SATHI: surgical accredited and trained healthcare initiative for task shifting in India

We conceptualized Surgical Accredited and Trained Healthcare Initiative (SATHI) as a community-based worker through which patients who are unaware or undecided of surgical conditions would be linked to service providers. These personnel will help patients to attain the benefits of health schemes and will offer counseling through trust-building and elimination of fear of surgical procedures to reduce the surgical unmet needs. Our baseline study identified five common surgical problems among the study population: extremity injuries/wounds; kidney stones; cataracts; abdominal pain, including external hernias, and menstrual disorders. Based on these findings, we designed a modular, skills-focused curriculum and recruited six full-time staff who have undergone didactic and practical training. Upon finding any suspected health condition, SATHI staff are trained to encourage the patient and their family to seek medical advice. They are also equipped with the basic information about the surgical management of these conditions and will offer preoperative and post-operative surgical care and psychosocial support. This publication describes the process of development of training material, methods and process. Each SATHI worker has been assigned 1000 households (~5000 population). Based on our estimates, he/she will have to cater to 64 cases of unmet surgical needs if the unmet need is 40%. This means a SATHI worker would have approximately five to six cases of unmet surgical needs per month. We are planning to analyze the survey findings, document the process of implementation, and based on learnings from the pilot project, modify the training material and protocol.