Rauf Khan : To Understand Community Health and Public Health

Item

Title: Rauf Khan : To Understand Community Health and Public Health
extracted text: Final Report
2013-14

Rauf Khan
CHLP Fellow

Acknowledgements
I am grateful to Dr.Thelma & Dr. Ravi who gave me this
wonderful opportunity to join this CHLP fellowship Program as
well I am thankful to My Mentor Prassana , Dr. As mohammed,
Dr.Yuvraj, Karthikey, Dr.Aditya, Shahni, SOCHARA Team & all
fellows who supported me in this journey .

1. Why did I join CHLP ?
After completing MSW I worked with many N.G.Os , I was keen
to work in health sector but no N.G.o could give me better
understanding in health . so from them I was feeling some lack in
myself regarding knowledge, understanding on health. So when I
heard about this opportunity I decided to join this fellowship and
I am glad to join this fellowship program.
2. Leanig objectives in CHLP
1. To understand Community Health & Public Health.
2. To understand Communitisation in NRHM.
3. Tounderstand Health senerio at global level.
4. To Develop Communication Skills, Reporting Skills.
3. Overall Leaning for CHLP
I get oriented with so many health subjects such as:3.1. Social Determinants of health –
3.2. Social Justice
3.3. Women’s Health
3.4. Communicable & Non Communicable Disease

3.5 Environment Health
3.6. AYUSH
4.Organizations visited and projects Undertaken
1- The Green Foundation, Bangalore April 2013
2- Basic Need India , Bangalore April 2013
3- FRLHT, Bangalore July, 2013
4- The Assocition of People with Disability(APD),Bangalore
Octomber 2013
5- KARUNASHRAY,Bangalore Hospice Trust, November
2013
6 - TRICHY Tamil Nadu , December 2013
5 .Conferences & meeting attended
1- KARUNA Trust , The PLASTIC COW Bangalore Jan, 2013
2- MFC , Hederabad February, 2013
4- State level consultation on “Ban on Tobacco Advertising,
Promotion and Sponsorship” July, 2013
5- Transation analysis, Octomber 2013
6- The 4th Annual Conference of The Karnataka Chapter of the
Indian Academy of Geriatrics on “Identifying solutions to
challenges in Geriatrics”, December 2013

6. Field Placement –
I was placed in Lepra Society
About the organization
Vision of Lepra Society –
• Equitable Access to Health and an improved life for India’s
Poor and Marginalized Communities.
Mission of Lepra Society
• "LEPRA Society, health in action; is a health and development
organization working to restore health, hope and dignity to
people affected by leprosy, tuberculosis, malaria, HIV/AIDS,
blindness and other health conditions exacerbated by stigma
and social discrimination"
History of the Organization
• History dates back to 1925, when the British Empire Leprosy
Relief Association (BELRA) started leprosy work in India.
LEPRA India was established in Hyderabad in 1988, as a
partner of LEPRA UK, to serve the needs of people affected
by leprosy. Operations were later extended to other areas of
Andhra Pradesh and other Indian states including Orissa,
Madhya Pradesh Bihar and Jharkhand.
• LEPRA India is a non-governmental organization that
promotes quality health care, initiates and fosters new
developments and implementation.
• The Society aims to support the National Health Programs in
the prevention and control of diseases such as Leprosy,
Tuberculosis, Malaria, HIV/AIDS and Blindness.
• The Society focuses health improvement activities in the
community that are marginalized or poor, especially women
and children, young people, slum populations and migrants
affected by the above mentioned diseases and tries to bring
about positive changes in their life-style. The work in Andhra

Pradesh, Orissa, Madhya Pradesh, Bihar and Jharkhand states
targets a population of nearly 12 million people..
• Established in 1989, LEPRA India is an independent not-forprofit NGO, with no religious, ideological or political
affiliation. The Management Committee formulates policies
which are implemented by the Chief Executive of the
organisation.
• LEPRA India registered as LEPRA Society under the Andhra
Pradesh (Telangana areas) Public Societies’ Act 1350 Fasli
(Act of 1350 F) No 474 on 22nd February 1989. It works in
close coordination with the Government of India, Ministry of
Health, and Family Welfare, at the Central, State and district
levels. It is a member of the State leprosy and TB societies of
the Government of Andhra Pradesh & Orissa.
• Established in 1989, LEPRA India is an independent not-forprofit NGO, with no religious, ideological or political
affiliation. The Management Committee formulates policies
which are implemented by the Chief Executive of the
organisation.
• Registered under section 12A of the Income Tax Act and has
also been granted exemption certificates under sections 80G of
the Income Tax Act 1961 and permitted to accept foreign
contributions by the Ministry of Home Affairs, Government of
India.
Collaborators of the Org.• Government of India
• Government of Andhra Pradesh
• Government of Orissa
• Government of Madhya Pradesh
• India HIV/AIDS Alliance
• Indian Council of Medical Research (ICMR)
• Andhra Pradesh State AIDS Control Society (APSACS)
• Orissa State AIDS Control Society (OSACS)
• TB Control Society in Andhra Pradesh, Orissa & Bihar
• Karnataka Health Promotion Trust

• SLAP India (Society of Leprosy Affected Persons)

Projects in Madhya Pradesh
• AROGYA
• AXSHAYA
• SPANDANA - COMMUNITY CARE CENTER
• BUNIYAD
• TRU

I am was associated with Arogya project, which was working
on HIV/AIDS –TB co-infection. About the project –
Arogya –
• Arogya Project is a five year (Jan.2009-Dec.2013) Project cofunded by European Union and LEPRA. The Project ensures
highly vulnerable groups in Madhya Pradesh benefit from

actions addressing HIV/AIDS, TB & HIV/TB co-infection.
The Project is being implemented in four districts of Madhya
Pradesh namely Dewas, Harda, Indore and Bhopal.
Areas of Operation

Goal
• To reduce the burden of HIV and TB and HIV/TB co-infection
on highly vulnerable communities in Madhya Pradesh by
strengthening the capacity of organizations, and facilitating
convergence between government and non-government
efforts.
Objectives
• To strengthen and link-up the work of public, private and
community based organisations so that they can respond more
effectively and reach more high risk and out-of-reach
populations to HIV/AIDs and TB in Dewas, Harda, Indore and
Bhopal districts of Madhya Pradesh
Outcomes
• Increased knowledge, attitude and practice relating to
HIV/AIDS amongst high risk groups and out-of reach
populations.
• Attainment (or improvement upon) of RNTCP targets for TB
in the project area.

• Improved government and private/traditional health service
provider’s capacity and coordination and to deal with
communicable diseases including HIV/AIDS and TB.
Key Activities:
• Establish and strengthen Community Health Forums
• Develop Behavior Change Communication (BCC) framework
and needs based Information Education, Communication
(IEC) material
• Strengthen ICTC (Integrated counseling and testing centers)
• Providing services through Mobile Voluntary Counseling and
Testing Centre (MICTC) with STI services

I visited lepra’s community care center ,where I met Mr. Rakesh
Rawat,Project Coordinator

He gave me some information which is as follows :Spandana Community Care Center (SPANDANA CCC)
 People living with HIV/AIDS (PLHA) require a range of HIV
services including care, treatment and support depending on the
progression and stage of the HIV infection. The progression of
the infection and consequent weakening of the immune system
will result in PLHA being vulnerable to various opportunistic
infections. The PLHA will require care and treatment for
opportunistic infections (OI) and some of these illnesses may
require in-patient care in a hospital or other centres that provide
this facility.
Goal
 To reduce HIV related morbidity and mortality in adult and
children and mitigate the impact of HIV on children and women
headed households.
Objective
 • To provide clinical as well as psychological care and support
• To reduce the load on tertiary hospitals and provide cost
effective
Treatment.
• To introduce the concept of home-based care among PLHAs
and
their
families.
• Helping them and their families to prepare for coping with life
after HIV.

Map of Indore District

FIELD WORK
• Visited villages of project area.
• Conducted one to one & group sessions along with out reach
worker.
• Organized Red Ribbon Activities in Red Ribbon Clubs with
orw.
• Meeting with cure patient group.
• Meeting with PLHA
• Visited CHC Manpur
• Meeting with B.M.O, B.P.M, B.C.M ,M.O & other staff at
Manpur.

• Visited I.C.T.C in Mhow & Manpur.
• Attended Block level Meeting at Manpur.
• Meeting with ASHA
• Participated in world T.B Day program organized by Lepra
Society.
• Visited A.R.T centre
• Visited CCC Spandana.
• Meeting with Msm group at Mhow
• Learned MCTS form filling.
• Visited PHC, SHC,& AWC.

NETWORKING :
Networking was done with Following Go, Ngo
& Health workers
• Networking with the mentor organization, know about their
work, staff structure and field intervention area.
• Networking with ASHA’s specially on Health related issue.
• Networking with Government Departments.
• Networking
with
NGOs
like
Mitra
Sringar
Smity,MPVHA,ART Centre, Jyoti Samity Bhartiya Grameen
Mahila Sangh and Pushpkunj).

Reflection on NRHM –
I visited CHC Manpur, PHC Simrol village
to know the
implementation of NRHM. As well I met PRI members, VHC members
ASHAs, ANM & MPW after discussing. I found
• At CHC doctors are working as a private doctor.
• No active involment of PRI members .
• VHC is not active.
• Politics involve in ASHA selection.
• Conflict in ASHAs
• ANM ,MPW are not sufficient , it effects on their performing

Research
“ The Study of the awareness on HIV/AIDS among ASHAs in
context with Manpur Block MHOW, District Indore”

Acknowledgement
I am grateful to, Mr.Prassnna Mr.As Mohammad, , Mr.Sabu,
Mr.Karthikeyan , Dr.rahul & friends for entire support to conduc
this studyt .without their support the study can not be reach at this
point.

Abstract
The study was conducted to know the knowledge of ASHAs on
HIV/AIDS.ASHAs are the key heath care providers in rural area and
HIV is spreading speedily in rural area so there is need to make ASHAs
Knowledgeable, skillful to regard of HIV/AIDS so rural people can
prevent from HIV, make use of Facilities provided by government.
Findings of this study shows that AHSAs have heard about HIV/AIDS,
but their knowledge on HIV/AIDS, Facilities& programs running by
government are limited and insufficient .there is huge need of
enhancing the knowledge on this emerging issue.
Key Words - : HIV,AIDS,AR T,NACO,ASHA,CHWs

1 INTRODUCTION -(Bedelu, Ford, Hilderbrand, & Reuter, 2007)
Human Immunodeficiency Virus/Acquired Immunodeficiency
Syndrome (HIV/AIDS) is a severe health issue all over the world. No
cure has been found for the disease yet. It is estimated by the Joint
United Nations Program HIV/AIDS and the World Health
Organization (UNAIDS &WHO, 2009) that the number of people living
with HIV worldwide is 33.4 million. Ever since HIV was first identified
in India among Sex workers in Chennai during 1986, HIV infections
have been reported in all states and territories. Approximately 2.47
million people in India are infected with the HIV; about 40% of these
people are women (National AIDS Control Organization (NACO,
2010) The estimated prevalence of HIV infection among people aged
15-49 yr is approaching 1 per cent and at least four million people are
infected, making it the country with the second largest number of HIV
positive people in the world. (Kermodeetal.,2005) The majority (87%)
of HIV infection in Indian women is due to heterosexual transmission
from a partner with whom the women have a monogamous relationship
(NACO, 2010). In India Adult HIV prevalence 0.31% ,(Male

0.36%,Female 0.25%) ,23,95,442 PLHA, New Infections 1,20668. In
M.P Adult HIV prevalence 0.19% ,(Male 0.23%,Female 0.16%)
,84,830 PLHA, New Infections 4806. (NACO-III2007-12)
The stigma and discrimination towards people living with HIV/AIDS is
high among health workers as well as the general population.
Knowledge and specific information has an important role in
HIV/AIDS prevention and the health workers have a central
responsibility in prevention, care and treatment. The knowledge and
attitudes of healthcare workers (HCWs) in relation to HIV infection is
an important factor influencing the willingness and ability of people
with HIV to access care, and the quality of the care they receive.
(Indian J Med Res 122, September 2005,)
The findings shows that
delegation of specific tasks to cadres of CHWs with limited training can
increase access to HIV services, particularly in rural areas and among
underserved communities, and can improve the quality of care for HIV.
There is also evidence that CHWs can make a significant contribution
to the delivery of a wide range of other health services. The study
concludes that, where there is the necessary support, the potential
contribution of CHWs can be optimized and represents a valuable
addition to the urgent expansion of human resources for health, and to
universal coverage of HIV services. CHW can more easily be
responsive to marginalized and underserved communities and so
contribute to making health services more widely available. Their
membership of the communities they serve makes them a vital link to
the network of comprehensive public health services ( 2010 Wolters
Kluwer Health )
A review of the recent literature also finds that there is a broad
consensus that delegation to cadres of health workers with no formal
clinical training can increase access to health care and improve the
quality of care. There is quantitative evidence that CHW can have a

positive impact on health outcomes. HIV programmers with the
involvement of CHW have resulted in better adherence rates and better
outcomes on ART [1-2]. A number of studies has found that CHW play
an important contributory role in countries that are scaling up HIV
services and concluded that overall CHW remain underutilized [3–5].
Some of the most robust evidence of the safety and effectiveness of task
shifting to CHW in well-designed programmes comes from rural Haiti,
where community-based care of people living with HIV/AIDS has been
highly effective [3,4].
It is of great importance to assess nursing
students‟ knowledge and attitudes towards people living with
HIV/AIDS since they will have an important role to halt this epidemic
in the coming years (Durkin).
Previous research has also shown that there is lack of knowledge about
HIV/AIDS among health care workers and nursing students. And the
need for more education on the topic is frequently expressed. Nurses
have a central role in prevention, care and treatment of people living
with HIV/AIDS (Durkin, 2004). Therefore it is important to assess
knowledge and attitudes towards people living with HIV/AIDS among
health professionals. Gained information can be used to direct
educational programs.
The Role & responsibilities of ASHA in context of HIV /AIDS has
been given in Training Modules : Raise awareness about, causation,
transmission and prevention of HIV/AIDS, Promote use of condom as
a method of dual protection, Counsel persons having risky sexual
behavior to undergo HIV/AIDS testing at nearby ICTC ,Assist HIV
positive /AIDS patients to access ART.(book No.3 NRHM2005-12)
. After a period of 6 months of her functioning in the village it is
proposed that she be sensitized on HIV / AIDS issues including STI,
RTI, prevention and referrals and also trained on new born care.
(NRHM2005-12) ASHAs had also undergone short 1-2 day trainings

on Malaria, Leprosy, Pulse Polio immunization, TB/DOTS, HIV/AIDS,
Reproductive Tract and Sexually Transmitted Infections.
Goal :- “ To Study the awareness , of HIV/AIDS among ASHAs in
context with MHOW Block Manpur, District Indore”
Objectives :• To study of literature regarding involvement of community health
workers for HIV/AIDS.
• To study ASHA Training Module -7 for understanding the role of
ASHA & HIV.
• To study the awareness , prevention and services of HIV/AIDS
among ASHAs.
Methodology:Study Design - A cross section study was conducted among 30
ASHA’s by mean of through a structured Schedule on HIV/AIDS.
Study Period

– Aug ust-September,2013

Study Area – Manpur Block –Mhow,District ,Indore(M.P)

Map of Indore District
Study Population : – 295 ASHAs are working in MHOW Block.

Sampling :interviewed .

By mean of convenient sampling 30 ASHAS were

Ethical Issue :- Verbal Consent
Inclusion :-

ASHAs who gave Verbal Consent

Data Collection – A structured Schedule was prepared for the study.
Data Analysis – data entry done in SPSS, Excel ,Table, Graph
Data Analysis
Table No. 1: Education of ASHA workers
Education of ASHA
workers
Frequency
Percent
Primary
7
23.3
Middle
12
40.0
Higher Secondary
11
36.7
Total
30
100.0
Table No.:1 Above the education status of ASHA Workers, the Majority
of respondent are Middle School Education (40%) ,11 respondent had
Secondary School Education (36.7) & 7 respondent had only primary
education (23.3%).
Table No 2: Age of the respondent
Age
of
the
respondent
Frequency
Percent
20-25
14
46.7
25-30
1
3.3
30-35
4
13.3
More than 35
11
36.7
Total
30
100.0
Table No.:2 Above the Age
of ASHA Workers, the Majority of
respondent are 20-25 age group(46.7%) ,11 respondent are more than
35 age group(36.7) , 4 respondent are 30-35 age group(13.3%)& only
one is 25-30 age group (3.3).

Table No 3: Religion of the respondent
Religion of the Frequency
respondent
Hindu
29

Percent
96.7

Muslim
1
3.3
Total
30
100.0
Table No.:3 Above the Religion of ASHA Workers, the Majority of
respondent are Hindu religion (96.7%) & 1 respondent is
Muslim(3.3%).

Table No 4: Caste of the respondent

Table No.:4 Above the Cast of ASHA Workers, the Majority of
respondent are ST(46.7%) ,11 respondent are OBC (36.7) ,3
respondent are SC(10%),& 2 respondent are General (6.7%).
Table No 7: From where heard about HIV/AIDS

Table No.: 7Above the Majority of respondent 21are heard about
HIV/AIDS in training (70%) ,6 respondent heard about HIV/AIDS
from T.V (20%,) , 2 respondent heard about HIV/AIDS from
radio(6.7%,) & 1 respondent heard about HIV/AIDS from Newspaper
(3.3%,) .
Table No :8 Knowledge on Unsafe sex & HIV spreading
70

60
50
40
could HIV/AIDS be by unsafe
sex Percent

30
20
10
0
yes

no

dont know

Table No.8 Above the Majority of respondent are 62% know that HIV
can be spread by unsafe sex while 5% says HIV can not be spread by
unsafe sex,& 30% says they don’t know about it.
Table No.:- 9 Using HIV infected needle
Knowledge on using HIV infected needle
Frequency
Percent
yes
5
16.7
no
9
30.0
dont know
16
53.3
Total
30
100.0
Table No.: Above the Majority of respondent are 16 (53.3%)said they
don’t know that HIV can be by using HIV infected needle, while 9
respondent (30%)said HIV can not be by using HIV infected needle &
5 respondent (17%)said Yes that by using HIV infected needle HIV
can be spared.
Table No 10: By HIV infected blood
Knowledge on using HIV infected blood
Frequency
Percent
yes
10
33.3
no
6
20.0
dont know
14
46.7
Total
30
100.0
Table No.: Above the Majority of respondent are 14 (46.7%)said they
don’t know that HIV can be by using HIV infected Blood, while 6
respondent (20%)said HIV can not be by using HIV infected Blood &
10 respondent (33.3%)said Yes , by using HIV infected Blood HIV
can be spared.
Table No 11: spared HIV/AIDS

Table No.: 11 Above the Majority of respondent are 26 said that they
know HIV/AIDS
spared(86.67%),while 4 respondent don’t
know(13.33%)
Table No 12: HIV infected Mother to Child
Knowledge on HIV infected Frequency
Mother to Child
yes
25
no
4
dont know
1
Total
30

Percent
83.3
13.3
3.3
100.0

Table No.: 12 Above the Majority of respondent are 25 said that they
know HIV can transmit infected mother to child(83.3%),4 respondent
said HIV can not transmit infected mother to child(13.3%)while 1
respondent don’t know about it.(3.3)
Table No 13:Prevention from HIV/AIDS
Knowledge on prevention from HIV/AIDS
Frequency
yes
21
no
7

Percent
70.0
23.3

don’t know
2
6.7
Total
30
100.0
Table No.: 13 Above the Majority of respondent are 21said that
HIV/AIDS can be prevented (70%) ,7 said that HIV/AIDS can not be
prevented (23%),& 2 said don’t know(6.7%)
Table No.14:- Knowledge about HIV testing facilities

Integrated counselling & testing center
Dots center
dont know
3%

17%
80%

Table No.14:- Above the majority of respondent are 24 (80%) know
that HIV testing done in ICTC, 5 respondent (17%) don’t know about
it,& 1 respondent wrongly said in Dots center(3%).
Table No15 : Refer to HIV Positive

Table No.15:- Above the majority of respondent are 12(40%) said HIV
Positive person refer to ICTC, 11respondent (36.6%) don’t know ,1
respondent said in Dots center(3.3%),& only 6 respondent rightly said
(20%) to ART centre.
Table No 16: Awareness programs running by Govt. for HIV/AIDS

Table No.16:- Above the majority of respondent are 26(87%) said they
don’t know about government programs on HIV/AIDS while
4respondent said (13.3%)yes they know about it.
Discussion :- As Previous research has also shown that “ there is lack
of knowledge about HIV/AIDS among health care workers and nursing
students. And the need for more education on the topic is frequently
expressed. Nurses have a central role in prevention, care and treatment
of people living with HIV/AIDS (Durkin, 2004) .This study also shows
that there is need to enhance the knowledge of ASHAs on HIV/AIDS
because their knowledge on HIV/AIDS is inadequate.

CONCLUSION : Most of respondents have heard about HIV/AIDS.
 They Have Knowledge regarding HIV/AIDS but it is insufficient.
 Most of respondents don’t Know (87%)about the programs
running by government on HIV/AIDS.
 Most of respondents Know (80%)about HIV Testing facility but
17% don’t know & 3% have wrong information on it.
 After HIV positive where someone should refer only 20%
respondent know about ART while 37% don’t know & 43% have
wrong information.
Suggestions: There is need of enhance the Knowledge regarding HIV/AIDS.
 There is need of conducting quality trainings ,workshops on the
issue.
 ASHAs should be get refresh by trainings & workshops on this
issue.
 Quality of trainings should be cheeked .
 Follow up of ASHAs should be ensured after training.
Reference :1.30. Mukherjee JS, Eustache FE. Community health workers as a
cornerstone for integrating HIV and primary healthcare. AIDS.
2. Rosen S. Patient retention in antiretroviral therapy programs in subsaharan
africa:
a
systematic
review.
:
http://www.plosmedicine.org/article/info:doi/

3. Weidle PJ. Adherence to antiretroviral therapy in a homebased AIDS
care programme in rural Uganda. Lancet 2006;
4.. Farmer P, Le´andre F, Mukherjee JS, Claude M, Nevil P, SmithFawzi MC, et al. Community-based approaches to HIV treatment in
resource-poor settings.
5. Koenig SP, Leandre F, Farmer P. Scaling up HIV treatment.
6.(Bulterys et al., 2002)
7.(Gilks et al., 2006)
8.(Bedelu et al., 2007)
9.(Celletti et al., 2010)
10.(Commminity Action on HIV/AIDS- For Indian Non-Governmntal
Organosations, 2002)
11.(Schneider, Hlophe, & van Rensburg, 2008)
12. (Bedelu et al., 2007)
13.(Nyamathi et al., 2012)
14. Book No.3 NRHM2005-12
15.Training Modules,NRHM2005-2007

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