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Perspective Airway and Lung Infection
A Snapshot of Grassroots Primary Care and
Tuberculosis Control in India—a US
Fulbright–Nehru Scholar Program Experience
Sonal Shah Parikh, 1 Juzar Ali, 2 Sanjay Bhatt 3 and DV Bala 1
1. Community Medicine, Smt. NHL Medical College, Ahmedabad, Gujarat, India; 2. Louisiana State University Health Sciences Center (LSUHSC) School of Medicine,
New Orleans, LA, US; 3. Los Angeles County and University of Southern California (LAC+USC) Medical Center, Keck School of Medicine, Los Angeles, CA, US
T he Department of Community Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Medical College, Ahmedabad, India, under the
aegis of the US Fulbright–Nehru Scholar Program, reviewed the rural and urban primary and district health delivery system, with focus on
primary care, child and maternal health and tuberculosis control. The National Health Mission program in India utilizes public and private
resources and partnerships to optimally increase access, referrals and improve quality of care. As a collateral, the Revised National Tuberculosis
Program, within its broader umbrella, incorporates digital-based locally applicable innovative approaches to tuberculosis (TB) control, to implement
the World Health Organization strategy of the Directly Observed Treatment Short-course (DOTS) program. With this approach the program has
consistently maintained a high treatment success rate. However, the deficiencies in the program include the loss to follow-up of missing persons
with TB, incomplete data in some cases, and erratic coordination between private, academic, public health primary and tertiary care centers.
Keywords Primary care, National Health Mission
(NHM), Revised National Tuberculosis
Control Program (RNTCP), tuberculosis,
US Fulbright–Nehru Scholar Program
Disclosure: Juzar Ali and Sanjay Bhatt were recipients
of the Fulbright–Nehru International Scholar Award.
Juzar Ali is also a member of the journal's editorial
board. Sonal Shah Parikh and DV Bala have nothing
to disclose in relation to this article. This article is an
opinion piece and has not been submitted to external
peer reviewers. Another member of the editorial
board reviewed the article before publication.
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have
given final approval to the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any noncommercial use, distribution,
adaptation, and reproduction provided the original
author(s) and source are given appropriate credit.
Received: November 19, 2017
Published Online: December 12, 2017
Citation: US Respiratory & Pulmonary Diseases,
2017;2(1):26–9 Corresponding Author: Sonal Shah Parikh,
Community Medicine Department, Smt.
NHL Medical College, Ahmedabad, Gujarat, India.
Support: No funding was received in
the publication of this article.
26 India and the US, aside from being the world’s two largest democracies with multi-ethnic communities
and dynamic economies, face challenges in dealing with access to healthcare. Both countries have
grappled with the demands of providing efficient and timely healthcare delivery, seeking to boost
primary care and public health. It is clear that primary healthcare can play a critical role in preventing,
detecting, and treating disease. Delivering primary care in India with a population of 1.3 billion, living
in densely populated cities, rural areas and villages, and throughout many different sub-cultures,
time zones, topographical domains, climates, languages, and dialects, is an enormous challenge.
To address this challenge, public health officials and multi-level healthcare providers in Gujarat, India,
as part of a national program, have implemented an innovative, grassroots program.
Juzar Ali and Sanjay Bhatt, as part of their Fulbright–Nehru International Scholar Award, along with
a faculty team from Smt. Nathiba Hargovandas Lakhmichand (NHL) Medical College in Ahmedabad,
Gujarat, India, explored and assessed this program.
The US Fulbright program was established in 1946 through the US Congress and was spearheaded by
Senator JW Fulbright. It operates in 160 countries and has, to date, sponsored about 360,000 students,
scholars, and senior faculty in all academic fields. It accepts reviews and approves applications and
programs based on credentials, merit, needs assessment, communication, skills, and the commitment
to further the goals of the Fulbright award. It expects its grantees to act as academic, teaching, and
research scholars, and to be cultural ambassadors, to foster professional relationships and mutual
goodwill (visit www.cies.org for further information).
Background India has faced a significant void in achieving consistent, nationwide healthcare delivery, especially in
three key categories: maternal and child health, immunization programs, and chronic communicable
disease programs, including tuberculosis (TB) control. Despite many limitations, India does recognize
the importance of primary healthcare and considers it to be the backbone of their health delivery
system. Thus, inspired by the concept outlined by Sir Joseph Bhore in 1946, and three decades
before the Alma Ata Declaration, emphasizing the importance of primary care, India has consistently
worked to develop and streamline an effective approach to fill this void. Aided by the World Health
Organization (WHO), the World Bank, UNICEF, and other international support agencies, the national
TOUCH ME D ICA L ME D IA