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264. Health care inequities in north India: Role of public sector in universalizing health care

Author

Prinja, Shankar, Kanavos, Panos, and Kumar, Rajesh

Subjects
Public Sector, Universal Health Insurance, service utilization, user charges, India, Humans, Original Article, Equity, Healthcare Disparities, hospitalization expenditure
Abstract

Background & objectives: Income inequality is associated with poor health. Inequities exist in service utilization and financing for health care. Health care costs push high number of households into poverty in India. We undertook this study to ascertain inequities in health status, service utilization and out-of-pocket (OOP) health expenditures in two States in north India namely, Haryana and Punjab, and Union Territory of Chandigarh. Methods: Data from National Sample Survey 60th Round on Morbidity and Health Care were analyzed by mean consumption expenditure quintiles. Indicators were devised to document inequities in the dimensions of horizontal and vertical inequity; and redistribution of public subsidy. Concentration index (CI), and equity ratio in conjunction with concentration curve were computed to measure inequity. Results: Reporting of morbidity and hospitalization rate had a pro-rich distribution in all three States indicating poor utilization of health services by low income households. Nearly 57 and 60 per cent households from poorest income quintile in Haryana and Punjab, respectively faced catastrophic OOP hospitalization expenditure at 10 per cent threshold. Lower prevalence of catastrophic expenditure was recorded in higher income groups. Public sector also incurred high costs for hospitalization in selected three States. Medicines constituted 19 to 47 per cent of hospitalization expenditure and 59 to 86 per cent OPD expenditure borne OOP by households in public sector. Public sector hospitalizations had a pro-poor distribution in Haryana, Punjab and Chandigarh. Interpretation & conclusions: Our analysis indicates that public sector health service utilization needs to be improved. OOP health care expenditures at public sector institutions should to be curtailed to improve utilization of poorer segments of population. Greater availability of medicines in public sector and regulation of their prices provide a unique opportunity to reduce public sector OOP expenditure.

Published
2012

277. Institutionalising health technology assessment: establishing the Medical Technology Assessment Board in India

Author

Downey, Laura E, primary, Mehndiratta, Abha, additional, Grover, Ashoo, additional, Gauba, Vijay, additional, Sheikh, Kabir, additional, Prinja, Shankar, additional, Singh, Ravinder, additional, Cluzeau, Francoise A, additional, Dabak, Saudamini, additional, Teerawattananon, Yot, additional, Kumar, Sanjiv, additional, and Swaminathan, Soumya, additional

Published
2017
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290. Geographic Inequities in Coverage of Maternal and Child health Services in Haryana State of India.

Author

Prinja, Shankar, Balasubramanian, Deepak, Sharma, Atul, Gupta, Rakesh, Rana, Saroj Kumar, and Kumar, Rajesh

Subjects
*CHILD health services, *CHILDREN'S health, *CONTRACEPTION, *HEALTH services accessibility, *HEALTH status indicators, *IMMUNIZATION, *MATERNAL health services, *MEDICAL care use, *POPULATION geography, *POSTNATAL care, *PRENATAL care, *STATISTICAL sampling, *SURVEYS, *FAMILY planning
Abstract

Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12–23 months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators − 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals. [ABSTRACT FROM AUTHOR]

Published
2019
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291. Health impact and economic burden of alcohol consumption in India.

Author

Jyani, Gaurav, Prinja, Shankar, Ambekar, Atul, Bahuguna, Pankaj, and Kumar, Rajesh

Subjects
*HEALTH impact assessment, *ALCOHOL drinking, *MARKOV processes, *GROSS domestic product, DEVELOPED countries
Abstract

Background: The health and economic consequences of alcohol consumption have been assessed mainly in developed countries. This study aims to estimate health impact and economic burden attributable to alcohol use in India.Methods: A combination of decision tree and mathematical markov model was parameterized to assess the health effects and economic cost attributable to alcohol consumption. Health effect of alcohol was modelled for a time period of 2011 to 2050 on three sets of conditions - liver disease, cancers and road traffic accidents. Estimates of illness, death, life years lost and quality adjusted life years (QALYs) gained were estimated as a result of alcohol consumption. Both direct and indirect costs were estimated to determine economic burden. Future costs and consequences were discounted at 3% for time preferences of cost and utility. Uncertainties in parameters were assessed using probabilistic sensitivity analysis.Results: Between 2011 and 2050, alcohol attributable deaths would lead to a loss of 258 million life years. In contrast, 552 million QALYs would be gained by eliminating alcohol consumption. Treatment of these conditions will impose an economic burden of INR 3127 billion (US$ 48.11 billion) on the health system. Societal burden of alcohol, inclusive of health system cost, out of pocket expenditure and productivity losses will be INR 121,364 billion (US$ 1867 billion). Even after adjusting for tax receipts from sale of alcohol, alcohol poses a net economic loss of INR 97,895 billion (US$ 1506 billion). This amounts to an average loss of 1.45% of the gross domestic product (GDP) per year to the Indian economy.Conclusion: Alcohol causes significant negative health impact and economic burden on Indian society and evidence informed policy interventions are needed to control alcohol attributable harm. [ABSTRACT FROM AUTHOR]

Published
2019
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292. Economic Analysis of Delivering Postpartum Intrauterine Contraceptive Device Services in India.

Author

Bahuguna, Pankaj, Khanduja, Puneet, and Prinja, Shankar

Subjects
INTRAUTERINE contraceptives, MEDICAL care costs, POSTNATAL care, COST analysis, DESCRIPTIVE statistics
Abstract

Introduction: We estimated the unit costs for implementing postpartum intrauterine contraceptive device (PPIUCD) services from the perspective of both health system and development agencies. Methodology: Seven districts from two Indian states, i.e., Uttarakhand (UK) and Madhya Pradesh (MP), were selected to study the cost of PPIUCD service. Data on costs incurred both by health system and development agencies for PPIUCD service were collected. Unit costs were estimated for providing PPIUCD and IUCD services by state and district level of care in public health-care system. We also estimated unit cost per couple-year protected (CYP) by the level of the health facility. Results: We found that the unit cost per PPIUCD insertion including all costs, i.e., for service delivery and program support, was INR 522 ($8.7) and INR 502 ($8.4) in MP and UK, respectively. Similarly, the unit costs per interval IUCD insertion were INR 287 ($4.8) in UK and INR 281 ($4.7) in MP. Development partners have a share of >50% in overall costs. From a health system's perspective, PPIUCD and interval IUCD cost per CYP at the level of district hospital were INR 440 ($7.3) and INR 449 ($7.5), respectively. Conclusions: In India, PPIUCD, being a low-cost procedure, should be considered as a primary strategy targeted toward pregnancy spacing over other contraceptory methods. [ABSTRACT FROM AUTHOR]

Published
2019
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295. Analysis of Quality of life of patients with refractive errors in India

Author

Purohit, Neha, Goyal, Aarti, Gupta, Parul Chawla, Soundappan, Kathirvel, Kotwal, Atul, and Prinja, Shankar

Abstract

Introduction: It is important to determine the health-related quality of life (HRQoL) to devise population-based cost-effective service delivery models. The present study aimed to evaluate the HRQoL of patients with refractive errors (RE) using generic and vision-specific instruments, identify the determinants of HRQoL, and examine the validity between the quality-of-life instruments for refractive errors.

Published
2024
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296. Estimating mortality using data from civil registration: a cross-sectional study in India

Author

Gupta, Mamta, Rao, Chalapati, Lakshmi, PVM, Prinja, Shankar, Kumar, Rajesh, Gupta, Mamta, Rao, Chalapati, Lakshmi, PVM, Prinja, Shankar, and Kumar, Rajesh

Abstract

Objective To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data. Methods We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice. Findings Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered. Conclusion The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.

Published
2016

298. A comparative study between dots & non-dots patients in two districts of Haryana, India

Author

Verma, Ramesh, Khanna, Pardeep, Meena, and Prinja, Shankar

Subjects
Directly observed therapy -- Health aspects, Directly observed therapy -- Comparative analysis, Tuberculosis -- Risk factors, Tuberculosis -- Care and treatment, Tuberculosis -- Demographic aspects, Tuberculosis -- Research, Health
Abstract

Tuberculosis (TB) is major public health problem in India & among the top killer diseases. It infects one third of the world's population at any point of time. There are approximately 9 million new cases of all forms of Tuberculosis occurring annually & 3 million people die from it each year. India accounts for 28% of the global T.B. burden. Every year, approximately 1.8 million persons develop Tuberculosis of which about 0.8 million are new smear positive highly infectious cases & about 4.17 lakh people die of TB every year, one person dies every minute & 1000 die every day. The emergence of multi-drug resistant TB (MDR TB) and the spread of HIV/AIDS are contributing to the worsening impact of the disease--the principal reasons for the WHO declaring. TB a global emergency in 1993 (2). Directly-observed treatment short-course (DOTS) is based on scientifically sound technology and direct observation of drug intake of the patient by treatment observers, thus obviating the drug default problem (3). It was introduced on a pilot-basis in India in 1993, and large scale expansion began in 1998. By year 2005 entire country was covered by the programme., Introduction Tuberculosis (TB) is major public health problem in India & among the top killer diseases. It infects one third of the world's population at any point of time. There [...]

Published
2010

299. Assessment of nutritional status and dietary intake of pre-school children in an urban pocket

Author

Verma, Ramesh and Prinja, Shankar

Subjects
Malnutrition -- Demographic aspects, Malnutrition -- Prevention, Preschool children -- Health aspects, Preschool children -- Food and nutrition, Preschool children -- Research, Nutrition -- Product/Service Evaluations, Nutrition -- Methods, Nutrition -- Usage, Health
Abstract

Nutrition of preschool child is of paramount importance, because the foundation for life time health, strength and intellectual vitality is laid during that period1. The pre-school children constitute about 15% of the total population and account for 40% of the total deaths in India. This age group is notoriously fraught with the risk of protein energy malnutrition2. Keeping this in view the present study was carried out., Table of Contents Abstract Introduction Material & Methods Results Discussion References Introduction Nutrition of preschool child is of paramount importance, because the foundation for life time health, strength and intellectual [...]

Published
2008

300. Role of ICDS program in delivery of nutritional services and functional integration between anganwadi and health worker in north India

Author

Prinja, Shankar, Verma, Ramesh, and Lal, Sunder

Subjects
Food habits -- Analysis, Teenage girls -- Food and nutrition, Pregnant women -- Food and nutrition, Children -- Food and nutrition, Nutrition -- Requirements, Nutrition -- Evaluation, Child welfare, Health
Abstract

Background: The Integrated Child Development Services ICDS program is poised for universal implementation in India to provide services to children, pregnant and lactating women and adolescent girls in close coordination with the health services for improvement of health status and overall holistic development of children and other beneficiaries. However there remain questions on its effectiveness in delivering desired services. Objectives: 1. To ascertain the nutritional status and dietary patterns of 1-3 year old children in areas served by ICDS program. 2. To assess the nature and extent of functional integration between the ICDS and health sector. Methodology: A Community based cross sectional study was done from June 2005 to November 2005 in 60 anganwadi centres within 30 'functional' subcentres from 5 community development blocks in district Rohtak selected by stratified random sampling. A total of 408 children between 1-3 years age, mothers of 408 children and 60 anganwadi workers were selected from these anganwadis for the study. All children were weighed to assess the nutritional status using IAP classification of weight for age. Mothers of all children were interviewed to assess dietary patterns and nutritional education imparted by anganwadi workers. 60 anganwadi workers were interviewed to assess the functional integration with Multipurpose health worker [MPHW(F)]. Results: The study revealed that 199 (48.7%) children were underweight and 19.8% children had dietary calories intake more than 80% of RDA. Advice regarding breast feeding and complementary feeding was given by anganwadi workers to 179 (43.8%) women only. Involvement of mothers in growth monitoring is very low. The program is well integrated in functioning with the health sector. Conclusion: The problem of under-nutrition continues to persist with low involvement of mother. The program needs to be further revamped with a holistic approach towards child development and making the mother responsible for the health of the child. Keywords: ICDS, under-nutrition, inter-sectoral coordination, exclusive breast feeding, Table of Contents Abstract Introduction Material and Methods Results Discussion References Introduction The Integrated Child Development Services (ICDS) program is the world's largest early child development program. It was initiated [...]

Published
2008

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