“The discussion is still going on…is the program continuing or not?” – Policymaker “The program has increased our awareness about diabetes and hypertension…now we need to keep it going.” – FLHW
Comparison facilities Patient focus group discussions and staff interviews at comparison facilities echoed many of the same themes as those from intervention areas, but a few key differences emerged. Patients in focus groups at comparison facilities demonstrated somewhat limited knowledge regarding diabetes and hypertension when compared to those from intervention facilities. Although comparison site patients were able to identify changes in diet as an important step for disease management, most could not elaborate on what kind of changes were needed and what types of foods should be avoided. Hypertension was usually described based on its symptoms only. Overall, similar barriers to care were raised in intervention and comparison regions, but while complaints regarding the availability of medication and specialized exams also arose in intervention facilities, these complaints were clearly more escalated in comparison facilities. Although facilitating the referral process to specialists was a core component of HealthRise in both sites, this seems to be a major problem in comparison facilities, according to patients, health providers, and facility managers. Additionally, FLHWs in comparison areas agreed that diabetes and hypertension were not their highest priority since there were so much else to address in these areas (e.g., maternal and child health). Comparison facilities from both regions have a program for diabetes and hypertension patients called “Hiperdia;” however, patients’ adherence is low, according to facility managers. Finally, staff in comparison facilities were more likely to request opportunities for trainings.
India Quantitative Shimla: Facility findings
Facility-based HealthRise awareness, implementation, and trainings. Compared with facilities located in blocks where HealthRise was not implemented, facilities in program implementation blocks had higher rates of e-clinic and HealthCard application availability (Table 19). HMIS use was more similar across facilities, though it remained relatively low among both groups. A comparable percentage of facilities had organized any training session in the last 12 months (i.e., 38.9% among facilities in HealthRise implementation locations; 41.7% among comparison facilities). While nearly 90% of facilities located in HealthRise implementation blocks had heard of the HealthRise/MAMTA program, 50% of comparison facilities indicated recognition of such programs as well. This result may reflect a more widespread recognition of the HealthRise program beyond its initial implementation areas.
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