Tripathi Stuti, Gupta Shefali, Sharma Sandeep, Nair Saritha, Menon Geetha, Gulati Bal Kishan, Yadav Jeetendra, Chalga Manjeet Singh, Rao Chalapati, Sharma Saurabh
ICMR- National Institute for Research in Digital Health and Data Science, Ansari Nagar, New Delhi, India.
ICMR- National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India.
J Family Med Prim Care. 2024 Dec;13(12):5840-5846. doi: 10.4103/jfmpc.jfmpc_969_24. Epub 2024 Dec 9.
Cause-of-death (CoD) information is crucial for health policy formulation, planning, and program implementation. Verbal Autopsy (VA) is an approach employed for the collection and analysis of CoD estimates at the population level where medical certification of cause of death is low and, secondly, for integrating it with the existing public health system by utilizing the grassroots level workforce.
The study aims to understand the field perspectives on implementing the 2022 WHO VA instrument in rural India through the existing public health system.
This article is derived from a qualitative arm of study that was conducted in one of the blocks of Kanpur district, Uttar Pradesh. Frontline health workers (FHWs), as well as Medical Officers (MOs) serving in the Community Health Centre (CHC) area, were selected as study participants. A 5-day training and orientation workshop was conducted to train the FHWs to conduct computer-assisted personal interview VA using the 2022 WHO VA instrument. MOs have been trained to assign the CoD via Physician-Certified VA (PCVA). In-depth interviews (IDIs) were conducted with FHWs involved in conducting VA and physicians involved in conducting PCVA within the field practice area.
A total of 13 IDIs were conducted, consisting of 10 FHWs and 3 MOs, within the selected CHC area of Ghatampur. Based on the responses received, five major themes were identified. Although VA is being used to collect CoD information from the community in India through a Sample Registration Survey (SRS), the key findings suggest that this activity could be scaled up by utilizing the existing public health system. However, additional manpower may be required for constant monitoring and evaluation of the program. Incentivization of FHWs would aid in the timely completion of VAs and coordination with local and higher health authorities.
The perception of healthcare workers about the feasibility and acceptability of VA in this study highlighted some of the challenges and possible solutions that could aid in developing a comprehensive model to improve CoD information at the population level through the existing public health system.
死因信息对于卫生政策制定、规划及项目实施至关重要。口头尸检（VA）是一种用于在死因医学认证率较低的人群层面收集和分析死因估计数的方法，其次，通过利用基层工作人员将其与现有的公共卫生系统相结合。
本研究旨在了解通过现有的公共卫生系统在印度农村地区实施2022年世界卫生组织VA工具的实地观点。
本文源自于在北方邦坎普尔区的一个街区开展的一项定性研究。一线卫生工作者（FHWs）以及在社区卫生中心（CHC）地区服务的医务人员（MOs）被选为研究参与者。举办了为期5天的培训和定向研讨会，以培训FHWs使用2022年世界卫生组织VA工具进行计算机辅助个人访谈式VA。MOs已接受培训，通过医生认证的VA（PCVA）来确定死因。在实地实践区域，对参与VA的FHWs和参与PCVA的医生进行了深入访谈（IDIs）。
在加坦布尔选定的社区卫生中心区域共进行了13次深入访谈，其中包括10名FHWs和3名MOs。根据收到的回复，确定了五个主要主题。尽管VA正在通过样本登记调查（SRS）从印度社区收集死因信息，但主要研究结果表明，利用现有的公共卫生系统可以扩大这项活动的规模。然而，可能需要额外的人力来持续监测和评估该项目。对FHWs给予激励将有助于及时完成VA，并与地方和上级卫生当局进行协调。
本研究中医疗工作者对VA可行性和可接受性的看法突出了一些挑战以及可能的解决方案，这些有助于通过现有的公共卫生系统开发一个综合模型，以改善人群层面的死因信息。
