Kesavan Sreekantan Nair

Cost of treatment for cancer: experiences of patients in public hospitals in India.

BACKGROUND To assess the treatment pattern and expenditure incurred by cancer patients undergoing treatment at government tertiary hospitals in India. MATERIALS AND METHODS A cross-sectional study of 508 cancer patients randomly selected from tertiary cancer hospitals funded by central/state governments located in major cities of five states in India, namely Kerala, Maharashtra, Rajasthan, West Bengal and Mizoram, during March - May 2011 was conducted. Information related to direct costs, indirect costs and opportunity costs incurred on investigations and treatment, major source of payment and difficulties faced by patients during the course of treatment was collected. RESULTS About 45% of the patients used private health facilities as the first point of contact for cancer related diseases as against 32% in public hospitals. About 47% sought private health facilities for cancer investigations, 21% at district/sub-district hospitals, and about 4% contacted primary health care facilities. A majority of the patients (76%) faced financial problems while undergoing treatment. CONCLUSIONS The results highlight the importance of involving the primary health care system in the cancer prevention activities.

Awareness Regarding Risk Factors, Symptoms and Treatment Facilities for Cancer in Selected States of India

OBJECTIVE To study the level of awareness and knowledge about cancers and associated risk factors among households in selected states of India. METHODS In the study 3070 households were interviewed from six states viz, West Bengal, Kerala, Madhya Pradesh, Rajasthan and Mizoram. RESULTS Knowledge of cancers other than those related to tobacco was very low (prostate 8%, colon 11% ) among the communities, with a poor awareness of warning signs and symptoms. The knowledge varied from state to state. It is found that the major source of information related to cancers was television (38%) followed by friends and relatives (36%). Only about 15 % of respondents had knowledge about cancer awareness camps organized in their districts but they did not have knowledge about the organizers of the camp. Findings suggested a strong need for strengthening of DCCP. CONCLUSION It is important to create awareness among community through educational programs on cancer prevention, preventable cancer risk factors, benefits of early diagnosis, and availability of screening facilities. Integration of District Cancer Control activities with NRHM could be the most cost-effective strategy to prevent cancers and rural population.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka

Meeting the needs of HIV-positive pregnant women and their offspring is critical to India′s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent-to-child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT-RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Implementing Rashtriya Swasthya Bima Yojana: Experience from Delhi

Rashtriya Swasthya Bima Yojana aims to improve access to quality health care and relieve the burden of health care costs of the poor population. This article, based on interviews conducted with different stakeholders of the scheme during October–December 2010, looks at the implementation of the scheme in Delhi. A large proportion of the beneficiaries were unaware about the features and benefits of the scheme. A significant proportion of the families availing benefits had incurred the out-of-pocket expenses. The coverage of population was very low. The empanelled hospitals/nursing homes were hesitant in admitting patients with chronic ailments requiring continuous treatment at the hospital. Low package rates and delay in settlement of claims were reported as the major issues by the empanelled hospitals.

Predictors of Risky Sex Behavior among Adolescents in a Traditional Indian Society: Implications for Program Intervention Strategies

Objective: The purpose of the study was to assess the risk behavior and its effect on involvement in sex among school-going adolescents as a part of assessing implementation of Adolescent Reproductive and Sexual Health Scheme (ARSH) in a state of India. Methods: The sample covered 3069 randomly selected adolescents (students) from 9 th to 12 th standard in various government, private and missionary-run schools from two districts, namely, Aizawl and Champhai in the state of Mizoram. Results: It was found that more than one-third of adolescents (37%) accepted taking alcohol and 72% of adolescents accepted seeing pornographic movies. Nearly 23% respondents were aware about premarital pregnancy among friends and 7.5% were aware about complication due to unsafe abortion among them. About 10% accepted involvement in premarital sex and majority of them (70%) had premarital sex between age group 15 and 19 years and 54% never used condom. Influence of peer group who were taking alcohol, tobacco and drug and exposure to erotic materials was found to be the major risk factors for indulgence in unsafe sex practices among adolescents. Conclusion: Better awareness and counseling against tobacco, alcohol and drug abuse, and pornographic literature among adolescents is needed through school health education.

Vouchers for Reproductive and Child Health Services:Demand Side Financing Scheme in Uttarakhand, India

The paper assesses the voucher scheme for Reproductive and Child Health (RCH) services in Uttarakhand with respect to awareness generation, delivery of services to clients and role of stakeholders in implementation. Data was collected from interview of stakeholders and review of records from the state government, Voucher Management Agency (VMA) and private nursing homes. The scheme was successful in reaching out to poor women in a short span. Majority of them were satisfied with the services received at the private nursing homes. Active involvement of community health workers and effective monitoring have helped in achieving the objectives of the scheme.