Progress Report - Global Bridges...namely Ajmer, Churu, Jaipur, Tonk and Jhunjhunu on 8th, 21st,...

PROGRESS REPORT

January 2016

PROGRESS REPORT | January 2016

Project: Strengthening Tobacco Cessation Capacity of Primary Care Professionals

(SCCoPE)

India is the world’s second largest producer and consumer of tobacco. Tobacco related diseases cause around one million deaths per year in India. To combat the tobacco epidemic, the National Tobacco Control Programme (NTCP) has been launched by the Government of India. An important component of the programme is to provide tobacco cessation services at the state and district level by building capacity of health care providers in brief interventions. However, less than half of the states under the NTCP programme have established tobacco training programmes. There is a lack of preparedness of health care providers to deliver brief interventions in tobacco cessation in Primary care in India. There is also limited evidence that training primary health care providers in tobacco cessation training translates into provision of brief interventions by health care providers. Designing and evaluating a training programme in brief interventions will thus help strengthen capacity in evidence-based tobacco cessation interventions. We aim to address this critical gap of effective population-based cessation services through strengthening the cessation component of India’s National Tobacco Control Programme (NTCP) by building capacity in primary care providers in evidence-based tobacco cessation interventions. The project is ongoing in two states of India; Rajasthan and Odisha. We are training health care personnel drawn from NTCP, state health department, training division of the National Health mission, faculty of reputed medical and dental colleges and regional cancer societies. We will be training about 500 such personnel from the two intervention states. The training will initially develop a cadre of 50 master trainers in tobacco cessation in each state/ region who will further train other health care providers in tobacco cessation through a cascade training method. We intend to provide a bouquet of online-course options ranging from brief interventions to three months intensive cessation certificate courses. The trainings are conducted through a hybrid model comprising of both face to face contact classes and online webinars and classes. The trainings are designed in a way so that they provide an opportunity for a stimulating exchange of ideas and experiences among participants working in tobacco cessation regionally and nationally. This project is innovative and will help in overcoming a significant gap in tobacco control in the country by creating a network of cessation experts. Through this project, a group of master trainers will be nurtured and champions in tobacco cessation under the NTCP will be prepared. These trained personnel will also be trained to advocate for prioritization of cessation in tobacco control programmes across the country. We also aim to produce evidence on effective intervention for smokeless tobacco which is not well known. Considering the huge burden of smokeless tobacco in the country the training will create new resources to address the burden. We are also in the process of establishing a research and practice platform which will connect researchers with policy makers and program managers. This will help in the creation of a “community of practice” in tobacco control.


SCCoPE – A brand in itself!

SCCoPE has turned out to be a brand in itself in this short time span. With contributions from cessation

experts from India and abroad, SCCoPE is a unique program in itself. The support from Barts and London

School of Medicine and Dentistry has added to the quality of SCCoPE. Having the SCCoPE trainings in the

distance learning portal of PHFI helped increase its spread.

The project was launched in the states of Odisha and Rajasthan with support of the respective state

governments. This hybrid training model was launched with a lot of apprehension, since it was the first

time that this mode of training was being followed for a tobacco cessation training in the country. After

several brainstorming session with government officials of both the states we got the green signal to

officially launch project SCCoPE. At present project SCCoPE enjoys support from officials and primary

care physicians of both the states.

Resources developed for the Physician’s training: - A resource pack was designed to support trainers

in the delivery of the training program in brief intervention in tobacco control. The brief

intervention includes 5A’s approach (Ask, Assess, Advice, Assist and Arrange), which is the most

commonly used intervention in tobacco cessation.

A variety of aids including the recorded presentation by experts, counselling guide, IEC/BCC materials used during this training. Counselling guide is an easy to use resource which presents evidence based tobacco cessation techniques through pictorial depiction. This has been developed by a team of tobacco cessation experts across India. The training of Master Trainers as well as physicians conducted in a hybrid format which comprises of both online and face-to-face training.

SCCoPE team has developed following resource materials as a part of resource pack for the tobacco

cessation training.

a. Training Manual for Tobacco cessation in primary care

b. Counselling Guide

c. Patient education materials

d. Education posters


a. Counselling guide b. Patient education material

C. Poster developed to put at different ward at facility,1 OPD,2 ANC ward/clinic and 3,waiting area for

patients


Dr.Lipika Nanda, Director IIPHB; Dr.K C Das, Director, Directorate

Public Health, Government of Odisha; Dr.Rajmohan Panda, Senior

Public Health Specialist; Dr.Hayden McRobbie, Prof of Public Health

Interventions, Queen Mary University of London (Left to Right)

Trainings in project SCCoPE

State Level Master Training

The second state level training programme of master trainers at Rajasthan was organized on 8th

September at Jaipur. In Odisha it was organized in two rounds, in first round it was on 24th-25th

August and in second round on 30th October 2015 at Bhubaneswar.

The training programme marked the official launch of the project – SCCoPE in the state of Rajasthan

and Odisha. Joint Secretary (JS), Medical & Health Department & Additional Mission Director,

National Health Mission (NHM) of Rajasthan formally inaugurated the programme. Director Public

Health (DPH), Government of Odisha formally inaugurated the programme. The JS, highlighted the

rising burden of tobacco and the need for capacity building of physicians. He also explained the

pivotal role of doctors to reduce this burden of tobacco use.

The training programme spanned over 8 hours with 10 interactive sessions on burden of tobacco,

various approaches of tobacco cessation and patient follow-up mechanism. The training also

highlighted ways to develop a tobacco cessation center. The sessions were highly interactive and

participants were encouraged to discuss actively on each of the topics. The participants were also

introduced to the online portal and oriented to use the web portal. By end of the training all the

participants were successfully registered to our online training portal. A pre and post training

evaluation was also conducted before and after the training respectively. Number of Primary Care Physicians trained as a master trainer against the target: - 81/100

State Number of Participants

Odisha 47

Rajasthan 34

The participants comprised of government officials, faculty of reputed cancer research institute, medical, dental colleges of Odisha and Rajasthan.

Odisha Resource persons:

Dr. P.K.B.Pattnaik, Jt. Director NCD-cum-(SNO) NTCP, Government of Odisha

Dr. NilamadhavRath, Prof. & HOD, MHI and SCB Medical College, Cuttack, Odisha.

Dr.B.K.Kindo, Additional Director, NCD, Government of Odisha

Dr. Lipika Nanda, Director, IIPH Bhubaneswar

Dr. Sanghamitra Pati, Additional Professor, IIPH Bhubaneswar

Dr. Hayden McRobbie

Dr. Rajmohan Panda

Officials attending the training program


Rajasthan - Resource persons:

Dr. Sunil Singh, Additional Director, Rural Health(RH),Rajasthan

Dr. Aditya Atreya, State Nodal Officer, NTCP &Joint Director (RH),Rajasthan

Dr. Rakesh Gupta, President, Rajasthan

Cancer Foundation, Jaipur, Rajasthan, India

Dr. Rajmohan Panda, Senior Public Health Specialist, PHFI

Dr. Vijay Mathur, Additional Professor, Centre for Dental Education & Research, All India Institute of Medical Sciences (AIIMS), New Delhi

Dr. Manu Raj Mathur, Research Scientist and Assistant Professor, PHFI Mr. Kumar Gaurav,

Programme Manager, PHFI

District Level Training

The first district level training commenced in December 2015 at both states. The district level training

programme of primary care physicians has been completed at all intervention districts of Rajasthan

namely Ajmer, Churu, Jaipur, Tonk and Jhunjhunu on 8th, 21st, 22nd, 23rd of December and 8th January

2016 respectively and in Bolangir, Khorda and Cuttack at Odisha respectively on 18th-19th and 22nd-

23rd.Trainings were organized at district’s head quarter. Chief Medical & Health Officer of respective

districts formally inaugurated the programme. CMHO, highlighted the rising burden of tobacco and the

need for capacity building of physicians. He also explained the pivotal role of doctors to reduce this

burden of tobacco use.

The training was highly interactive and witnessed healthy discussion on tobacco cessation. Post training,

the participants were enrolled into the online portal for further capacity building.

Project launch and Release of counselling guide and IEC materials by Dr. Niraj K.

Pawan (IAS),Joint Secretary, Medical & Health Department & Additional Mission

Director, National Health Mission (NHM), Rajasthan, Dr. Rajmohan Panda, Senior

Public Health Specialist, PHFI, Dr. Sunil Singh, Additional Director (RH), Rajasthan, Dr.

Rakesh Gupta, President, Rajasthan Cancer Foundation, Jaipur, Rajasthan, India (Right

to Left)

Dr. Aditya Atreya, State Nodal Officer, NTCP &Joint Director (RH), Rajasthan interacting

with participants


(Left) Chief district health officer (CMHO) inaugurating the training and Deputy CMHO Dr. Lal explaining the importance of the tobacco cessation to

participants at Ajmer.(Right)Dr. Rakesh Gupta, Explaining the Pharmacological approaches for cessation at Tonk Training

- Total Primary Care Physicians Trained against the target: 329/400

State-Rajasthan, District

Number of Participants

Ajmer 22

Churu 55

Jaipur 47

Tonk 47

Jhunjhunu 41

State-Odisha District

Number of Participants

Bolongir 37

Khorda 42

Cuttack 35

koraput 22

Odisha

Additional Director, NCD addressing the physicians in Bolangir (left), participants during the session (right)


-Confidence in Counselling of Patients on Tobacco Cessation (Master Trainers) Odisha Rajasthan

(Source: - From the analysis of pre-post data)

It was reported after the master training that confidence level of primary care physicians has increased

significantly for counselling the tobacco users.

-Distribution of trained Primary care Physicians

THE TRAINING PROGRAMME HAS CHANGED MY ATTITUDE

TOWARDS TOBACCO USER, THEY ARE SICK AND NEED HELP FROM

HEALTH CARE PROFESSIONAL

DR.JAI PRAKSH SINGH,PRIMARY CARE PHYSICIAN,

JAIPUR

NOW I AM CONFIDENT THAT I CAN PRESCRIBE AND

CAN COUNSEL TO THE PATIENT FOR TOBACCO

CESSATION

PRIMARY CARE PHYSICIANS

JHUNHJUNU

Out of total Primary care Physicians those

attended the SCCoPE training programme,

52% from Community Health center (CHC),

39% from Primary health center (PHC), 5%

from Urban health center and 4% from

district tobacco control cell (DTCC).


Standard Agenda followed for training

DAY 1 Sessions

10.00 AM– 10.15 AM Registration and Tea

10.15 AM – 10.30 AM Welcome to participants and overview of the course, Pre-training Assessment

10.30 AM – 10.45 AM Opening remarks

10.45 AM– 11.00 AM Tobacco and Health

11.00 AM – 11.20 AM Introduction to Tobacco Cessation

11.20 AM– 12.00 PM Theories of Addiction

12.00 PM – 12.45 PM Behavioral and psychological approaches for cessation

12.45 PM – 02.30 PM Pharmacological approaches for cessation

02.30 PM – 02.45 PM How to develop a tobacco cessation center?

02.45 PM – 03.15 PM Patient follow-Up & Introduction to Vignettes

03.15 PM – 04.00 PM Evaluation of cessation practices

04.00 PM – 04.20 PM Role of Physicians & Pedagogy

04.20 PM– 04.30 PM How to use the online training program and Registration

04.30 PM – 04.45 PM Closing Remarks


Media Coverage

Odisha,

Project SCCoPE has received ample media attention since its launch in the state of Odisha and

Rajasthan. Leading newspapers of the state have written about the launch of project and successive

trainings in both states. A wide variety of local and regional newspapers reported the event highlighting

the cessation trainings offered. Here some of the media coverage reports.

Picture 12, 13, 14 (left, centre and, right) TIMES OF INDIA,


PRAMEYA NEWSPAPER

DHARITRI NEWSPAPER

Knowledge will lead to tobacco cessation

Bhubaneswar, 23 Oct.: Tobacco is a leading cause of death

in the state. Lack of awareness has led to such uncontrolled

use. Awareness form primary level of care can help make

Odisha tobacco free. More than 40 percent people

consuming tobacco wish to quit. Training primary care

professionals on tobacco cessation so that they can further

advice patients to quit will make Odisha tobacco free and

will emerge as a model state, said Director of Public Health,

Odisha during a tobacco cessation training program at a

regional Public Health institute where he was invited as the

chief guest. The meeting was attended by Director Indian

Institute of Public Health director Dr. Lipika Nanda, Dr. Raj

Mohan Panda, London’s Queen Mary University Prof.

Hayden McRobbie and IIPHB associate Prof. Dr.

Sanghamitra Pati.

Awareness can keep the state tobacco free

Summary:

People are not aware about the dangers of tobacco cessation.

Lack of awareness has led many people to use tobacco. ‘’If the

tobacco cessation advice is given right from the primary care

level, the state can become tobacco free’’ said K C Das, Director

Public Health. He was the chief guest at regional Public Health

institute during a training program on Tobacco Cessation. The

training was attended by Director Indian Institute of Public

Health director Dr. Lipika Nanda, Dr. Raj Mohan Panda, London’s

Queen Mary University Prof. Hayden McRobbie and IIPHB

associate Prof. Dr. Sanghamitra Pati.


SAMBAD

SAMBAD KALINGA

Tobacco cessation training program inaugurated

Summary: A state level training on tobacco cessation was inaugurated

at Indian Institute of Public Health, Bhubaneswar. This 2 day workshop

will train master trainers for training the district level primary care

physicians on tobacco cessation. This workshop was attended by Dr. K C

Das, Director Public Health, Government of Odisha as the chief guest. ‘’

More than 40 percent people consuming tobacco wish to quit. If the

tobacco cessation advice is given right from the primary care level, the

state can become tobacco free’’ said K C Das, Director Public Health.

Training primary care professionals on tobacco cessation so that they

can further advice patients to quit will make Odisha tobacco free and

will emerge as a model state among other states in the country. Dr.

Lipika Nanda, Director, Indian Institute of Public Health, Bhubaneswar

was among the dignitaries for the workshop.

Tobacco cessation training program inaugurated at Indian

Institute of Public Health Bhubaneswar

Summary: A two day tobacco cessation training program was

organized at Indian Institute of Public Health, Bhubaneswar. The master

trainer who will further train the primary care physicians, will be trained

in this training. Director Public Health, Dr. K C Das who was the chief

guest at the event inaugurated the training program. During this

addressing the gathering Dr. Das said that lot of people are dying in our

state due to tobacco use. To get rid of it, people should be made aware

of its harmful effects and it should start from the primary care level.

Government is taking various steps to control use of tobacco through

NTCP. Along with this various cessation activities are also being

undertaken at the district level. More than 40 percent people

consuming tobacco wish to quit. Training primary care professionals on

tobacco cessation so that they can further advice patients to quit will

make Odisha tobacco free and will emerge as a model state. The training

was attended by Director Indian Institute of Public Health director Dr.

Lipika Nanda, Dr. Raj Mohan Panda, London’s Queen Mary University

Prof. Hayden McRobbie and IIPHB associate Prof. Dr. Sanghamitra Pati.


DAINIK BHASKAR 8th September’2015

Rajasthan,

Ajmer Patrika, 9th December 2015

Dainik Jyoti, 9th December 2015

Training programme was organized for doctors on

Tobacco cessation

Summary: - Public Health foundation (PHFI), New Delhi has organized one day training programme for government doctors on tobacco cessation. Training was inaugurated by Chief district health Officer, Ajmer, During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance.

Training programme was organized for control of

tobacco product consumption

Summary: - Public Health foundation (PHFI), New Delhi and health and family welfare department Ajmer jointly organized one day training programme for government doctors on control of tobacco product consumption. Training was inaugurated by Chief district health Officer, Ajmer, During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance. Dr. Manu Mathur from PHFI has explained different methods of consumptions of tobacco product in details.

Doctors will get training on how to advice tobacco

user to quit tobacco at SWATHYA BHAWAN

Summary: - Training programme on how to advice tobacco user to quit tobacco will organize in five district of Rajasthan including Jaipur. On Tuesday in SWASTHYA BHAWAN, State tobacco cell and PHFI will launch this training programme. For this initiative, master trainers will get training about the different aspect of tobacco cessation. In this training programme, doctors from Jaipur, Jhunjhunu, Churu ,Tonk and Ajmer will participate. In this training programme, State Nodal officer, NTCP has explained the importance of this programme in detail.

.


Churu Patrika, 23rd December 2015

Churu Patrika, 23rd December 2015

Training programme was organized for doctors

about the control of tobacco product consumption

Summary: - Public Health foundation (PHFI), New Delhi and health and family welfare department Ajmer jointly organized one day training programme for government doctors on control of tobacco product consumption. Training was inaugurated by Chief district health Officer, Churu, During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance. Dr. Manu Mathur from PHFI has explained different methods of consumptions of tobacco product in details.

Harm effects of smoking and Gutkha was explained

Summary: - Ten lacs people die due to smoking and use of tobacco product (GUTKHA) in country.Public Health foundation (PHFI), New Delhi and health and family welfare department Churu jointly organized one day training programme for government doctors on control of tobacco product consumption at Town hall Ratangadh. Training was inaugurated by Chief district health Officer, Churu, During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance. Dr. Manu Mathur from PHFI has explained different methods of consumptions of tobacco product in details.


Times of India, 8th September 2015

DAILY NEWS 9th September 2015

Trainers Trained for Tobacco Control

Summary: Training programme on how to advice tobacco user to quit tobacco will organize at Jaipur. On Tuesday in SWASTHYA BHAWAN, State tobacco cell and PHFI has organized a one day training programme to train a master trainers. In this training programme, Additional Mission Director, NHM and Joint Secretary Health and family welfare, Rajasthan has explained the importance of this programme in detail. He mentioned that to curb the problem arising due to tobacco consumptions, State government.During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance. Dr. Manu Mathur from PHFI has explained different methods of consumptions of tobacco product in details.


PANJAB KESRI 9th September 2015

SAMACHAR JAGAT 8th September 2015

Master Trainers Trained for Tobacco Control

Summary: Training programme on how to advice tobacco user to quit tobacco will organize at Jaipur. On Tuesday in SWASTHYA BHAWAN, State tobacco cell and PHFI has organized a one day training programme to train a master trainers. In this training programme, Additional Mission Director, NHM and Joint Secretary Health and family welfare, Rajasthan has explained the importance of this programme in detail. He mentioned that to curb the problem arising due to tobacco consumptions, State government.During training sessions different aspects of tobacco cessation was covered by the experts from PHFI like behavioral and pharmacological aspects of tobacco cessation, theory of addiction, Expert has also explained the online portal course and its importance. Dr. Manu Mathur from PHFI has explained different methods of consumptions of tobacco product in details.

Training for Tobacco Control

Summary: - Training programme on how to advice tobacco user to quit tobacco will organize in five district of Rajasthan including Jaipur. On Tuesday in SWASTHYA BHAWAN, State tobacco cell and PHFI will launch this training programme. For this initiative, master trainers will get training about the different aspect of tobacco cessation today at 10 AM.

Master Trainers Trained for Tobacco Control

Summary: -Training programme on how to advice tobacco user to quit tobacco will organize in five district of Rajasthan including Jaipur. On Tuesday in SWASTHYA BHAWAN, State tobacco cell and PHFI will launch this training programme. For this initiative, master trainers will get training about the different aspect of tobacco cessation


Tracking of Patient:- A tobacco user register is being piloted at some facilities. Feedback from the pilot will help in

improvising it. Our local team will then do the follow up of tobacco users who have been registered. This

register will be filled by medical officer in charge of the primary care facilities.

Key Challenges

Active support from government stakeholders

Building confidence of the stakeholders on the online/hybrid mode of training.

Maintaining the compliance of the participants post training.

Conducting trainings in harsh weather and limited infrastructure in primary care

Key Learnings

Bringing change in attitudes and practices of primary care physicians requires a comprehensive

and holistic effort, over and above the training program.

Tobacco user surveillance recording register finalized for patient follow up


Commitment and support from the government is of utmost importance. Having premier

institutes as partners can help.

The training of support staffs of NTCP (Psychologist, frontline health worker) will help sustain

the programme

Branding is important for long term sustainability

Certification is important for effective participation in the program.

A second round of follow-up, face to face training may be fruitful after 9-12 months to maintain

the momentum and motivational level of primary care professionals

Progress Report - Global Bridges...namely Ajmer, Churu, Jaipur, Tonk and Jhunjhunu on 8th, 21st,...

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