|Year : 2019 | Volume
| Issue : 3 | Page : 233-237
Mixed-method analysis of community health camps: A novel approach beckoning
Amit Bhondve, Barsha Pathak, Rukman M Manapurath
Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
|Date of Submission||17-Nov-2018|
|Date of Acceptance||19-Aug-2018|
|Date of Web Publication||20-Sep-2019|
Dr. Barsha Pathak
Department of Community Medicine, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: In India, 60% of the population lack basic medical facilities, so health camps which provide short-term medical interventions for target communities may be beneficial. This study epidemiologically analyzes a health camp event in a rural area of Maharashtra to provide practical insights for organizing, planning, and implementation of health camps. Objectives: 1. Assess the sociodemographic profile and spectrum of morbidity of camp beneficiaries. 2. Assess expectations and satisfaction perceived by community and organizers from health camps. 3. Gain practical insights from the camp event to advocate participation-friendly policies in the community. Materials and Methods: This is a cross-sectional mixed design study. Using qualitative method, a total of four focus group discussions (FGDs) were held with beneficiaries attending the camp and three in-depth interviews (IDIs) were held with camp organizers. A semi-structured questionnaire was used to interview 358 beneficiaries to be studied quantitatively. Results: The camp comprised 52.7% of males and 36.7% of females as beneficiaries. Observed were cases of acute disease (41.6% [n = 149]) and chronic disease (58.7% [n = 209]) with maximum beneficiaries visiting ophthalmology department (25.4%) followed by general medicine (16.70%). FGDs and IDIs revealed two major themes – expectation and satisfaction and several subthemes. Conclusion: The beneficiaries appreciated the event and expressed the requirement of organizing such camps in future again. The camp was need based as revealed by the organizers and beneficiaries. Few strategies in future can result in more participation-friendly health camps.
Keywords: Community participation, expectation, health camp, Health for All, satisfaction
|How to cite this article:|
Bhondve A, Pathak B, Manapurath RM. Mixed-method analysis of community health camps: A novel approach beckoning. Indian J Community Med 2019;44:233-7
|How to cite this URL:|
Bhondve A, Pathak B, Manapurath RM. Mixed-method analysis of community health camps: A novel approach beckoning. Indian J Community Med [serial online] 2019 [cited 2019 Oct 17];44:233-7. Available from: http://www.ijcm.org.in/text.asp?2019/44/3/233/267352
| Introduction|| |
Health care is the right of every individual, but lack of quality infrastructure, dearth of qualified medical functionaries, and nonaccess to basic medicines and medical facilities thwart its reach to Indian citizens. In rural areas, the number of primary health-care centers (PHCs) is limited: 8% of the centers do not have doctors or medical staff, 39% do not have laboratory technicians, and 18% of the PHCs do not have a pharmacist. In the current health care scenario of our nation, health camps which are stationary or mobile can be a convenient solution imparting short-term medical intervention to the targeted population., Most of the camps are initiated by nongovernmental organizations and political organizations and also the local private practitioners which mobilize the government health system for this purpose, but proper utilization of these health camp services is determined by the attitude of the target population. If epidemiological approach on need-based evidence is adopted, these health camps can be an effective media for delivery of health services needed  than just focusing on disease-oriented approach.
This study focuses on a mega health camp event organized in the Beed district of Maharashtra state, which is categorized as a low-performing district. Like the prevailing scenario in rural India, Beed area also had the problems of accessibility to health services and dependence on private sectors. Hence, a novel model, i.e., the community health camp, is studied, which may be helpful for the masses and increases the outreach of the health services. This study helped to provide practical insights for organizing, planning, and implementation of a mega health camp. The basic objectives were to assess the sociodemographic profile and spectrum of morbidities among camp beneficiaries and to utilize qualitative and quantitative methods to identify the health concerns, expectations, and satisfaction perceived by the community and the organizers helping in advocating participation-friendly policies in the community.
| Materials and Methods|| |
A mixed-methods study design was employed to assess the expectation of the organizing committee while conducting a mega camp and the perception of beneficiaries about the camps. Quantitative data was collected via a pre-validated semi-structured interview schedule. Qualitative data was collected by a pre-designed focus group discussion (FGD) guide for conducting the FGDs among the camp beneficiaries and an In-depth interview(IDI) guide for interviewing the camp organizers.
The study was conducted in Beed town, Maharashtra, India.
The present study employed a cross-sectional design, where quantitative data were collected by convenient sampling method with a sample size of 358 of adult rural men and women who were above 21 years of age and gave consent for FGDs and interviews.
Four FGDs were conducted. Each FGD group consisted of 5–6 participants, and each session lasted for 20–30 min' duration. After taking written informed consent from the key informants, key informant interviews were conducted for 2 days during the camp and 1 month after the camp for a duration of 30–45 min. We selected purposive sampling technique for selecting the key informants including organizing committee members; for instance, medical officers, general practitioners, and community volunteers. The interviews focused on health issues that need to be addressed in the community, mobilization techniques used, motivation behind organizing the camp, and elaborating their postcamp opinions.
The study was approved by the Ethical Review Board of Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra. All participants gave written consent prior to participating in the baseline interview and FGDs.
The constant comparative method was used to compare themes across the groups and key informants and to determine relationships among them. The qualitative data was coded and the analysis of focus group and key informant transcripts were done by using N6, 2006 version (QSR International, Melbourne, Australia). For the quantitative questionnaires, descriptive statistics were generated to characterize respondents in terms of socioeconomic background by using Microsoft Excel 2016. A list of conditions which required improvement were identified by the respondents and these were labeled as themes. After this, the frequencies were generated to characterize the number of individuals who identified each type of condition and were framed as sub-themes.
| Results|| |
Out of the 358 camp beneficiaries, 52.7% were male beneficiaries and 36.1% were female beneficiaries. Nearly 37.9% of the beneficiaries were having farming and cultivation as their occupation. Almost 30.7% of the beneficiaries were having primary education and 28.2% were illiterate. Nearly 37.7% of the beneficiaries were belonging to lower class and only 1.1% beneficiaries were of higher class according to the B. J Prasad's classification [Table 1].
|Table 1: Sociodemographic characteristics of the camp beneficiaries n=358)|
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Out of the 358 beneficiaries, 41.62% (n = 149) of the beneficiaries had acute diseases and 58.7% (n = 209) had chronic diseases. Chronic disease in this study is defined as a disease lasting for >3 months and not prevented by vaccine or totally cured by medicine. The total number of surgeries performed was 76. Nearly 55.2% (n = 42) of the surgeries were ophthalmological surgeries [Figure 1].
|Figure 1: Spectrum of morbidity of diseases of camp beneficiaries (n = 358)|
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For the qualitative data, initially, open coding was done. Furthermore, in vivo coding was applied followed by axial coding. Subthemes were established for the themes of “expectation and satisfaction” of the beneficiaries. IDI s were further coded into subthemes for the theme of “expectation of organizers” from the camp. We have prepared a conceptual model based on the results of this study. The model represents a summary of the themes and subthemes from the four FGDs and three IDIs held  [Figure 2].
The responses of the camp beneficiaries on days 1 and 2 were recorded by four FGDs. After analyzing these discussions, we developed two main themes – satisfaction and expectation among the patients and several subthemes [Table 2].
|Table 2: The responses of the camp beneficiaries on days 1 and 2 recorded by focus group discussions|
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The IDIs conducted by the camp organizers evolved the following components – accessibility, affordability, expert consultations, and challenges [Table 3].
|Table 3: The response of the camp organizers recorded after in-depth interviews|
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| Discussion and Conclusion|| |
Analyzing the transcript of all the four FGDs, we identified two themes, i.e., satisfaction and expectation. The subthemes identified for satisfaction were medical services, physician conduct, nonmedical services, and affordable services. Medical services were the first factor in which the respondents were either satisfied or unsatisfied. The participants commented that they were satisfied with medical services such as rehabilitative, curative, and diagnostic but unsatisfied with the absence of superspecialty medical services. Expensive diagnostic tests and few surgical procedures were provided free of costs, which was another main reason for their satisfaction. Provision of transportation, food water services, shaded waiting area, and proper guidance by the camp volunteer while availing services inside the camp also supplemented to the satisfaction level. However, absence of ventilation and overcrowding in the waiting area were issues of dissatisfaction. Although the beneficiaries were dis-satisfied with consultation duration, they agreed that the physicians were empathetic and responsive to their health issues.
The subthemes identified for expectation were expert doctor, availing camp services, affordable medical facilities, and unavailability of services in the native area. Most of the expectations of the camp beneficiaries were met in the camp.
An important fact which came into light from these FGDs was that there were many areas in this district which had paucity of medical services.
The key informant interviews conducted helped us to assess the major expectations and challenges faced by organizers while conducting the camp.
The camp organizers expected to make health facility affordable services accessible for the population staying in backward and underprivileged areas. The organizers invited expert doctors from different states of India to provide these community with optimal health services. However, mobilizing the beneficiaries from distant backward area was an arduous task. Voluntary workers; community health workers; and social media including radio, newspaper, and social networking sites such as Facebook and WhatsApp helped people to gain information about the mega camp. The organizers provided buses as the mode of transportation for the beneficiaries who wanted to attend camp from distant places. Most of the attendees of the camp required neurology and cardiology consultation which was unavailable, resulting in dissatisfaction among few beneficiaries. However, this issue was handled by proper referrals to higher centers and reassuring the beneficiaries that all costs required for consultation to superspecialty departments of higher centers will be borne by the camp organizing the committee. However, the practical feasibility of such assurance may be dubious for beneficiaries of poor and backward areas. Managing, guiding, and giving proper consultation time to each beneficiary attending the camp were difficult as the total number of attendees outnumbered the precamp estimation. However, the organizing committee's major motives to help the poor, needy, and backward communities residing in distant areas with expert affordable consultation were congregated.
According to the WHO theme, 2019, “Universal Health Coverage: Everyone, Everywhere,” it is essential to provide basic primary care to every stratum of people of the society. Health camps have gleamed as a reasonable and practicable approach to provide universal health coverage as it has a reach to the most backward and underdeveloped communities of a society. To construct these community health camps, more participation-friendly strategies such as organizing multiple small-scale health camps in the subdistrict areas, helping in more distinctive attention to individual beneficiaries, enlistment of the disease trend of a particular area, and categorizing the patients requiring superspecialty care for further organization of specific superspecialty camp should be developed for future camps. Prioritizing the specific health-care requirement of a particular area can be accelerated by community participation, which will further help in gaining the status of universal health coverage.
In this study, IDIs could not be conducted with the local politicians of the area as they had a busy schedule. This could have provided wider perspectives of the challenges faced. Second, this study involved a single mega camp only. Multiple camp studies will provide a better generalization of the study findings.
I would like to thank Seth G. S. Medical College and K.E.M. Hospital as it was part of this camp and the medical team including by colleagues who helped me in completing this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]