Using Community Participation to Improve the Health System in South India

利用社区参与改善印度南部的卫生系统

基本信息

批准号：
8131143
负责人：
Kaivan Munshi
金额：
$ 46.93万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8131143
关键词：
Adherence Adult Area Biological Markers Caring Case Management Castes Cause of Death Censuses Characteristics Communicable Diseases Communities Community Health Community Participation Confidentiality Cooperative Behavior Country Data Decentralization Economics Employee Ensure Exclusion Experimental Games Future Generations Government Health Health Personnel Health system Home environment Household Human Resources India Individual Institution Intervention Laboratories Lead Literature Measures Methods Monitor Motivation Neighborhoods Outcome Measure Patients Performance Pharmaceutical Preparations Policies Population Public Health Pulmonary Tuberculosis Questionnaires Randomized Randomized Controlled Trials Regimen Research Research Infrastructure Role Rural Social Interaction Social Network Social Welfare Social support Sociology Source Study Section Surveys System Techniques Testing Time Treatment Protocols Treatment outcome Tuberculosis Work arm base burden of illness cost density experience improved insight interdisciplinary collaboration member population based preconditioning programs public health relevance response rural area social social capital solidarity success theories trait volunteer willingness

项目摘要

DESCRIPTION (provided by applicant): The unsatisfactory performance of public health systems, particularly in poor rural areas, has lead to calls for decentralization and greater community participation throughout the developing world. This project rigorously investigates where and why community health volunteers will be motivated to effectively carry out their assigned tasks. The project focuses on tuberculosis, a leading contributor to the global burden of disease, and proposes to use community volunteers as Directly Observed Treatment (DOT) providers to ensure that TB patients adhere to their extended treatment regimen. Social solidarity-the selfless willingness to help another without receiving direct benefits in return-is seen as the primary motivation for community volunteers when strict confidentiality must be maintained, as with TB case management. The new theory of solidarity formation that is developed indicates that spatially dispersed communities with less dense social networks will compensate for their limited ability to enforce cooperation among their members by investing in solidarity. The theory predicts that these communities should therefore produce more effective DOT providers. This hypothesis will be tested in a unique social laboratory in rural South India with a population of 1.2 million, covering 420 villages (neighborhoods) and including 50 kin-groups (sub-castes); kin-groups span a much larger area than the village and are an important source of economic and social support in the rural Indian context. Data will be collected from three sources. First, a randomized control trial will assign the 4000 adult pulmonary TB patients who enter the public health system over a 2.5-year period to one of four arms: (1) community DOT provider within the patient's kin-group in the same village; (2) community DOT provider within the patient's kin-group from a nearby village; (3) community DOT provider outside the patient's kin-group in the same village; (4) government DOT provider, the current method of care (control arm). DOT provider performance will be based on objective measures of treatment success as well as assessment of the patient's (and DOT provider's) experience. Second, a survey of 10,500 households will collect measures of solidarity using multiple techniques (questionnaire responses and experimental games). Third, historical census data on community spatial dispersion will be matched to TB patient outcomes and measures of community solidarity. Based on the theory, patients assigned to TB volunteers from their own kin-group are expected to enjoy relatively high levels of treatment success (Aim 1) and solidarity is expected to be greater within kin-groups than within villages (Aim 2). Looking across kin-groups, more spatially dispersed kin-groups are expected to generate better volunteer performance (conditional on the patient being assigned within kin-group) (Aim 3) and greater levels of solidarity (Aim 4). Given current efforts to decentralize the health system in India and other countries, research aiming to systematically evaluate successful community participation and understand its underlying preconditions comes at a particularly opportune time. PUBLIC HEALTH RELEVANCE: Using Community Participation to Improve the Health System in South India Project Narrative The major objective of this project is to rigorously investigate where and why community participation in the health system in rural South India can be successful. The project explores the feasibility of using community volunteers for case management of tuberculosis, a serious infectious disease and a leading cause of death worldwide.

描述（由申请人提供）：公共卫生系统的表现不尽如人意，特别是在贫困农村地区，导致整个发展中国家呼吁权力下放和更多的社区参与。该项目严格调查社区卫生志愿者将在何处以及为何被激励有效地执行其分配的任务。该项目重点关注结核病这一造成全球疾病负担的主要因素，并建议利用社区志愿者作为直接观察治疗 (DOT) 提供者，以确保结核病患者坚持其延长的治疗方案。当必须严格保密时，就像结核病病例管理一样，社会团结——无私地帮助他人而不获得直接利益回报——被视为社区志愿者的主要动机。新的团结形成理论表明，空间分散、社交网络密度较低的社区将通过投资团结来弥补其在成员之间加强合作的有限能力。该理论预测，这些社区应该因此产生更有效的 DOT 提供者。这一假设将在印度南部农村地区一个独特的社会实验室进行检验，该实验室拥有120万人口，覆盖420个村庄（居民区），包括50个亲属群体（亚种姓）；亲属群体的范围比村庄大得多，是印度农村地区经济和社会支持的重要来源。数据将从三个来源收集。首先，一项随机对照试验将在 2.5 年期间进入公共卫生系统的 4000 名成年肺结核患者分配到四个组之一：（1）同村患者亲属内的社区 DOT 提供者； (2) 来自附近村庄的患者亲属内的社区 DOT 提供者； (3) 患者同村亲属以外的社区 DOT 提供者； (4) 政府 DOT 提供者，当前的护理方法（控制臂）。 DOT 提供者的绩效将基于治疗成功的客观衡量以及对患者（和 DOT 提供者）经验的评估。其次，对 10,500 个家庭的调查将使用多种技术（问卷调查和实验游戏）收集团结措施。第三，社区空间分散的历史人口普查数据将与结核病患者的治疗结果和社区团结的衡量标准相匹配。根据该理论，从自己的亲属群体中分配给结核病志愿者的患者预计会获得相对较高的治疗成功率（目标 1），并且亲属群体内的团结预计会比村庄内更强（目标 2）。纵观亲属群体，空间上更分散的亲属群体预计会产生更好的志愿者表现（条件是患者被分配到亲属群体内）（目标 3）和更高水平的团结（目标 4）。鉴于印度和其他国家目前正在努力分散卫生系统的权力，旨在系统评估成功的社区参与并了解其基本前提条件的研究来得正是时候。公共卫生相关性：利用社区参与改善印度南部的卫生系统项目叙述该项目的主要目标是严格调查印度南部农村地区社区参与卫生系统的地点和原因可以取得成功。该项目探讨了利用社区志愿者进行结核病病例管理的可行性，结核病是一种严重的传染病，也是全球主要的死亡原因。