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January 27, 2023

Ni-Kshay Setu: What is the Ni-kshay Setu and How it Supports the Health System

Need of Capacity Building For NTEP Program Implementation 

Health services, particularly those that feature work-based learning experiences, often require designated staff to spend most of their time in the patient management. They also require that staff to have the skills and supports to deliver health services properly and effectively. 

Healthcare workers and professionals offer an entry point to the health care system whether it is public or private sector. Challenges experienced by healthcare providers include limited resources, poor or inadequate knowledge, skills, and attitudes in management of TB patients, delay in identification and referral from the field to the primary care level and to further levels of care. These contribute to poor outcomes and delay in getting the services ultimately leading to morbidity and mortality of TB patients. 

Training of general health care professional; especially those working into the government program; National TB elimination Program (NTEP) in management of TB patients can help improve the care of TB patients. It also ensures the availability of proper healthcare services to the beneficiaries at the field level.

Rationale: Development of Decision-making tool for Health Care providers- "NIKSHAY SETU" (Ni: Kshay (End TB)……… SETU (Support to End Tuberculosis))

The baseline research was conducted on 450+ health care workers and 900+ TB patients and intense efforts were made to gather feedback from the State and District TB officials, selected front line workers, CHO, MO PHI, STS, STLS, GHS staff, and private doctors of the project intervention states (Gujarat and Jharkhand).

During the baseline research, 75% the healthcare professionals raised the need for trainings on different parameters of TB management and newer information on diagnostic and treatment modalities. It was observed that care specific average knowledge gap was 30% on various program management protocols which includes screenings, diagnosis, treatment, adverse drug event management etc.

During the baseline, it was found that need-based, cadre-specific, and comprehensive training methods and tools were not followed for the capacity building. Adoption of e-learning content was sparsely implemented for capacity building.

The overall consensus was to build on developing a mobile app. The series of consultative meetings with State, District officials and NTEP experts revealed that building a mobile app encompassing the self-learning model for service providers embedded with core aspects of NSP guidance documents could be a possible solution. 

Landscaping for Nikshay Setu App and Development

The exercise was carried out for developing digital training content by reviewing the academic and global public health digital learning platforms and by consultation with Government NTEP officials, Private doctors and specialists, medical college experts and stakeholders who are working into the community. Certain areas were explored to understand the need for content and the quantity to provide for the field staff. It also came to notice that when presented in a specific way, community field staff finds it more pleasant to read and understand the contents as per their choice and requirements in providing the patient-centric care under the NTEP program. 

The outline was prepared for the modules along with the contents and design to present in the app. The content was basically distributed into three sections, i.e., Learn, Manage, and Access. + Knowledge Chatbot. Considering the lack of clarity on cadre-specific training cascade for the frontline staff, the digital tool was designed to have brief learning, know more through chatbot and quick assessment components to support the government team to design the training methods and modules.

Finally, a web-based and android-based application: NIKSHAY SETU was developed to address the need of digital platform to disseminate the program guidelines and recent evidence of TB patient management to healthcare workers. The technical support from State TB and Central TB Division was continuous during the development of each interface of the application. The app has the concise the content from the 20,000 pages of the different national guidelines and reached up to 16,000+ active users in 10 months of period. 

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