Patient navigation program plays a huge role in directing implementation of existing and new system in public health. Studies show that patient navigation system across healthcare have proven to have

• reduced time for diagnosis and treatment of disease
• improved adherence of patient to the treatment 
• improved quality of life in chronic illness 
• improve communication and knowledge of patient for seeking healthcare 

The key component of these program are navigators dedicated to reduce barriers to healthcare by identifying critical resources to promote good health of patients. Patient navigators are part of healthcare team in public health. Example : nurses, community health worker, ASHA worker, Social workers. In a fragmented public health system in India like many developing nation completion of "test and treat loop" seems to be lagging. To address this a systematic review was conducted to track the navigation system used by patient of hypertension, tuberculosis, diabetes, typhoid. The study showed that patient navigation program in India depended on health seeking behavior of patient  rather than addressing prominent navigation barriers  such as structural factors, diagnostic process, concept of visible and invisible work, absence of diagnostic agent, poor counselling at the beginning of diagnosis and treatment. In long term illness like tuberculosis these barrier led to seeking second opinion, trust deficit, lack of social support, social consequence.

These barriers led to ambiguity in public healthcare delivery, diagnostic delays and frustration, public mistrust of public health. Due to the overwhelming healthcare system navigation became time consuming that led to self treatment, spread of infectious diseases, economic burden in chronic illness and disability, burdening the public health in long term. Thus patient navigation programs is important in public health not only to diagnose and treatment of diseases at a point in time but to complete "test and treat" loop to encourage positive health practices and reduce burden of disease in the community. 

Reference : 

Vijayshree yallapa et al, 2017,How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India, Global Health Action, Article: 1350452, Volume1, Issue1. //doi.org/10.1080/16549716.2017.1350452

According to the estimates, India's cancer burden will certainly rise from an expected 1 million cases in 2012 to 1.7 million in 2035. The number of cancer cases reported in Indian hospitals has steadily increased over time.

The goal of starting a patient navigation program is to develop a taskforce that is qualified to support cancer patients as they navigate the range of cancer diagnosis, treatment, cure, and survival, as well as to meet the special needs of palliation and end-of-life care, in order to provide patients and survivors with seamless care (2).

Nevertheless, cancer prevention, diagnosis, and therapy are complicated procedures that frequently call for consultations with various medical specialists in a variety of venues and with the aid of numerous medical tests. A series of hearings with low-income Americans from all throughout the United States were held in 1989 to better understand the special difficulties that disadvantaged populations confront in gaining access to these complex processes. They found these issues to tackle:

1) The study found that significant financial barriers, such as being unable to afford health insurance, being ineligible for Medicaid or Medicare, losing employment that offers health insurance, and a lack of readily available cancer services, are common among the poor and prevent them from receiving the necessary care.

2) Logistical obstacles including a lack of transportation, living distant from a healthcare facility, a lack of alert systems, and a lack of clear cancer information

3) Social and cultural hindrances, include a lack of social support and poor health literacy.

Additionally, to help overcome these challenges, patient navigators are started being hired in the hospital settings the aim were to:

1) Overcoming obstacles in the health system

2) Spreading awareness of cancer prevention, detection, and treatment through health education.

3) Addressing patient obstacles to receiving cancer care.

4) To offer psychosocial assistance. Patient navigators can help patients’ complete medical paperwork, book, confirm, reschedule, and attend appointments, coordinate cancer diagnostic or treatment services from different physicians, and promote patient-provider communication.

Furthermore, other patient aid models and patient navigation have similar traits. Oncology patients may get health education materials from hospital-based social workers, and community health workers, lay health advisers, or promoters may advocate for cancer screening in the local area (1).

Reference: 

1. Wells, K. J., Battaglia, T. A., Dudley, D. J., Garcia, R., Greene, A., Calhoun, E., ... & Patient Navigation Research Program. (2008). Patient navigation: state of the art or is it science?. Cancer, 113(8), 1999-2010. //doi.org/10.1002/cncr.23815a

  2. //tmc.gov.in/index.php/en/kevat-patient          navigator#:~:text=The%20aim%20of%20initiating%20a,care%20to%20patients%20and%20survivors.

KEVAT is the first in India to focus on an emerging patient navigation model that can be applied across all cancer care institutions. The program shall empower the navigators to:

• Build knowledge base in patient navigation in oncology with adept understanding of medical terminologies & assimilate understanding on cancer and its treatment protocols, supportive care options, including risks and benefits of integrative therapies, rehabilitation, funding options, insurance and other patient allied services; along with honing skill set for developing and implementing patient navigation programs in hospitals.
• Garner perspective on principles and operations of health systems, concepts of evidence-based information on cancer screening, diagnosis, treatment and survivorship
• Actively manage and devise follow-up practices & use evaluation metrics (patient encounters, patient feedback and overcoming barriers to care) to improve hospital systems to ensure better patient compliance and outcomes
• Advocate for quality and optimal patient care systems and improving healthcare delivery through appropriate resource planning and management
• Bring about attitudinal change in concept of care with a common vision and mission to offer best socio-economic support and strike equitable balance with limited resources.

Reference :- //tmc.gov.in/index.php/en/kevat-patient-navigator

Patient navigation programs are an important part of the healthcare delivery system. They provide patients and caregivers with the resources and support they need to manage their health. patient navigation programs are usually implemented at the primary care level and focus on patients with chronic conditions such as diabetes or hypertension. These programs have been shown to reduce healthcare costs and improve treatment adherence in these patients. Some studies have shown that these patient navigation programs can decrease the amount of time spent in the emergency department by as much as 40% and increase the number of patients who choose primary care clinics(1).

The Patient navigation program KEVAT, by Tata Memorial Centre (TMC) in collaboration with TISS is the first to offer this program across India(2), This calls the need for such programs across India considering the growing number of medical colleges across India . 

Reference:

1. Saluja, S., Hochman, M., Dokko, R., Morrison, J. L., Valdez, C., Baldwin, S., Tandel, M. D., & Cousineau, M. (2022). Community-Based Health Care Navigation’s Impact on Access to Primary Care for Low-Income Latinos. The Journal of the American Board of Family Medicine, 35(1), 44–54. //doi.org/10.3122/jabfm.2022.01.210253

‌2. //www.tatatrusts.org/upload/patient-navigation-program-kevat.pdf

Patient navigation is a patient-centred health care service delivery model with the aim to provide timely access to health care. The concept was developed based on the findings of the American Cancer Society National Hearings on Cancer in the Poor. With the increasing burden of Cancer worldwide, it is imperative to understand the navigation pathways for cancer patients for timely diagnosis and treatment. Read this paper to know more about Patient navigation pathway and barriers to treatment seeking in cancer in India.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC4557777/

//www.sciencedirect.com/science/article/abs/pii/S1877782113001641

The patient navigation programme is playing vital role in field of public health.KEVAT is the first navigation academic programme in india which is started by TATA MEMORIAL CENTRE(TMC ) and TATA INSTITUTE OF SOCIAL SCIENCES(TISS).Rapidly cancer is increasing .It is estimated that the cancer burden is in India likely to increase 1 million 2012. 1
Three main areas have patient navigation used cancer transitional and services targeted at vulnerable and social disadvantages patients. Patient navigators have increasingly been implemented for patients who has been suffering various and single chronic diseases like heart stroke, diabetes,cancer obesity etc.2
refrence:
1. //tmc.gov.in/index.php/en/kevat-patient-navigator.10.2.23/10:45.
2. //apps.who.ins.9.2.23/22:23.

Patient navigators use care coordination strategies to engage people in HIV treatment in rural communities. Patient navigators can also play an important role in reducing health disparities for racial and ethnic minorities and underserved populations.

Patient navigators work with people, their families, and their caregivers to overcome barriers to cancer screening and diagnosis, cancer care, and resources needed after cancer treatment. 

Patient barriers may include:

• Lack of transportation.
• Lack of care for children or elderly relatives.
• Not understanding why they should get screened.
• Speaking a language other than English.
• Mistrust of the health care system.
• Fear of finding out they have cancer or fear of the screening procedures.

//www.google.com/url?sa=t&source=web&rct=j&url=//www.cdc.gov/screenoutcancer/patient-navigation.htm%23:~:text%3DPatient%2520navigation%2520helps%2520people%2520get,resources%2520needed%2520after%2520cancer%2520treatment.&ved=2ahUKEwiWutPSlov9AhUYTGwGHQkKDPUQFnoECFAQBQ&usg=AOvVaw2clanldTqtw80JriOB50yh

Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, a patient navigation system was designed and implemented that aimed to improve patients' subjective care experience. A team of patient navigators was hired and trained who were recruited from the local area. Their responsibility was exclusively to demonstrate compassion and to guide patients through their care process. Visual cues was designed throughout hospital complex to assist in navigating patients through the buildings. Patient navigators were incorporated within the management and communications systems of the hospital care team, and established standard operating procedures. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited. The lessons  learned at Hospital with regards to patient navigation may be relevant to other healthcare facilities serving similar patient populations. Patients with low health literacy, and those who suffer from social exclusion and economic marginalization in rural settings, often struggle with navigating complicated healthcare facilities.

References

//www.sciencedirect.com/science/article/abs/pii/S2213076415000937

Patient navigation helps people get the health care and other resources they need to be as healthy as possible. Patient navigators work with people, their families, and their caregivers to overcome barriers to cancer screening and diagnosis, cancer care, and resources needed after cancer treatment. 

Create a Patient Navigation System

• Identify internal and external partners—like clinics or community-based organizations—to work with.
• Determine the type of patient navigator you need—for example, a social worker, community health worker, or nurse.
• Develop a process to monitor the system and track screenings and outcomes. Identify what data will be needed.
• Use the Patient Navigation Barriers and Outcomes Tool developed by George Washington University as a guide.
• Review the New Hampshire Colorectal Cancer Screening Program’s replication manual to learn about an effective model.

References:- //www.cdc.gov/screenoutcancer/patient-navigation.htm#:~:text=Patient%20navigators%20guide%20patients%20through,be%20as%20healthy%20as%20possible.

A recent study titled The Emerging Field of Patient Navigation: A Golden Opportunity to Improve Healthcare emphasizes the significance of patient navigators. The study also looks at how patient navigators may improve patient satisfaction, lower no-show rates, and lessen healthcare disparities.

Based on a recent study of 29 patients, patient navigation improved patient knowledge of their cancer and engagement with the hospital staff. Additionally, it shortened the interval between diagnosis and treatment, increased cooperation with treatment, and improved quality of life.

5 An important survival benefit was also observed in a recent study of patients with advanced cancer. In this study, patients who were African Americans who already had Medicaid and a diagnosis of either lung or liver problems saw the biggest survival benefit.

Reference:

//www.jons-online.com/issues/2018/october-2018-vol-9-no-10/1998-the-benefits-of-patient-navigation

Chronic diseases, including physical and mental illnesses, are a significant burden to both patients and the health care system. There were an estimated 12.7 million new cases of cancer worldwide in 2008 ; and diabetes prevalence was estimated to be 6.4%, affecting 285 million adults worldwide in 2010 . Despite widespread dissemination of practice guidelines, many people with chronic diseases do not receive or adhere to recommended care .

This difficulty in implementing evidence-based care may be due to a combination of patient, provider and system level barriers . Patient level barriers may include lack of awareness of publicly funded programs (including community-based resources), financial constraints, competing priorities (e.g., family and work), personal circumstances, language and culture (i.e., race/ethnicity) ; such barriers could make it challenging to follow even seemingly simple lifestyle recommendations. At the provider level, barriers may include lack of clinical decision support systems to implement recommended care, lack of time and knowledge. System level barriers include the inherent complexity of the health care system and suboptimal access to primary or specialty care.

Patient navigators are trained personnel who help patients overcome modifiable barriers to care and achieve their care goals by providing a tailored approach to addressing individual needs .

Sources: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5819768/

To address COVID-19 pandemic, WHO recommended contact tracing, communication of information regarding risk and prevention, engaging at risk population and supporting those who are affected by COVID-19. Patient navigators and community health workers are an essential part of the workforce as they have skills in community engagement, helping community members in basic needs and at the same time navigate through healthcare and public health system. Healthcare and public health agencies should collaborate with agencies that employ navigators or should employ community health workers and navigators to reduce burden from healthcare and public health workforce. The below mentioned research paper talks about how community health workers and patient navigators are critical in tackling any pandemic and contribute effectively to the needed workforce    //www.ncbi.nlm.nih.gov/pmc/articles/PMC7901305/

Patient Navigators are very important in the delivery of public health services. they are also called patient health advocates. A patient navigator is a person who guides a patient through the healthcare system. This help includes;

1. Going through the screening, diagnosis, treatment, and follow up of medical condition such as Cancer.

2. Communication with patients healthcare providers so that they get information they need to make decisions about their health care.

3. Setting up patients appointments for Doctor visits, medical tests and get financial, legal and social support

4. Working with insurance companies, employers, case managers, lawyers and others who may have effect on patient's health care needs.

People with cancer, both newly diagnosed and those living with chronic diseases, mostly have questions about their specific cancer, related research, clinical trials, prognosis and many more. patient navigators can help to provide answers to questions and provide necessary resources. They make sure that you and your caregivers have the knowledge necessary to be active partners.

Other studies also demonstrates the great role of patient navigators in eliminating health disparities especially those disparities associated with language and cultural differences. They can foster trust and empowerment within the communities they serve.

Reference

//www.cancer.org/publications/dictionaries/cancer-terms/def/patient-nevigator