RESUMEN
Cost-benefit analysis underlines the importance of screening non-communicable diseases (NCDs) and seeking treatment which can aid early detection, cutting expenses and averting deaths. The government of India NCD screening program leaves many to opportunistic screening whilst the health system is inadequate to deliver its goal due to short-staffing, underequipped, and incomplete data management. In order to ease the cost and convenience barrier faced by the Indian poor, we propose testing the efficacy and sustainability of Community Health Workers (CHW), referred to as Barefoot nurse (BFN) for screening NCD. The BFN intervention will be evaluated using a two-arm cluster randomized controlled trial. The participants of the study are residents of eight selected wards each of Doddabalapura and Hoskote respectively, North Bangalore, Karnataka. The intervention will be delivered by eight BFNs. The control area will receive usual care by the Auxiliary Nurse midwife (ANM). The primary outcome indicators are a) proportion of population screened for NCDs, b) proportion of population, diagnosed with NCDs repeated the screening, c) proportion of first-time detection and referral. The secondary outcome measures are a) average amount of money earned, b) timeliness and c) completeness of data entry. Cluster randomization will be done prior to recruitment of participants. Enrolment of cluster will ensure non-overlap of intervention and control wards. The net change in the key outcome measures will be assessed using the difference in difference (DID). Amidst huge NCD burden the proposed study seeks to test the efficacy of a self-sustainable CHW model in resource deficient areas.
RESUMEN
This is a review of the manner in which the Revised National Tuberculosis Control Programme (RNTCP) is being implemented, with a focus on the attention being paid to ethical principles and the incorporation of these into the programme. The article elucidates how ethical principles can be applied to protect the rights of the potential beneficiaries of the RNTCP. The authors consider the RNTCP in the light of a framework that is usually applied in research to evaluate ethical principles in public health practice. The three key principles of the framework are: respect for persons, beneficence and justice. The authors propose that this framework be used to make an ethical evaluation of other pu health programmes at several levels, since this could bring far-reaching benefits to society.