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Among the 100 million refugees and displaced persons in 2022, the category of "climate refugees" has become more salient, yet countries still do not know how to handle it. Two aspects of climate refugees also remain understudied; how climate refugees are perceived, since they are viewed through the dual lenses of climate risks and migratory flows and how these perceptions impact policies. Climate refugees are thus doubly impacted by the spill-over effect of securitization processes in the fields of climate change and immigration. This paper analyzes how climate- and migration-security legislation in a resource-constrained nation conceptualizes climate refugees, and how their diverse conceptual categories spill over into policymaking and create a mutually beneficial and humanitarian approach for host and migrant populations. This paper uses India as a case study based on its historical practice of refugee protection despite significant resource constraints, high risk of inbound climate refugees, participation in key global agreements, and domestic discourse over climate and immigration securitization. Using policy analysis and expert interviews, this study demonstrates that India successfully exemplifies a broadly humanitarian climate mobility regime in the South Asian region through relocations, Humanitarian Assistance and Disaster Relief operations, and ad hoc legal protection. Despite crucial structural limitations, India illustrates a democratic global south template implicitly recognizing migrants' vulnerability to climate change and attempts to minimize risk, with potential for replication in other developing and developed nations. This normative policy framework, notwithstanding its limitations, presents an alternative to the threat-centric and unsustainable securitization of climate migration practiced in the Global North. [ABSTRACT FROM AUTHOR]

Foods high in fat, sugar or salt are important contributors to the rising burden of non-communicable diseases globally and in India. Health taxes (HTs) have been used by over 70 countries as an effective tool for reducing consumption of sugar sweetened beverages (SSBs). However, the potential impacts of HTs on consumption and on revenues have not been estimated in India. This paper aims to estimate the potential impact of health taxes on the demand for sugar, SSBs and foods high in fat, sugar or salt (HFSS) in India while exploring its impact on tax revenues. PE of sugar was estimated using Private Final Consumption Expenditure and Consumer Price Index data while price elasticities for SSBs and HFSS were obtained from literature. The reduction in demand was estimated for an additional 10–30% HT added to the current goods and services tax, for varying levels of price elasticities. The results show that for manufacturers of sweets and confectionaries who buy sugar in bulk and assuming a higher price elasticity of −0.70, 20% additional HT (total tax 48%) would result in 13–18% decrease in the demand for sugar used for confectionaries and sweets. For SSBs, HT of 10–30% would result in 7–30% decline in the demand of SSBs. For HFSS food products, 10–30% HT would result in 5–24% decline in the demand for HFSS products. These additional taxes would increase tax revenues for the government by 12–200% across different scenarios. Taxing unhealthy foods is likely to reduce demand, while increasing government revenues for reinvestment back into public health programmes and policies that may reduce obesity and the incidence of non-communicable diseases in India. [ABSTRACT FROM AUTHOR]

This paper assesses the impact of an information dissemination intervention on the local-level implementation of the rural public works program in India. One key feature of the intervention is to provide information to workers once their wages get credited into their accounts. Using administrative and survey data, its impact on delays in wage payments and days of work along with the awareness levels of the entitlements is evaluated. The findings indicate a substantial reduction in payment delays and in trips made for wage withdrawal, in addition to improvements in awareness. The decrease in the payment delays in the treated villages persists even beyond the intervention period. While a limited impact on work days is observed during the intervention, a significant increase in the post-intervention period is found. The findings substantiated through qualitative evidence provide a platform for an innovative and cost-effective intervention to improve the implementation of social protection programs. [ABSTRACT FROM AUTHOR]

Since the inception of the novel coronavirus, immense research efforts have been made to understand how several economic indicators, including food security, would be affected. With India racing behind the United States in terms of daily infection rate and being a country with challenging food security issues, it is important to investigate how the presence of the pandemic has influenced the dynamics of food prices in the country. This paper considers seven price series from 167 markets across the five regions in India as well as the growth rate of COVID-19 infection. The paper uses a time-varying autoregressive model to investigate the nonlinear dynamics of food prices in relation to the pandemic in India. The resultant models reveal strong asymmetric properties with shock-inflicted persistence, which appear not to converge over the simulation period. Moreover, in terms of the location of the burden of the pandemic impact, we find a food product divide. [ABSTRACT FROM AUTHOR]

This paper presents axiomatic arguments to make the case for distribution-sensitive multidimensional poverty measures. The commonly used counting measures violate the strong transfer axiom, which requires regressive transfers to be unambiguously poverty increasing, and they are also invariant to changes in the distribution of a given set of deprivations among the poor. The paper appeals to strong transfer as well as an additional cross-dimensional convexity property to offer axiomatic justification for distribution-sensitive multidimensional poverty measures. Given the nonlinear structure of these measures, it is also shown how the problem of an exact dimensional decomposition can be solved using Shapley decomposition methods to assess dimensional contributions to poverty. An empirical illustration for India highlights distinctive features of the distribution-sensitive measures. [ABSTRACT FROM AUTHOR]

Aims: This structured review aimed to discuss the existing literature on therapeutic hypothermia for moderate to severe neonatal encephalopathy exclusively in low- and middle-income countries (LMICs).Methods: Medline, Embase, CINHAL and Cochrane Registry were searched for original papers with therapeutic hypothermia (TH) for treating neonatal encephalopathy in LMIC with no language restrictions. The search identified 1413 papers from 1990 to 31 August 2021.Results: Twenty-one original papers were included after duplicates removal and full-text screening in the final review. Fourteen randomized control studies and seven non-randomized studies were discussed with various modes of cooling (servo-controlled, phase changing material, traditional methods), complications during cooling, mortality and long-term neurodevelopmental assessment. Although there is sufficient evidence in LMIC favouring cooling for the reduction in mortality and improving the neurodevelopmental outcomes, nonetheless these studies were widely heterogeneous in terms of method of cooling, tools for assessing developmental outcomes, age at assessment and variations in neuroimaging tools and reporting.Conclusion: Therapeutic hypothermia is beneficial in LMICs with low certainty of evidence in reducing mortality and improving neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Evidence-informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource-constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation, and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking, particularly for some of its high-priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence-informed decision making, demonstrating the continued evolution of India's evidence policy system. [ABSTRACT FROM AUTHOR]

In recent years, community health governance structures have been established in many low and middle-income countries (LMICs) as part of decentralization policies aimed at strengthening primary healthcare systems. So far, most studies on these local structures either focus on measuring their impact on health outcome or on identifying the factors that affect their performance. In this paper we offer an alternative contribution that draws on a sociological interpretation of community health governance to improve understanding of how the government's policy vision and instrumentation translate to interactions that take place within local spaces at field level. We study 13 Village Health Sanitation and Nutrition Committees (VHSNCs) in Karnataka, India, from 2016 to 2018 focusing on sanitation, nutrition and hygiene which remain impediments to improving primary healthcare amongst poor and marginalized communities. Three local governance mechanisms of horizontal coordination, demand for accountability and self-help help to explain improvements that have taken place at village level and contribute to the creation of a new theory of community health governance as evolving phenomenon that requires a constant process of learning from the field to strengthen policymaking. [ABSTRACT FROM AUTHOR]

Background The number of patients with visual impairment and blindness from glaucoma is rapidly increasing with wide-ranging impacts for individuals and societies. However, the disease often goes undiagnosed for a long time, especially in low- and middle-income countries where healthcare services are limited. This paper presents the results of a pilot programme, which integrated targeted glaucoma screenings of people aged ≥40 y in community-based eye care services in the Ganjam district of Odisha state, India. Methods Using routine programme data, descriptive statistics were produced for the characteristics of patients participating in the screening programme and the rate and uptake of glaucoma referrals. Bivariate analysis was used to examine associations between patient characteristics, clinical risk factors and glaucoma diagnosis. Results Out of 23 356 individuals aged ≥40 y screened for glaucoma over a period of 18 mo, 2219 (9.5%) were referred and 2031 presented for further examination. Among them, almost half (n=968, 48%) were diagnosed with glaucoma, representing a screening to diagnosis conversion rate of 4.14% (95% CI 3.9 to 4.4%). A positive diagnosis of glaucoma among suspects was associated with female sex, age >60 y, visual impairment, vertical cap-to-disc ratio ≥0.6:1, intraocular pressure ≥30 mmHg and shallow anterior chamber (p<0.001). Conclusions The importance of targeted screening for glaucoma using simple referral criteria to identify patients at high risk of vision loss who can benefit from treatment is critical to slow the progression of the disease and the prevention of blindness. Further studies assessing costs of the targeted screening, the role of technology in improving programme effectiveness and efficiency and the longer term compliance with treatment are needed to support glaucoma policy frameworks, guidelines and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes. Data sources PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts, EconLit, Science Direct, the ISI Web of Knowledge, Social Science Research Network and databases of research centers were searched up to September 2010. An Internet search was executed. Study selection One thousand hundred and thirty-three papers were assessed for inclusion and exclusion criteria. Twenty-five papers were selected providing information on eight schemes. Data extraction A realist review was performed using Hirschman's exit-voice theory: mechanisms to improve exit strategies (financial assets and infrastructure) and strengthen patient's long voice route (quality management) and short voice route (patient pressure). Results of data synthesis All schemes use a mix of measures to improve exit strategies and the long voice route. Most mechanisms are not effective in reality. Schemes that focus on the patients’ bargaining position at the patient-provider interface seem to improve access to quality care. Conclusion Top-down health insurance interventions with focus on exit strategies will not work out fully in the Indian context. Government must actively facilitate the potential of CHI schemes to emancipate the target group so that they may transform from mere passive beneficiaries into active participants in their health. [ABSTRACT FROM PUBLISHER]

Background This study is part of a multicountry matched-cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI) of children exposed to invasive group B Streptococcus (iGBS). The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non iGBS group in our population. Methods Survivors of iGBS in a South Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age- and gender-matched non iGBS children. Participants were assessed using Bayley Scales of Infant and Toddler Development–3rd edition (BSID-III), Wechsler Preschool and Primary Scale of Intelligence–4th edition (WPPSI-IV), Wechsler Intelligence Scale for Children–5th edition (WISC-V), Child Behavior Checklist (CBCL), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), depending on age. Results Our cohort comprised 35 GBS-exposed and 65 matched non iGBS children, aged 1–14 years. The iGBS-exposed group had 17 (48.6%) children with impairment in ≥1 domain compared to 25 (38%) in the non iGBS group (unadjusted OR, 1.51; 95% CI,.65–3.46), 9 (26%) children with "multi-domain impairment" compared to 10 (15.4%) in the non iGBS group (unadjusted OR, 1.90; 95% CI,.69–5.24), and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non iGBS group (unadjusted OR,.60; 95% CI,.06–6.07). In the iGBS group, more children had motor impairments compared with the non iGBS group (unadjusted OR, 10.7; 95% CI, 1.19–95.69; P  = .034). Conclusions Children with iGBS seem at higher risk of developing motor impairments compared with a non iGBS group. [ABSTRACT FROM AUTHOR]

India with a population of 1.3 billion has a unique health care system in its different states. Mental health care varies widely across the country and this became even more apparent after the COVID-19 pandemic set in. This paper examines the various strategies in response to COVID-19 adopted by the Government of India, the health departments of the individual states, and other private players such as on-government organizations and the civil society. The cessation of many services including outpatient and inpatient care and the scarcity of medicines were serious impacts of COVID-19. The prolonged lockdown in many parts of the country impeded access to mental health care services since public transport was unavailable. This led to many relapses in persons with serious mental disorders. The emergence of new cases of psychosis and an increase in suicides were also seen. Tele consultations came to the fore and many helplines were started offering counseling and guidance regarding the availability of mental health care facilities. While these helped the urban dwellers, those in remote and rural areas were unable to use these services effectively. Many mental health wards were used for COVID-19 patients and mental health professionals were deployed for COVID-19 related duty. The severely mentally ill, the homeless mentally ill, and the elderly were especially vulnerable. Based on our experience with COVID-19, we urge a strong call for action, in terms of strengthening the primary care facilities and increasing the manpower resources to deliver mental health care. [ABSTRACT FROM AUTHOR]

The SHRUG is an open data platform describing multidimensional socioeconomic development across 600,000 villages and towns in India. This paper presents three illustrative analyses only possible with high-resolution data. First, it confirms that nighttime lights are highly significant proxies for population, employment, per capita consumption, and electrification at very local levels. However, elasticities between night-lights and these variables are far lower in time series than in cross section, and vary widely across context and level of aggregation. Next, this study shows that the distribution of manufacturing employment across villages follows a power law: the majority of rural Indians have considerably less access to manufacturing employment than is suggested by aggregate data. Third, a poverty mapping exercise explores local heterogeneity in living standards and estimates the potential targeting improvement from allocating programs at the village—rather than at the district—level. The SHRUG can serve as a model for open high-resolution data in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to explore the transformations in the relation of global health and capitalism during the last three decades and its reflections on the nature of power relations between the state, local and transnational capital in the Indian pharmaceutical industry. Methods: In this study, the effects of the developments in the international political economy after TRIPS (Trade-Related Aspects of Intellectual Property Rights) in the global pharmaceutical sector and in the Indian local sector are examined within the framework of the International Relations discipline. In this sense, a historical review of the Global Patent Regime has been made and a literature review has been conducted on the global pharmaceutical industry, drug patents and post-TRIPS agreements. Qualitative research method is used in the study in which the literature review is evaluated in an empirical and theoretical framework. Key findings: The Global Patent Regime has been constructed for the interests of the transnational capitalist hegemon and in this sense has increased inequality in the global health. However, when the changes created by the global economy in the pharmaceutical sector, cooperation between the Southern countries and state policies are analysed, it is seen that a struggle area has been formed. This struggle adds value to global health in terms of access to medicine. Conclusions: In transnational capitalism, the emergence of the state in strategic sectors such as the pharmaceutical sector in India indicates a new political and economic power. [ABSTRACT FROM AUTHOR]

In much of the developing world, cooking accounts for the largest share of women's time in home production. Does relying on solid fuels drive this time burden? This study revisits a clean energy information experiment in rural India to assess the time savings' potential of cleaner cooking technologies. Treatment villages were randomly assigned to receive information about negative health effects of cooking with solid fuels and about public subsidies for cleaner liquid petroleum gas (LPG). Time-use data indicate that primary cooks spend almost 24 hours cooking each week. Cleaner fuel use is correlated with about 140 minutes less cooking time each week. Yet households only reduce their weekly cooking time by about 35 minutes in response to the randomized clean energy information nudge. Factors limiting the impact of clean energy nudges on the choice of home production technologies and time use are discussed and an avenue for future research is suggested. [ABSTRACT FROM AUTHOR]

This paper employs the policy capacity framework to develop a multidimensional and nested policy analysis that is able to examine how different types of capacity--analytical, organizational, and political from different related levels of the health system--have contributed to both policy success and failure during the implementation of a politically significant national community health worker (CHW) program in India. Directed toward rural and urban marginalized populations in India, this CHW has become the world's largest CHW program. Launched in 2006, it has targeted communitization, strengthening of the primary health-care system, and universal health-care coverage, ultimately receiving an international award in 2022. We argue that, in a context of capacity deficits and tensions between different capacity domains, the individual political capacity has been more critical to policy success and strengthening. The analysis not only clarifies the ways in which the government took some initiatives to build up capacity but also highlights capacity deficits along different competency dimensions. This approach demonstrates the value of understanding and creating awareness concerning complex poor-resource settings and low organizational capacity while concomitantly building up the capacities needed to foster (workforce and leadership) strengthening. [ABSTRACT FROM AUTHOR]

This paper presents the broad macro parameters of the growth of the Indian economy since the nation's independence and a cross-country evaluation of where India stands, drawing out the patterns discernible in these aggregative statistics. The paper gives an overview of the on-going debate on the components of the Indian growth and the relative importance of the different policies in the 1980s and 1990s. It contributes to this debate by identifying the landmark years, and analysing the politics behind some of the economics. The paper also analyses the factors behind the changes in India's savings rate and the relation between growth and development, on the one hand, and the nature of labour market regulation, on the other. [ABSTRACT FROM AUTHOR]

This paper examines the evolution in a few public institutions over time in India. It presents three types of evidence: on institutional outcomes (such as losses in power generation, backlogs in disposal of court cases); on perceptions-based measures of governance, some going back to the 1960s, and, finally, on customs administration and whether it has been more effective at detecting evasion over time. All the evidence suggests that institutional quality has not improved over time. It then addresses the two-way relationship between growth and institutions in terms of two apparent paradoxes. The first is why growth has turned around so dramatically in India despite the relatively limited nature of reforms, especially compared with other countries. The second paradox is why, despite nearly 30 years of rapid growth, institutions have not improved. The paper offers some explanations that might help explain these paradoxes. [ABSTRACT FROM AUTHOR]

This paper provides an overview of school education in India. First, it places India's educational achievements in international perspective, particularly against countries with which it is now increasingly compared, especially China. Second, the paper examines schooling access in terms of enrollment and school attendance rates, and schooling quality in terms of literacy rates, learning achievement levels, school resources, and teacher inputs. Third, the paper investigates the role of private schooling in India, examining the extent of growth of private schooling and surveying evidence on the relative effectiveness and unit costs of private and public schools. Last, the paper discusses some major public education initiatives. The concluding section suggests a future research agenda and appeals for rigorous evaluation of the impacts and costs of the numerous existing educational interventions, in order to learn about their relative cost-effectiveness for evidence-based policy-making. [ABSTRACT FROM AUTHOR]

The recent growth pattern of India is set in the context of the parallel experience of China, the experience of poverty reduction is reviewed, and a number of papers illuminating India's development are introduced. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between output growth and employment growth in India for the period 1978–2010 at the aggregate and sectoral levels. Using a Kaldorian framework of endogenous productivity growth, we find that Kaldor–Verdoorn effects in the economy have become more predominant over time, especially in the post-reform (1994–2010) period. Our estimated Kaldor– Verdoorn coefficients, measured as the employment elasticity of output growth, for both formal sector and total employment have dropped dramatically over time, suggesting that India has leapfrogged into a high-productivity regime without the broad-based expansion of labour-intensive production that has been characteristic of fast-growing economies in East Asia. We examine some explanations for why these Kaldor–Verdoorn effects have become pronounced over time and are not convinced that wage pressure has been one of the reasons. A shift in the composition of demand towards higher-productivity sectors, however, does appear to be an important part of the explanation. We also find mixed evidence that forces of international competition have generated pressures to adopt more capital-intensive techniques of production. [ABSTRACT FROM AUTHOR]

Providing social support to tuberculosis (TB) patients is a recommended strategy as households having TB patients find themselves in a spiral of poverty because of high cost, huge income loss and several other economic consequences associated with TB treatment. However, there are few examples of social support globally. The Indian government introduced the 'Nikshay Poshan Yojana' scheme in 2018 to provide nutritional support for all registered TB patients. A financial incentive of 500 Indian Rupee (6 United States Dollars) per month was proposed to be transferred directly to the registered beneficiaries' validated bank accounts. We examined the reach, timing, amount of benefit receipt and the extent to which the benefit alleviated catastrophic costs (used as a proxy to measure the impact on permanent economic welfare as catastrophic cost is the level of cost that is likely to result in a permanent negative economic impact on households) by interviewing 1482 adult drug-susceptible TB patients from 16 districts of four states during 2019 to 2023, using the methods recommended by the World Health Organization for estimating household costs of TB nationally. We also estimated the potential amount of social support required to achieve a zero catastrophic cost target. At the end of treatment, 31–54% of study participants received the benefit. In all, 34–60% of TB patients experienced catastrophic costs using different estimation methods and the benefit helped 2% of study participants to remain below the catastrophic cost threshold. A uniform benefit amount of Indian Rupee 10 000 (127 United States Dollars) for 6 months of treatment could reduce the incidence of catastrophic costs by 43%. To improve the economic welfare of TB patients, levels of benefit need to be substantially increased, which will have considerable budgetary impact on the TB programme. Hence, a targeted rather than universal approach may be considered. To maximize impact, at least half of the revised amount should be given immediately after treatment registration. [ABSTRACT FROM AUTHOR]

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India. [ABSTRACT FROM AUTHOR]

Setting reimbursement rates in national insurance schemes requires robust cost data. Collecting provider-generated cost accounting information is a potential mechanism for improving the cost evidence. To inform strategies for obtaining cost data to set reimbursement rates, this analysis aims to describe the role of cost accounting in public and private health sectors in India and describe the importance, perceived barriers and facilitators to improving cost accounting systems. In-depth interviews were conducted with 11 key informants. The interview tool guide was informed by a review of published and grey literature and government websites. The interviews were recorded as both audio and video and transcribed. A thematic coding framework was developed for the analysis. Multiple discussions were held to add, delete, classify or merge the themes. The themes identified were as follows: the status of cost accounting in the Indian hospital sector, legal and regulatory requirements for cost reporting, challenges to implementing cost accounting and recommendations for improving cost reporting by health care providers. The findings indicate that the sector lacks maturity in cost accounting due to a lack of understanding of its benefits, limited capacity and weak enforcement of cost reporting regulations. Providers recognize the value of cost analysis for investment decisions but have mixed opinions on the willingness to gather and report cost information, citing resource constraints and a lack of trust in payers. Additionally, heterogeneity among providers will require tailored approaches in developing cost accounting reporting frameworks and regulations. Health care cost accounting systems in India are rudimentary with a few exceptions, raising questions about how to source these data sustainably. Strengthening cost accounting systems in India will require standardized data formats, integrated into existing data management systems, that both meet the needs of policy makers and are acceptable to hospital providers. [ABSTRACT FROM AUTHOR]

There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset. [ABSTRACT FROM AUTHOR]

In the last decade nanotechnology entered the policy arena as a technology that is simultaneously promising and threatening, and with a similar Janus-like face, nanotechnology entered the development agenda. How does a developing country like India deal with nanotechnology? Combining a quantitative and qualitative approach, this paper outlines the developments, discussions, and silences concerning nanotechnology in India. The nanotechnology landscape in India is dominated by government initiatives. Government investments led to a steady rise in global publication rankings, scientific collaborations and the number of institutions involved. This growth is mainly rooted in fundamental research and public research institutes. Industry involvement and patenting activity are at a nascent stage and developing slowly. Issues that were raised in the Indian context relate to funding, capacity, commercialization, regulation of risks, and the distribution of benefits. Nanotechnology is positively viewed across the board, with notable silences on ethical issues and the relation to the public. [ABSTRACT FROM PUBLISHER]

This paper examines how actors construct the public problem of multi-drug resistant tuberculosis (MDR-TB) in India. MDR-TB has been framed by the World Health Organization as a pressing, global public health problem. The responses to MDR-TB are complicated as treatment takes longer and is more expensive than routine TB treatment. This is particularly problematic in countries, such as India, with high patient loads, a large and unregulated private sector, weak health systems and potentially high numbers of MDR-TB cases. This paper analyses how actors struggle for control over ownership, causal theories and political responsibility of the public problem of MDR-TB in India. It combines Gusfield’s theory on the construction of public problems with insights from literature on the social construction of diseases and on medical social control. It highlights that there are flexible definitions of public problems, which are negotiated among actor groups and which shift over time. The Indian government has shifted its policy in recent years and acknowledged that MDR-TB needs to be dealt with within the TB programme. The study results reveal how the policy shift happened, why debates on the construction of MDR-TB as a public problem in India continue, and why actors with alternative theories than the government do not succeed in their lobbying efforts. Two main arguments are put forward. First, the construction of the public problem of MDR-TB in India is a social and political process. The need for representative data, international influence and politics define what is controllable. Second, the government seems to be anxious to control the definition of India’s MDR-TB problem. This impedes an open, critical and transparent discussion on the definition of the public problem of MDR-TB, which is important in responding flexibly to emerging public health challenges. [ABSTRACT FROM AUTHOR]

This paper formalises the balance-of-payments-constrained (BPC) growth model in a two-regime framework to re-examine India’s growth transition in 1980 from a demand-side perspective, as an alternative to the ‘supply-oriented’ approaches of previous studies. The results provide strong evidence of a demand-led growth transition. Although the government-led expenditure strategy of the 1980s fulfilled the role of moving the Indian economy out of its slow-growing demand regime (1952–79) into a faster-growing one, it could not sustain demand growth at the natural rate due to a balance-of-payments constraint. Consistent with the prediction of the BPC growth model, faster export growth in the post-1990 liberalisation period sustained demand growth at its maximum rate by allowing expenditure (including government spending) to grow at a fast rate. The analysis further suggests that India’s export surge in the post-1990 liberalisation period has a significant demand-side explanation, rather than an exclusively supply-side interpretation. [ABSTRACT FROM AUTHOR]

In general, economists have treated the services sector as a black box. India, where the sector now dominates economic activity, is no exception. The object of this paper is to develop a taxonomy of the services sector with reference to different economic characteristics. Analysing data from India, we find that it is a set of highly heterogeneous economic activities with respect to productivity-enhancing technology characteristics, barriers to entry for employment, factor use, linkages with other sectors and tradability in international markets. This is indicative of subsector-specific implications for economic growth, balance of payments, employment, the sustainability of services-led growth, poverty, inequality and the different explanations for the growing share of the services sector in total output. Importantly, these implications, which lend perspective to the findings of a growing literature on the subject, provide a stepping stone for advancing significant research questions, both in the context of India and elsewhere. [ABSTRACT FROM PUBLISHER]

This paper examines the pattern of international trade specialization in Indian manufacturing since the mid-1980s by using data on trade flows. Low-technology sectors still dominate the categories for which India exhibits the largest degree of trade specialization. By contrast, high-technology sectors are prevalent among the categories for which India is import-dependent. Significantly, India has experienced an improvement in the degree of specialization in some of the most dynamic sectors of world trade. [ABSTRACT FROM AUTHOR]

It is important to understand the service conditions of nurses because these influence nurses' motivations and ability to provide care. Although nurses are estimated to constitute 30% of India's health workforce, limited empirical information is available about them. This paper attempts to address this gap in research. A cross-sectional survey of 266 nurses in the state of Gujarat was conducted to understand the demographic characteristics, qualifications and employment features of nurses working in India's private and public health sectors. Descriptive and univariate analyses were performed using the collected information. A multivariate regression model was also estimated with monthly earnings as the dependent variable, and workplace, type of employment contract, caste background and years in the nursing workforce as independent variables. The three main findings presented in this article highlight considerable heterogeneity in the background and employment of nurses in India. First, 49% of nurses working in private hospitals and as temporary employees in public facilities belonged to historically disadvantaged social groups (deemed Scheduled Castes and Scheduled Tribes) and were estimated to earn 9% less than similarly qualified and practiced nurses from general caste categories (P = 0.02). Second, 18% of nurses working in private hospitals did not have formal nursing qualifications. Third, nurses working in private hospitals and as temporary employees in public facilities earned less than the minimum wage stipulated by the Government of India. Permanent public sector nurses were estimated to earn 105% more than private sector nurses with the same qualifications, years of work and caste background (P <  0.001). This study finds that the disproportionate presence of women and socially discriminated caste groups in the nursing workforce, coupled with the failure of governmental agencies to regulate the health sector, might help explain the low wages and lack of job security that most nurses in India contend with. [ABSTRACT FROM AUTHOR]

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This paper critically examines the feasibility and desirability of green growth in India. Currently, its environment is being plundered at all levels, local, national, and global. The stresses that result raise the fundamental question of whether the aspirations of Indians for greater material comfort can ever be fulfilled. The current 5-year plan aims for ‘Faster and More Inclusive Sustainable Growth’ but it is clear that the emphasis of the Plan is mostly on growth and inclusion, rather than sustainability. A modelling exercise reported here suggests that a ‘visionary development’ growth scenario with major social and environmental benefits is possible for India at low cost. However, combining that scenario with a low-carbon growth trajectory consistent with international aspirations to limit climate change would be significantly more expensive. As it is not clear that the Indian people would be willing to bear these extra costs, some combination of accelerated low-carbon innovation, technology transfer from developed countries, and climate finance from outside the country will be needed if green growth is to take root in India. [ABSTRACT FROM AUTHOR]

Background This paper provides information on the association of tobacco smoking and alcohol consumption with pulmonary TB (PTB) in central India. Methods A community based cross-sectional TB prevalence survey was conducted in Jabalpur district of the central Indian state of Madhya Pradesh. The information on tobacco smoking and alcohol consumption was collected from individuals aged ≥15 years. Using logistic regression analysis, the risk factors for PTB were identified. Results A total of 94 559 individuals provided information on tobacco smoking and alcohol consumption. Persons aged 35–54 years and 55 years and above had, respectively, a 2.19 (95% CI 1.57–3.07) and a 3.26 (95% CI 2.23–4.77) times higher risk of developing PTB compared to persons aged below 35 years. Males had a 2.35 (95% CI 1.66–3.32) times higher risk than females. Tribals (indigenous population) had a 2.32 (95% CI 1.68–3.21) times higher risk than non-tribal population. The adjusted prevalence odds ratio for mild, moderate and heavy tobacco smokers were 2.28, 2.51 and 2.74 respectively as compared to non-smokers. Alcohol consumption was not found to be a risk factor on multivariate analysis. Conclusion Tobacco smoking is significantly associated with PTB in this central Indian district. Smoking cessation services need to be integrated into the activities of the TB control programme. [ABSTRACT FROM PUBLISHER]

Objectives. There are no valid instruments to measure disease activity in Takayasu arteritis (TA). We aim to provide a valid measure to assess clinical disease activity with or without incorporating acute phase reactants.Methods. The Indian Takayasu Clinical Activity Score (ITAS) was initially derived from disease manifestations scored in the Disease Extent Index (DEI.Tak). The ITAS was validated by a group of physicians scoring both live and paper cases for inter-rater reliability (IRR), convergence with BVAS, correlation with the Physician’s Global Assessment (PGA) and ESR/CRP. It was further validated at a single centre in 177 patients for its ability to discriminate between active and inactive disease state at first visit and sensitivity to change in 132 active patients measured serially at two follow-up visits. ITAS-A also included graded scores for ESR/CRP.Results. The final ITAS2010 contains 44 items with 33 features arising from the cardiovascular system. Seven key items are weighted to score 2 and all others score 1 only. Inter-observer variability was highly satisfactory (IRR 0.97). The ITAS showed superior inter-rater agreement compared with the BVAS (IRR 0.9) and PGA (IRR 0.82). In the single-centre study, median ITAS scores at first visit were significantly higher in active disease (5.62 ± 3.14) compared with grumbling (3.36 ± 1.96) and inactive disease (1.27 ± 1.26, P < 0.0001). The therapy induced a significant decrease in the ITAS2010 but the higher ITAS-A scores remained elevated.Conclusion. The ITAS2010, validated in over 300 TA patients and sensitive to change, is a useful measure of clinical disease activity for patient monitoring. Higher ITAS-A scores suggest poor control of active disease by current therapy. [ABSTRACT FROM AUTHOR]

Up until now, the genus Parvulobathynella Schminke, 1973, had eight species in the world. Of these, three species each are known from South America and Africa, and two from peninsular India. Parvulobathynella macrodentata n. sp. is described herein from the phreatic zone of southeastern India. Interestingly, the new species has striking mandibular affinity with the Brazilian Odontobathynella amazonica Delamare Deboutteville and Serban, 1979. So the mandibular criteria of Parvulobathynella are suitably amended to accommodate the new species and the interrelationships of Parvulobathynella and Odontobathynella, briefly discussed. The paper also provides an updated key to the world species of Parvulobathynella in addition to some ecological notes on the new species. [ABSTRACT FROM AUTHOR]

Migration begets migration in a constant flow of currents and eddies with people moving in to fill the niches vacated by emigrants thus blurring boundaries and spaces. This paper explores the nested complexities of the migration processes between India and the Middle East, and within India, from the regional perspective of Kerala. It assesses the claim that migration flows do not yield to a particular framing, highlighting the necessity of rethinking existing theoretical notions in terms of dependency and development and locating the migrants in multiple domains across spaces, regions and social locales as well as the practical implications thereof. [ABSTRACT FROM AUTHOR]

In 1863, the young Danish princess Alexandra married Edward, eldest son of Queen Victoria and heir to the throne. For forty years she successfully negotiated the notoriously complex rigours of the London Season and its British aristocracy, a popular figure with both her peers and a wider general public. Much of her success derived from a sartorial shrewdness, gaining herself a reputation for elegant, appropriate dress whatever the occasion. On the death of Queen Victoria in 1901, Alexandra was faced with sartorial decisions based upon her new status as queen consort. This paper will examine the design and realization of her most important ceremonial garment—the gown worn for the coronation of her husband in August 1902. Alexandra chose to have her dress designed and woven in India with the final construction taking place at a couture house in Paris. Taking an object-based approach, studying the gown as it survives today, this article interrogates some key questions. What was Alexandra’s vision of India before the coronation? How did her clothing practices sit within the contemporary Anglo-Indian textile trade, and why was it so important for the new queen that her coronation dress be made in India? [ABSTRACT FROM PUBLISHER]

The aim of the paper is to apply a political economy framework both to explain the rise of the information technology (IT) industry and to analyse the spatial and developmental consequences of this growth, especially the distributive dimension on the wider society. The purpose is also to reveal the contradictions associated with the industry, question the crude optimism surrounding the IT sector's transformative capabilities, and by extension, assess the ‘model’ of development implicit with its growth trajectory. As there is class bias in the workings of the sector, which excludes large swathes of the population and reproduces educational inequality, policy implications are briefly discussed. [ABSTRACT FROM AUTHOR]

Summary: This paper appraises the public health burden of mortality in India caused by the practice of dowry and examines the association of some demographic and socio-economic factors with dowry deaths and dowry-related suicides. The paper is based on the data available on the public domains of the National Crime Records Bureau (NCRB), third National Family Health and Survey-2005-06, Planning Commission of India and Census of India 2001. In 2007, the total number of dowry deaths and dowry-related suicides reported in India were 8093 and 3148, respectively. There was a 74% increase in dowry-related deaths from1995 to 2007, while there was a 31% increase in the reporting of dowry-related suicides. Occurrence of dowry deaths has significant association with some demographic and socio-economic variables. The data reveal that the status of women is undesirable, and the burden of mortality and related morbidity is enormous. There should be a national injury surveillance system and reliable estimates of dowry-related homicides. However, available information can be used to design and implement some counter-measures to prevent dowry-related violence and deaths. The study warrants the undertaking of research to give insights into circumstances and triggers of such violence, the healthcare seeking of these victims, bottlenecks in seeking health care and reporting to the police. [ABSTRACT FROM AUTHOR]

This paper situates the development of the limited liability partnership in India in the context of the real processes of neoliberal ‘globalisation’ and ‘liberalisation’, which will distinguish it from the idealised versions put forward by neoclassical theorists. In these processes big business has driven a particular type of ‘liberalisation’ to expand and enhance its profit opportunities, often using unorthodox methods like legal provisions for the Hindu Undivided Family to gain tax exemptions over the years of change in state policy from dirigisme to neoliberalism. The support by big business for the limited liability partnership, which apparently benefits very small partnerships, can be understood by looking at the ways in which this legal form is likely to further enhance profits by helping big business reduce its potential liabilities. [ABSTRACT FROM PUBLISHER]

In India, traditional values as well as the timeless way of building compact residential environments is now threatened by new and foreign influences from the Occident. These influences are incompatible with the climate of the country and traditional culture of its people. [Schoenauer N. 6000 Years of Housing. W.W. Norton, New York, 2000]In the context of the worldwide concern for global warming and a need for reduced carbon emissions, increased energy efficiency, reduced waste and need for alternative sources of energy; this paper reviews passive design strategies that were used in the traditional buildings across India and assess their potential in modern design. This study offers a classification of vernacular environmental design traditions across the subcontinent based on the Koppen–Grieger climatic regions and a detailed study of thermal comfort in traditional and modern dwellings, in two of the eight regions, using environmental performance modelling. The results show that traditional passive techniques provide a high degree of comfort for a longer part of the day while potentially minimizing energy use. Some problems were identified in adopting the passive strategies to the present context. For example, there are limitations in the use of traditional building materials, such as, earth, but suitable alternatives with similar properties can be readily adapted to the same effect. [ABSTRACT FROM PUBLISHER]

Smokeless tobacco (SLT) consumption increases the risk of cardiovascular diseases and cancer and leads to adverse reproductive health outcomes among women and newborns. This study examines the factors associated with initiation, continuation and cessation of SLT use among women in the reproductive age so as to formulate and include prevention and cessation interventions from its inception. The study was conducted in urban low-income communities in India. Using snowball and purposive sampling techniques, in-depth interviews were conducted with 20 pregnant and 22 lactating women who currently used SLT products. Data were analysed using thematic analysis with the help of QSR NVivo software. Findings revealed that factors such as people influencing usage change with different life stages including pre-marital and post-marital periods. Perceived health benefits, altered taste preferences during pregnancy and social influences were also studied. Women were found to be more aware of the harmful effects of tobacco during pregnancy than during breastfeeding. Social stigma around women consuming tobacco acted as a major driving factor for cessation. Most of the participants were willing to quit but were not aware of any technique or programme for cessation. The findings of the study highlight the need to develop behavioural change intervention tools, which are culturally and locally appropriate and have a gender-sensitive approach. Different socio-cultural factors associated with initiation/cessation at different life stages should also be taken into consideration while developing these tools. [ABSTRACT FROM AUTHOR]

Background Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored. Methods We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015–2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N  = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition. Results Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17–1.24)], diabetes [1.29 (1.22–1.37)], heart disease [1.27 (1.18–1.36)], asthma [1.19 (1.11–1.28)] and thyroid disorder [1.10 (1.02–1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages. Conclusions Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group. [ABSTRACT FROM AUTHOR]

Are ostensibly demand-driven public works programs with high levels of safeguards nonetheless susceptible to political influence? We investigate this conjecture using expenditure data at the local level from India's National Rural Employment Guarantee Scheme. Focusing on one state where accountability and transparency mechanisms have been employed and implementation efforts have been widely applauded, we find no evidence of partisan-influenced spending before the 2009 election and find that the political leaning of a mandal played only a small part in fund distribution after the 2009 election. Most variation in public works expenditures is explained by the observed needs of potential beneficiaries, as the scheme intended. [ABSTRACT FROM AUTHOR]

Using aggregate data from the Annual Survey of Industries, we analyze profitability in India's organized manufacturing sector from 1982-83 to 2012-13. Over the whole period of analysis, the rate of profit grew at about 1% per annum, primarily driven by a rising share of profits. We use visual inspection to identify five shorter-run profitability regimes: 1982-91, 1991-96, 1996-2001, 2001-07 and 2007-12. Profit rate decomposition analysis shows that both technological factors and aggregate demand have been important determinants of changes in profitability in these shorter periods. [ABSTRACT FROM AUTHOR]

Many countries are using health insurance to advance progress towards universal health coverage (UHC). India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme in 2018. We examine the political economy context around PM-JAY policy formulation, by examining the perspectives of policy stakeholders shaping decisions around the reform. More specifically, we focus on early policy design at the central (national) level. We use a framework on the politics of UHC reform proposed by Fox and Reich (The politics of universal health coverage in low- and middle-income countries: A framework for evaluation and action. J. Health Polit. Policy Law 2015; 40 :1023–1060), to categorize the reform into phases and examine the interactions between actors, institutions, interests, ideas and ideology which shaped reform decisions. We interviewed 15 respondents in Delhi between February and April 2019, who were either closely associated with the reform process or subject experts. The ruling centre-right government introduced PM-JAY shortly before national elections, drawing upon policy legacies from prior and state insurance schemes. Empowered policy entrepreneurs within the government focused discourse around ideas of UHC and strategic purchasing, and engaged in institution building leading to the creation of the National Health Authority and State Health Agencies through policy directives, thereby expanding state infrastructural and institutional power for insurance implementation. Indian state inputs were incorporated in scheme design features like mode of implementation, benefit package and provider network, while features like the coverage amount, portability of benefits and branding strategy were more centrally driven. These balanced negotiations opened up political space for a cohesive, central narrative of the reform and facilitated adoption. Our analysis shows that the PM-JAY reform focused on bureaucratic rather than ideological elements and that technical compromises and adjustments accommodating the interests of states enabled the political success of policy formulation. Appreciating these politics, power and structural issues shaping PM-JAY institutional design will be important to understand how PM-JAY is implemented and how it advances UHC in India. [ABSTRACT FROM AUTHOR]

Multisectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves >100 million people annually across more than one million villages, a key point of multisectoral collaboration—or 'convergence', as it is often called in India—is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW) and auxiliary nurse midwife (ANM) or 'AAA' workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it. Informed by a conceptual framework of collaborative governance, this study applies inductive thematic analysis of in-depth interviews with 18 AAA workers and 6 medical officers from 6 villages across three administrative blocks in Hardoi district of Uttar Pradesh state to identify the key elements of collaboration. These are grouped into three broad categories: 'organizational' (including interdependence, role clarity, guidance/support and resource availability); 'relational' (interpersonal and conflict resolution) and 'personal' (flexibility, diligence and locus of control). These findings underscore the importance of 'personal' and 'relational' collaboration features, which are underemphasized in India's ICDS, the largest of its kind globally, and in the multisectoral collaboration literature more broadly—both of which place greater emphasis on 'organizational' aspects of collaboration. These findings are largely consistent with prior studies but are notably different in that they highlight the importance of flexibility, locus of control and conflict resolution in collaborative relationships, all of which relate to one's ability to adapt to unexpected obstacles and find mutually workable solutions with colleagues. From a policy perspective, supporting these key elements of collaboration may involve giving frontline workers more autonomy in how they get the work done, which may in some cases be impeded by additional training to reinforce worker role delineation, closer monitoring or other top-down efforts to push greater convergence. Given the essential role that frontline workers play in multisectoral initiatives in India and around the world, there is a clear need for policymakers and managers to understand the elements affecting collaboration between these workers when designing and implementing programmes. [ABSTRACT FROM AUTHOR]

Background India accounts for one-quarter of the world's TB cases. Despite efforts to engage the private sector in India's National TB Elimination Program, informal healthcare providers (IPs), who serve as the first contact for a significant TB patients, remain grossly underutilised. However, considering the substantial evidence establishing IPs' role in patients' care pathway, it is essential to expand the evidence base regarding their knowledge in TB care. Methods We conducted a cross-sectional study in the Birbhum district of West Bengal, India. The data were collected using the TB vignette among 331 IPs (165 trained and 166 untrained). The correct case management was defined following India's Technical and Operational Guidelines for TB Control. Results Overall, IPs demonstrated a suboptimal level of knowledge in TB care. IPs exhibited the lowest knowledge in asking essential history questions (all four: 5.4% and at least two: 21.7%) compared with ordering sputum test (76.1%), making a correct diagnosis (83.3%) and appropriate referrals (100%). Nonetheless, a statistically significant difference in knowledge (in most domains of TB care) was observed between trained and untrained IPs. Conclusions This study identifies gaps in IPs' knowledge in TB care. However, the observed significant difference between the trained and untrained groups indicates a positive impact of training in improving IPs' knowledge in TB care. [ABSTRACT FROM AUTHOR]

There is a proliferation of digitalisation of urban and health services in India under the Smart City and Digital Health missions, respectively. This study brings digital and feminist geographies together to understand the role of technologies in urban areas, particularly in health service delivery and how healthcare workers mediate these health platforms. Using a case study of Varanasi city in Uttar Pradesh, India this study documents whether—and to what extent—digital technologies and services enable citizens and service providers to access and improve their lived experiences. The findings indicate a top-down, innovation-focussed model is adopted which excludes and alienates different user groups and citizens shaping their interaction and access to these services. [ABSTRACT FROM AUTHOR]