Geeta Pardeshi1,2, Weiyu Wang3, Julie Kim3, Jeffrey Blossom4, Rockli Kim5,6, S V Subramanian3,7,8. 1. Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. 2. Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Harvard Center for Population and Development Studies, Cambridge, MA, USA. 4. Center for Geographic Analysis, Harvard University, Cambridge, MA, USA. 5. Division of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea. 6. Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, South Korea. 7. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 8. Honorary Senior Fellow, National Institution for Transforming India (NITI) Aayog, Govt. of India, India.
Abstract
OBJECTIVE: National averages obscure geographic variation in program performance. We determined Parliamentary Constituency (PC)-wise estimates of TB notification to guide political engagement. METHODS: We extracted district-level TB notification data from the 2018 annual TB report. We derived PC-level estimates by building a 'cross-walk' between districts and PCs using boundary shapefiles. We described the spatial distribution of the PC-wise estimates of Total Notification Rate and percentage of Private Sector Notification. RESULTS: The median PC-wise Total Notification Rate was 126.24/100 000 (IQR: 94.86/100 000, 162.22/100 000). The median PC-wise Percentage Private Sector Notification was 18.03% (IQR: 9.56%, 26.84%). Only 16 (2.94%) PCs met the target of 50% private sector notification. Most of high notification rates in PCs were driven by high notification in public sector. There was geographic - both interstate and within state inter-PC - variation in the estimates of these indicators. The study identified some geographic patterns of notification - high positive outlier PCs with adjoining PCs in lower deciles of notification rates, intra-state differences in PC performance, and similarities in notification rates of adjoining PCs in different states. CONCLUSION: In addition to regional inequality, the study identified geospatial patterns that can aid in the formulation of suitable interventions. These include decongestion of overburdened facilities by strengthening poorly performing units. The PCs with a high percentage Private Sector Notification can act as role models for neighbouring PCs to improve private sector engagement. MPs can play a crucial role in mobilising additional resources, creating awareness, and establishing inter-PC and inter-state collaboration to improve TB program performance.
OBJECTIVE: National averages obscure geographic variation in program performance. We determined Parliamentary Constituency (PC)-wise estimates of TB notification to guide political engagement. METHODS: We extracted district-level TB notification data from the 2018 annual TB report. We derived PC-level estimates by building a 'cross-walk' between districts and PCs using boundary shapefiles. We described the spatial distribution of the PC-wise estimates of Total Notification Rate and percentage of Private Sector Notification. RESULTS: The median PC-wise Total Notification Rate was 126.24/100 000 (IQR: 94.86/100 000, 162.22/100 000). The median PC-wise Percentage Private Sector Notification was 18.03% (IQR: 9.56%, 26.84%). Only 16 (2.94%) PCs met the target of 50% private sector notification. Most of high notification rates in PCs were driven by high notification in public sector. There was geographic - both interstate and within state inter-PC - variation in the estimates of these indicators. The study identified some geographic patterns of notification - high positive outlier PCs with adjoining PCs in lower deciles of notification rates, intra-state differences in PC performance, and similarities in notification rates of adjoining PCs in different states. CONCLUSION: In addition to regional inequality, the study identified geospatial patterns that can aid in the formulation of suitable interventions. These include decongestion of overburdened facilities by strengthening poorly performing units. The PCs with a high percentage Private Sector Notification can act as role models for neighbouring PCs to improve private sector engagement. MPs can play a crucial role in mobilising additional resources, creating awareness, and establishing inter-PC and inter-state collaboration to improve TB program performance.
Authors: Shaffi Fazaludeen Koya; Jinbert Lordson; Salman Khan; Binod Kumar; Chitra Grace; K Rajasekharan Nayar; Vinod Kumar; Anand M Pillai; Lal S Sadasivan; A Marthanda Pillai; Abu S Abdullah Journal: J Epidemiol Glob Health Date: 2022-01-10