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Purpose: Population ageing is a demographic transition and burdens every country's health sector. A lack of social security combined with low government health-sector spending has made health-care utilisation difficult among elderly in many developing countries like India. This makes population ageing a global phenomenon for policymakers, researchers and stakeholders to discuss and debate in 21st century. The purpose of this paper is to examine the behavioural determinants of health-care utilisation among elderly population in Punjab. Design/methodology/approach: This study examines health-care utilisation among the elderly population in Punjab. A structured questionnaire was used to collect the data in the state of Punjab, with a multi-stage stratified random sample of 385 respondents. Logit regression was used to analyse the association between several behavioural factors like age, gender, place of residence, source of livelihood, education and frequency of visits with health-care utilisation among elderly aged 60 and above. Findings: This study revealed that gender, age, place of residence, source of livelihood, education and frequency of visits were significant determinants of health-care utilisation among elderly population. Originality/value: This study directs the need to improve health-care utilisation in a country, reducing inequalities that exist among the elderly population with respect to socio-economic and demographic differences. [ABSTRACT FROM AUTHOR]

Purpose: India has been on the pathway of improvement concerning healthcare and health outcomes of its population. However, India must overcome its unique challenges and cover a long journey ahead. This mandates a need for a high-quality, contemporary and community-based health system that promises consistent and quality healthcare, is trusted and valued by all its citizens, considers the changing population needs and should be affordable and accessible. Design/methodology/approach: The study examines various dimensions and elements associated with the integrated healthcare system in India and uses input, process and output structural measures. Findings: The present paper proposes an integrated, comprehensive healthcare system in India that endorses participation from diverse stakeholders such as the government, organizations, the community and individuals who can contribute uniquely. It also focuses on defined and measurable output that can make health a topic of social movement or "Jan Andolan" and create a sustainable and integrated care system. Originality/value: The study is unique as it focuses on the role of stakeholders in health care. The research emphasized the involvement of the government, community, people and organizations in developing an integrated healthcare ecosystem that includes modern technology, skilled employees, enough finance, governance, efficient delivery platforms and top-tier infrastructure. The model's output is focused on healthcare that is inexpensive, accessible, available, accountable and user-centered. This would gradually improve everyone's health and well-being. [ABSTRACT FROM AUTHOR]

Health is crucial for personal happiness, productivity, and fulfillment. It impacts physical well-being, mental health, longevity, academic and professional success, and interpersonal relationships. It reduces healthcare costs, contributes to economic growth, and promotes community well-being. This paper explores the status of the healthcare system in rural India. Paper reviews available research and also collects data from rural hospitals. It also considers efforts by the Indian government and other organisations, such as Ayushman Bharat, which is acknowledged for its aim to strengthen primary healthcare and protect economically vulnerable populations. However, addressing these complex issues requires continuous efforts, adequate funding, and proactive measures in healthcare infrastructure, workforce development, and policy reforms. The presented data reflects rural areas' ongoing challenges, underscoring the pressing need for proper treatment and care. By prioritising the presented aspects, the healthcare landscape in rural India can witness positive transformations and ensure improved healthcare outcomes for its population. In this paper, the possible problems and solutions addressed which has been observed while visiting hospitals in rural areas of northeast India. Research findings emphasise the significance of implementing supply chain strategies in improving healthcare delivery. It concludes that the potential of Medical 4.0 applications with seven common effective findings can save numerous lives in rural areas by providing timely access to healthcare solutions. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to discover and analyze the challenges hampering blockchain technology's (BT's) implementation in the Indian health-care sector. A total of 18 challenges have been prioritized and modeled based on an extensive literature search and professional views. Design/methodology/approach: An integrated multi-criteria decision-making approach has been used in two phases. Best worst method (BWM) is used in the first phase to prioritize the challenges with sensitivity analysis to validate the findings and eliminate a few challenges. In the second phase, interpretive structural modeling is applied to the remaining 15 challenges to obtain relative relationships among them with cross-impact matrix multiplication applied to classification analysis for their categorization. Findings: The study's results reveal that limited knowledge and expertise, cost and risk involved, technical issues, lack of clear regulations, resistance to change and lack of top management support are the top-ranked or high-intensity challenges according to the BWM. Interpretive structural modelling findings suggest that the lack of government initiatives has been driving other challenges with the highest driving power. Research limitations/implications: This work has been conducted in the Indian context, so careful generalization of the results is needed. Practical implications: This work will give health-care stakeholders a better perspective regarding blockchain's adoption. It will help health-care stakeholders, service providers, researchers and policymakers get a glimpse of the strategies for eradicating mentioned challenges. The analysis will help reduce the challenges' impact on blockchain's adoption in the Indian health-care sector. Originality/value: The adoption of BT is a novel concept, especially in developing countries such as India. This is one of the few works addressing the challenges to BT adoption in the Indian health-care sector. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine the socio-economic inequalities that exist in the use of unhygienic menstrual practices in India and its states, as well as to identify the contribution of various socio-economic factors that leads to these inequalities. Design/methodology/approach: Data from the National Family Health Survey-5 (2019–21) for 240,285 menstruating women aged 15–24 years is used to examine the above objectives. The concentration index for unhygienic menstrual practices is calculated to measure the socio-economic inequalities, which are then decomposed into their determining factors. Findings: The state of Punjab experiencing the highest level of economic inequality, followed by Telangana and Haryana. The results from decomposition analysis suggest that rural residence (13%), illiteracy (7%), poor economic status (53%), not reading newspaper (12%) and not watching TV (14%) contribute 99% to the total socio-economic inequality in using unhygienic menstrual practices in India. The contribution of economic status to total inequalities is more in all the states except for Kerala and Mizoram, where caste and residence play an important role. Originality/value: This paper signifies the role of economic inequality in the use of unhygienic menstrual practices in India as well as the contribution of various socio-economic factors contributing towards these inequalities. The results from decomposition analysis suggest the need for unique health intervention strategies for different states following the evidence of major contributions to total inequalities in the use of unhygienic menstrual practices. [ABSTRACT FROM AUTHOR]

Quality health care is the essential need for all the citizens of the country. It forms the basis for equitable and sustainable economic development. India has made significant progress in basic health care over the past few decades. However, still most people do not have access to essential health care services. Health insurance is very important for every citizen, especially in India, where there is a large rural population. As everyone cannot afford private Health insurance coverage, so government must take initiatives to provide health insurance coverage to poor people. Government of India has been taking initiatives to provide financial assistance for health care costs for vulnerable and needy families. Rastriya Swasthya Bima Yojana (RSBY) was launched in the year 2008, but was not very successful. Prime Recently, Ayushman Bharat Jana Arogya Yojana (PMJAY) was launched on 23rd September 2018. It provides health insurance cover of Rs. 5 lakhs per year, per family for secondary and tertiary care hospitalization to more than 10.74 crore poor and vulnerable families. Ayushman Bharat PMJAY card holders can claim cashless services at all the empanelled hospitals or at the private hospitals (approximately 20,000 plus) those have registered to offer PMJAY. The total number of Ayushman Bharat Cards issued till 21st March 2022 are 17,86,97,235 and Hospital admissions under PMJAY as of 21st March 2022 since launch are 3,11,27,750. Ayushman Bharat PMJAY has shown a good progress since its launch. It is a successful health insurance scheme till now. This paper studies about reasons of perceived failure of Rastriya Swasthya Bima Yojana (RSBY), Introduction of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), its features, coverages and benefits, the factors behind the success of Ayushman Bharat PMJAY scheme, its challenges and about the future of the scheme. [ABSTRACT FROM AUTHOR]

For years now, the Indian healthcare system has been viewed through the lens of heteronormativity, sidelining sexual and gender minorities. Despite the lack of established data, an estimated 45.4 million people in India belong to the LGBTQ community and these individuals face increased risk of various physical and mental health disorders. Given the rapidly changing sexual demographic of the country, along with the changes of legislation and other factors that mold it, this paper systemically reviews LGBTQ individuals vulnerabilities toward various communicable and non-communicable diseases along with the lacunae in the primary healthcare system and the need for their inclusion in it. [ABSTRACT FROM AUTHOR]

Background: Resource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India. Methods: Various recent budget documents of the Centre and States/Union Territories have been used to extract expenditure on NCDI. The aggregates thus arrived at have been analysed to estimate aggregate and state level per capita spending. State level spending have been compared against disease burden using DALYs. Patterns of spending on NCDI across states were also analysed together with state level poverty to observe possible patterns. Findings: The total spending on NCDI by the government is low at less than 0.5% of GDP. NCDI spending is little more than one-fourth of total health spending of the country and most spending takes place at the state level (80%). The Ministry of Health and Family Welfare’s share in Central spending on NCDI is around 65%, and currently it spends 20% of its total health spending on NCDI. The gap between spending and DALYs is the most for the economically vulnerable states. Also, the states with high poverty levels also have low per capita expenditure on NCDI Interpretation: India does not depend on donor funding for health. It will have to step up domestic funding to address the increasing disease burden of NCDIs and to reduce the high out-of-pocket expenditure on NCDI. Policies on NCDI need to focus on UHC, service integration and personnel gaps. [ABSTRACT FROM AUTHOR]

In India, marginalised people with serious or chronic illness face particular challenges to finding sustainable treatment, and often experience financial devastation. One state welfare scheme (the EWS hospital bed quotas) holds the promise of treatment for those in Delhi's margins, through partnerships with corporate hospitals. Yet, the process of gaining access to treatment via the scheme is very frustrating. This ethnography illustrates the ways in which low-income patients' attempts to lay claim to state services often bring them into play with a mode of the state that is, in anthropologists' conceptions, opaque, arbitrary and erratic. In response to the 'illegible' modes of access to the scheme, patients and their families are compelled to construct and reproduce their eligibility to access treatment, through a repertoire of intricate and entwined practices, namely: the attainment of credible low-income documentation, the use of big men to leverage resources, and different kinds of performance. The burden of enacting these practices is further compounded and troubled by the state scheme's blurry entanglement with the private sector, in which roles and responsibilities for a 'duty of care' to citizens with illness are elusive. This paper therefore aims to be an original contribution to the social sciences, in interpreting health-seekers' experiences of state-private schemes in Delhi within anthropological understandings of the state and marginalised people's meaning-making of illegible state processes. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to determine the gender differentials in childhood feeding practices, health care utilization and nutritional status of children by birth order and sex composition of previous living children in Northern India. Design/methodology/approach - In this paper, data were drawn from India's 2006 National Family Health Survey. A variety of different analytic methods were used to look for gender differentials in childhood feeding practices, health care utilization and nutritional status of children. Bi-variate analysis was applied to examine the raw values of gender differentials in childhood feeding, health care and nutritional status of children. Besides, gender differentials at the different birth order and sex composition of previous living children have been measured through multivariate logistic regression analysis. Findings - The raw values of gender differentials in childhood feeding, health care and nutritional status of children, regardless of child's birth order, mother's number of living sons and other characteristics of the child or mother, shows that the proportion of children who received any liquid, proportion of children receiving solid/semi-solid food and the proportion of fully immunized children vary by their gender significantly. The results of standardized gender differentials by birth order and sex composition of previous living children in the selected indicators of childhood feeding, immunization and health care and nutritional status of children based on multivariate binary logistic regression show that among children of birth order 3+ (3 and higher), male children were less likely to receive solid/semi-solid foods during 24 hours prior to the survey in families with no living son, but two times were more likely to receive any solid/semi-solid food than female children in families with 1+ living sons (po0.0001). Male children aged 12-23 months born to mothers with no living son were more likely to be fully immunized than female children, while male children born to mothers with 1+ living sons were less likely to be fully immunized than female children (po0.05) at birth order 3+. However, the analysis showed no significant gender differentials in the nutritional status of children. Research limitations/implications - The authors observed a strong association between the extents of gender differentials and birth order of the index child and the sex composition of older living siblings. Strong evidence of sex bias against female children was found in families with no living sons and particularly at higher birth orders 2 and 3+ (3 and higher). Overall, the study demonstrates the need to focus on predominance of intra-household differential rather than inter-household differential. Originality/value - This paper brings out the gender differentials in childhood feeding practices, health care utilization and nutritional status of children by birth order and sex composition of previous living children in Northern India. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to take a close look at factors that influence the choice and quality of healthcare received by ailing and elderly people in rural north India. The author is primarily interested in seeing what role is played by the presence of sons in the family, particularly co-residence with sons. In the absence of some broad-based social security arrangement in countries like India, older adults traditionally turn to living arrangement where the older adults are supported by their children or extended family. In a patriarchal society as India, such responsibility lies with the sons if one has son/s. Such dependence on sons explains preferential treatment towards younger sons as a justification for the care parents receive from sons in their advanced years. This culture of son preference behavior provides the context for this paper. Design/methodology/approach -- The empirical model is based on testing three inter-related research questions. First, the author asks whether having grown sons or living with son/s leads to up-front better quality of healthcare for parents. If the empirical analysis does not show support for this research question, the author broadens the research question to ask whether those with grown son/s or those that live with their son/s have a higher probability of seeing a trained medical professional as compared to some traditional healer. If the empirical analysis does not support the second question, the author further broadens the research question and asks whether those elderly who are sick are more likely to receive any healthcare (medical or traditional) if they have grown son/s or live with their son/s. Findings -- The results show that co-residence with a son does not have a statistically significant impact on the quality of healthcare received by the elderly individual. Additionally, not having a son also does not have a statistically significant impact on quality of healthcare received. Research limitations/implications -- For the purpose of the empirical analysis, the author utilizes World Bank's Living Standard Measurement Survey (LSMS) data collected from rural villages in Uttar Pradesh and Bihar in India in 1997-1998. The dataset may be somewhat dated, but it provides relevant information which transcends time. Additionally, with economic growth and modernization, more and more young people in India have migrated away from rural areas in the recent decade. Thus, surveys carried out in the last decade by the National Family Health Surveys in India show very little evidence of elderly parent in rural areas living with their adult children. This practice seemed to be much more prevalent at the time of the LSMS survey of 1997-1998. Practical implications -- Contrary to popular expectation, the results show that co-residing with a son has no statistically significant impact on healthcare received by parents. Additionally, not having sons does not matter either. Originality/value -- The author finds relatively fewer studies done on factors that determine the choice of healthcare for the elderly, particularly relating to those that are ailing (for reasons other than simply aging) and with reference to their living arrangement. The present paper addresses this void in the literature and is expected to make a meaningful contribution in bridging this gap in the literature. [ABSTRACT FROM AUTHOR]

Purpose: A multispecialty hospital possesses sustainable competitive advantage if it continuously improves performance, repeatedly delivers quality service and unique value to the patients and the sources of competitive advantage are valuable, rare, inimitable, non-substitutable or causally ambiguous. The term sustainable competitive advantage is vague and ambiguous and the environment in which hospitals operate is dynamic, turbulent and disruptive. Therefore, sources of competitive advantage must change and evolve with time. This paper aims to explore the themes of competitive advantage in a dynamic environment for multispecialty hospitals in India by studying data from secondary sources for five hospitals. Design/methodology/approach: The findings of the case study were based on the analysis of secondary data that are extracted from the official websites of the hospitals, with the grounded theory approach. Findings: Five identified themes are as follows: changing and adapting; clinical excellence; creating unique value; managing unpredictable circumstances and patient-centric approach. All the themes supported hospital performance, service and value delivered to patients and therefore may help in building a competitive advantage of the hospital. However, sustainability factors were inconsistent across the themes. Practical implications: The CXOs and CMOs of hospitals can review the themes periodically and re-align the business strategies to build a sustainable competitive advantage. Originality/value: The findings of the study uncovered the criticality of re-alignment of resources deployed in the unpredictable and ever-changing environment in which hospitals thrive to build sustainable competitive advantage. [ABSTRACT FROM AUTHOR]

Purpose The primary objective of this paper is to identify and analyze factors that influence choice and quality of healthcare of the elderly population in two northern and two southern states in India. The purpose of this paper is to look beyond the obvious factors that influence choice and therefore the quality of healthcare and seek to find whether there are some additional indirect factors that also influence choice and quality of healthcare.Design/methodology/approach This paper utilizes data from the Longitudinal Aging Study in India pilot project, which was a cross-sectional survey of men and women aged 45 and over focusing on two northern states (Punjab and Rajasthan) and two southern states (Kerala and Karnataka). In this paper the authors carry out a Probit analysis to estimate the factors that influence the elderly’s choice of healthcare.Findings The authors find that social activity via different types of social interactions outside the home and access to a phone (which is one of the cheapest and most commonly used methods of communication used by people in India) are statistically significant in influencing better quality of healthcare for the elderly. Moreover, gender-segregated results suggest that social activity is particularly important for elderly females. Relative price of healthcare is also an important determinant of the quality of healthcare sought. The authors also find some consistent regional influences on healthcare choices by the elderly.Research limitations/implications The main limitation is the data itself which is cross-sectional in nature. However, as further rounds of survey are conducted the authors hope to be able to build on the results of this paper using a longitudinal approach. A second limitation is the lack of variables available for carrying out an instrumental variables analysis. The results imply that elderly males and females are influenced by different things when it comes to healthcare choices. Thus for policy to be effective, the government needs to pursue avenues that would be most likely to succeed.Practical implications One of the most important practical implications of this research is the understanding that informal channels of knowledge transmission are important especially for the elderly in India. Traditional methods of knowledge transmission such as education, media, and income are less likely to be effective in a country where majority of the people are illiterate and poor. Social interactions appear to be most effective in influencing healthcare choices of elderly females.Social implications The most obvious social implications of this paper are the importance of social interactions via social activities outside the home and ability for social communication via access to a phone for the elderly population in India to make better healthcare choices and therefore receive better healthcare.Originality/value The literature on elderly healthcare is limited when it comes to developing countries. What makes matters worse for India is that up until recently there have been no comprehensive efforts to collect reliable data on the elderly population in India. As a result there is extremely limited availability of policy-relevant research dedicated to issues relating to the older population. Most of the existing literature looks at self-reported health and healthcare status or utilization. This paper would be among the first to address factors influencing quality of healthcare received by the elderly population in India. [ABSTRACT FROM AUTHOR]

Purpose – The national health policy should strive towards achieving the concept of "healthcare for all" conceptualized by the World Health Organization (WHO) through health insurance scheme. The purpose of this paper is to identify and discuss the various gaps affecting the health care systems and to evolve strategic issues in health care in India through an exploratory survey. Design/methodology/approach – The main thrust is to analyze the problems of India's health care system and review of related literature, to identify the areas in the field of healthcare and health insurance which are unexplored or need to be tapped. This evaluation would give ample data to reinforce these areas and would lead us ultimately to the pre-set target of WHO. Findings – India's march to prosperity faces a serious risk of slowing down due to the main reason – lack of proper access to health care due to the absence of a well laid out public policy. Therefore, the key stakeholders of the health insurance industry jointly need to build a robust health insurance system and help to bridge the gap that exists in reaching quality healthcare in India. A review of the health policy for modifications and to implement it successfully through health insurance without road blocks is called for. Practical implications – The results of this study, it is hoped, will outline equity in health care, which matters to every Indian citizen and how it can be achieved in India. Originality/value – This paper suggests the adoption of an approach of management science called the gaps model of service quality in dealing with India's healthcare system problems, a new indicator aimed at assessment of the deficit in access to health services through a structured integrated way. The strategy takes account of the significant gaps identified to suggest new pragmatic methods to close the gaps. [ABSTRACT FROM AUTHOR]

India has the world’s second largest urban population (after China). This paper shows the large disparities within this urban population in health-related indicators. It shows the disparities for child and maternal health, provision for health care and housing conditions between the poorest quartile and the rest of the urban population for India and for several of its most populous states. In the poorest quartile of India’s urban population, only 40 per cent of 12 to 23 month-old children were completely immunized in 2004—2005, 54 per cent of under-five year-olds were stunted, 82 per cent did not have access to piped water at home and 53 per cent were not using a sanitary flush or pit toilet. The paper also shows the large disparities in eight cities between the poorest population (the population in the city that is within the poorest quartile for India’s urban areas), the population living in settlements classified as “slums” and the non-slum population. It also highlights the poor performance in some health-related indicators for the population that is not part of the poorest quartile in several states — for instance in under-five mortality rates, in the proportion of stunted children and in the proportion of households with no piped water supply to their home. [ABSTRACT FROM PUBLISHER]

Purpose: Significant advances have been made in the field of healthcare service delivery across the world; however, health coverage particular for the poor and disadvantaged still remains a distant dream in developing world. In large developing countries like India, disparities in access to healthcare are pervasive. Despite recent progress in ensuring improved access to health care in past decade or so, disparities across gender, geography and socioeconomic status continue to persist. Fragmented and scattered health records and lack of integration are some of the primary causes leading to uneven healthcare service delivery. The devised framework is intended to address these challenges. The paper aims to discuss these issues. Design/methodology/approach: In view of such challenges, in this research a Big Data and blockchain anchored integrative healthcare framework is proposed focusing upon providing timely and appropriate healthcare services to every citizen of the country. The framework uses unique identification number (UID) system as formalized and implemented by the Government of India for identification of the patients, their specific case histories and so forth. Findings: The key characteristic of our proposed framework is that it provides easy access to secure, immutable and comprehensive medical records of patients across all treatment centers within the country. The model also ensures security and privacy of the medical records based upon the incorporation of biometric authentication by the patients for access of their records to healthcare providers. Originality/value: A key component of our evolved framework is the Big Data analytics-based framework that seeks to provide structured health data to concerned stakeholders in healthcare services. The model entails all pertinent stakeholders starting from patients to healthcare service providers. [ABSTRACT FROM AUTHOR]

Background: Equitable access to healthcare for rural, tribal, and underprivileged people has been an emerging area of interest for researchers, academicians, and policymakers worldwide. Improving equitable access to healthcare requires innovative interventions. This calls for clarifying which operational model of a service innovation needs to be strengthened to achieve transformative change and bring sustainability to public health interventions. The current study aimed to identify the components of an operational model of mobile medical units (MMUs) as an innovative intervention to provide equitable access to healthcare. Methods: The study empirically examined the impact of scalability, affordability, replicability (SAR), and immunization performance on the sustainability of MMUs to develop a framework for primary healthcare in the future. Data were collected via a survey answered by 207 healthcare professionals from six states in India. Partial least squares structural equation modeling (PLS-SEM) was conducted to empirically determine the interrelationships among various constructs. Results: The standardized path coefficients revealed that three factors (SAR) significantly influenced immunization performance as independent variables. Comparing the three hypothesized relationships demonstrates that replicability has the most substantial impact, followed by scalability and affordability. Immunization performance was found to have a significant direct effect on sustainability. For evaluating sustainability, MMUs constitute an essential component and an enabler of a sustainable healthcare system and universal health coverage. Conclusion: This study equips policymakers and public health professionals with the critical components of the MMU operational model leading toward sustainability. The research framework provides reliable grounds for examining the impact of scalability, affordability, and replicability on immunization coverage as the primary public healthcare outcome. [ABSTRACT FROM AUTHOR]

Health care sector is a segment within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative and palliative care. It is one of the largest and fastest growing sectors in the world. Health care sector of India constitutes government sector that is financed publicly providing promotive and preventive health services throughout the country from primary to territory level and the private sector providing curative care by levying fee. Health care sector can be expected that the numbers will increase with increased internet penetration and Smartphone usage. This paper provides a critical review of health care sector with reference to problems and prospects and also discusses the significance of the study, recent trends, problems, suggestions and conclusion. [ABSTRACT FROM AUTHOR]

Introduction: With the enforcement of CSR Act 2013 by Government of India, the corporate sector has been mandated to spend 2% of their average net profit for the last three years on community development related activities. Indian companies have been actively spending the CSR budget on various areas which includes health and sanitation. It has been observed that major emphasis in terms of CSR is on their own areas of interest. The paper aims to investigate the pattern of CSR budget spend in the health and sanitation areas by top 300 stock market listed Indian companies in the context of the UN Sustainable Development Goals. Method and Materials: For the study the data was collected from the annual reports available on the company websites for the financial years 2015, 2016, 2017 and 2018 as also from online financial platforms like Bloomberg. Results: The preliminary findings of the data suggest that most of the pharma and health care companies CSR spend is focused on health and related areas. [ABSTRACT FROM AUTHOR]

This paper uses care pathway and delay models to better understand the possible social reasons for maternal deaths in a city with good public and private health infrastructure. The findings can inform programmes to reduce maternal mortality. During 2007–15, 136 maternal deaths were reported in Chandigarh, India. Using World Health Organisation’s verbal autopsy questionnaire, interviews were conducted with primary caregivers of 68 (50%) of the 136 deceased women, as majority of the families had returned to their native places. We used process-tracing techniques to construct the care pathways and identify delays, and explored open-ended responses using thematic analysis. The mean age of the deceased women was 27 years, 51% resided in slums, 32% were primigravida, 25% had their deliveries assisted by traditional birth attendants, and 23% had Caesarean section. Eight percent died at home, and 54% died in tertiary level facilities. Post-partum haemorrhage (26.5%), and complications of puerperium (25%) and labour/delivery (14.7%) were the reported medical causes. Male child preference and norms for home delivery were identified as the distal socio-cultural causes. Individual and family level factors included: shame on multiple pregnancies; fear of discrimination from providers; past successful deliveries at home leading to overconfidence and not seeking institutional care; and lack of awareness about family planning, antenatal care, and danger signs of pregnancy. Healthcare system factors were: non-availability of senior doctors at the time of consultation in the emergency that delayed initiation of immediate treatment, and lack of availability of life-saving equipment due to patient load. Empirical evidence was found on social causes of maternal deaths, which could have been prevented by appropriate actions at individual, family, societal, institutional and policy levels. This study identified potential preventable causes of primarily social origin, which could help in taking actionable steps at several levels to further reduce maternal deaths in India. [ABSTRACT FROM AUTHOR]

Using the consumption expenditure data, National Sample Survey, 2009-2010, this paper test the hypothesis that the monthly per capita household health spending of elderly households is significantly higher than non-elderly households in India. The households are classified into three mutually exclusive groups; households with only elderly members (elderly households), households with elderly and non-elderly members and households without any elderly member. The health spending include the institutional (hospitalization) and non-institutional health expenditure of the households, standardized for 30 days. Descriptive statistics and a two part model are used to understand the differentials in health expenditures across households. Results indicate that the monthly per capita health spending increases with economic status, occupation, age and educational attainment of the head of the household. The monthly per capita health spending of elderly households is 3.8 times higher than that of non-elderly households. While the health spending accounts 13 % of total consumption expenditure for elderly households, it was 7 % among households with elderly and non-elderly members, and 5 % among non-elderly households. Controlling for socio-economic and demographic correlates, the per-capita household health spending among elderly households and among household with elderly and non-elderly members was significantly higher than non-elderly households. The health expenditure is catastrophic for poorer households, casual labourer and households with elderly members. Based on the finding we suggest to increased access to health insurance and public spending on geriatric care to reduce the out-of-pocket expenditure on health care in India. [ABSTRACT FROM AUTHOR]

Background: Migrant labourers living in the slums of urban and industrial patches across India make up a key sub-population so far controlling Tuberculosis (TB) in the country is concerned. This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India. This marginalized community usually seeks early-stage healthcare from “friendly neighbourhood” non-formal health providers (NFHPs). Because, RNTCP has limited capacity to involve the NFHPs, an implementation research project was conceived, whereby an external partner would engage with the NFHPs to enable them to identify early TB symptomatics from this key sub-population who would be then tested using Xpert MTB/RIF technology. Diagnosed TB cases among them would be referred promptly to RNTCP for treatment. This paper aimed to describe the project and its impact. Methods: Adopting a quasi-experimental before-after design, four RNTCP units from two major urban-industrial areas of Odisha were selected for intervention, which spanned five quarters and covered 151,400 people, of which 30% were slum-dwelling migrants. Two similar units comprised the control population. The hypothesis was, reaching the under reached in the intervention area through NFHPs would increase TB notification from these traditionally under-notifying units. RNTCP notification data during intervention was compared with pre-intervention era, adjusted for contemporaneous changes in control population Results: The project detected 488 Xpert+ TB cases, of whom 466 were administered RNTCP treatment. This translated into notification of additional 198 new bacteriologically positive cases to RNTCP, a 30% notification surge, after adjustment for 2% decline in control. This meant an average quarterly increase in notification of 41.20(20.08, 62.31; p<0.001) cases. The increase was immediate, evident from the rise in level in the time series analysis by 50.42(10.28, 90.55; p = 0.02) cases. Conclusion: Engagement with NFHPs contributed to an increase in TB notification to RNTCP from key under reached, slum-dwelling migrant populations. [ABSTRACT FROM AUTHOR]

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention. [ABSTRACT FROM AUTHOR]

Background: Empirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India's slums. Methods: The study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through individual face-to-face in-depth interviews with a semi-structured questionnaire. Results: The data analysis shows six categories of reasons underlying women's preferences for informal healers, which are presented in the form of the following themes: cultural competency of care, easy communication, gender-induced affordability, avoidance of social stigma and labelling, living with the burden of cultural expectations and geographical and cognitive distance of formal health care. In case of men ease of access, quality of treatment and expected outcome of therapies are the three themes that emerged as the reasons behind their preferences for formal care. Conclusion: Our results suggest that both men and women utilise formal and informal care, but with different motives and expectations, leading to contrasting health-seeking outcomes. These gender-induced contrasts relate to a preference for socio-cultural (women) versus technological (men) therapies and long (women) versus fast (men) treatment, and are linked to their different societal and familial roles. The role of women in following and maintaining socio-cultural norms leads them to focus on care that involves long discussions mixed with socio-cultural traits that help avoid economic and social sanctions, while the role of men as bread earners requires them to look for care that ensures a fast and complete recovery so as to avoid financial pressures. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore prisoner dental health in Haryana, India. Design/methodology/approach – The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana. Findings – The mean age of 1,393 subjects examined was 35.26±12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications – Long-standing prisoner dental problems indicated a need for dental treatment in prisons. Originality/value – This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners. [ABSTRACT FROM AUTHOR]

This paper considers how changes in urban governance in Delhi over the last two decades have influenced the provision of health care services. It begins by describing the introduction of, or return to, elected governments for the National Capital Territory of Delhi and for the Municipal Corporation of Delhi. It then discusses public health care, which in effect serves low-income groups as most higher-income groups now use private services, and how this has changed, drawing on interviews and direct observations of elected representatives and officials at state and municipal levels, political cadres, NGOs, members of residential welfare associations and public health care users. The research focused on four municipal wards that included a middle-class area, a mixed-income area, a ward where many slum communities had been relocated and an “urban village”. The research also included an analysis of the priority given to health care issues (and what those issues are) in the Legislative Assembly and in the Municipal Health Department and Municipal Health Committee. The paper suggests that the opening by state government of new invited spaces for resident welfare associations meant that the elected members of the Legislative Assembly and of the municipal government were by-passed. It increased the influence of resident welfare associations, but these are a feature of middle-class areas whose inhabitants use private health care. It avoided contestation, as the state could decide who was invited. The role of NGOs as advocates for the urban poor also diminished, as many were drawn into becoming implementers of government programmes. In effect, this increase in participation can be seen as a new form of centralization, strengthening the position of senior bureaucrats and by-passing the elected politicians. [ABSTRACT FROM PUBLISHER]

Background: Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease. Methodology/Principle findings: We acquired district level data on cholera case reports of 2010–2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as “hotspots” based on the reported cases. On the other hand, 111 districts in nine states were identified as “hotspots” from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district. Conclusions/Significance: The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India. [ABSTRACT FROM AUTHOR]

Out-of-pocket spending at out-patient departments (OPD) by households is relatively less analyzed compared to hospitalization expenses in India. This paper provides new evidence on the levels and drivers of expenditure on out-patient care, as well as choice of providers, using household survey data from 8 districts in 3 states of India. Results indicate that the economically vulnerable spend more on OPD as a proportion of per capita consumption expenditure, out-patient care remains overwhelmingly private and switches of providers—while not very prevalent—is mostly towards private providers. A key result is that choice of public providers tend to lower OPD spending significantly. It indicates that an improvement in the overall quality and accessibility of government facilities still remain an important tool that should be considered in the context of financial protection. [ABSTRACT FROM AUTHOR]

Introduction: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India’s vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. Materials and Methods: The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. Results: The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. Discussion: A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen’s behavioural model of health services use. Conclusion: The findings assisted with refining the intervention prior to large-scale implementation and evaluation. [ABSTRACT FROM AUTHOR]

For many years, the Punjab province of India has had the dubious distinction of having the worst sex ratio among all other states of India. In recent years, both the child sex ratio and the overall sex ratio has shown a marked improvement in the state. This paper analyses whether the improvement in sex ratios has narrowed down gender discrimination against the girl child in Punjab. This paper examines the intra-household gender differences in indicators of nutrition and well-being by employing logistic regression analysis on the latest available data from the National Family Health Survey (NFHS) for the year 2015–2016. It also evaluates the cash transfer schemes currently being implemented in Punjab for the welfare of the girl child and analyses their relative efficacy. The key results from the study reveal that gender continues to have a significant impact on indicators of child well-being and nutrition such as the average duration of breastfeeding and intra-household food allocation. The paper also finds that cash transfer schemes do not have a statistically significant impact on indicators of child malnutrition in the state. [ABSTRACT FROM AUTHOR]

Most rural areas in the developing countries lack access to qualified out-patient (OPD) care. The gap in health services provision arises, due to lack of qualified doctors and is oftentimes filled by unqualified doctors who are also known as private non-degree practitioners (PNDPs). Despite their dominance, their presence is often neglected in access to health care studies. This leaves a scenario which lacks informal, but predominant, care. This paper uses a mix-method approach, combining exhaustive quantitative census of all health care providers along with location details in Geographic Information System to address the accessibility to PNDP. Longitudinal quantitative as well as spatial surveys were conducted for 3 years (2010, 2012 and 2013) in districts of Pratapgarh and Kanpur Dehat in state of Uttar Pradesh and Vaishali in Bihar state. The results of this study show that PNDPs account for 25 % of the all health care providers active across the study areas. The PNDPs are active in a radius of 2-5 km and are main workforce for the OPD care. Considering all health care providers PNDPs provide best potential accessibility to OPD care. If the PNDPs are removed from the scenario; remote areas will be the most affected ones, leaving them with almost no OPD care. [ABSTRACT FROM AUTHOR]

Health and illness were interpreted in a cosmological and anthropological prospective. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultural and civilization. Over the years development planning in India has focused on reducing the burden of illness and mortality among women and children. A large number of development and public health programmes such as the Integrated Child Development Services (ICDS) have been geared towards this, since a long time. India is committed to achieve the Millennium Development Goals, particularly with respect to maternal and child health. Awareness generation is a major responsibility and fundamental importance, to ensure utilization of various healthcare programmes implemented by Government. The Indian healthcare sector can be viewed as a glass half empty or a glass half full. In this research paper author focuses on The Status of health care services in India. [ABSTRACT FROM AUTHOR]

Purpose – People often migrate from rural to urban areas within a country or from less developed to more developed countries for better life opportunities but may remain outside the range of health services. The purpose of this paper was to find out the socio-economic and health system factors that may affect the utilization of health services by the migrants. Design/methodology/approach – Five villages and three slums were randomly selected from 23 villages and 18 slums of Chandigarh, a northwest Indian city. Using stratified random sampling, 145 migrants and 63 native women, who were pregnant or had delivered a baby from April 1, 2009 to March 31, 2012 were interviewed using semi-structured interview schedule. χ2 was used for testing statistical significance of the differences, and logistic regression was utilized to evaluate the “independent effect” of migration on Maternal and Child Health (MCH) service utilization. Findings – The level of education was higher among migrants than the natives but their income was less than that of natives. Majority of the migrant women had registered themselves for antenatal care (ANC) in the first trimester of pregnancy (55 percent) compared to the natives (21 percent), but only few had availed more than three ANC check-ups (18 percent) as compared to the natives (44 percent). Knowledge about danger signs of childhood diarrhea and pneumonia was low among migrants compared to the natives (p < 0.0001). Health workers interacted less often with migrants (29 percent) than the natives (67 percent). After controlling the effect of socio-economic and -demographic variables, utilization of MCH care services were significantly higher among natives than the migrants. Inadequate community support among migrants led to the lower utilization of MCH care. Research limitations/implications – Present study reflects early ANC registration among migrants but the number of ANC visits much less than the natives. This could be further be investigated using qualitative methods. Practical implications – Specific strategies are required to address the health needs of migrants such as formation of community-based support groups. Health services and health workers need to be oriented to support migrants to the special needs of migrants. Social implications – Reduction in inequality in accessing health between natives and migrants can be addressed with social support. Originality/value – The study supports the fact that migration is one of the social determinants of health. Lack of community support to migrants is the major barrier in accessing the health services. [ABSTRACT FROM AUTHOR]

The development in the country's health status has not kept pace with its economic development. Although India along with most countries of the world was a signatory to the Alma Ata Declaration of 1978, its performance particularly on health equity and quality issues, so far, has been far from satisfactory. There are vast variations in health-care status by states, by ethnic groups, gender, and urban-rural difference. Till recently, government policies and people's perceptions also seemed to be on the wrong track. Our priorities seemed to be all wrong - we seemed to prefer setting up of high-cost tertiary health institutions at the expense of the primary health centers. The recently launched Swachh Bharat and Ayushman Bharat schemes offer hope of addressing these asymmetries. This paper briefly dwells on these issues. [ABSTRACT FROM AUTHOR]

Background: The tribal culture views health care practices differently from the mainstream. Infertile tribal women practice treatment-seeking behaviour that reflects the community's cultural access to and availability of treatment as well as customs to meet their health care needs. In the environment of rising awareness of infertility and numerous treatment options, this study aims to highlight the infertility treatment-seeking behaviour of tribal communities. Data and methods: The study employed a mix methods approach to collect data from 153 tribal couples suffering with infertility (interview schedule) and the community (in-depth interviews--14 and focus group discussions--12). The data was analyzed using Stata 13.0, and NVivo 10. Results of the quantitative data were triangulated with qualitative data for writing. Results: Many treatment options were available for infertility in the community. Generally, traditional healers (98.7%) were preferred over modern healthcare practitioners (35%). Community members usually guided infertile couples for choosing providers. Treatment practices were very different among primary infertile women than sub-fertile. Women frequently discontinued treatment and switched between providers because of unaffordability, poor connectivity, distance, travel time, time constraints, and non-supportive circumstances. The couples were advised to consume herbs, and eat or avoid certain food items, were given massage, burns on the abdomen (dagani), removed black blood (phasani) and other various rituals to appease spirits, get rid of ghosts while offering animal sacrifice, and conducting shidwa ritual. The mean expenditure on treatment was INR 18,374. If treatment did not yield any result, couple resorted to add another wife, divorce, accept childlessness and foster a child. Conclusion: Local authorities should strive to work towards the socio-economic development of the tribal communities and provide good healthcare services at their doorstep. The infertility problem needs to be understood in the context of poverty, tribal beliefs, and unequal access to healthcare resources. [ABSTRACT FROM AUTHOR]

Purpose: The present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives. Design/methodology/approach: To determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures. Findings: The results indicate "internal processes" perspective assumes the key role within BSC perspectives, while performance measures "nursing staff turnover" and "staff training" play the key roles. The results also signify that "patient satisfaction" is the most vital issue and can be strongly influenced by measures belonging to the "learning and growth" perspective. In "learning and growth" perspective, "staff training" is the most decisive criteria, very highly influencing "patient satisfaction", highly influencing "profitability," "change of cost per patient (both in and out patients)" and "outpatient waiting time" while moderately influencing "staff satisfaction," "bed occupancy" and "nursing staff turnover". Moreover, "staff training" criteria have a positive influence on "nursing staff turnover." Originality/value: The contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework. [ABSTRACT FROM AUTHOR]

This paper aims to report and compare the immunization coverage of various vaccines among tribal and rural children in a distinct socio-economic environment in India. The study was conducted in two tribal and two rural developmental blocks of Visakhapatnam district of Andhra Pradesh, India, by employing both qualitative and quantitative data collection techniques. Data collected included the immunisation coverage and the associated socio-demographic factors. The majority of mothers was aware of vaccination of children, and usually the primary heath centres and their health workers were the source of vaccination. Vaccination cards were received by 79.2% of tribal and 71.3% of rural children. Some of the socio-demographic characters of mothers, such as habitat, caste and occupation, were associated with the reception of a vaccination card. The coverage of various vaccines was higher among the tribal than among the rural population. Of the eligible children aged above 9 months, 63.3% of tribal children and only 14.5% of rural children were fully vaccinated [three doses of diphtheria, pertussis and tetanus (DPT), four doses of oral polio vaccine, Bacille Calmette Guerin (BCG) and measles vaccine]. The coverage of vaccination against measles and vitamin-A supplementation were very low among rural children (19.6% and 15.2%, respectively) when compared to tribal children (69.2% and 64.2%, respectively). The qualitative data indicated that the community was not satisfied with regard to vaccination services, particularly in the rural area. The coverage of various vaccines was moderate in tribal areas and poor in rural areas. The sole dependence on and demand for public health services was responsible for relatively better coverage of immunisation in tribal areas compared to rural areas where the private sector plays a major role. The existing strategies of health-care delivery including delivery of vaccination services need to be examined and improved. Improvements in physical access, infrastructure, quality of care and increased use of mass media and interpersonal communication are indispensable for improvement in the provision of services. [ABSTRACT FROM AUTHOR]

Healthy pregnancy and safe childbirth is a goal of all Indian health care systems. Despite significant improvements in recent decades, mothers and their babies are still in danger during the prenatal period, which covers pregnancy, delivery, and therefore the postpartum. Babies born too early are more likely to die than those born at term. To enhance prenatal health, we would like the proper tools to assess problems and their causes. We also got to monitor the health condition of the pregnant woman frequently. We have proposed the system using IOT which is predicated on maternal health care solution that promises to effectively monitor the health of the pregnant women in rural India. This technique allows sensing various attributes just like the temperature, pulse and therefore the vital sign of the mother frequently. The readings of the attributes are stored during a cloud. Just in case of any abnormal conditions there's a message which is shipped to the hospital, doctor responsible and therefore the guardian of the patient. We have also used Diffie Hellman Key Exchange algorithm to secure transmission of knowledge. [ABSTRACT FROM AUTHOR]

This paper discusses five innovative programmes in medical education with the view of giving a glimpse of the new approaches to the education of physicians. Each one of them has unique features and provides useful lessons. The School of Medicine, McMaster University, Hamilton (Canada), pioneered the use of interdisciplinary problem based learning. The programme obliterates the basic science and clinical science dichotomy, and involves self-directed, small group (tutorial) learning as the principal educational method. Faculty of Medicine, University of Sherbrooke (Canada) shows the way for introduction of innovative problem-based curriculum in a traditional medical school. The University Centre for Health Sciences, Ben Gurion University of the Negev, Beersheva (Israel), serves as the nodal point of the health care system in the region. Merging of the service and the educational systems has not only succeeded in better community orientation of graduates, but also in improving the health care availability in the region. The University of Philippines, College of Medicine, Institute of Health Sciences, Tacloban (Philippines), trains grassroot workers as well as physicians. Through a ladder-type curriculum, a health worker can rise to become a doctor of medicine. The Chulalongkorn University Medical School, Bangkok, Thailand, has successfully run a parallel innovative track for students of rural background. The students are identified from the underserved areas, and are given a large part of their clinical training at the provincial/district hospitals. The programme has succeeded in inculcating favourable attitudes towards working in rural areas, and in improving the care at provincial/district hospitals. These innovative programmes have emerged as role-models for bold experimentation in medical education. [ABSTRACT FROM AUTHOR]

'Palliative care', a branch of medicine, aims to alleviate pain and enhance quality of life in the patient suffering from life-threatening illnesses. In addition to regular curative treatment for the patient, it also provides bereavement support to the family thereafter. Search for exhaustive literature on palliative care initiatives and current status in India confirms a dearth for nationwide awareness as well as published literature concerning the performance of palliative care units. While only few institutions are involved in disseminating palliative care initiatives, the services are quite limited, demanding a need to consider this topic holistically. Conclusively, palliative care should address every aspect of health care and support to the ailing patient and their family members. The purpose of this paper is to analyse the palliative care process adopted by the case institution, i.e. a renowned Palliative Care and Training Centre (PCTC-1) in India, to discuss the palliative care initiatives and their performance outcomes. A situation-actor-process and learning-action-performance (SAP-LAP) model of inquiry has been applied for the case study (PCTC-1). It considers the present operations of the centre and actors as participants influencing the situation through different processes. Several pertinent issues leading to actions have been analysed, which have considerable impact on the delivery of palliative care services. Responses elicited through in-depth interviews with the actors form the basis of primary data along with the published secondary sources. PCTC-1 has undertaken numerous initiatives such as 'care beyond cure', 'wearing smiles' and rendering health care at the centre as well as homes. Issues related to spreading awareness and holistic services on palliative care demands priority. The government national healthcare system needs to include palliative care as a core programme for people inclusion. Presently, palliative care services in India are negligible, and people lack awareness about it. This study uses SAP-LAP inquiry as a novel approach, which attempts to analyse and synthesise the processes holistically in a single study on the performance of palliative care services rendered only by the case organisation (PCTC-1). The findings of this study could be widely used for managerial problem-solving experienced by other palliative care centres. Further empirical tests can be undertaken in the palliative care sector for deriving deeper linkages in the model. [ABSTRACT FROM AUTHOR]

In this research, we utilise a multi-method braided approach for a real-world health care intervention in rural India. We first use action research to conceptually underpin the role of self-help groups, disease profiles and appropriate interventions in health care behaviour change and improvement. Action research is then coupled with a non-linear integer-programming-based simulation to determine how health care resources need to be distributed over time, disease type and groups. The action research provides specific research questions and distributional forms needed for the optimisation analysis, while the non-linear integer-programming simulation provides specific recommendations on where and when to distribute resources. External validity of the study is ensured by the adoption of recommendations in the field as part of the action research. Findings from this research have important policy implications. For example, it identifies the value of continuous embedded interventions as opposed to periodic ones and the importance of flexibility in terms of which community groups and disease types to serve over time. This research also provides an important bridge between the operations research, health care in developing nations, organisational theory and humanitarian operations bodies of knowledge. [ABSTRACT FROM AUTHOR]

Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication and low compliance, is likely to contribute to gaps and delays in the provision of emergency obstetric care. [ABSTRACT FROM AUTHOR]

Background and Objective: The translational research objective is to produce meaningful and applicable results that directly benefit the community. The objective of translational research is to move from traditional research discoveries rapidly and efficiently into practice. Translational research encourages and promotes multidisciplinary collaboration among clinicians, researchers, industry, policy makers, and other related stakeholders. It further incorporates the needs of the general public with communities being engaged to determine their requirements for health invention. It identifies and supports medical and health practices. Translational research is frequently classified by which stage of restatement (from beginning exploration to societal operation and impact) it falls into. Translational research is the process of turning compliances in the laboratory, clinic, and community into interventions that apply to the health of individualities, public from diagnostics, and to medical procedures as well as behavioral changes. Methods: This study adopted a qualitative research methodology based on Hill et al. consensual qualitative research (CQR) to build multiple case studies to acquire the information. We ion.opted to apply a modified method of CQR based on multiple case studies. This is an emerging methodological approach in research. Results: Based on the 24 semistructured interviews, these interviews were directly with researchers who carry out the research. Twenty-four voluntary researchers participated in the research and these semi-structured interviews were made into 24 case studies to be analyzed. Each case study was built based on the questions on methods of research. These were used to identify and build the tools for practicing translational research. Conclusion: There is a huge untapped potential for India in the area of translational research. [ABSTRACT FROM AUTHOR]

Background: Despite growing awareness of HIV/AIDS the exact level of knowledge regarding the associated stigma among healthcare trainees needs to be ascertained. Their knowledge reflects the quality of care delivered by them in the future. Aims: This study aimed to assess the knowledge of stigma associated with HIV/AIDS among trainee healthcare students in Delhi. Settings and Design: cross-sectional survey design. Methods and Material: A total of two hundred healthcare students were contacted for the survey. The HIV stigma scale with 18 items was administered one-one/mail after receiving the informed consent. Finally, data were collected from one hundred and twenty-seven subjects after excluding the dropouts. Related statistical analysis was performed to examine the data. Statistical analysis used: Descriptive statistics were used for the variables. Results: Scores on the three domains reflected that the maximum number of subjects had awareness of the negative attitude and equity issues related to HIV/AIDS. Also, there seemed to be less recognition of the perceived discrimination prevalent within the community. Conclusions: This study reports on HIV/AIDS-related discriminatory attitudes and stigma encountered by persons living with HIV/AIDS. Such attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts to manage and prevent HIV. Thus, knowledge of healthcare trainees about HIV/AIDS-related stigma that can hinder efforts to manage and prevent HIV needs to be addressed. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines access to health care by poorer residents in Chennai, India. It reveals constraining and enabling conditions for impoverished users seeking treatment. We explore patterns of health-seeking behaviour through the reasoning of residents themselves as well as stakeholders involved in providing care for these users. Particular attention is paid to the needy residents’ preference for private health care providers despite the costs involved and that free public facilities are available. We address this issue by combining Sen’s entitlement approach with Penchansky and Thomas’ work on access to health care. Based on data gathered in a qualitative field-based research design including interviews with 14 residents and 58 stakeholders involved in caring for poor people, we argue that the availability of health care facilities within walking distance is a necessary but not sufficient precondition for satisfactory access. Rather, we demonstrate the influence of ‘entitlements to health care’ which allow poor households that are endowed with resources such as income, knowledge and social networks to realise access. The narratives we present reveal not only experiences of health care, but also feelings about its utilisation. The latter, we contend, are crucial in determining choice of health care facilities. This finding suggests that analyses of affordability and physical access to health care in less developed countries should include a focus on emotional dimensions of utilisation. In other words, there is a need to consider not only effective access to health care, but also affective dimensions of treatment for poorer citizens. [Copyright &y& Elsevier]

Connecting rural India to modernised healthcare facilities through telemedicine has been a long-time vision of the Government of India. Telemedicine provides continuity of care to patients keeping the doctor-patient interaction alive. This study aims to explore telemedicine and its ever-growing trend. The journey of its evolution from a doubtful start to its current position is examined in this study. A systematic electronic search for articles available between 2014 to 2020 using MEDLINE, EMBASE, Cochrane Database and Google Scholar was performed using PRISMA guidelines. Studies published in English, with free full-text availability and “telemedicine” and “India” used as keywords were included. 126 studies were identified and, after a further analysis, 21 of 44 articles were chosen for assessment. The healthcare industry is largely benefitting from telemedicine. Different fields of medicine have provided successful evaluations and remedies by utilising telemedicine. We found that systematic availability and functioning of ICT, technical infrastructure, data storage systems, standardization of health protocols are few of the challenges faced. COVID 19 has forced the resilience of patients and professional Indians to overcome the barriers and explore telemedicine to achieve quality patient-centric and value-based healthcare. Digitization displays tremendous potential to facilitate a booming practise in telemedicine with suitable training and stringent guidelines. [ABSTRACT FROM AUTHOR]

Platelets are valuable, but highly perishable, blood components used in the treatment of, among others, viral dengue fever, blood-related illness, and post-chemotherapy following cancer. Given the short shelf-life of 3–5 days and a highly volatile supply and demand pattern, platelet inventory allocation is a challenging task. This is especially prevalent in emerging economies where demand variability is more pronounced due to neglected tropical diseases, and a perpetual shortage of supply. The consequences of which have given rise to an illegal 'red market'. Motivated by experience at a regional hospital in India, we investigate the problem of platelet allocation among three priority-differentiated demand streams. Specifically we consider a central hospital which, in addition to internal emergency and non-emergency requests, faces external demand from local clinics. We analyze the platelet allocation decision from a social planner's perspective and propose an allocation heuristic based on revenue management (RM) principles. The objective is to maximize total social benefit in a highly supply-constrained environment. Using data from the aforementioned Indian hospital as a case study, we conduct a numerical simulation and sensitivity analysis to evaluate the allocation heuristic. The performance of the RM-based policy is evaluated against the current sequential first come, first serve policy and two fixed proportion-based rationing policies. It is shown that the RM-based policy overall dominates, serves patients with the highest medical urgency better, and can curtail patients' need to procure platelets from commercial sources. [ABSTRACT FROM AUTHOR]

The right to health and equity is the paramount concern of the State, especially in times of epidemic and pandemic. The nationwide lockdown and COVID-19 has witnessed a series of judicial inte3rvention in health right and equity. Although there is a settled jurisprudence concerning health right and entitlement, the current streak of judicial innovation represents a novel discourse in the understanding of the public health administration and governance in India. An inquiry into the judicial policy of the epidemic-pandemic in the comparative jurisdiction seems fascinating in deepening our understanding of the state expediency and citizens liberty. The precedents in Gibbons v. Ogden, Louisiana State Board of Health Case, Jew Ho v. Williamson and Wong Wai v. Williamson deepens the understanding of the public health administration and governance. The rulings of Indian Supreme Court in Alakh Alok Srivastava v. Union of India, Shashank Deo Sudhi v. Union of India, suo motu cognizance of COVID-19 Testing and Sachin Jain v. Union of India also open a new vista of health right and justice in India. [ABSTRACT FROM AUTHOR]

Ageing involves multidimensional changes including those in the biological, psychological and social spheres of a person's existence. Based on the IHDS 2011-12 the study tries to analyse the morbidity/ disability status and the income and expenditure coverage incurred for treatment of the 60 plus folks in the country. High Blood Pressure, diabetes and Asthma are the most prevalent morbidity types among the aged people and these are suffered through out of the rest of life. The inadequate care and support in the older age creates stress and makes the infirmity problem more severe. Accessibility and quick improvement in health condition become the major reason for preferring the allopathic treatments. Availing any sort of pension or health insurance schemes is the possible way that makes the elderly more independent and stable. However the data reveals that the percent of elderly availing these services are slight in number. Financial burden and dependence force them to skip their treatment or to ignore the affliction, this makes their health condition more severe and further leads to more illness. [ABSTRACT FROM AUTHOR]

Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons with Disabilities Act 1995 (equal opportunities, protection of rights, and full participation), neurological conditions are ignored. Although Indian Disability Evaluation and Asessment Scale (IDEAS), which assesses psychiatric conditions, does include dementia as one of the neurodegenerative conditions. Additionally, according to the global burden of disease report, 33% of years lived with neurological disability and 13% of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders. In 2001, the World Health Organization (WHO) established a new definition of disability, declaring it an umbrella term with the following three major components; 1) impairments: problems in body function or structure, 2) activity limitations: difficulties encountered by a person in executing a task or action, and 3) participation restrictions: problems of involvement in life situations experienced by a person. Hence, an attempt was made to rectify the above concerns. To address the above mentioned concerns, we think that there is a need of a comprehensive format for neurological disabilities assessment which would also include objective neuropsychological assessments. As future directions, national level meetings are required to formulate 'Indian Standard Track for Assessing Neurological Disability' (I-STAND) and uniform guidelines for disability assessment in 'chronic neurological conditions' with a special focus on "neuropsychological disability". [ABSTRACT FROM AUTHOR]