Standardized patients methodology used to assess clinical skills
Relationships with Interviews with a sample of formal providers and key
formal system informants. FGDs with community members.
Barriers/facilitators FGDs with community members and key informants.
for integration Interviews with formal providers and policy makers.
Key findings
1. Provider enumeration and characteristics
2. Education and training
3. Practice characteristics
4. Knowledge and skills
5. Relationships with formal system
6. Barriers and facilitators for integration
1. Provider enumeration and characteristics
Tehri (263 IPs) Guntur (368 IPs)
Sure Health - Increasing access to health in NigeriaDaniel Emeka
So I came up with this idea of how to use the existing technology of mobile phones to increase access to health.
glad a lot of others a thinking in that light today
Integrating microfinance and health programs can provide benefits to both clients and microfinance institutions. Health education combined with microfinance access has led to positive health outcomes in areas like reproductive health, child health, and disease prevention. Evidence shows interventions that combine health education, trained health workers, and linkages to care can improve health knowledge, behaviors, and access to services. Moving forward, addressing barriers like program costs and identifying best practice health programs can help scale up integrated microfinance and health initiatives.
This document discusses integrating microfinance and health programs to improve access to healthcare for poor clients. It notes that illness is a major barrier to escaping poverty, and that microfinance institutions reach hundreds of millions globally. Integrating basic health education, services, and products can help address clients' health needs while leveraging the vast network of microfinance institutions. The evidence shows that combining health education with microfinance can positively impact reproductive health, child health, nutrition, disease prevention and more. Programs providing health education, loans for healthcare, or linking clients to providers have demonstrated improved access, behaviors, and health outcomes. Moving forward, barriers to integration like costs must be addressed to realize the potential of joining microfinance and health.
The document describes a telemedicine project that aimed to provide access to quality healthcare for underprivileged persons affected by the 2004 Indian Ocean tsunami. The project established one central hub and two spoke centers to deliver mental healthcare via videoconferencing. It sought to address immediate health problems, facilitate disease surveillance, and provide counseling for post-traumatic stress disorder. Initial funding came from Microsoft and CIDA. The project demonstrated improvements in access to specialists, continuity of care, and cost and time savings for patients.
This document proposes an information strategy for general practice in New Zealand to improve patient care. It suggests taking a population health, clinical governance, and patient-centered approach. The strategy would use existing infrastructure like enrolment and IT systems to routinely collect health data on populations to better understand current practice, identify best practices, and manage gaps through decision support, quality processes, and outcomes focus. This would help practices provide proactive, structured care for long-term conditions while reactively addressing acute issues. The next steps outlined are drafting the strategy for sector feedback by May 2007 and a full report by August 2007.
This document proposes a project called SCHDU to reduce HIV transmission among injecting drug users in Ho Chi Minh City, Vietnam. It involves establishing an integrated network of services including a mobile clinic, detoxification center, and website to provide harm reduction, treatment, and community support. The goals are to distribute healthcare, reduce HIV transmission through coordination of services, demonstrate improved treatment adherence and outcomes, and support clients' rehabilitation and reintegration into the community. Key services proposed include outreach, counseling, detoxification, medication-assisted treatment, and linking clients to long-term support.
This document discusses integrating substance use disorder (SUD) treatment into patient-centered medical homes (PCMHs).
The key ideas are:
1) PCMHs are based on the chronic care model and focus on team-based care and care management.
2) SUDs are important for healthcare to address because they are prevalent, increase costs, and can cause or worsen other health conditions.
3) Integrating SUD treatment into PCMHs through approaches like behavioral health consultants in primary care, medication-assisted therapies, and on-site SUD services can improve health outcomes and reduce costs.
The document summarizes the launch of the RCGP Rural Forum at the RCGP conference in 2009. It discusses key issues for rural patients and doctors. A survey found that most rural GPs felt the RCGP had little understanding of rural issues. The forum aims to represent rural GPs, promote rural healthcare, and improve engagement with the RCGP. Membership would provide benefits like influencing policy and networking opportunities. The forum could help with issues like revalidation and primary care federations.
Sure Health - Increasing access to health in NigeriaDaniel Emeka
So I came up with this idea of how to use the existing technology of mobile phones to increase access to health.
glad a lot of others a thinking in that light today
Integrating microfinance and health programs can provide benefits to both clients and microfinance institutions. Health education combined with microfinance access has led to positive health outcomes in areas like reproductive health, child health, and disease prevention. Evidence shows interventions that combine health education, trained health workers, and linkages to care can improve health knowledge, behaviors, and access to services. Moving forward, addressing barriers like program costs and identifying best practice health programs can help scale up integrated microfinance and health initiatives.
This document discusses integrating microfinance and health programs to improve access to healthcare for poor clients. It notes that illness is a major barrier to escaping poverty, and that microfinance institutions reach hundreds of millions globally. Integrating basic health education, services, and products can help address clients' health needs while leveraging the vast network of microfinance institutions. The evidence shows that combining health education with microfinance can positively impact reproductive health, child health, nutrition, disease prevention and more. Programs providing health education, loans for healthcare, or linking clients to providers have demonstrated improved access, behaviors, and health outcomes. Moving forward, barriers to integration like costs must be addressed to realize the potential of joining microfinance and health.
The document describes a telemedicine project that aimed to provide access to quality healthcare for underprivileged persons affected by the 2004 Indian Ocean tsunami. The project established one central hub and two spoke centers to deliver mental healthcare via videoconferencing. It sought to address immediate health problems, facilitate disease surveillance, and provide counseling for post-traumatic stress disorder. Initial funding came from Microsoft and CIDA. The project demonstrated improvements in access to specialists, continuity of care, and cost and time savings for patients.
This document proposes an information strategy for general practice in New Zealand to improve patient care. It suggests taking a population health, clinical governance, and patient-centered approach. The strategy would use existing infrastructure like enrolment and IT systems to routinely collect health data on populations to better understand current practice, identify best practices, and manage gaps through decision support, quality processes, and outcomes focus. This would help practices provide proactive, structured care for long-term conditions while reactively addressing acute issues. The next steps outlined are drafting the strategy for sector feedback by May 2007 and a full report by August 2007.
This document proposes a project called SCHDU to reduce HIV transmission among injecting drug users in Ho Chi Minh City, Vietnam. It involves establishing an integrated network of services including a mobile clinic, detoxification center, and website to provide harm reduction, treatment, and community support. The goals are to distribute healthcare, reduce HIV transmission through coordination of services, demonstrate improved treatment adherence and outcomes, and support clients' rehabilitation and reintegration into the community. Key services proposed include outreach, counseling, detoxification, medication-assisted treatment, and linking clients to long-term support.
This document discusses integrating substance use disorder (SUD) treatment into patient-centered medical homes (PCMHs).
The key ideas are:
1) PCMHs are based on the chronic care model and focus on team-based care and care management.
2) SUDs are important for healthcare to address because they are prevalent, increase costs, and can cause or worsen other health conditions.
3) Integrating SUD treatment into PCMHs through approaches like behavioral health consultants in primary care, medication-assisted therapies, and on-site SUD services can improve health outcomes and reduce costs.
The document summarizes the launch of the RCGP Rural Forum at the RCGP conference in 2009. It discusses key issues for rural patients and doctors. A survey found that most rural GPs felt the RCGP had little understanding of rural issues. The forum aims to represent rural GPs, promote rural healthcare, and improve engagement with the RCGP. Membership would provide benefits like influencing policy and networking opportunities. The forum could help with issues like revalidation and primary care federations.
Understanding Personality Disorders By Tom BurnsAnsel Group Ltd
Article for the Insight Supplement of Mental Health Today Magazine July/August 2010. Tom Burns, CEO of the Ansel Group, provides an insight into this patient group and provides some messages around organising services to best meet their needs.
The 2021 Guide to Fully Integrating Telehealth and Eliminating No-ShowsMichael Dillon
Telehealth is here to stay! Easily integrate it with your practice and reduce administrative overhead and patient no-shows.
A Must Read Guide to Eliminating No Shows in Healthcare Organizations.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Technoogy-Based Intervention: Enhancing Treatment for Substance Use Disordersmikewilhelm
This training introduces participants to technology-assisted care (TAC) interventions for substance use disorders. It aims to improve awareness and adoption of TAC by reviewing evidence for its benefits, including increased treatment reach and effectiveness. The training describes two validated TAC interventions: the Therapeutic Education System (TES), a web-based program combining CRA and contingency management; and CBT4CBT, a computer-based cognitive behavioral therapy. Studies found TES improved abstinence rates and retention, while CBT4CBT led to more negative drug tests and was better accepted by participants compared to standard treatment alone.
This document describes an integrated primary health care partnership model between the Aga Khan University East Africa, the University of California San Francisco, and the government of Kenya. The model aims to test mechanisms for partnership between district health systems and higher education to increase access to high-quality primary health care, focusing on maternal, newborn, and child health. An initial planning grant supported partnership development and needs assessment in Kaloleni District, Kenya. Key learnings included identifying barriers to maternal care access and priorities for community engagement, training, and innovations like mobile technology to strengthen the health system and referral pathways. Next steps involve developing a multi-year partnership proposal and mobilizing resources to provide critical supports applying the integrated primary health care model.
Role of ng os in promoting mental health for the plhiv in malaysia (ismail baba)Hidzuan Hashim
The document discusses the role of NGOs in promoting mental health among people living with HIV/AIDS (PLHIVs) in Malaysia. It notes that PLHIVs experience a diverse range of mental health issues. NGOs play important roles as mediators, counselors, and service providers for PLHIVs. However, NGOs also face limitations like a lack of expertise, training, and manpower. There is a need to supplement existing mental health programs for PLHIVs with counseling skills training and mental health facilitation. Collaboration between Universiti Sains Malaysia and international organizations has led to the establishment of mental health facilitation training in Malaysia to help address these needs.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Summary Report: Performance-Based Incentives: Consultations for Haryana State...HFG Project
The government of the northern Indian state of Haryana has evinced strong interest in adopting a PBI scheme to improve primary health care services in the state. To this end, in December 2014 the HFG project conducted a qualitative investigation in two blocks of Haryana (Nuh block, Mewat district, and Rai block, Sonipat district) to examine the existing incentive and operating environments, assess whether performance incentives would be motivating to facility staff and supervisors, and inform the design of a PBI scheme for demonstration in the two study blocks.
1) The number of people over 50 living with HIV in the UK is rising and will double within 5 years, with older adults often not considering themselves at risk and doctors failing to recognize HIV symptoms in older patients.
2) People living long-term with HIV experience accelerated aging effects, reporting three times as many health issues as those over 70. Specific health risks associated with chronic HIV include cardiovascular disease, cancers, neurological and renal issues, and reduced bone density.
3) A survey of 410 HIV-positive individuals over 50 in the UK found their top concerns were financial difficulties, inability to care for themselves, mental health issues, inability to access proper healthcare, and social stigma. Respondents called for more support
Supporting Cancer Survivors in the Workplace and Managing CostsHuman Capital Media
This document summarizes a webinar on cancer, culture, and careers. It provides 3 options for listening to the webinar - computer speakers, telephone dial-in, or teleconference. It also outlines the agenda which includes speakers from the National Comprehensive Cancer Network and National Business Group on Health discussing survivors in the workplace, the high cost of cancer, taboos and stereotypes, survivor stories, and employer challenges. Polling questions are included to gauge participant understanding.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
This document discusses issues with the NHS continuing healthcare (NHS CHC) system in England. It evaluates several areas of concern, including lack of information provided to applicants, professionals conducting assessments who often have little knowledge of conditions, flaws in the decision-making tool, long delays in the application process, inconsistent decisions, and negative impacts of frequent reassessments. The document calls for improvements like ensuring assessment teams have proper expertise, improving training and tools, reducing delays, limiting unnecessary reassessments, and increasing transparency through improved data collection. It shares one woman's negative experience navigating the system while caring for her husband with advanced Parkinson's disease.
A Study to Assess the Effectiveness and Reliability of the Telemedicine Bring...Rajat Agarwal
Telemedicine business in India is estimated to expand at a good pace. The
aim of the present study is to assess the effectiveness and reliability of the
telemedicine equipment in bringing specialist healthcare to the rural areas,
and complimenting it with a case study conducted in the Pilani. The study
was also presented in AIIMS as a part of the National Conference for MedicalInformatics (NCMI 2012) and was published in their journal.
This document discusses how new media can be leveraged for health communication and behavior change. It outlines several theories of health communication and how they can be applied through new media's interactive capabilities. New media allows for immediate, transactional feedback through features like tailored messaging, stage-based interventions, and targeting individual attitudes. While access remains limited, the Internet has potential to reach broad audiences as a mass medium through technologies that deliver content through televisions and familiar settings. Examples of new media resources that can create and implement health campaigns are also provided.
Guidance for commissioners of financially, environmentally, and socially sust...JCP MH
This guide supports commissioners, local health authorities and providers to think broadly, but practically, about building sustainable, resilient communities that have the potential, over time, to reduce mental ill health.
Sustainable commissioning involves making sure services make the most effective use of financial, environmental and social resources. This includes commissioning services that support secondary (reducing relapse) and tertiary (improving rehabilitation) prevention. It is these aspects, rather than primary preventative measures, that are the focus for this guide. The issue of primary prevention is discussed in the Guidance for commissioning public mental health services.
This guide has been written by a group of experts in mental health and sustainability, in consultation with service users and patients, and strengthened by input from a local government and public health perspective. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
By the end of this guide, readers should:
- understand the concept of sustainability in mental health care, and how using this commissioning framework can create sustainable services
- be aware of the legislation relating to sustainability that the NHS is required to meet
- understand what sustainable commissioning looks like in practice
- understand how and why improving the sustainability of mental health interventions will contribute to achieving the aims of both the mental health, public health, NHS, and social care strategies, as well as improving quality and productivity
- be able to commission sustainable mental health services and interventions.
Find out more and download all the guides published by the Joint Commissioning Panel for Mental Health at http://www.jcpmh.info.
The document discusses the internship of Jessica Liang at Upstate Cardiology. It covers several topics:
1) Access to care was highly valued at Upstate Cardiology, which provided care regardless of ability to pay. Disease prevention was also promoted.
2) The referral system was crucial to services, but more convoluted between different health systems due to varying forms and missing information.
3) Overbooking appointments was problematic and reducing it would benefit physicians and patients through better use of time.
This document provides an evaluation of the experiences of Black and Minority Ethnic (BME) service users in accessing and engaging with the Leeds Psychology & Psychotherapy Service. It conducted a two-phase study: Phase One involved distributing questionnaires to BME service users to understand barriers to accessing the service. Phase Two consisted of interviews to understand experiences of engaging in therapy. The results found various barriers like lack of information, stigma, and cultural sensitivity issues. It provided recommendations like improving information provision and cultural competence training for staff. The study aimed to help the service better meet the needs of BME service users.
This document discusses the costs associated with amputation prevention for diabetes patients in India. It notes that amputation prevention is more costly than amputation itself currently in India. It identifies several components of costs for amputation prevention, including regular monitoring, medications, footwear, hospitalization, dressings, and rehabilitation. It also discusses the limited existing financial supports for amputation prevention in India, including insurance, employer reimbursement, public healthcare, and out-of-pocket spending. It argues that insurance must play a larger role in covering costs to make a significant social impact in preventing amputations in India over the next 20 years.
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
This document discusses using private sector approaches and information communication technologies (ICT) to scale up family planning programs in India. It proposes partnering with private medical providers and manufacturers to distribute contraceptives. It also describes developing a mobile phone-based fertility awareness app called CycleTel and conducting pilot tests of it in India. Preliminary results found interest among users and a willingness to pay for the service. Next steps include further pilot testing, software development, and scaling up programs within India and other countries.
The role of informal providers in health marketsJeff Knezovich
Gina Lagomarsino of Results for Development's Center for Health Market Innovation reflects on findings from a new book, Transforming Health Markets in Asia and Africa and adds information about recent studies in which CHMI has been involved on informal providers in Bangladesh, India and Nigeria.
Understanding Personality Disorders By Tom BurnsAnsel Group Ltd
Article for the Insight Supplement of Mental Health Today Magazine July/August 2010. Tom Burns, CEO of the Ansel Group, provides an insight into this patient group and provides some messages around organising services to best meet their needs.
The 2021 Guide to Fully Integrating Telehealth and Eliminating No-ShowsMichael Dillon
Telehealth is here to stay! Easily integrate it with your practice and reduce administrative overhead and patient no-shows.
A Must Read Guide to Eliminating No Shows in Healthcare Organizations.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Technoogy-Based Intervention: Enhancing Treatment for Substance Use Disordersmikewilhelm
This training introduces participants to technology-assisted care (TAC) interventions for substance use disorders. It aims to improve awareness and adoption of TAC by reviewing evidence for its benefits, including increased treatment reach and effectiveness. The training describes two validated TAC interventions: the Therapeutic Education System (TES), a web-based program combining CRA and contingency management; and CBT4CBT, a computer-based cognitive behavioral therapy. Studies found TES improved abstinence rates and retention, while CBT4CBT led to more negative drug tests and was better accepted by participants compared to standard treatment alone.
This document describes an integrated primary health care partnership model between the Aga Khan University East Africa, the University of California San Francisco, and the government of Kenya. The model aims to test mechanisms for partnership between district health systems and higher education to increase access to high-quality primary health care, focusing on maternal, newborn, and child health. An initial planning grant supported partnership development and needs assessment in Kaloleni District, Kenya. Key learnings included identifying barriers to maternal care access and priorities for community engagement, training, and innovations like mobile technology to strengthen the health system and referral pathways. Next steps involve developing a multi-year partnership proposal and mobilizing resources to provide critical supports applying the integrated primary health care model.
Role of ng os in promoting mental health for the plhiv in malaysia (ismail baba)Hidzuan Hashim
The document discusses the role of NGOs in promoting mental health among people living with HIV/AIDS (PLHIVs) in Malaysia. It notes that PLHIVs experience a diverse range of mental health issues. NGOs play important roles as mediators, counselors, and service providers for PLHIVs. However, NGOs also face limitations like a lack of expertise, training, and manpower. There is a need to supplement existing mental health programs for PLHIVs with counseling skills training and mental health facilitation. Collaboration between Universiti Sains Malaysia and international organizations has led to the establishment of mental health facilitation training in Malaysia to help address these needs.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Summary Report: Performance-Based Incentives: Consultations for Haryana State...HFG Project
The government of the northern Indian state of Haryana has evinced strong interest in adopting a PBI scheme to improve primary health care services in the state. To this end, in December 2014 the HFG project conducted a qualitative investigation in two blocks of Haryana (Nuh block, Mewat district, and Rai block, Sonipat district) to examine the existing incentive and operating environments, assess whether performance incentives would be motivating to facility staff and supervisors, and inform the design of a PBI scheme for demonstration in the two study blocks.
1) The number of people over 50 living with HIV in the UK is rising and will double within 5 years, with older adults often not considering themselves at risk and doctors failing to recognize HIV symptoms in older patients.
2) People living long-term with HIV experience accelerated aging effects, reporting three times as many health issues as those over 70. Specific health risks associated with chronic HIV include cardiovascular disease, cancers, neurological and renal issues, and reduced bone density.
3) A survey of 410 HIV-positive individuals over 50 in the UK found their top concerns were financial difficulties, inability to care for themselves, mental health issues, inability to access proper healthcare, and social stigma. Respondents called for more support
Supporting Cancer Survivors in the Workplace and Managing CostsHuman Capital Media
This document summarizes a webinar on cancer, culture, and careers. It provides 3 options for listening to the webinar - computer speakers, telephone dial-in, or teleconference. It also outlines the agenda which includes speakers from the National Comprehensive Cancer Network and National Business Group on Health discussing survivors in the workplace, the high cost of cancer, taboos and stereotypes, survivor stories, and employer challenges. Polling questions are included to gauge participant understanding.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
This document discusses issues with the NHS continuing healthcare (NHS CHC) system in England. It evaluates several areas of concern, including lack of information provided to applicants, professionals conducting assessments who often have little knowledge of conditions, flaws in the decision-making tool, long delays in the application process, inconsistent decisions, and negative impacts of frequent reassessments. The document calls for improvements like ensuring assessment teams have proper expertise, improving training and tools, reducing delays, limiting unnecessary reassessments, and increasing transparency through improved data collection. It shares one woman's negative experience navigating the system while caring for her husband with advanced Parkinson's disease.
A Study to Assess the Effectiveness and Reliability of the Telemedicine Bring...Rajat Agarwal
Telemedicine business in India is estimated to expand at a good pace. The
aim of the present study is to assess the effectiveness and reliability of the
telemedicine equipment in bringing specialist healthcare to the rural areas,
and complimenting it with a case study conducted in the Pilani. The study
was also presented in AIIMS as a part of the National Conference for MedicalInformatics (NCMI 2012) and was published in their journal.
This document discusses how new media can be leveraged for health communication and behavior change. It outlines several theories of health communication and how they can be applied through new media's interactive capabilities. New media allows for immediate, transactional feedback through features like tailored messaging, stage-based interventions, and targeting individual attitudes. While access remains limited, the Internet has potential to reach broad audiences as a mass medium through technologies that deliver content through televisions and familiar settings. Examples of new media resources that can create and implement health campaigns are also provided.
Guidance for commissioners of financially, environmentally, and socially sust...JCP MH
This guide supports commissioners, local health authorities and providers to think broadly, but practically, about building sustainable, resilient communities that have the potential, over time, to reduce mental ill health.
Sustainable commissioning involves making sure services make the most effective use of financial, environmental and social resources. This includes commissioning services that support secondary (reducing relapse) and tertiary (improving rehabilitation) prevention. It is these aspects, rather than primary preventative measures, that are the focus for this guide. The issue of primary prevention is discussed in the Guidance for commissioning public mental health services.
This guide has been written by a group of experts in mental health and sustainability, in consultation with service users and patients, and strengthened by input from a local government and public health perspective. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
By the end of this guide, readers should:
- understand the concept of sustainability in mental health care, and how using this commissioning framework can create sustainable services
- be aware of the legislation relating to sustainability that the NHS is required to meet
- understand what sustainable commissioning looks like in practice
- understand how and why improving the sustainability of mental health interventions will contribute to achieving the aims of both the mental health, public health, NHS, and social care strategies, as well as improving quality and productivity
- be able to commission sustainable mental health services and interventions.
Find out more and download all the guides published by the Joint Commissioning Panel for Mental Health at http://www.jcpmh.info.
The document discusses the internship of Jessica Liang at Upstate Cardiology. It covers several topics:
1) Access to care was highly valued at Upstate Cardiology, which provided care regardless of ability to pay. Disease prevention was also promoted.
2) The referral system was crucial to services, but more convoluted between different health systems due to varying forms and missing information.
3) Overbooking appointments was problematic and reducing it would benefit physicians and patients through better use of time.
This document provides an evaluation of the experiences of Black and Minority Ethnic (BME) service users in accessing and engaging with the Leeds Psychology & Psychotherapy Service. It conducted a two-phase study: Phase One involved distributing questionnaires to BME service users to understand barriers to accessing the service. Phase Two consisted of interviews to understand experiences of engaging in therapy. The results found various barriers like lack of information, stigma, and cultural sensitivity issues. It provided recommendations like improving information provision and cultural competence training for staff. The study aimed to help the service better meet the needs of BME service users.
This document discusses the costs associated with amputation prevention for diabetes patients in India. It notes that amputation prevention is more costly than amputation itself currently in India. It identifies several components of costs for amputation prevention, including regular monitoring, medications, footwear, hospitalization, dressings, and rehabilitation. It also discusses the limited existing financial supports for amputation prevention in India, including insurance, employer reimbursement, public healthcare, and out-of-pocket spending. It argues that insurance must play a larger role in covering costs to make a significant social impact in preventing amputations in India over the next 20 years.
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
This document discusses using private sector approaches and information communication technologies (ICT) to scale up family planning programs in India. It proposes partnering with private medical providers and manufacturers to distribute contraceptives. It also describes developing a mobile phone-based fertility awareness app called CycleTel and conducting pilot tests of it in India. Preliminary results found interest among users and a willingness to pay for the service. Next steps include further pilot testing, software development, and scaling up programs within India and other countries.
The role of informal providers in health marketsJeff Knezovich
Gina Lagomarsino of Results for Development's Center for Health Market Innovation reflects on findings from a new book, Transforming Health Markets in Asia and Africa and adds information about recent studies in which CHMI has been involved on informal providers in Bangladesh, India and Nigeria.
The Joint Learning Network in Action: Spotlight on GhanaHFG Project
More and more countries are implementing complex health systems reforms to achieve universal health coverage. The Joint Learning Network (JLN) is a country-driven network of practitioners and policymakers who together develop knowledge products to bridge the gap between theory and practice, with the goal of extending health care coverage to more than 3 billion people.
The JLN community is comprised of leaders from ministries of health, national health financing agencies, and other key government institutions in 27 Asian, African, European, Latin American, and Middle Eastern countries as well as a diverse group of international, regional, and local partners.
On Thursday, September 22, the HFG Project hosted a technical briefing session on the JLN's work on the ground, and about Ghana’s National Health Insurance Authority (NHIA) on their collaboration with the JLN and the HFG project. Speakers included: Amanda Folsom (JLN Program Director, Results for Development), Nathaniel Otoo, (Chief Executive, Ghana NHIA), Dr. Lydia Dsane-Selby (Director, Claims, NHIA), and Chris Lovelace (Principal Associate, International Health, Abt Associates).
The document discusses key issues in health system development and the Thai experience as an example. It summarizes that Thailand achieved early Millennium Development Goals through sustained action over time to address access barriers, including expanding infrastructure and human resources, gradually increasing financial risk protection, and strengthening community awareness of health programs. This sustained action was enabled by values-based leadership, support from elites, use of evidence, decentralized decision-making, and flexible implementation within a pro-poor, pro-rural ideology.
Recap - Patient Engagement: The Future of Healthcare Communications Summitprnewswire
This document summarizes a healthcare communications summit that discussed strategies for improving patient engagement and outcomes through digital technologies, social media, and wellness programs. Key topics included:
- Integrating patient data and feedback to enhance care experiences.
- Using social media, education, and motivation to activate patients in their own care.
- Partnering with patients in research and communications to ensure their perspectives are heard.
- Developing policies and training for social media use while protecting privacy and complying with regulations.
- Coordinating engagement goals between industry and patients to define success.
This document discusses public-private partnerships (PPPs) in healthcare in India. It notes that while India has made progress in health indicators, it still lags developed countries and needs to improve healthcare spending and access. PPPs are presented as a way to leverage the strengths of both public and private sectors by utilizing existing infrastructure and mobilizing additional resources. Several models of PPPs are described, including social franchising, branded clinics, contracting, voucher systems, and partnerships with various organizations. Key criteria for initiating different models of PPPs are outlined. The document emphasizes the need for PPPs to improve reproductive and child health in India through increased access, quality, efficiency and community ownership of health services.
The document summarizes a patient safety workshop that introduced the Whole Systems Integrated Care (WSIC) programme and Imperial College Health Partners (ICHP) patient safety initiatives in North West London. The workshop aimed to gather feedback on how patients can get more involved in improving safety. It covered the vision for integrated care in NWL and patient stories. Group exercises discussed risks to a safer system and how patients and professionals can work together on safety. The Patient Safety Champion Network was introduced to promote patient engagement in safety work across NWL.
The document discusses healthcare systems and some of the challenges they face. It notes that WHO has defined the goals of healthcare systems as good health, responsiveness to population needs, and fair financial contributions. Many countries are struggling with rising costs, inconsistent quality, and limited access to timely care. Healthcare expenditures are rising faster than economic growth in developed countries. Access is also becoming more problematic as costs and demand increase. These challenges are exacerbated by factors like globalization, changing demographics, and rising chronic diseases. The document discusses some focus areas for healthcare systems including greater value, active citizens, new care approaches, and addressing growing resource constraints.
Rare Diseases SA has been actively improving the quality of life for those impacted by Rare Diseases over the last 5 years.
Our key focus areas have remained advocacy, patient navigation and community engagement, and through these strategic objectives we have successfully managed to see positive impact in our community.
From the development of over 80 patient connect points, to the implementation of a mobile app, RDSA has ensured patients remain supported and connected whilst the organization remains focused on our advocacy efforts.
The successful roll-out of our Rare Assist service has also seen a reduction in out of pocket costs for patients in the private sector.
We have attached our 5 year impact report which demonstrates some of the impact our work has had within our community. We have also included our programme overview of the Rare Assist Programme.
We would love to have your feedback on these reports, as well as feedback on the following questions:
1. What interest do you have with our organisation?
2. What is your current opinion on our work?
3. How would you like to stay informed about what we do?
4. What motivates you to stay connected with us?
Should you have any questions for us, we would love to hear from you.
Kind Regards
Kelly du Plessis
CEO -Rare Diseases South Africa
info@rarediseases.co.za
Engaging Non-State Actors in Governing Health: Key to Improving Quality of Care?HFG Project
USAID’s Health Finance and Governance (HFG) and the Joint Learning Network hosted an hour-long webinar on engaging non-state actors in governing quality of care. The webinar presented in-country examples of private sector contributions in governing health quality — providing technical inputs on policy development, monitoring health service delivery, and promoting accountability in the health system.
Engaging Non-State Actors in Governing Health – the Key to Improving Quality ...HFG Project
USAID’s Health Finance and Governance (HFG) project and the Joint Learning Network hosted a webinar on Wednesday, May 3rd, on engaging non-state actors in governing quality of care. Webinar panelists presented in-country examples of private sector contributions in governing health quality — providing technical inputs on policy development, monitoring health service delivery, and promoting accountability in the health system. Country examples included the Philippines, Ghana, and Mexico.
This document proposes a business to improve healthcare in rural India by maintaining wellness through affordable access to medicines. Key points:
- The business aims to address limited rural healthcare access through free drug cards and a centralized healthcare records system.
- Preventable diseases are common in rural India and 66% lack access to critical medicines. Barriers include an unappealing private sector, distributed populations, and inefficient public systems.
- The proposal describes a digital healthcare system using unique identification codes, medical histories, and prescription details to improve diagnosis and avoid interactions. It aims to promote generic drugs and analysis.
- Stakeholders are rural Indians, private companies for investments and publicity, and the government's moral duty.
Human Genomics and Public Health in a Global World: Challenges for Low & Midd...Human Variome Project
This document discusses challenges for low and middle income countries regarding human genomics and public health in a global context. It notes that while genomics activity is increasing in about 50 countries, it remains fragmented without systematic monitoring or links to health policymakers. Five priorities for international genomics are identified: building an evidence base for genomic medicine, addressing health disparities, managing diverse patient populations, implications for medical education, and coordination across diseases. The document argues for greater global collaboration to improve access, establish standards, and promote equity and justice.
This project identified opportunities for radical improvements in vaccine delivery and uptake towards the achievement of excellence and near-total vaccine coverage in regions similar to Bihar, India.
- Conduct user-centered research and design to improve vaccine delivery.
- Study behaviors, practices and attitudes of frontline workers and recipients.
- Identify key dimensions of the delivery challenge.
- Generate and validate concepts and solutions through collaborative brainstorming and dialogue with field data.
The document discusses a meeting between health plans and the Center to Champion Nursing in America to support the IOM's recommendations. It describes how health plans are driving innovations through nurse-led programs that improve quality of care, consumer experience, and health outcomes. Examples are provided of single nurse care manager models and personalized care plans that have led to measurable improvements such as reduced healthcare costs, fewer emergency visits, and better diabetes management.
This document discusses the potential for electronic data capture in community health research and development. It notes that nurses are becoming major contributors of electronically captured data, but that the data is often interpreted and used in ways removed from its original purpose. It outlines six domains where increased data transparency could impact: accountability, choice, productivity, care quality, social innovation and economic growth. However, it stresses the importance of nurses actively participating in and influencing how this data is captured, interpreted and used.
Study on the Attitude of Medical Partitioners towardAnjum Kazimi
This document summarizes a study on the attitudes of medical practitioners in Pakistan towards social accountability. It describes the study's objectives to investigate medical practitioners' knowledge, attitudes, and practices related to social accountability. The methodology included surveys and interviews with 120 doctors. The results found the practitioners had average knowledge of social accountability but varying attitudes. Their attitudes were not strongly oriented towards social responsibility. The researchers recommend including social accountability training in medical curricula to improve practitioners' knowledge and attitudes.
This document discusses legal and ethical ways for dentists in India to market their dental practices. It begins by providing context on the controversy around healthcare professionals advertising in India. It then outlines specific ethical and unethical marketing acts according to regulations. Unethical acts include false promises, demeaning solicitation, and misleading advertisements. Acceptable marketing includes formal announcements of new practices or services without exaggerated claims. The document concludes by noting debate around the necessity of advertising for dental practices to compete and attract patients.
Se30 improving hw ist - harvesting good practices and lessons learntTana Wuliji
This document provides an overview of a workshop on improving in-service training (IST) for health workers. The objectives are to launch an IST improvement framework, share experiences on addressing IST challenges, and facilitate networking to strengthen IST. The framework was developed through an expert consensus process involving multiple organizations. It includes 40 recommendations across six themes: strengthening training institutions and systems; coordination of training; continuum of learning from pre-service to in-service; design and delivery of training; support for learning; and evaluation and improvement of training. The workshop will provide an overview of the framework and its application in different countries, and engage participants in discussions on strengthening IST.
Similar to Harnessing informal providers for health systems improvement: Lessons from Indiamal providers webinar (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Osteoporosis - Definition , Evaluation and Management .pdf
Harnessing informal providers for health systems improvement: Lessons from Indiamal providers webinar
1. http://www.pshealth.org/ https://twitter.com/psinhealth
Harnessing informal providers for health
systems improvement: Lessons from
India
An initiative of the Private Sector in
Health Symposium
2. Symposium: Sydney 6 July 2013
• Since 2009 a group of researchers and policy analysts
working on health markets in low and middle-income
countries have organised a pre-congress symposium
at the biennial conferences of the International Health
Economics Association
• The aim has been to encourage and disseminate high
quality research on the performance of these markets
and on practical strategies for improving access to
safe and effective services by the poor
• The Future Health Systems Consortium is responsible
for organising the 2013 symposium with financial
support from the Gates and Rockefeller Foundations
and SHOPS
www.pshealth.org
3. Webinar series
• Facilitated by the Future Health Systems Consortium
• Organised by a number of institutes
• Publicised widely to involve a wide audience
• The next webinar will be held on 7 March 2013
entitled, ‘Shaping the future of health markets:
Reflections from a meeting in Bellagio’. Registration will
open soon!
Providing opportunities to set the scene well before the
Sydney meeting and to ensure that those who may not be
attending the Symposium have the opportunity to
participate in debates about strategies for improving the
performance of health markets in meeting the needs of the
poor.
4. Harnessing informal providers for
health systems improvement
• Important sources of advice and drugs for poor
people in many low and middle-income countries
• Growing body of evidence on who uses them and
the services they provide
• A variety of innovators and social entrepreneurs are
testing strategies for improving their performance
• Governments are gradually recognising the
importance of these providers
Engaging with informal providers: an opportunity for
governments to increase access to effective and
affordable services?
5. Future Health Systems’ work on
informal providers
• Case studies in
India, Bangladesh, Nigeria and
China
• Transforming Health Markets in
Asia and Africa: Improving Quality
and Access for the poor
• Collaboration with CHMI
programme of work on informal
providers
• Meeting in Bellagio and production
of a briefing note: Future Health
Markets: a meeting statement
from Bellagio
• Building networks and testing
interventions
6. Organisation of webinar
• Presentations by Gina Lagomarsino and Meenakshi
Gautham
• On the side of the screen you should see a control panel with
a chat function. Participants are invited to send written
questions or comments to the meeting organiser via Instant
Message. If you send your questions to the entire audience
they will be public. We will remove any duplications and select
questions to pose to each presenter
• We are recording the webinar and so your questions may be
made public
• The aim of the webinar is to stimulate discussion and debate
about the role of informal providers and strategies for
improving their performance
• Help us to improve the organisation of webinars by
completing an evaluation form
8. Growing Knowledge
about the Role of
Informal Providers
within Health Systems
Gina Lagomarsino Results for Development
Harnessing Informal Providers for Health Systems February 5, 2013
Improvement: Lessons from India
9. CHMI CONVENED GROUP ON INFORMAL PROVIDERS
Members of Working Group of researchers and practitioners
Sofi Bergkvist, AccessHealth
Peter Berman, Harvard
Abbas Bhuiya, ICDDR,B
Gerry Bloom, IDS
Bill Brieger, Johns Hopkins
Annapurna Chavali, AccessHealth
Birger Forsberg, Karolinska
Gopi Gopalakrishnan, World Health Partners
Mohammad Iqbal, ICDDR,B Group met two times:
Gina Lagomarsino, R4D • Sept. 2010 – Washington, DC
Kim Longfield, PSI • March 2012 – Dhaka
Bruce Mackay, HLSP
Dominic Montagu, UCSF
Stefan Nachuk, Rockefeller Foundation
Gael O’Sullivan, Abt Associates
Karen Pak Oppenheimer, World Health Partners
David Peters, Johns Hopkins
Edumund Rutta, MSH
Nirali Shah, PSI
Guy Stallworthy, Gates Foundation
Hongwen Zhao, WHO
10. WHO ARE INFORMAL PROVIDERS (IPS)?
Definition of Informal Providers
The following definition was developed by UCSF Global Health Group with input and
agreement from the CHMI Informal Provider Working Group:
• Chiefly entrepreneurs
Business • Collect payment from patients, not institutions
Model • Payment is often undocumented and tendered in
cash
• Possess little or no officially recognized training
Training from formal bodies such as a government, NGO,
or academic institution
• Operate outside of effective regulation of
Registration
government and independent regulatory
/ Regulation organizations
11. WHAT DO WE KNOW ABOUT INFORMAL PROVIDERS?
Literature review findings
In 2011, CHMI, in collaboration with May
Sudhinaraset and Dominic Montagu at the Global
Health Group at the University of California, San
Francisco (UCSF), completed a literature review on
IPs to determine what is known on the topic.
Size: IPs make up a significant portion of the
health sector—ranging from 51-55% in India to
96% in rural Chakaria, Bangladesh.
Scope: IPs are used in day-to-day healthcare
and function across the continuum of care.
Quality: Information is limited; the quality of
care delivered by IPs appears variable.
Reasons for use: IPs are used because of
their convenience, low price and for
cultural/social reasons.
Study published in PLoS-ONE on Feb. 6 2013
12. LEARNING MORE ABOUT THE DYNAMICS OF INFORMAL
MARKETS
CHMI Commissioned studies in Bangladesh, India and Nigeria
Research Lead Study Site IP Studied
Bangladesh
Nabeel Ashraf Ali, Shams El Arifeen Tangail district
Sunamgang district Village Doctors/
ICDDR,B; James P Grant School of Public Rangpur district Drug Sellers
Health-BRAC University Cox Bazar
Dr. Meenakshi Gautham
Centre for Research on New Rural Medical
India
International Economic Order (CReNIEO); Guntur district, Andhra Pradesh
Tehri district, Utarrakhand Practitioners
Garhwal Community Development and (RMPs)
Welfare Society; London School of
Hygiene and Tropical Medicine
Professor Oladimeji Oladepo 10 Local Government Areas,
Nigeria
Oyo State Patent Medicine
Faculty of Public Health-College of 10 Local Government Areas, Vendors (PMVs)
Medicine, University of Ibadan Nasarawa State
13. FINDINGS FROM 3-COUNTRY STUDY
Theme 1: IPs’ relationship to their communities
IPs and their communities
• IPs have local roots and have well-
established, long-running, practices
• IPs are often the first point of care for patients
• IPs have developed lucrative businesses
• They appear to be well-regarded and trusted
members of the community
• IPs are relatively well educated compared to
their clients, which contributes to their high
profile in the community
14. FINDINGS FROM 3-COUNTRY STUDY
Theme 2: Education and Training
Education and training received by IPs
• Most informal providers appear to have some
form of health training
• The duration, formality, and content of health
training varies widely
• Training can comprise commercially offered
courses, public training for community health
workers, or apprenticeship
15. FINDINGS FROM 3-COUNTRY STUDY
Theme 3: Quality of care
Quality of care delivered by IPs
• IPs engage in some incorrect and
potentially harmful practices
• IPs exhibit some appropriate
knowledge regarding basic conditions
and standards of care
• Also evident that knowledge does not
always translate into practice, with
polypharmacy and irrational use of
drugs a common problem
16. FINDINGS FROM 3-COUNTRY STUDY
Theme 4: Relationship with the formal sector
Relationship between IPs and the
formal healthcare sector
• IPs function within a complex health
market and have established some ties
to other parts of the market
• Many have some ties to the formal
health sector for new medical
information, drug supplies, and
referrals
• IPs also operate in reaction to demand
from consumers
17. FINDINGS FROM 3-COUNTRY STUDY
Theme 5: Organization of IPs
Organization and recognition of IPs
• Can range from little coherent
organization and government hostility
to nation-wide organization and
government recognition
• Examples exist of well-organized and
strong informal provider associations
acting on behalf of the members’
interest
18. POTENTIAL INTERVENTIONS WITH INFORMAL PROVIDERS
Goal Intervention
1. Organization: IPs are organized, Provider Associations
thereby reducing the fragmentation Provider Networks
of health care delivery
2. Education: IPs are trained to provide Provider Training
specific interventions Standard Operating Procedures
3. Certification: IPs are certified in the Accreditation/Licensing
area of health in which they practice Aggressive Enforcement/Forced Shutdown
4. Compliance: IPs comply with set Regulatory/Monitoring Policies and Groups
procedural and quality standards Financial Incentives/subsidies
5. Job support: IPs are well-equipped to On-site support: (E.g., job aids, decision-support software)
provide quality care Remote support: (E.g., call centers, telemedicine)
Supply-chain improvements: (E.g., pre-packaged medications,
pooled procurement of drugs)
6. Referrals: IPs have access to and Incentivized referrals
utilize referral networks for Collaboration with the formal sector
complicated cases Rural postings for formal providers
19. IPS ARE RELEVANT FOR MANY BROAD HEALTH SYSTEM
CHALLENGES
Necessary to consider IPs if we are to address a number of related issues
Convergence between IPs and other health
systems issues include:
Health human resource
shortages, including
frontline/community health
workers
Poor quality of medicines,
irrational drug use, and
inadequate access to essential
medicines
High out-of-pocket spending
Lack of universal health
coverage
20. POTENTIAL NEXT STEPS
Research to be completed
• Country papers published
• Three-country study synthesis paper published
Potential action steps
• Policymaker engagement in select countries
• Convene community of practitioners working with IPs in
different countries to share promising practices
• Engage with global Human Resources for Health and Frontline
Health Workers/Community Health Workers communities
21. OTHER RELEVANT WORK ON INFORMAL PROVIDERS
Recent Publications
Transforming Health Markets in Asia and Africa:
Improving Quality Access for the
Poor, Bloom, G., Kanjilal, B., Lucas, H. and
Peters, D.
In Urban And Rural India, A Standardized
Patient Study Showed Low Levels Of Provider
Training And Huge Quality Gaps, Health
Affairs, Das, j. et al.
Developing World: Bringing order to
unregulated health markets, Commentary in
Nature, Peters, D. and Bloom, G.
Mapping Health Care Markets in Rural
Cambodia: A Survey of formal and Informal
providers, Presentation at the Health Systems
Research Symposium, Beijing, Özaltin, E.
23. A study of informal
providers in two districts of
India
Dr. Meenakshi Gautham
Centre for Research in New International
Economic Order (CReNIEO), Chennai
Garwhal Community Development and Welfare
Society (GCDWS), Tehri Garhwal
Research Fellow LSHTM
26. The demand side: providers of first contact
Providers of first contact, AP (a previous study)
Allopathic
practitioner
(94.8%)
Private
Public (3.2%)
(91.6%)
Same or Same or
nearby village Town (22.1%) nearby village Town (2.0%)
(69.5%) (1.2 %)
Source: Gautham et al. First we go to the small doctor: First contact for curative healthcare sought by rural
communities in AP and Orissa, India. Indian J Med Res 134, November 2011, pp 627-638
27. Bihar
First contact health providers in rural Bihar (previous study)
100%
90%
90%
80%
Village practitioner
70%
60% qualified private
doctor
50%
govt. facility
40%
30% Homeopathic/ayur/
unani
20%
10%
0%
Source: Dror et al. Household survey in rural Bihar -1000 households. Erasmus University, NL, and Micro Insurance
Academy, India. May-June 2010
28. Different mix of frontline health workers across different rural
locations
45.00%
40.00%
35.00%
Village practitioner
30.00%
Traditional healer
25.00%
Govt. facility
20.00%
Govt. health worker
15.00%
Ayurvedic/homeo./unani
10.00%
Private doctor
5.00%
0.00%
First contact health providers in rural Orissa
Source: Gautham et al. First we go to the small doctor: First contact for curative healthcare sought by rural
communities in AP and Orissa, India. Indian J Med Res 134, November 2011, pp 627-638
31. Tehri was more rural with lower population density,
higher literacy but higher IMR, no medical colleges
Key features Tehri Guntur
Population density (sq km) 139.43 429.43
% of rural population 86.63% 66.11%
No. of inhabited villages 1,752 1,047
% of villages with 82.4% 1.45%
population size ≤ 500
% of adults literate 75.10% 67.99%
Monthly per capita Na 599.11
expenditure (UT=901) (AP=816)
Infant mortality rate 64 49
No. of medical colleges 0 3
32. Study objectives
• Identify and enumerate informal and formal
providers in the study areas
• Document IPs’ levels of education and training,
physical set up, mobility, practice characteristics,
and costs of services
• Assess knowledge and skills/performance
• Explore relationships with the formal health
system/providers
• Analyse barriers and facilitating factors in the
process of integrating IPs
33. Study samples and processes
1. Block selection
Guntur, 9 out of 57 blocks were selected by:
• Stratification into 3 clusters by level of development (low,
medium, high)
• Proportional sampling from each cluster (3 from low, 5 from
medium, 1 from high)
Tehri
• All 9 blocks were included
• Blocks also categorised into low (2), medium (5), and high (2)
using same criteria
34. Study processes..contd
Study objectives/key Study Processes
variables
Provider enumeration Provider identification through key village contacts, group
discussions with community members, and snowballing
technique. Surveyed market places and facilities.
Structured questionnaire for interviewing IPs
Education and training Interviews with all mapped IPs (368 in Guntur; 263 in Tehri)
Practice Interviews with all mapped IPs.
characteristics
Knowledge Interviews with a sample of IPs:100 in AP and 90 in Tehri.
Skills/Performance Patient-provider observations using an Observation tool with
the sampled IPs. (Description slide follows).
Relationships with In-depth interviews with sampled IPs, their associations,
formal sector professional doctors, health administrators
35. Knowledge and performance assessments
Conditions Protocols Knowledge Performance
• Fever • Adapted • Scores • Same
• Diarrhoea from WHO based on conditions
• Respiratory guidelines number of and
problems by 3 correct protocols
physicians responses • Observed
for each first 3
question consenting
patients for
each
condition
• Total 9
patients
per
provider
36. Example of knowledge and performance items
Knowledge question (interviewed) Performance item (observed)
What physical examination will you perform on a Checks for dehydration
diarrhea patient? -skin pinch for adults or
-abdomen pinch/sunken eyes/lethargy/ inability to eat or
Check for dehydration drink for children
-skin pinch for adults or
- abdomen pinch/sunken eyes/lethargy/ inability to 1=Yes; 0=No
eat or drink for children
Check fever (pulse or thermometer) Checks fever (pulse or thermometer)
Check BP 1=Yes; 0=No
Do nothing
Any other (please write verbatim) Checks BP
1=Yes; 0=No
0 =Incorrect (‘d’, or any other incorrect response) Any other examination (write verbatim)
1 = mentions any one of ‘a’, ‘b’ or ‘c’
2 = mentions any two of ‘a’, ‘b’ or ‘c’
3 = mentions any three of ‘a’, ‘b’ or ‘c’
90 =no response/doesn’t know
38. Greater population coverage by IPs than formal
providers; greater in AP than UT
Greater population coverage by IPs than formal providers, greater in AP than UT
60 53.56
Tehri Garhwal
50 42.3
Ratio of IPs to popn 39.35
40 IPs per 100,000 pop
=1:2299 27.5
30
Doctors to popn 20 Private docs per
10 3.79 5.17 3.06 100,000 pop
=1:9599 0.54 0
0 Public docs per 100,000
Low Medium Highest pop
development development development
blocks blocks blocks
Guntur
70 63.77
Ratio of IPs to popn 60 52.32
=1:1941 50 38.63 IPs per 100,000 pop
40
Doctors to popn 30 18.82 16.65
=1:5412 20 Private docs per
10 5.44 2.52 3.99 100,000 pop
0.77
0 Public docs per
Low Medium High 100,000 pop
development development development
blocks blocks blocks
39. Differences in education and types of training
IP’s education and training Tehri Guntur
(N=263) (N=368)
Studied up to class 11 in school 94% 41%
Graduates 43% 10%
Held a health related diploma or certificate 93% 35.6%
Worked as compounder / assistant before starting 55% 100%
independent practice
Worked under a qualified doctor (with MBBS or MD 40% 91%
degrees)
Average number of years of apprenticeship 4 years 7 years
Mean number of years of independent practice in 10.5 years 13 years
the present location
40. IPs had strong local roots in both districts
Nativity and origin of the IPs Tehri Guntur
Born in the same block 51.50% 53.00%
Born in the same district (but 18.70% 41.00%
not in the same block)
Born in the same state (but not 10.30% 5.70%
in the same district)
Born in another state 19.50% 0.30%
41. Door step services in AP; clinic based in UT;
the key is proximity
IP characteristics Tehri Guntur
Type of practice
Mainly clinic 99.00% 31.25%
Mainly mobile 0.50% 39.40%
Clinic and mobile 0.50% 29.35%
Clinic location
Clinic at IPs’ residence 29.00% 37%
Mean distance of clinic from residence 2.3kms 1.3kms
Clinic operating hours
Open 7 days a week 90.00% 95.00%
Mean number of hours 9.4 hours 11.0 hours
Mobile provider characteristics
Mean hours of travel/day - 6.6hours
Mean distance covered - 2.1 kms
42. ‘I go from village
to village, house
to house ringing
my bell….’
43. AP: More prescribers, more ‘allopathic’ medicines
UT: More dispensers, more blended medicines
IP characteristics Tehri Guntur
Clientele
Average number of patients /day 14 17
Mean number of client households 367 604
Medical system followed
Treats only with allopathic medicines 33.00% 99.00%
Treats only with non-allopathic medicines 9.00% 0.50%
Treats with allopathic and non-allopathic 58.00% 0.50%
Provision of medicines
Only dispenses 42.00% 17.00%
Only prescribes 7.00% 48.00%
Mostly dispenses but also prescribes 49.00% 25.00%
Mostly prescribes but also dispenses 3.00% 10.00%
46. Biggest difference – injections and medicines
Injections/ antibiotics Tehri Guntur
received by patients
% of patients that 13% 71%
received an injection
Mean number of 0.94 1.19
antibiotics received
% of patients that 19% 30%
received 2 or more
antibiotics
47. Relationships with the formal sector
Qualified doctors were the main source of new knowledge for more than
half of Guntur IPs
60
54
50
40
34 Medical reps
30 Qualified doctors
Medical journals
20 17 17
Mass media
10 8.1
4
0 0.5
0
Tehri IPs Guntur IPs
48. Relationships with the formal sector
Win-win relationships in Guntur
• 40.5% IPs received referral commissions from private doctors
• 7% received gifts -small medical equipment and sample medicines
• IPs’ confidence and faith in private doctors due to their perceived technical skills and
their interpersonal bonds
• Government doctors were IPs’ trainers in the state training programme, no signs of
overt hostility
• But IPs also perceived doctors as their biggest competitors; thus a double edged
sword
Hostility and lack of interaction in Tehri
• With only 5 private doctors within the district, IP referrals were directed equally towards
public facilities and private facilities, including in nearby towns outside the district
• Bitter experiences with health department officials, who demanded certificates and
diplomas and sometimes bribes.
50. Flexible One Year Training
1 year, bi-weekly sessions at nearby health facilities
51. Barriers and supporting factors
Barriers
• Legal obstacles and periodic court orders against ‘quacks’
• IPs not united or organised, not seen as a political force
• Weak support by local governments or political leaders
• Opposition/ambivalence of the formal medical fraternity
• Insufficient knowledge about IPs and their role, and what interventions?
Supporting Factors
• United and organised IPs have become a political strength in AP
• Strong political will displayed by AP’s former Chief Minister
• Win-win partnerships with the formal sector, especially private sector
• State level certification initiatives as in AP have set a useful example
• Increasing body of knowledge, support and pressure from local and international
health community
52. Conclusions and recommendations
• IPs on the margins of institutional frameworks, but their role is firmly
institutionalized
• IP markets have evolved in different ways in response to different contextual
influences
• IPs will continue to play this role for quite a long time
• Dispels the myth that IPs are solo providers. The have interactions
amongst themselves and with other formal sector providers
• Role of the apprenticeship model needs to be examined closely
• Interventions need to move beyond training now
• Universal health coverage provides a good framework, as it includes issues
of equity, quality, and calls for immediate as well long term strategies
53. Acknowledgements
Centre for Research in New Garhwal Community Development
International Economic and Welfare Society, Tehri
Order, Chennai, India Garhwal, India
Dr. K.M Shyamprasad Dr. Rajesh Singh
Dr. S. Srinivasan Ms. Rajkumari Singh
Ms. Anshi Zachariah Mr. Manoj Kumar
Ms. Premila Vijayraghavan Field research team
Dr. Lalitha & the field team All hospital staff
Mr. Christopher Singh
Crenieo training centre staff
Contact:
Meenakshi.gautham@lshtm.ac.uk
Gautham.meenakshi@gmail.com