Village Health Nurses (VHN) are the last-mile health workers attending to the primary health care needs of the rural villagers in the state of Tamil Nadu; where the real-time biosruveillance program (RTBP) is being pilot tested in India. They work under harsh conditions. For instance transportation schedule is limited to a bus that leaves in the morning and returns in the afternoon. Baking and sweating in the hot sun in Sivaganga District of Tamil Nadu, they walk for several kilometers, carrying a heavy load of Registers, making house calls to give the much needed health care to the rural poor.
During a recent workshop, in Tamil Nadu, a discussion around the accountability of submitting data revealed that the VHN sometimes cheat on the statistics they tediously record on large volumes of paper forms. At times if a certain disease count, during a given visitation to a village is, let’s say 6, they may record 2. This is to avoid additional work imposed on them by the Deputy Director of Health Service office. If the count is above a certain threshold, let’s say 4, then they must immediately notify the Sector Health Nurse (SHN) resident at the Public Health Center (PHC) in that VHN’s jurisdiction. The VHN are provided with mobile phones by the state to communicate such incidents. The RTBP will complement the present State of Tamil Nadu health data collection system by introducing the, RTBP developed, m-Health application, termed as the m-HealthSurvey.
Another interesting aspect revealed during the meeting was that almost one member from each household was working abroad. They label them as visitors. As a result the VHNs attending to the patients wished to distinguish between resident patients and visitor patients. If the patient was a visitor the VHN would record additional information such as the patient’s overseas address. This was one of the elements that the RTBP had addressed in the proposal; i.e. the fear of locals working overseas carrying diseases back to the home land and the need to detect such cases well in advance; as it is the case with the swine-flu alert these days.
The workshop was organized by the Rural Technology and Business Incubator research team, partners of the RTBP carrying out the field work with resepect to the Inian case study. The meeting took place in Karriakudi, Sivaganga District, May 4th and 5th, 2009 (see workshop program).