"Be faithful in small things because it is in them that your strength lies"
- Part 2 -

Shobha Shukla *

Dr KS Sachdeva - Deputy Director General at the national AIDS programme in India

‘Change is never easy’

There indeed are complex challenges confronting our health programmes. Ushering a positive change in public health is not easy. Whether it is HIV or TB or other specific health programmes in India, one of the challenges which people often refer to is engaging private healthcare sector. Despite innumerable efforts to engage private sector in public health, successes have been sketchy, few and far in between. Solving this riddle continues to haunt us till date and the blame game is on, at times, rightly so.

As the old adage goes: We do not grow when things are easy; we grow when we face challenges. Dr Sachdeva feels this is an area where a lot remains to be done to optimize public health outcomes.

“We did realize that a lot of patients are seeking treatment from outside the programme [RNTCP]. So we began initiatives to involve the private sector to be able to reach these patients. One of these initiatives was standardizing treatment options, which are common for both public and private sector. That is why we developed an enabling 'Standards of TB Care in India' document, which talks of common standards across public and private sector. It also helped us in gaining the confidence of the private sector. We also made TB notifications mandatory – but it is not truly mandatory as it is an executive order and practitioners are encouraged to notify TB patients so that the programme has a better sense of TB load within a community and we can address it optimally. When I look back, I realize that we have not been very effective in involving the private sector on scale. This is one area we need to lay more emphasis on-- involvement of private sector in TB programme, and same holds true for HIV programme” said Dr Sachdeva.

“At this conference [ASICON 2016] I interacted with 5-6 drug manufacturers and tried to get a sense of their annual sales with the intent to have an idea of the number of patients outside of the National AIDS programme. It roughly translates to about 100,000 patients who do not seek HIV care from National AIDS programme. There could be many reasons for this– may be they do not want to visit government facility or be recognized as having HIV. So if we can make processes which enable patients to seek care in confidence and they can repose faith in their providers that they will not share their status with anybody else (which is a national policy but somehow confidence in patients may be lacking), perhaps we can get more patients on board, provide them treatment free of cost and offer them good quality services.”

“So this is one area we aim to work on – not only with patients but also with their providers. Patients may choose to remain with their [preferred] providers but we get to know of how he or she is doing and how we can link our services with those patients” shared Dr Sachdeva.

Next goalpost: Bridging the gap

“We should be developing models of care which are community oriented and public health oriented and get all stakeholders onboard. While specific national programmes are engaging stakeholders, but more or less, they are working within their silos – we should be bridging that gap” emphasized Dr Sachdeva.

An enabling environment for health seeking behaviours is also a part of progressing towards health justice. “Involving more community members to take care of their own health, demystifying some of the treatment options for complex diseases, and building the capacity of health personnel to address these public health issues, might be some of the key priorities for the near future” suggests Dr Sachdeva.

Innovative health financing is indeed becoming a compelling priority. "We should be leveraging resources beyond the Ministries of Health. For example tapping into corporate social responsibility programmes, corporate philanthropists, individual donors, there is thinking going on that we should be having a common platform and tapping into these resources" rightly opines Dr Sachdeva. Optimising every rupee or dollar invested in health is not 'a choice' anymore - it is the only choice to make most of what we have!

"We also need to look into human resource beyond what is available in national health system – qualified individuals who are available within the country should be able to contribute for a disease-free India" said Dr Sachdeva.

Moments that glitter as years rolled by

"One of such moments I can think of is when we introduced the essential drug list and essential list of surgical consumables for government of Delhi and then carried out procurement on them, saving 40% of costs incurred earlier. It is satisfying to see such initiatives are sustainable and rolling. Similarly India’s drug resistant TB programme diagnoses and puts on treatment the highest number of patients compared to any other country in the world, and we have treatment outcomes comparable to the rest of the world. Pharmacovigilance and introduction of new drugs is another such moment but there is still a lot of work to do," said Dr Sachdeva. We cannot agree more with him as a lot more needs to happen for ensuring that the new anti-TB and HIV care drugs reach every person in need.

Persistence is key

For those who are beginning their journey in public health, Dr Sachdeva has some words of advise: "One of the messages I will like to give them is that this is a very exciting, challenging and satisfying area, but it is not that the rewards will come instantaneously. Rewards may come after few years after you have put in hard work, as opposed to clinical work where rewards may come within days, weeks or months of putting in hard work. Rewards you see here are very disproportionate to the efforts you may have put in--one policy level change can affect the entire spectrum of lives of the community. We need dedication, patience, and perseverance to see the results of our efforts."

o Watch or embed this video interview: http://bit.ly/2fRqXHa
o Listen, embed or download this audio podcast: http://bit.ly/2gXwl7p

Concluded...