Shahid Akhter, editor, ETHealthworld, spoke to Dr. Paul Sebastian, Head of Public Health and Palliative Care, Cancer Care Programme of Tata Trusts, to find out about the need and role of public health interventions to build a more resilient health system.
- Need for public health interventions ? Barriers and challenges?
The Integrated Child Development Services (ICDS), the world’s largest such programme, which looks at improving maternal and child health, has been in existence since 1975 working with grassroot healthcare workers. Public health programmers gained prominence in 2015, with the introduction of 17 Sustainable Development Goals (SDG) adopted by the United Nations (UN). The 17 SDGs are a universal call to action to improve the lives of people, with SDG 3 focusing on ensuring healthy lives and promoting well-being for all at all ages. India is one among the 193 countries which adopted the SDGs and committed to work towards them. Public health interventions have always been a priority in India.
Towards this, India’s national health policy has actively sought to address the high burden of disease, its inequitable distribution, and achieve its ambitious goal of universalising health care. Efforts are being made to develop a more resilient health system.
Multiple public and private sector organisations, as a part of their corporate social responsibility or outreach initiatives, are focusing on health and, hence, are trying to align themselves with the SDGs and/or public health interventions by Central and State Governments to strengthen the healthcare delivery. These collaborations have enduringly enhanced health care in remote geographies, and have made available quality healthcare closer to where patients live, reducing their out-of-pocket expenditure incurred due to travel to large cities, which have an abundance of quality healthcare facilities.
The NCD screening programme of the Government of India, supported by Tata Trusts, since 2017 has ensured regular screening of people for NCDs across India.
While there is a great degree of work happening on this front, one of the challenges that the public health sector faced in recent times was the COVID-19 pandemic. It added some amount of stress on our system but we have managed to overcome them to a great extent.
The barriers that need to be addressed still are inadequate healthcare infrastructure, understaffed health system, under-subscribed training programmes, unequal distribution of qualified manpower, and general public apathy towards health care.
What are the processes and guidelines to keep in mind while curating public health interventions?
The process of curating a public health intervention starts from identifying the ‘health intervention area’; analysing the current situation; public and private interventions that are being conducted in the area; assessing the Knowledge, Attitude and Practices (KAP) of the population in target geographies; based on the situational analysis and KAP assessment, areas of interventions are finalised; resources and partners for sustained delivery of intervention are aligned and; Regular impact assessment exercise is carried out to identify and fill the gaps.
Following the above process, the Cancer Care Programme of the Trusts identified the need and introduced interventions in conjunction with State National Health Missions for building awareness and regular screening of cancer, introduced patient navigators for continuum of care so that people do not drop out of treatment, initiated training of front-line health workers for screening of oral, breast and cervical cancer and joined hands with State Tobacco Control Cells for tobacco control interventions. Such partnerships and processes help in ensuring sustainability of the programme/ intervention.
How has the role of technology evolved for better access to public health interventions over the years?
Technology in healthcare is especially important to reach the remotest of areas. Over the years technology has become an integral part of the department of Health and Family Welfare (HFW) to achieve Universal Health Coverage (UHC) in India.
In the recent years, we have seen how telemedicine has played a pivotal role in mitigating health disparities among people. This has been enabled by the Government of India’s telemedicine practice guidelines issued in March, 2020. These were highly resourceful during the pandemic and lockdowns, when movement was restricted. The concern, however, was not about introducing technology but building acceptance of its adoption among key stakeholders. Addressing these concerns through social and behavioural change communications campaigns, with participation from key local representatives from the community, for community buy-in, have proven to be successful.
Today, the Government and many private players have made technologies available that have been accepted by people, and are accessible and replicable solutions in the healthcare sector.
At the Cancer Care Programme of Tata Trusts, virtual help desks have been set-up in the geographies where the programme is operational. These desks, managed by trained counsellors, have been handling queries on cancer awareness, screening, diagnosis and treatment. This has further been supplemented through a phone-based application, which is being used to record and analyse data.
Can you share examples of how programs can be better designed to address issues that cover both communicable and non-communicable diseases effectively?
A very good example is Ayushman Bharat – Health and Wellness Centre Programme under Comprehensive Primary Health Care (CPHC) of Government of India. This involves upgradation of sub-centres and select Primary Health Centres (PHC) to Health & Wellness Centres (HWC) which delivers primary care for communicable and non-communicable diseases effectively. This is a holistic approach through continuum of care.
How are grassroots communities kept in mind while designing these interventions? What is their role at the awareness and execution level?
While designing any intervention, one must be mindful of local demographics. It is always better to collaborate with frontline health workers and influential representatives at a village level for proper implementation of the intervention and building acceptance within the community.
Can you share a few examples of successful public health interventions designed by the Trusts, what was the goal, and how was it achieved?
Example 1: Tata Trusts’ Cancer Care Programme
Tata Trusts has evolved and is implementing the Distributed Cancer Control Model, aimed at facilitating affordable, accessible and standardised world-class treatment in the country.
In India, over 14 lakh individuals are diagnosed with cancer every year. Currently, cancer care in India is concentrated in the big cities. The situation forces patients and their families to travel to these centres, bearing high cost, often unaffordable for many, besides late diagnoses. As a result, the mortality rate is about 70%. The Trusts’ distributed model eliminates these handicaps, and makes world-class treatment accessible, closer to where patients live, and, therefore, affordable. The model includes screening and detection programmes.