Health care coverage among long-distance truckers in India: an evaluation based on the Tanahashi model

Figures & data

Table 1 A framework for analysis of access to health care coverage under the Kavach Project, a part of the Avahan India initiative funded by the BMGF

Type of access/coverage	Definition	Effectiveness indicators
Availability coverage (service capacity)*	Resources required and availability of those resources to provide a service, limits the maximum capacity of the service. The degree of this capacity to the target populace is known as service capacity.	Sites/clinic per 100,000 estimated beneficiaries Condoms per thousand estimated beneficiaries
Accessibility coverage	Services should be located within a reasonable reach of the people who might benefit from them. In this context capacity of the service is constrained by the number of individuals who can reach and use the service.	% of total LDTDs interviewed during IBBA-NH who had either heard of or seen the logo of Khushi clinic: • % of total LDTDs interviewed during IBBA-NH who had heard about Khushi clinic • % of total LDTDs interviewed during IBBA-NH who had seen the logo of Khushi clinic
Acceptability coverage	Service should be acceptable in the given societal and cultural norms. In this context, the capacity of the service is limited by the number of individuals who are willing to use accessible services.	• % of total LDTDs interviewed, who had associated with Khushi clinic for more than or equal to 6 months • % of LDTDs who had heard about/seen the logo of Khushi clinic and who had associated with it for more than or equal to 6 months
Contact coverage	This stage in the process of service provision is a measurement of service output and is the ratio of actual users to target population.	• % of total LDTDs interviewed who had visited a doctor at Khushi clinic • % of LDTDs who had heard about/seen the logo of Khushi clinic and had visited a doctor at Khushi clinic • % of total LDTDs interviewed who had visited for general ailments • % of LDTDs who had heard about/seen the logo of Khushi clinic and visited for general ailments • % of total LDTDs who had visited for STI • % of LDTDs who had heard about/seen the logo of Khushi clinic and visited for STI
Effectiveness coverage	At this stage of service provision, service performance is evaluated. The number of individuals who have received satisfactory services is in this way an effective measurement of service output.	Preventive • % of total LDTDs who received a health card • % of LDTDs who had heard about/seen the logo of Khushi clinic and had their own health card • % of total LDTDs who received counseling • % of LDTDs who had heard about/seen the logo of Khushi clinic and received counseling • % of total LDTDs who received condoms • % of LDTDs who had heard about/seen the logo of Khushi clinic and received condoms • % of total LDTDs who received referrals for other health facilities • % of LDTDs who had heard about/seen the logo of Khushi clinic and received a referral for other health facilities • % of total LDTDs who took part in the meeting conducted by Khushi clinics for LDTDs regarding their health issues or any entertainment program • % of LDTDs who had heard about/seen the logo of Khushi clinic and took part in the meeting conducted by Khushi clinics for LDTDs regarding their health issues or any entertainment program Curative • % of total LDTDs who sought advice/medicine from Khushi clinic • % of LDTDs who had heard about/seen the logo of Khushi clinic) and sought advice/medicine from Khushi clinic

Note:

* Aggregate-level data will be required to estimate the ratio between the capacity and target population.

Abbreviations: BMGF, the Bill & Melinda Gates Foundation; LDTDs, long-distance truckers; IBBA-NH, Integrated Behavioural and Biological Assessment, National Highway; STI, sexually transmitted infection.

Table 2 Service capacity under the Kavach project

Service capacity	Indicators	Round 1 (2007)	Round 2 (2009)
Targeted beneficiaries	Estimated number of truckers	295,000	285,000
Infrastructure	Number of sites	17	12
Average number of footfalls	Average number of footfalls in the year	19,171	21,368
Provision	The number of condoms socially marketed	1,306,837	1,959,525
Effective indicator	Sites per 100,000 beneficiaries	6	4
Effective indicator	Condoms distributed per thousand beneficiaries	4,430	6,876

Notes: Adapted from Avahan CMIS Data. FHI 360:V6. Available from: http://dx.doi.org/10.7910/DVN/24631.³⁴

Table 3 Evaluation of health care coverage among truckers under the Kavach project, IBBA-NH (Rounds 1 and 2)

Type of access	Indicators	IBBA-NH survey
		Round 1 (n=2,066)	Round 2 (n=2,085)	Sig (P-value)a
Availability coverage	Service capacity	100.0%	100.0%	*
Accessibility coverage	% of total LDTDs interviewed who had heard about Khushi clinic	46.1%	53.8%	P<0.001
	% of total LDTDs interviewed who had seen the logo of Khushi clinic	58.5%	45.4%	P<0.001
	% of the total who had either heard or seen the logo of Khushi clinic	60.9%	54.6%	P<0.001
Acceptability coverage	% of total LDTDs interviewed who associated with the Khushi clinic (those who are aware about the Khushi clinics for more than or equal to 6 months)	13.8%	50.6%	P<0.001
Contact coverage	% of total LDTDs who visited Khushi clinic in the year prior to the survey	12.6%	22.1%	P<0.001
	% of total LDTDs who visited Khushi clinic in the year prior to the survey for STI-related ailments	0.8%	2.4%	P<0.001
	% of total LDTDs who visited Khushi clinic last year for general ailments	10.8%	21.5%	P<0.001
	% of total LDTDs visiting Khushi clinic for any purpose	12.7%	22.3%	P<0.001
Effectiveness coverage (preventive)	% of total LDTDs who received a health card	9.9%	7.3%	P=0.003
	% of total LDTDs who received condoms	5.5%	12.3%	P<0.001
	% of total LDTDs who received counseling	10.7%	20.0%	P<0.001
	% of total LDTDs who received referral from Khushi clinic to other health facilities	0.8%	3.3%	P<0.001
	% of total LDTDs who attended a meeting/took part in other activities	3.6%	7.4%	P<0.001
	% of total LDTDs receiving any important preventive services (condoms or counseling)	11.5%	22.3%	P<0.001
Effectiveness coverage (curative)	% of total LDTDs who sought advice/medicine at Khushi clinic	0.4%	1.4%	P=0.002
	Effectiveness coverage for any purpose (important preventive or curative coverage)	11.5%	22.4%	P<0.001

Note:

a P-value is estimated based on Pearson’s chi-square test.

* Statistical significance is not estimated for this category.

Abbreviations: IBBA-NH, Integrated Behavioural and Biological Assessment, National Highway; LDTDs, long-distance truckers; sig, significance; STI, sexually transmitted infection.

Table 4 Evaluation of route-specific health care coverage under the Kavach project, IBBA-NH (Rounds 1 and 2)

Type of access	Indicators	North–East route (NE)			North–South route (NS)			North–West route (NW)			South–East route (SE)
		Round 1 (n=498)	Round 2 (n=524)	Sig (P-value)	Round 1 (n=540)	Round 2 (n=538)	Sig (P-value)	Round 1 (n=515)	Round 2 (n=526)	Sig (P-value)	Round 1 (n=513)	Round 2 (n=497)	Sig (P-value)
Availability coverage	Service capacity	100%	100%	*	100%	100%	*	100%	100%	*	100%	100%	*
Accessibility coverage	% of total LDTDs interviewed who had heard about Khushi clinic	54.7%	50.4%	P=0.168	58.3%	56.1%	P=0.498	35.7%	62.4%	P<0.001	38.4%	20.9%	P<0.001
	% of total LDTDs interviewed who had seen the logo of Khushi clinic	71.7%	48.3%	P<0.001	72.1%	49.3%	P<0.001	46.5%	49.0%	P=0.420	35.9%	20.7%	P<0.001
	% of the total LDTDs who had either heard or seen the logo of Khushi clinic	73.8%	52.3%	P<0.001	73.1%	56.9%	P<0.001	49.2%	62.5%	P<0.001	42.1%	23.0%	P<0.001
Acceptabilit coverage	% of total LDTDs interviewed who associated with the Khushi clinic (those who are aware about the clinic for more than or equal to 6 months)	14.1%	49.6%	P<0.001	20.6%	54.3%	P<0.001	10.9%	57.0%	P<0.001	9.6%	20.1%	P<0.001
Contact coverage	% of total LDTDs who visited Khushi clinic in the year prior to the survey	14.3%	19.3%	P=0.036	18.5%	19.4%	P=0.756	10.3%	30.4%	P<0.001	3.3%	1.2%	P=0.033
	% of total LDTDs who visited Khushi clinic last year for STI-related ailments	0.6%	3.1%	P=0.004	1.3%	1.1%	P=1.000	0.6%	3.8%	P<0.001	0.8%	0.0%	P=0.124
	% of total LDTDs who visited Khushi clinic in the year prior to the survey for general ailments	12.3%	19.8%	P=0.001	14.4%	18.4%	P=0.085	8.9%	29.8%	P<0.001	2.5%	0.8%	P=0.48
	% of total LDTDs visiting Khushi clinic for any purpose	14.3%	20.2%	=0.13	18.5%	19.5%	=0.698	10.5%	30.4%	P<0.001	3.3%	1.2%	P=0.33
Effectiveness coverage (preventive)	% of total LDTDs who received a health card	10.0%	10.5%	P=0.837	15.0%	9.5%	P=0.007	7.8%	6.1%	P=0.329	2.5%	3.4%	P=0.461
	% of total LDTDs who received condoms	5.8%	11.5%	P=0.002	9,4%	7.1%	P=0.184	3.7%	18.6%	P<0.001	2.5%	2.4%	P=1.000
	% of total LDTDs who received counseling	9.4%	23.3%	P<0.001	15.5%	16.9%	P=0.564	10.5%	25.3%	P<0.001	2.3%	4.6%	P=0.058
	% of total LDTDs who received referral from Khushi clinic to other health facilities	0.4%	4.2%	P<0.001	1.3%	0.7%	P=0.547	0.8%	5.7%	P<0.001	0.2%	0.4%	P=0.619
	% of total LDTDs who attended a meeting/took part in other activities	2.4%	5.9%	P=0.007	7.0%	5.6%	P=0.381	2.3%	10.6%	P<0.001	8.2%	2.2%	P<0.001
	% of total LDTDs receiving any important preventive services (condoms or counseling)	11.5%	24.6%	P<0.001	16.5%	17.8%	P=0.572	10.5%	28.9%	P<0.001	3.1%	6.4%	P=0.017
Effectiveness coverage (curative)	% of total LDTDs who sought advice/medicine at Khushi clinic	0.6%	2.1%	P=0.5	0.2%	0.4%	P=0.624	0.6%	2.3%	P=0.034	0.2%	0.0%	P=1.000
	Effectiveness coverage for any purpose (important preventive or curative coverage)	11.5%	25.0%	P<0.001	16.5%	17.8%	P=0.572	10.5%	29.3%	P<0.001	3.3%	6.4%	P=0.027

Notes: P-values are based on Pearson’s chi-square test; percentages are weighted percentages using route-specific sampling weights.

* Statistical significance is not estimated for this category.

Abbreviations: IBBA-NH, Integrated Behavioural and Biological Assessment, National Highway; sig, significance; LDTDs, long-distance truckers.

Table 5 Evaluation of provision-specific coverage under the Kavach project, IBBA-NH (Rounds 1 and 2)

Type of access	Indicators	IBBA-NH survey
		Round 1 (n=1,258)	Round 2 (n=948)	Sig (P-value)a
Acceptability coverage	% of LDTDs who had either heard of or seen the logo in Khushi clinic and were associated with it (those who are aware about the clinic for more than or equal to 6 months)	22.6%	92.8%	<0.001
Contact coverage	% of LDTDs who had either heard of or seen the logo in Khushi clinic and visited Khushi clinic in the year prior to the survey	20.7%	40.5%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and visited Khushi clinic in the year prior to the survey for STI-related ailments	1.3%	4.5%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and visited Khushi clinic in the year prior to the survey for general ailments	17.8%	39.4%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and visited Khushi clinic for any purpose	20.9%	40.8%	<0.001
Effectiveness coverage (preventive)	% of LDTDs who had either heard of or seen the logo in Khushi clinic and received a health card	16.2%	13.3%	<0.05
	% of LDTDs who had either heard of or seen the logo in Khushi clinic	9.0%	22.5%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and received counseling	17.5%	36.5%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and received a referral from Khushi clinic to other health facilities	1.4%	6.1%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and attended a meeting/took part in other activities	5.9%	13.6%	<0.001
	% of LDTDs who had either heard of or seen the logo in Khushi clinic and received any important preventive services (condoms or counseling)	18.9%	40.8%	<0.001
Effectiveness coverage (curative)	% of LDTDs who had either heard of or seen the logo in Khushi clinic and sought advice/medicine at Khushi clinic	0.7%	2.5%	<0.001
	Effectiveness coverage for any purpose (important preventive or curative coverage)	18.9%	41.8%	<0.001

Notes:

a P-values are estimated based on Pearson’s chi-square test.

Abbreviations: IBBA-NH, Integrated Behavioural and Biological Assessment, National Highway; LDTDs, long-distance truckers; sig, significance; STI, sexually transmitted infection.

Figure 1 Coverage curves for the provision of health care to LDTDs through the Kavach project. Coverage curves based on all LDTDs (A), and provision-specific coverage curves (B).

Abbreviation: LDTDs, long-distance truckers.

Avahan CMIS Data [database on the Internet]. FHI 360:V6 Available from: http://dx.doi.org/10.7910/DVN/24631Accessed February 4, 2015

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