utilisation along the continuum.

Summary

The objective is to determine the coverage, utilisation and feasibility of the mental health service scheme being implemented in PHCs. Paper also aims to develop a set of indicators for routine monitoring of mental health services for Sehore district of Madhya Pradesh, India. By using a sequential exploratory mixed methods design, key mental health indicators measuring service delivery and system performance were developed for the context of Madhya Pradesh, India. The research design involved a situation analysis, and conducting a prioritisation exercise and consultation workshops with key stakeholders.

Outcomes/Observations

Organisational outcomes: Local experts take part in the prioritisation and planning in the development of indicators for routine monitoring of mental health services in primary health care. The study generated, prioritised and selected nine mental health indicators that can be used to examine whether people with mental illnesses are effectively covered by the public mental health services.

Summary

The paper assesses the acceptability, feasibility, perceived costs and sustainability of implementing indicators relating to integrated mental health service coverage in six South Asian and Sub-Saharan African countries. A qualitative study using semi-structured key informant interviews was conducted. The ‘Performance of Routine Information Systems’ framework served as the basis for a coding framework covering three main categories related to the performance of new tools introduced to collect data on mental health indicators: (1) technical; (2) organisation; and (3) behavioural determinants.

Outcomes/Observations

Provider/managerial outcomes: Implementation strategies such as training courses and supervision were reported to be essential. Organisational outcomes: Simplicity of the forms, motivation, competence of health workers, and perceived use of mental health indicators, were reported as facilitators for better implementation outcomes. Various new indicators developed were reported to have contributed to mental health service improvement.

Summary

As a part of the Emerging Mental Health Systems for Low-and Middle-Income Countries (Emerald) project, context-specific mental health indicators were developed to measure mental health care needs, utilisation, quality and financial protection for primary care health facilities in Sehore district. Through the Programme for Improving Mental Health Care (PRIME), a mental health service delivery platform was created at these facilities, within which these indicators were developed and sequentially tested. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators were assessed.

Outcomes/Observations

Provider/managerial outcomes: Simplicity of the forms, as well as technical support from the project team, contributed to acceptability and feasibility of implementation. Organisational outcomes: Most practitioners reported that nurses are competent enough to lead data collection tasks within mental health programmes. Staff shortages and other priorities made it difficult for nurses to complete registers and conduct counselling sessions. Unintended outcomes: Staff perception of the burden due to new forms increased over time.