The CURE Clubfoot Management Model
CURE India has developed a program management model to successfully manage the Ponseti method of treatment to a successful conclusion. The CURE Clubfoot management model includes a set of best practices that is followed very intentionally.
In the CURE India Clubfoot programme model,
- Children are treated in designated weekly clubfoot clinics, which have a trained doctor, counsellor, enough stock of different sizes of braces, a system to document etc. There is a 36-point check list that is followed to check the minimum required essentials in any ideal clubfoot clinic.
- A designated weekly clubfoot clinic is not established in any state, country or province unless the respective government or hospital authority signs an agreement with CURE.
- A designated weekly clubfoot clinic will not have children enrolled for treatment until it has a trained doctor/healthcare practitioner and a trained counsellor.
- Children and parents are not entertained in the clinic unless there are treatment materials like plaster of Paris, soft ban, tenotomy requirements, and foot abduction braces available.
- Children do not meet the doctor to start treatment unless the standard medical record file has all the details about the child recorded.
- Children do not get their weekly plaster casting until the medical practitioner records the pirani score.
- Parents do not return home from the clinic until they parents are given detailed counselling and are taught all relevant information from the parent teaching brochure with images of treatment progress and a new appointment date as per the treatment protocol written down in the printed brochure.
- If any parent misses their appointment opportunity immediately they are contacted by the counsellor and asked and counselled to continue the treatment without any delay. A new appointment is given over the ‘phone and reminder calls are made to ensure the child visits.
- Enough foot abduction braces of all sizes are stored in all designated clubfoot clinics so that there is no delay or waiting period for any child for any brace size. The day the tenotomy cast is removed the child gets the right size of brace before leaving the clinic.
- Every clinic has a counselling location, cast removing corner and display of clinic timings and helpline number.
- Every state in India has 24X7 clubfoot helpline numbers and a toll-free national clubfoot helpline number where parents can always talk to the counsellors to clarify their doubts, share their challenges or confirm an alternate appointment date with the doctor.
Ownership and support of the local government is vital for the success of large clubfoot management programs at the state, province, union territory or national level. CURE India’s policy is to work only with public/ government hospitals and medical colleges managed by the State or Central government because the poorest of the poor visit public hospitals for any treatment or medical care and the priority of the CURE initiative is to serve the poor who cannot afford paid treatment. Healthcare provided at public hospitals is free of cost to people below the poverty line. CURE also provides what is missing in the public healthcare systems and hospitals (refresher training to doctors on the Ponseti method, counsellors to follow-up, brace, documentation and helpline support). Designated weekly clubfoot clinics are established with the approval and guidance of each of the State governments. A memorandum of understanding is signed with each 29 states in India, where the doctors are trained and designated clinics are established. Trained counsellors are appointed to counsel and teach the parents who bring children for clubfoot treatment. Counsellors also help doctors maintain medical records electronically and braces are distributed free of cost to each child by the counsellors.
In the partnership with State governments, the role of CURE is to
- Provide annual refresher training to healthcare professionals who participate in the treatment of clubfoot.
- Maintain medical records (electronically and manually) for every child enrolled in the program.
- Appoint counsellors to teach parents the protocol on the Ponseti method, maintain medical records, distribute braces and attend the 24X7 Clubfoot helpline.
- Distribute foot abduction brace for every child free of cost.
- Manage programs by appointing program managers and coordinators to work in coordination with the respective state government.
- Establish and maintain a 24/7 state-level clubfoot helpline.
In the public-private partnership, the role of the state government is to
- Depute dedicated doctors for every clinic who attend the refresher training and provide quality Ponseti care to the children.
- Ensure availability of quality treatment materials like plaster of Paris (PoP), soft ban, cotton and the materials required for the tenotomy procedure.
- Provide clinic space where counsellors meet the parents, store brace & medical records, doctors consult the children, provide casting etc.
- Use the existing community health awareness and screening team to identify and refer children born with clubfoot for free treatment from the designated clubfoot clinics in the state.
In partnership with the central government, CURE works very closely with the National Health Mission (NHM). The Rashtriya Bal Swasthya Karyakram (RBSK) the National Child Health Program of NHM has included clubfoot as one of the birth defects to be identified and treated compulsorily. In several states, when children are identified for treatment for clubfoot, the information is shared with CURE and the counsellors follow up with the parents to ensure successful treatment from the designated clubfoot clinic. The shared vision in this public-private partnership program is to see India free from the disability of clubfoot.
