Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands".

BACKGROUND: Over the last 20 years, community health workers (CHWs) have become a mainstay of human resources for health in many low- and middle-income countries (LMICs). A large body of research chronicles CHWs' experience of their work. In this study we focus on 2 narratives that stand out in the literature. The first is the idea that social, economic and health system contexts intersect to undermine CHWs' experience of their work, and that a key factor underpinning this experience is that LMIC health systems tend to view CHWs as just an 'extra pair of hands' to be called upon to provide 'technical fixes.' In this study we show the dynamic and evolving nature of CHW programmes and CHW identities and the need, therefore, for new understandings. METHODS: A qualitative case study was carried out of the Indian CHW program (CHWs are called accredited social health activists: ASHAs). It aimed to answer the research question: How do ASHAs experience being CHWs, and what shapes their experience and performance? In depth interviews were conducted with 32 purposively selected ASHAs and key informants. Analysis was focused on interpreting and on developing analytical accounts of ASHAs' experiences of being CHWs; it was iterative and occurred throughout the research. Interviews were transcribed verbatim and transcripts were analysed using a framework approach (with Nvivo 11). RESULTS: CHWs resent being treated as just another pair of hands at the beck and call of formal health workers. The experience of being a CHW is evolving, and many are accumulating substantial social capital over time - emerging as influential social actors in the communities they serve. CHWs are covertly and overtly acting to subvert the structural forces that undermine their performance and work experience. CONCLUSION: CHWs have the potential to be influential actors in the communities they serve and in frontline health services. Health systems and health researchers need to be cognizant of and consciously engage with this emerging global social dynamic around CHWs. Such an approach can help guide the development of optimal strategies to support CHWs to fulfil their role in achieving health and social development goals.

Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media.

Genetic polymorphism of CYP2C19 in Maharashtrian population.

Inter-individual variability in drug response is well known. Genetic polymorphism in genes encoding drug-metabolizing enzymes results in variation in drug metabolism and in turn drug response. The cytochrome P450 enzymes (CYP) play a central role in the metabolism of many therapeutic agents. CYP2C19 gene polymorphism is widely studied in Caucasians, African, and Oriental populations; however, far less is known about other ethnic groups such as Indians. Indian population is an inter-mixture of the Aryan, Dravidian, Kolarain, and the Mongoloid races. CYP2C19 gene polymorphism is reported in North Indian and South Indian populations yet not much is known about Maharashtrian population of Australoid-Europoid origin residing in Western India. This is the first report on CYP2C19 allele and genotype frequencies in Maharashtrian population. In this study, genotypes of major allelic variants of CYP2C19 gene in 139 unrelated healthy Maharashtrian subjects was determined and their frequencies were compared with previously studied Indian and other populations. Meta-analysis revealed that the study population is distinct from Caucasians, Africans and some of the Asian populations and significant heterogeneity exists among Indian subpopulations.

Social status makes a difference: tuberculosis scenario during National Family Health Survey-2.

BACKGROUND: The poorest people are vulnerable to Tuberculosis because of the living and working conditions but they plunge deeper into poverty as a consequence of this disease. AIMS: The present study focuses on the socio-demographic characteristics of patients of TB with specific reference to prevalence of TB and health care seeking behaviour of men and women. METHODS: The data for the study comes from nation-wide National Family Health Survey -2, conducted in 1998-99. Paper looks at the relationship of reporting TB infection and seeking treatment for men and women by various socio-economic characteristics. Multivariate logistic regressions are applied to find the significant factors explaining reporting of TB and treatment-seeking. RESULTS: In the entire sample 1735 males and 1266 females are reported to suffer from TB. Reporting of TB is significantly (p=0.000) more among males having charecteristics with lower standard of living, scheduled tribes from rural area and illiterate population. It increases with age. Significant difference (p=0.002) is observed between urban and rural female's treatment seeking for TB. In case of females as age increases, treatment seeking goes down (p=0.007). Treatment seeking for currently married women is less frequent than that of all other women. CONCLUSIONS: Apart from economic status and living conditions, place of residence (urban / rural) and ethnic identity made people more vulnerable in terms of reporting the disease and access to treatment.