BACKGROUND Evidence on the implementation of morbidity management and disability prevention (MMDP) remains limited in India. OBJECTIVES To assess characteristics of persons with lymphatic filariasis (PwLF) registered for MMDP services from 2023 to 2025 and factors associated with regular receipt of services, the quality of MMDP services at designated health facilities, and barriers and facilitators to MMDP services in Gorakhpur district. METHODOLOGY An explanatory mixed-methods study. The quantitative component involved cohort review of routine programme data from 16 public health facilities and cross-sectional quality assessment of 10 health facilities using WHO Direct Inspection Protocol. The qualitative component involved interviews and focus group discussions with beneficiaries, programme staff, and frontline workers. RESULTS Out of the 946 registered PwLF, 811 were eligible to receive annual MMDP services, of which only 172 (21.4%) regularly received it. Patients with stage III or higher lymphoedema were twice as likely to regularly receive the annual services. All facilities assessed provided either suboptimal or poor-quality services, with gaps in availability of guidelines, supplies, and staff knowledge. Key barriers included supply interruptions, stigma, travel costs, and staff workload while community health workers facilitated follow-up. CONCLUSION MMDP services continuity and quality remain suboptimal, requiring strengthened supply chains, provider capacity, and community-based follow-up.
SETTING Selected public health facility pharmacies, private pharmacies, and Jan Aushadhi Kendras (JAKs) outlets dispensing generic medicines in four districts of Tamil Nadu, India. OBJECTIVE To compare essential medicine availability, affordability, and knowledge on generic medicines among clients across pharmacy types. Additionally, to explore barriers to the use of generic medicines. DESIGN A concurrent mixed-methods study with a quantitative cross-sectional assessment of the availability of 50 essential medicines in 70 pharmacies and structured interview of 1,750 clients. Eight focus group discussions with clients and 24 in-depth interviews with health care providers to qualitatively explore barriers. RESULTS The median number of essential medicines available in private pharmacies (43) was higher than that in public pharmacies (30) and JAKs (29) ( P < 0.001). The medicine purchase was unaffordable (expenditure >6USD) for 92% of clients in JAKs and 98% of private pharmacies. Knowledge of generic medicine was low among clients attending public (24%) and private (31%) pharmacies. Barriers to generic medicine use included unavailability of medicines, concerns about effectiveness, and suboptimal marketing. CONCLUSION JAKs have to address the unavailability of medicines, high unaffordability, and barriers to utilisation by expanding their drug baskets, further reducing costs, and implementing strategies to build trust in generic medicines.
SETTING Primary care settings in a rural district of Telangana, India, under an anaemia control programme. OBJECTIVE To explore the facilitators and barriers to parenteral iron therapy for moderate and severe anaemia, and possible solutions from the perspective of health care providers and pregnant women. DESIGN A qualitative descriptive study. Twenty in-depth interviews and four focus group discussions were conducted with health care providers (primary care and district hospital) and postnatal mothers who had moderate or severe anaemia. Manual content analysis with inductive coding was done to identify themes and sub-themes. RESULTS Facilitators included availability of IV iron at higher-level facilities, support from ASHAs (community health volunteers), community nutrition schemes, and growing access to digital health information. Barriers clustered around medicine stock-outs at lower-level facilities, transport difficulties, out-of-pocket costs, wage loss, need for escorts to hospitals, and strong fears and misconceptions about injections. Suggested solutions focused on uninterrupted IV iron supply, decentralised service delivery, capacity-building of frontline workers, digital and community-led communication strategies, and social support mechanisms. CONCLUSION Strengthening supply chains, decentralising parenteral iron therapy, and enhancing culturally sensitive counselling and community support are essential to improve uptake and completion of parenteral therapy in primary care settings.
This issue of Public Health Action includes a series of articles on ‘Research leadership in India’, a Structured Operational Research and Training Initiative (SORT IT), led by TDR, as a model for strengthening operational research capacity within health systems globally. Conducted in 19 institutions in India, it transforms frontline health challenges into research that informs policy and practice. The 11 articles in this issue address public health challenges while enhancing self-reliance and people-centered health approaches as drivers for universal health coverage and equity. By placing individuals, communities and frontline realities at the center of research, the series reaffirms that meaningful and lasting health system transformation begins with listening, learning, and leading from within.
SETTINGS Dermatology clinic in a public tertiary hospital in Telangana, India. OBJECTIVES Among newly diagnosed leprosy patients (2023–2025), to describe patient care pathways, quantify patient and health system delays and compare across private and public sectors, and explore patient and provider perceptions about care delays. DESIGN Mixed-methods study with cross-sectional quantitative (questionnaire-based interviews) and descriptive qualitative components (in-depth interviews). RESULTS Of 90 eligible, 46 (51%) were recruited. The median (inter-quartile range [IQR]) number of providers consulted was 3 (2–3). Three fourths first sought care from a public provider. Median (IQR) overall delay was 108 days (40–255), patient delay of 73 days (16–158) (symptom onset to first health care contact) and health system delay of 14.5 days (11–39) (first health care contact to treatment initiation). Patients initially approaching private sector had longer median health system delay than those seeking public sector (28 vs. 13 days, P = 0.02). Poor symptom awareness, symptom neglect, and stigma contributed to patient delay, while poor provider capacity and long-distance travel contributed to health system delays. CONCLUSION Delays in leprosy care are largely driven by patient delay and missed diagnostic opportunities, particularly in the private sector. Strengthening community awareness and private sector engagement is essential for early detection.
