Challenges in the Implementation of the Rajasthan Pneumoconiosis Policy

OBJECTIVES

"Silicosis" is a leading cause of occupational morbidity globally. In Rajasthan, India silicosis has been recognized as an epidemic, resulting in the development of a new pneumoconiosis policy in 2019. This study was conducted to provide an overview of the policy implementation regarding the detection, prevention, and control of silicosis.

METHODS

A qualitative study was carried out in the Jodhpur district of Western Rajasthan in which stakeholders were interviewed. Themes were identified regarding prevention, detection, diagnosis, and certification, and organized by stakeholder role. Data were retrieved from the Silicosis Grant Disbursement Portal of the Government of Rajasthan to present an overview of the existing system for detection, prevention, and control of silicosis and to determine the delays in various aspects.

RESULTS

A total of 35 stakeholders were interviewed. There was low awareness regarding the prevention, detection, diagnosis, and rehabilitation of silicosis amongst multiple stakeholders. There is a need for robust enforcement in mining units regarding silicosis prevention and screening. Unregistered mining activities and migration of mineworkers are major challenges in the detection of silicosis cases. Misdiagnosis and low notification rates prevent workers from accessing resources. There are myriad reasons for delays in workers receiving diagnosis and benefits, which have systemic roots but can be uprooted through rigorous implementation of the legislative provisions.

CONCLUSION

There are several well-established pieces of legislation to protect the rights of mineworkers; however, there are gaps in the effective implementation of various provisions that require immediate attention to address the challenges faced during the prevention, detection, diagnosis, and rehabilitation of workers with silicosis.

Assessment of e-aushadhi program (drug inventory e-health initiative in Rajasthan) using benefit evaluation framework

Background:

E-aushadhi is a drug supply chain management initiative of the Rajasthan government. This study is conducted to assess this e-health program as evidence is lacking in this context

Methods:

A mix-method study was conducted. Primary data were recorded from key stakeholders using qualitative interviews. Secondary data were collected from internet-based searches, reports, documents, and available literature. Findings were contextualized into the Benefit-Evaluation framework using six dimensions

Results:

E-aushadhi provides a systematic approach for sourcing, storing, and re-distribution of essential medicine through its three-tier structure. Its user-friendly dashboard entails accurate entries, customizable reports, and easy tracking. It has reduced workload and improved information management with timely drug supply while allowing monitoring with key performance indicators

Conclusions:

E-aushadhi has been successful in improving beneficiary access at public health facilities and may act as a backbone architecture for various digital interventions in the National Digital Health Mission that supports the universal health coverage.

Economic analysis of ASHA-soft programme (online payment and monitoring system) in Jodhpur, Rajasthan

Context:

The Government of India under a performance-based payment scheme is providing remuneration as per the activities completed by the Accredited Social Health Activists (ASHA) health workers. Each state in India has a differentperformance-based payment system for ASHAs. The state of Rajasthan developed the ASHA-Soft system in 2014 for providing incentives to ASHAs.

Aims:

This study is planned to analyze the performance of ASHA-Soft considering the economic aspects as there is a paucity of studies in this context.

Settings and Design:

This study was conducted in Jodhpur, Rajasthan.

Methods and Material:

Economic analysis of ASHA-Soft program was performed based on Incentive paid to ASHA workers; Number of beneficiaries; Overall contribution of ASHAs in the health services; and unit cost per health service under ASHA-Soft program. Data of five financial years, that is, from the inception of ASHA-Soft was analyzed.

Results:

Consolidated incentive for maternal health, child health, and Immunization services provided to ASHAs through ASHA-Soft in the year 2015--16 was $96794.22, $35348.32, and $49016.83 which increased to $200285.00, $116320.52, and $101686.48 in the year 2019—20, respectively. Family planning and national program services were provided to 6,259 and 4,061 beneficiaries, respectively, in the year 2015--16 which markedly increased to 16,360 and 9,552 in the year 2019--20. Unit-cost of service provided by ASHAs in the National Programme ($1.13) was the lowest and for Family Planning Services ($5.71) were the highest.

Conclusions:

ASHA-Soft program seems a potential program to attract ASHA workers for delivering health care services. The findings of this study could assist policymakers in guiding further decision-making.

Challenges, Barriers, and Good Practices in the Implementation of Rashtriya Bal Swasthya Karyakram in Jodhpur, India

Introduction The Rashtriya Bal Swasthya Karyakram of the Government of India subsumes the existing school health program to provide care and treatment to children below 18 years through screening and early interventions. Benefitting an estimated 270 million children for 30 preidentified conditions is a step toward “health for all.” Although the program is running since 2013, due to paucity of studies particularly in Thar desert region and its associated challenges, this study was planned to assess challenges and good practices in the implementation of RBSK in Jodhpur.

Objectives To assess the challenges, barriers, and good practices in the implementation of RBSK among the mobile health team (MHT) in Jodhpur, Rajasthan.

Methods A community based descriptive cross-sectional study in all 11 medical blocks of Jodhpur district, with purposive sampling to invite all members of MHT to participate in the study as grassroot workers was planned. A pretested, semistructured questionnaire was processed using SPSS for quantitative component and in-depth interviews were reported using qualifiers for qualitative observations.

Results As much as 74.1% (n = 40) of the staff perceived the trainings to be sufficient for daily work needs but needed more sessions for birth defects (33.3%) and development delays (29.6%). As much as 96.3% (n = 52) of the staff considered salaries to be low and 55.5% were dissatisfied with the jobs. However, 70.4% found targets to be achievable and 76% found the work environment helpful. Taboos and superstitions in community, harsh climate, dual workload on pharmacists as data operators, and noninclusion of AYUSH medicines for AYUSH medical officers (MOs) were few of the challenges, while good practices such as fully equipped MHTs, readily available vehicles, information education communication (IEC) materials, and treatment coverage under Bhamashah Bima Yojana (BSBY) were also observed.

Conclusion Many good practices were observed during the study which can be adopted by other states for better implementations elsewhere. Certain challenges such as belief in quackery, superstitions and taboos could be minimized by conducting rapport-building meetings with community stakeholders. Feedback and regular trainings of MHT staff can further increase the success manifold.

Analysis of Facility and Home Isolation Strategies in COVID 19 Pandemic: Evidences from Jodhpur, India

Purpose

Jodhpur administration directed its efforts to control and mitigate COVID 19 infection by implementing and monitoring facility isolation (FI) and home isolation (HI) measures. This study is conducted with a hypothesis that there is no difference in the quality of life and cost-effectiveness of mildly symptomatic or asymptomatic patients in HI and FI.

Patients and Methods

A mixed-method study was conducted in Jodhpur in September 2020. The purposive sampling technique was used and data from 120 individuals admitted in HI and FI were collected. The information about the status and functioning of isolation facilities was collected from various sources. Multi-stakeholder interactions with 15 personnel engaged in managing isolation facilities were done. EQ-5D version (EQ-5D-5L) which consists of the EQ-5D descriptive system and the EQ visual analog scale (EQ-VAS) was used to assess health-related quality of life.

Results

The strength of HI strategy is demonstrated by its ability to provide psychological and social support with minimal logistic requirements but the issue of sufficient household infrastructure, adequate family and societal support for implementing this strategy is of concern. The strength of FI strategy includes its ability to provide support to patients who have issues of sufficient household infrastructure, adequate family and societal support, but this strategy poses a threat of increasing human resource constraints and financial load on the health system. The respondents from HI obtained a mean EQ-5D index score of 0.90 and a mean VAS score of 85, whereas it was 0.80 and 78.5, respectively, for FI. The cost estimated for home isolation was Rs 549 (7.43 US $) per person, whereas it was Rs 2440 (33.02 US $) for facility Isolation.

Conclusion

Though HI seems advantageous in terms of a better quality of life and cost-saving over FI, both the strategies are context-specific having their own trade-offs.

Assessment of monitoring and online payment system (Asha Soft) in Rajasthan using benefit evaluation (BE) framework

Context

e-Health programs are implemented assuming that e-health/digital health can prove beneficial but pieces of evidence for assessing the actual benefits of e-health programs are lacking.

Aims

To utilize the benefit evaluation (BE) framework to assess Asha Soft, which is an online payment and performance monitoring system initiative taken by Rajasthan.

Settings and Design

BE of Asha Soft in Rajasthan.

Methods and Materials

BE of ASHA Soft was done using scoping review with consultation exercise. The rationale behind using this methodological framework is to contextualize knowledge of the current state of understanding within BE framework practice contexts. The themes used for data compilation and analysis were based on three broad dimensions of BE framework namely, health information technology quality, use, and net benefits.

Results

The state of Rajasthan has been the first in the country to start an online system of payment and monitoring of ASHA workers, through Asha Soft. It has administrative and supportive functions. Its simple and easy to use graphical user interference helps users to make accurate data entries and obtain desired monitoring and analytical reports. It has attributed to the availability of data on various parameters which help decision-maker to decide about the performance of ASHA worker and has brought a positive impact on the work performance of ASHAs. This online payment and monitoring mechanism has argumented motivational level and intention of use. The program has optimally utilized available human resources and no apparent monetary cost was involved in developing this software.

Conclusions

This scoping study using the BE framework has provided evidence on the potential benefits of Asha Soft adoption in Rajasthan. It is recommended that future in-depth assessment of other e-health initiatives could be undertaken to guide the decision making.