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2. Street-Level Bureaucracy in Tobacco Control: A Qualitative Study of Health Department in District Jalandhar, Punjab.
- Author
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Menon, Shaveta
- Subjects
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TOBACCO products , *COMMUNITY health services , *CONCEPTUAL structures , *DECISION making , *HEALTH facility administration , *HEALTH services administrators , *INTERVIEWING , *RESEARCH methodology , *PROFESSIONAL ethics , *SANITATION , *SUPERVISION of employees , *QUALITATIVE research , *SOCIAL boundaries , *CONTROLLED substances , *HUMAN services programs , *TOBACCO laws - Abstract
Background: The implementers of the tobacco control policy in the field have been neglected by the policymakers. They are the ones who have first-hand knowledge and their experiences in the field are not being used to bring about changes in the area of tobacco control. Objective: The objective of this paper is to critically examine how Michael Lipsky's concept of street-level bureaucracy can be used to address tobacco control in the health department in district Jalandhar of Punjab. Methods: Semi-structured interview schedules were used to interview Senior Medical Officers/Nodal Officers and Health Supervisors/Sanitary inspectors in four out of ten Community Health Centers and District hospital in Jalandhar. Data so collected were subjected to the process of inductive analysis and themes developed within the framework given by Lipsky. Results: The street-level bureaucrats (SLBs) were not given adequate training, and various organizational resources for tobacco control are missing in the district. There are threats and challenges which are faced by them in the field, and they do not exercise decision-making power to handle these barriers for effective implementation of the tobacco control program. Conclusion: The government needs to be inclusive in the process of policymaking meaning that it can be more accommodative of the suggestions given by the SLBs and provide them with discretionary powers to exercise their role efficiently. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
3. Women's well-being and reproductive health in Indian mining community: need for empowerment.
- Author
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D'Souza, Melba Sheila, Karkada, Subrahmanya Nairy, Somayaji, Ganesha, and Venkatesaperumal, Ramesh
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REPRODUCTIVE health , *CONCEPTUAL structures , *CONTENT analysis , *DECISION making , *DOMESTIC violence , *HEALTH status indicators , *INTERVIEWING , *MARITAL status , *RESEARCH methodology , *RESEARCH , *SELF-efficacy , *SOCIAL classes , *WOMEN'S health , *QUALITATIVE research , *CULTURAL values , *SOCIOECONOMIC factors , *WELL-being , *PSYCHOLOGY - Abstract
This paper is a qualitative study of women's well-being and reproductive health status among married women in mining communities in India. An exploratory qualitative research design was conducted using purposive sampling among 40 selected married women in a rural Indian mining community. Ethical permission was obtained from Goa University. A semi-structured in-depth interview guide was used to gather women's experiences and perceptions regarding well-being and reproductive health in 2010. These interviews were audiotaped, transcribed, verified, coded and then analyzed using qualitative content analysis. Early marriage, increased fertility, less birth intervals, son preference and lack of decision-making regarding reproductive health choices were found to affect women's reproductive health. Domestic violence, gender preference, husbands drinking behaviors, and low spousal communication were common experiences considered by women as factors leading to poor quality of marital relationship. Four main themes in confronting women's well-being are poor literacy and mobility, low employment and income generating opportunities, poor reproductive health choices and preferences and poor quality of martial relationships and communication. These determinants of physical, psychological and cultural well-being should be an essential part of nursing assessment in the primary care settings for informed actions. Nursing interventions should be directed towards participatory approach, informed decision making and empowering women towards better health and well-being in the mining community. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
4. Bureaucracies and power: Examining the Medical Council of India and the development of emergency medicine in India.
- Author
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Sriram, Veena, Baru, Rama, Hyder, Adnan A., and Bennett, Sara
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CONCEPTUAL structures , *CONFERENCES & conventions , *CURRICULUM planning , *EMERGENCY medicine , *INTERVIEWING , *MEDICAL quality control , *MEDICAL education , *HEALTH policy , *MEDICAL societies , *POLICY sciences , *PUBLIC administration , *QUALITATIVE research - Abstract
In many countries, professional councils are mandated to oversee the training and conduct of health professionals, including doctors, nurses, pharmacists and allied health workers. The proper functioning of these councils is critical to overall health system performance. Yet, professional councils are sometimes criticized, particularly in the context of low- and middle-income countries, for their misuse of power and overtly bureaucratic nature. The objective of this paper is to understand how professional councils use their bureaucratic power to shape health policy and systems, drawing upon the recent development of emergency medicine in the context of the former Medical Council of India. We undertook a qualitative case study, conducting 87 interviews, observing 6 meetings and conferences, and reviewing approximately 96 documents, and used the Framework method to analyze our data. The passive exercise of bureaucratic power by the Council resulted in three challenges – 1) Opaque policy processes for recognizing new medical specialties; 2) Insular, non-transparent training policy formulation; 3) Unaccountable enforcement for regulating new courses. The Council did not have the requisite technical expertise to manage certain policy processes, and further, did not adequately utilize external expertise. In this time period, the Council applied its bureaucratic power in a manner that negatively impacted emergency medicine training programs and the development of emergency medicine, with implications for availability and quality of emergency care in India. The successor to the Council, the National Medical Commission, should consider new approaches to exercising bureaucratic power in order to meet its objectives of strengthening medical education in India and ensuring access to high-quality services. Future studies should also explore the utilization of bureaucratic power in the health sectors of low- and middle-income countries in order to provider a deeper understanding of institutional barriers to improvements in health. • Limited research on the bureaucratic power of health sector professional councils. • We studied the Medical Council of India, power and emergency medicine in India. • We found several limitations to the application of bureaucratic power by the Council. • Technical expertise was not a core aspect of their bureaucratic power. • The National Medical Commission can reimagine typical uses of bureaucratic power. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
5. "Is there a medicine for these tensions?" Barriers to treatment-seeking for depressive symptoms in rural India: A qualitative study.
- Author
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Roberts, Tessa, Shrivastava, Ritu, Koschorke, Mirja, Patel, Vikram, Shidhaye, Rahul, and Rathod, Sujit D.
- Subjects
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DIAGNOSIS of mental depression , *CONCEPTUAL structures , *CONFLICT (Psychology) , *MENTAL depression , *HEALTH services accessibility , *HEALTH status indicators , *HELP-seeking behavior , *INTERVIEWING , *MENTAL health services , *PRIMARY health care , *RURAL conditions , *SELF-evaluation , *PSYCHOLOGICAL stress , *QUALITATIVE research , *SOCIOECONOMIC factors , *HEALTH & social status - Abstract
Rationale and objective Fewer than 15% of adults who meet criteria for a depression diagnosis in India seek treatment for these symptoms. It is unclear whether this reflects limited supply of mental health services or lack of demand for medical intervention for these experiences. This paper aims to identify and describe self-reported barriers that contribute to this "treatment gap" in a rural district in central India, where depression treatment had recently become available in primary care facilities. In this qualitative study we conducted in-depth interviews with 35 adults who screened positive for depression and who had not sought treatment for their condition, and 15 of their relatives. We analysed the data using the framework approach. A key barrier to seeking health care for psychological symptoms was lack of perceived need for treatment for these symptoms. Low perceived need for health interventions arose because participants frequently attributed depression-like symptoms to their socio-economic circumstances, or to the stress of physical illness, which conflicted with the biomedical approach associated with health services. Despite widespread recognition of the links between psychological symptoms, social circumstances and physical health, it was believed that health care providers are equipped to treat only somatic symptoms, which were commonly reported. Low demand for depression treatment reflected discrepancies between the community's perceived needs and a narrow biomedical model of mental health. Meeting their needs may require a radical change in approach that acknowledges the social determinants of distress, and the interactions between mental and physical health. The capabilities approach may provide a framework for more holistically conceptualising people's needs. • Participants conceptualised their depressive symptoms as "tension" (stress). • "Tension" is seen as a natural response to poverty/physical illness/family problems. • Most participants consulted health workers but only reported somatic symptoms. • Participants did not believe that health workers could treat "tension". • Conceptualisations of health must recognise psychological, physiological and social needs. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
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