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.

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.

Indigenous system of medicine lady doctors and general nurse midwives in operationalization of 24 x 7 services under NRHM in selected districts of Uttar Pradesh

OBJECTIVES

To find out the status of utilization of MCH services after the induction of the indigenous system of medicine (ISM) lady doctors and CNMs for 24 x 7 services and the acceptance of this innovation by the health system and the community.

METHODS

This was a cross-sectional descriptive study conducted during October to November 2008 in 10 blocks of 5 selected districts in Uttar Pradesh. Study subjects (CMO, MO I/C, ISM lady doctors, GNMs, PRI members) were interviewed and FGDs were also conducted.

RESULTS

Shortages of medical and paramedical staff as well as facilities for institutional delivery at the district and block level were revealed. Only 6 out of 16 ISMs were trained. Knowledge of the ISMs/GNMs was lacking in many essential components of MCH including identifying high-risk pregnancy, high-risk newborn for urgent and timely referral. 36% could identify high-risk pregnancy and only 18% used partograph during labour. About 68% of the ISMs/GNMs were dissatisfied regarding honorarium, 59% with work conditions and 55% with delivery instrument. Induction of ISMs/GNMs were welcomed and accepted by medical officers and panchayets. Delay in payment of honorarium and pay disparity between MBBS doctors and ISM lady doctors and lack of proper logistic support were some of the problems facing the ISMs/GNMs.

CONCLUSION

For sustenance, in service training, provision of transport and accommodation, logistic support, well equipped labour room, timely monitoring and supervision, removal of pay disparities need to be ensured. The contractual appointment should also be made permanent and lucrative.