Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state

Autor: Samir Garg, Narayan Tripathi, Jayathra Datla, Tomas Zapata, Dilip S. Mairembam, Kirtti K. Bebarta, C. Krishnendhu, Hilde de Graeve
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Human Resources for Health, Vol 20, Iss 1, Pp 1-10 (2022)
Druh dokumentu: article
ISSN: 1478-4491
DOI: 10.1186/s12960-022-00737-w
Popis: Abstract Background The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh. Methods The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs. Results The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p
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