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  Possible Causes Suggested Solutions
Is there any problem in patient tracing and contact at PHI/ private hospital level?
  • Contact information not available in Ni-kshay
  • Incorrect address
  • No contact number
  • Assign one Drug-resistant TB (DR-TB) coordinator for the patient and entrust him for the follow-up.
  • Ensure correct data entry in Ni-kshay. Double check the address with id at Ni-kshay entry. Proper training and capacity building of the staff for the same.
  • Procure more than one contact number.
  • Seek the help of a Local Self Government (LSG) representative.
  • If the patient has moved out of the area, take measures to trace and transfer out to the respective area.
Patient resistance
  • Fear
  • Apprehension
  • Lack of family support 
  • No bystanders
  • Proper counselling of the patient and the immediate relative at the time of disclosure of the result is very important.
  • Counselling should be provided at each stage.
  • An immediate relative can be counselled and trained to be a treatment supporter of the patient. 
  • Seek cooperation from Non-government Organisations (NGOs)/ volunteers.
Is there any issue in pretreatment evaluation?
  • Distance to the testing facility
  • Cost of evaluation
  • Multiple visits needed
  • Delay in getting the reports
  • Transportation issues
  • Arrange for patient-centric quality services at a government facility to avoid patient discomfort.
  • Outsource in a partnership model in areas where facilities are not available. 
  • Arrange for transportation or refund of travel expenses.
Is there a delay in the initiation of treatment?
  • Patient resistance
  • Delay in results of pretreatment evaluation
  • Distance from the treatment centre
  • Counselling 
  • Fast-tracking the report
  • OPD-based treatment
  • Setting up a decentralized treatment facility
  • Arranging for transportation or reimbursement for travel
Do the patients from the private sector have issues in starting treatment?
  • Patient wants to continue the clinical services from the private provider, but drugs are not available.
  • Patient wants to change the treatment to a public health facility.
  • Coordinate with the hospital management and provide the drugs and necessary support.
  • Linkage through Public Private Partnership (PPP) 
  • Arrange for the patient transfer to a public health facility.
Other causes
  • Duplication of data entry leading to an inflated denominator (total diagnosed cases)
  • Issues with data entry in Ni-kshay
  • Proper monitoring to avoid duplication 
  • Training, monitoring of staff
  • Sort out internet connectivity issues

 

Note: This page describes only an approach for analysis of low performance and has not captured the entire list of problems or solutions. The root cause analysis may be modified according to the local context.

 

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Assessment

Question Option1 Option 2 Option 3 Option 4 Correct answer Explanation Page id Pretest Post-test
Which of the following does not minimise the delay in treatment initiation/ treatment not initiated for MDR-TB cases? Timely tracing of the patient Proper counselling of the patient A trained treatment provider  Not offering drugs to private patients  4 Timely tracing of the patient. proper counselling of the patient, a trained treatment provider will help minimise the delay in treatment initiation.      

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