Search

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India's experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm's length of government; primarily to govern and manage the state's health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC. [ABSTRACT FROM AUTHOR]

Objective: To assess the prescription practices in the Indian state of Rajasthan with a view to demonstrate the effect of provider and system level factors, and their interactions on good prescription practices. The study analysed two major dimensions of good prescription practice; first, the completeness of prescription, a measure of adequacy; and second, the appropriateness of prescription, a measure of quality of care. Design: A retrospective cross-sectional study with a mixed method approach Setting: 24 rural and 7 urban government Primary Health Centres of Rajasthan, India Participants: Audit of 2801 prescriptions from health facility and the service providers in these facilities, including doctors, and nurses Primary and Secondary Outcomes: The study outcome testified the study objective that provider level factor is critical to assure adequacy and appropriateness of good prescription practice. The secondary level outcome revealed that the system level factors are equally important to ensure compliance to good prescription practice Result: We found that the documentation of patient complaint, examination findings largely depended on system level factors, such as availability of space in the piece of paper used for writing prescription; because for the doctor documenting diagnosis, and prescribing medicines and investigations were of greater importance. Ownership compliance of doctors, measured in terms of their signature on the prescriptions, emerged as an important factor determining both adequacy and accuracy of prescriptions. Further, the treatment appropriateness, measured in terms of QoC, depends on both provider & system level factors. Conclusion: There is a need to focus on provider and system level factors to improve prescription practices in primary health care. We recommend that institutional strengthening at systemic & provider level using innovative ways; such as task shifting to nurses as ‘physician assistants’, and reducing administrative activities of physicians to enhance focus on clinical work can propel better prescription practice. [ABSTRACT FROM AUTHOR]

State-driven community surgery camps have been organised in India for nearly five decades. Despite their being extremely beneficial to people not having ready access to surgical healthcare (SHC), they continue to be mired in controversies because of negative consequences following free surgery, eg blindness following cataract surgery; infection/death following tubectomy/vasectomy. While the onus of complications during and following surgery camps is commonly ascribed to deficient camp infrastructure/facilities; the contribution of the tendency to achieve high-frequency targets, ie to-do-more-surgery-in-less-time to the problem; continues to escape public scrutiny. Ironically, even the significant and multiple morbid events during surgery camps only evoke a transient public outcry, reflective professional criticism, hyper-media whimpers, and legal turbulence; before fading completely from public memory. This viewpoint piece, by taking into consideration the various ethical burdens that assail community surgery camps (13 deaths in the Chhattisgarh tragedy of 2014, as a case in point); aims to deconstruct inadequate SHC systems and conflicted surgery targets seeking promotion and fame. It also suggests remedial measures to address the problems, especially in terms of identifying a valid end-point for successful surgery, ie surgery completion or surgery outcome; and how the media, polity, professional fraternity, and executives could reorient themselves to respond more sensitively to problems, for the benefit of the patients and community at large. Keywords: community, surgical camps, system, surgery, reporting, mishaps.

Bio-medical waste management rules were formulated in response to the worldwide public concern over medical waste. The practice of separation into different types of waste in health care institutes should be evaluated more scientifically. Due to a lack of data from the Indian sub-continent, this study was initiated at a tertiary care hospital. Samples were collected from different types of waste at the hospital, at different time intervals, for microbiological evaluation. The results reveal that the microbial flora isolated from infectious waste and general waste from the hospital are similar. The samples from general waste in this study reveal many types of pathogens. The bacteria present in the waste initially was low in quantity, but they replicated rapidly over time so that significant numbers were detected by 24 hours, due to environmental factors which were favorable for growth during this period. This study strongly suggests that waste should be removed from the hospital within 24 hours of its generation to prevent environmental contamination caused by any accidental spillage of waste. General waste generated in the hospital should be treated similar to infectious waste, as it can be equally hazardous.

With the emergence of Transfusion Medicine Department the definition of Blood Bank has changed. Today, it is not just a bank to collect & issue blood, it prepares and supplies individual blood component, to the patients as and when the need arises during the course of treatment. The planning & management of any blood bank depends on number of functions it is required to serve and the number of units of demand of blood & blood products. This has also changed the role of nursing from skilled nursing care to managing the blood bank services. Hence, there is a need for the nursing personnel to know about the recent advances in planning and management of transfusion medicine, so that they can handle this dual responsibility as a Nurse and a manager.