Title : Facilitators and challenges for integrating campaigns for control of neglected tropical diseases in North India
Integrated health campaigns with multiple interventions can potentially lead to improved population coverage, service delivery, quality assurance and time efficiencies. We conducted a study in Uttar Pradesh where disease control campaigns are held routinely to achieve national health programme targets inorder to explore scope of integration of campaigns by identifying facilitators and challenges to future integration on the basis of experiences of the key stakeholders. We proposed integration of lymphatic filariasis, helminthiasis, screening for high blood pressure and blood sugar, as well as COVID related communication as campaigns for integration and encouraged the stakeholders to share their perceptions and opinions regarding facilitators and challenges to integration. The data collection techniques used were in depth interviews and focus group discussions of the respondents in two districts of Uttar Pradesh – Gorakhpur and Deoria. The respondents were the district administrators, district and block level programme managers, health providers, grass root workers, community members and partner agencies. Many of the stakeholders upheld that political and administrative support from state level officials to grass-root level workers was crucial to facilitate health campaign integration. There is an existing surveillance campaign called DASTAK (meaning- a knock on the door) which was originally launched in response to Japanese encephalitis but over time has integrated surveillance for tuberculosis, malaria, dengue, water borne diseases and COVID-19. Most of the respondents felt that the DASTAK programme offered insights for integration. Accredited Social Health Activists (ASHA), who are grass root workers serving as a link between their communities and the health care delivery system were pointed out as key to the success of any campaign in the two districts by almost all the respondents. Regarding the campaigns we proposed for integration, screening for high blood pressure and sugar could be planned only in a camp mode in the health facilities since ASHAs were not trained for both. The responses pointed out that a well-functioning integrated campaign required well-managed finances and a seamless flow of funds, partnership with international organizations, involvement of civil societies, and increased use of technology for communication, monitoring, supervision, and reporting. Other important facilitators were inter-sectoral coordination among all the stakeholders, adequate resources (e.g., infrastructure, logistics) and the participation grass-root level workers who acted as the link between the health system and community. A few challenges observed were low financial incentivization for ground-level workers along with high dependence on them for campaign delivery. Non acceptance of a few interventions by a few pockets of the community, stemming from low awareness and sensitization, also posed a challenge to integration. Local decision making and collaborative planning, training, supportive supervision and incentivisation of ASHAs and grass root workers, community sensitization and mobilization, with use of appropriate technology for monitoring are important for collaborative planning and integration of campaigns.
Audience take away:
1. The presentation will share insights for integrating more than one campaign in areas where campaign mode of service is frequently delivered.
2. The findings of the study – facilitators and challenges may be applicable in similar setings.
3. The research can be utilized for teaching and training