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In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety. [ABSTRACT FROM AUTHOR]

Half the world’s people currently live in rural and remote areas. About 70% of the world’s 1.4 billion people who are extremely poor live in rural areas. The problem is that the majority of healthcare providers prefer to serve in urban areas. Only a comprehensive and systematic approach can address these inequities. India, the largest democratic republic in the world, possesses 2.4% of the world’s land area and supports 16% of the world’s population. According to census 2011, 68.84% of population resides in rural areas. Nearly 86% of all the medical visits in India are made by rural inhabitants with a majority still traveling more than 100 km to avail healthcare facility, of which 70%–80% is born out of pocket landing them in poverty. A country’s approach must systematically and simultaneously address legal coverage and rights, health worker shortages, extension of healthcare protection, and quality of care. Only then can equitable access for all be fully achieved. Those living in rural areas have access to health protection and services that meet the criteria of availability, affordability, accessibility, acceptability, and quality. Family medicine as a broad specialty has its role from womb till tomb. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences. As an academic discipline, it includes comprehensive healthcare services, education, and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological, and social problems; and coordinates comprehensive healthcare services with other specialists, as needed. The practitioners in family medicine can play an important role in providing healthcare services to the suffering humanity. The general practitioner’s responsibility in Medicare includes management of emergencies, treatment of problems relating to various medical and surgical specialties, care of entire family in its environment, appropriate referrals, and follow-up. He or she is the first-level contact for the patients and his or her family. Family medicine is the ideal solution to growing rural healthcare challenges. This article is a formal position paper of the Academy of Family Physicians of India. [ABSTRACT FROM AUTHOR]

This paper explores the effect of the banknote ban and GST, which were implemented within a span of 8 months in 2016-2017, on self-reported illnesses and healthcare consumption in India. The findings show that the increasing trend of self-reported illness from 1995-96 to 2014, reversed in 2017-2018. The reduction in healthcare consumption between 2014 and 2017-2018 is primarily within the private care sector rather than public care, indicating economic duress induced by the banknote ban and GST as its cause. The reduction in self-reported illness and healthcare consumption is more prolonged among the occupationally vulnerable. The reduction in reporting of illnesses, healthcare consumption, and out-of-pocket expenditure on health continued even after one-and-half years of the banknote ban; this may also have been exacerbated later by the implementation of GST. Data indicate that the condition of public healthcare deteriorated between 2014 to 2018. As a result, even though the weaker sections' access to private healthcare diminished, they could not turn to public healthcare either, resulting in a reduction in overall healthcare consumption. The findings of this paper call for a robust, functioning, affordable public healthcare system in India for greater crisis resilience. [ABSTRACT FROM AUTHOR]

Self-Help Groups (SHGs), the credit based voluntary groups in India are widely known for their potential to alleviate poverty and empower women. This research article explores a lesser-known theme. It tries to analyze the possibility of utilizing the current SHG model of the Indian Government to build and strengthen resilience of the SHG members in case of an external shock like financial stress, food insecurity, dispute in home for joining SHG, and difficulty to repay loan amidst lockdown due to the COVID-19 pandemic. This article also focuses on their coping mechanisms and attitude towards these crises. By utilizing primary data collected from 320 SHG members in one of the aspirational districts in West Bengal, India, the present paper tries to fulfill its objective. It provides a comprehensive understanding of the problems faced by the SHG members by combining both quantitative and qualitative techniques. The findings reveal that from organizing vocational trainings to relaxing loan repayment, SHGs and its women members overcame various adversities with tenacity, especially during the COVID-19 pandemic. Based on the study findings, it is reasonable to conclude that the current SHG model in India presents a promising avenue for enhancing the resilience of its members in the face of external shocks. Article Highlights: Idiosyncratic stress like financial stress and systemic stress like the COVID-19 pandemic were ranked the top two crises faced by the SHG members. Recognizing financial stress and stress due to the COVID-19 pandemic as the top challenges faced by SHG members implies the need for immediate support (that includes access to financial resources, and assistance in adapting livelihood strategies to withstand external shocks), resilience-building efforts (by providing members with skills to diversify their income sources, creating emergency funds, and fostering community solidarity to collectively address crises), and policy attention (implementing policies that provide targeted assistance, such as social safety nets, healthcare access, and economic stimulus). The SHG members mostly had an active attitude towards the crises faced demonstrating their remarkable resilience and adaptive capacity. This highlights the most dominant role of SHGs in their ability to foster a sense of solidarity and collective problem-solving. Members often share experiences, skills, and resources, which can be invaluable during times of crisis. Additionally, the group dynamic encourages mutual support and encourages members to take proactive steps to address challenges rather than feeling overwhelmed by them. Moreover, participating in SHGs often empowers individuals to develop skills, build confidence, and access resources that enable them to better cope with crises. Thus, it implies the importance of community-based approaches like the SHGs to resilience-building. The primary role of SHGs in strengthening resilience among its members, particularly during challenging times like the COVID-19 pandemic was preventive measures (organizing COVID awareness programs), followed by promotional measures (organizing vocational trainings) and protective measures (distribution of food grains). By engaging in these preventive, promotional, and protective measures, SHGs bolstered the resilience of their members by equipping them with knowledge, skills, and resources to navigate challenges effectively. Overall, the implication is that SHGs have played a multifaceted role in supporting their members through the COVID-19 crisis, by focusing on prevention, promotion, and protection measures to enhance their resilience and mitigate the adverse effects of the pandemic on their well-being. [ABSTRACT FROM AUTHOR]

Background: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach. Methods: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. Results: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. Conclusions: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC. [ABSTRACT FROM AUTHOR]

India's North-Eastern region, known for its cultural diversity and scenic beauty, has confronted distinctive developmental challenges. This diversity has given rise to unique cultural practices, music, dance, and crafts that are renowned across the world. Despite this richness, the region has grappled with developmental challenges such as lack of infrastructure, poor connectivity, poverty, hunger and limited access to healthcare and education. The adoption of the United Nations' Sustainable Development Goals (SDGs) by India in 2015 provides a framework to address these challenges and promote sustainable development in the region. This paper illustrates the progress made in achieving the SDGs in terms of SDG Index released by NITI Aayog and the various initiatives taken by the Government of India in the process. [ABSTRACT FROM AUTHOR]

India continues to grapple with a significant burden of HIV infections. Despite notable progress in prevention and treatment efforts, multiple challenges, such as high-risk populations, inadequate testing facilities, and limited access to healthcare in remote areas, persist. Though the Government of India offers HIV-1 plasma viral load testing at various medical centers, aiding treatment decisions and monitoring antiretroviral therapy effectiveness, enhancing care for individuals living with HIV under the National AIDS Control Program (NACP), the nation's large population and diverse demographics further complicate its outreach and response. Hence, strategic interventions and alternative methods of testing remain crucial to curbing HIV transmission and improving the quality of life for those affected. Dried blood spot (DBS) sampling has emerged as a convenient and cost-effective alternative for HIV-1 viral load testing, revolutionizing the landscape of diagnostic and monitoring strategies for HIV infection. Though the plasma-based viral load remains the gold standard for monitoring HIV-1, DBS-based HIV-1 viral load testing holds immense promise for improving access to care, particularly in resource-limited settings where traditional plasma-based methods may be logistically challenging. DBS entails the collection of a small volume of blood onto filter paper, followed by drying and storage. This approach offers numerous advantages, including simplified sample collection, transportation, and storage, reducing the need for cold-chain logistics. Recent studies have demonstrated the feasibility and accuracy of DBS-based HIV-1 viral load testing, revealing a strong correlation between DBS and plasma measurements. Its implementation can enhance the early detection of treatment failure, guide therapeutic decisions, and ultimately contribute to better clinical outcomes for HIV-infected individuals. Hence, this review explores the principles, advancements, feasibility, and implications of DBS-based HIV-1 viral load testing. [ABSTRACT FROM AUTHOR]

Introduction: The healthcare delivery system of Assam faces several challenges to provide affordable, accessible and quality care services. GNRC (Guwahati Neurological Research Center) is the first super-speciality hospital to address many of these gaps by delivering integrated affordable healthcare services to the populations of Assam and other parts of North-eastern India. Description & Discussion: This paper describes the implementation of a care delivery model which provides integrated care delivery services through linking hospitals to primary healthcare services, including preventive, promotive, and curative care, along with delivering easily accessible and affordable care to the people of Assam and other parts of North-eastern India. Conclusion: The proposed model is the first innovative approach from Northeastern India, Assam, to deliver affordable, accessible and patient-centric hospital led community-based preventive, promotive, and primary, secondary, and tertiary hospital-based care. It is anticipated that GNRC's "Affordable Health Mission" will help redesign and integrate the way primary, secondary and tertiary healthcare is delivered to the population of Assam in helping patients manage their own health and reduce the numbers that needs to be admitted to secondary care and tertiary care by improving patients' independence and well-being as well as dramatically reducing the cost to the overall health system. [ABSTRACT FROM AUTHOR]

Background: The burden of the COVID-19 pandemic on healthcare systems worldwide has been compromising the progress made in the fight against HIV. This paper aims to determine how the COVID-19 pandemic has impacted HIV comprehensive care service delivery globally as well as to consolidate the evidence and recommendations that may be useful in averting future crisis. Methods: This review adheres to PRISMA guidelines. PubMed, DOAJ, Science Direct and other sources like Google Scholar and citations from included studies were searched methodically to locate studies evaluating the effects of COVID on services for HIV care. The NIH and JBI quality assessment tools were used for the quality assessment of individual studies. Results: In the present review 31 eligible studies were included and the impact on HIV care cascade were summarised under six themes: Lab services, Treatment and allied services, Counselling services, Outreach services, Psycho-social impact and Implementation of sustainable strategies. The studies also presented many innovative alternatives which were lucidly highlighted in the present article. Conclusion: Current evidence depicts multiple factors are responsible for the interruption of HIV care service delivery during the pandemic, especially in low resources settings. The prospective, alternative solutions that have been used to circumvent the threat have also been addressed in this review, in addition to the negative aspects that have been observed. Transition with new innovative, sustainable care paradigms may prove to be the building blocks in removing HIV-AIDS as a public health threat. Registration: Open Science Framework (DOI: 10.17605/OSF.IO/74GHM). [ABSTRACT FROM AUTHOR]

The dream of universal health care demands a much larger and wider approach, engaging not just the public but also the private sector. This paper has attempted mapping the present public-private partnership scenario in India using the WHO health system functions framework, giving an insight into the nature and extent ofchallenge of the present dominant model. A systematic review methodology was adopted to identify published literature on private-public partnership in India. From an initial pool of 785 articles were identifi ed. Finally a total of 29 published articles meeting the inclusion criteria were included. The descriptive framework of Health system functions by WHO (2000), were used to analyze the data. All papers which were considered for the study were segregated based on the 4 prime health system functions: Financing; Management of non-fi nancial inputs; Health service delivery and Oversight. The literature review reveals that more than half of the papers (51.72%) selected for the study were focused on health service delivery functions and quite thin literature were available for other 3 functions, which includes fi nancing, management of non-fi nancial inputs and oversight functions as per WHO. This fi nding raise an important question if the genesis of most of the public-private partnerships is out of the inability of the public sector in reaching out to a particular target group by virtue of its geographical position or diffi culty in working with high risk groups. Considering the limitations of the present model of engagement of private and public sectors, it demands for an alternative model of engagement where the mutual strength that exists with each one of the partners, could be harnessed and complemented. An alternate model is to engage in tri-partite partnership (TPP) between the government, non-government and the corporates. [ABSTRACT FROM AUTHOR]

With an estimated two billion people being carriers of latent tuberculosis infection (LTBI), the gains achieved by increasing access to diagnostics and treatment, although substantial, have had a modest impact on the global burden of tuberculosis (TB). At the same time, increased access to treatment has had the unintended consequence that drug-resistant TB (DR-TB) has increased dramatically. Earlier TB control strategies strongly emphasizing medical treatment have failed to address these issues effectively. The current strategy to eliminate TB by 2050 is accompanied by a call for a paradigm shift, emphasizing patient rights and equity more. Based on ethnographic fieldwork in Odisha, India, and global-level TB conferences, this paper contrasts the dynamics of global health policy and strategy-making with the lived realities of patients with DR-TB. A more thorough rethinking of the biosocial dynamics that impact the pathogenic disease is required to develop a comprehensive paradigm shift for TB control in the twenty-first century. [ABSTRACT FROM AUTHOR]

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes. [ABSTRACT FROM AUTHOR]

Background: Health care services express social and structural inequalities, especially for Dalits and women, due to the indignity and discrimination experienced in health care facilities. Jagrutha Mahila Sanghatane (JMS), a grass-roots organization led by neo-literate Dalit women in rural Karnataka in India, adopted a human rights-based social accountability (SA) approach to address discrimination and dignity in accessing maternal health services. This approach integrated community-based evidence with multi-pronged and multi-level accountability processes with their goal of socio-political empowerment. Methods: The methodological approach is qualitative and uses document analysis, including thematic and content analysis, in-depth group discussions with the campaign leaders, participant observation and interviews with the community health workers. Results: JMS embedded the practice and processes of SA in the politics of empowerment which was central to addressing the structural issues of discrimination and social exclusion faced by Dalit women. The human rights perspective and the pathway of conscientize-organize-struggle provided by the Dalit liberation leader, Dr B. R. Ambedkar, facilitated the organization to conceptualize SA as a process of claiming dignity and justice for Dalit women. Integrating the evidence generation and its deployment into the community campaign cycles, Dalit women could use the accountability process for intensifying mobilization and empowerment. The cumulative impact of the community enquiry relentlessly pursued through the framework of a campaign brought changes in several aspects of primary health care and specific dimensions of maternal health care. Community ownership of the SA process, participation and empowerment were integral to the generation, synthesis and deploying of evidence. Deploying evidence in multiple forms, both horizontally with the communities and vertically with the authorities deepened communities' mobilization and intensified Dalit women's negotiating power with the authorities. The iterative and persistent process of SA provides insights into re-articulating SA beyond the usual recognition of outputs such as report cards into the politics of meaning-making by the mobilized community of the marginalized. The community-based organization posited the SA itself as the process of resistance to structural injustice and as an avenue or their empowerment. Conclusions: For marginalized communities, the SA process has the potential to be a tool for their empowerment in addressing structural power inequities. For such a repositioning of SA, it is critical to focus not only on the technicality of generating evidence but also on the framework driving such a process, the mode of evidence generation and deployment, and integration into the organizational strategy. Such a process can be equally empowering, efficient in addressing the systemic challenges of increasing marginalized community's access to health care services, and valuable in sustaining those changes. The analysis of the strategies of JMS offers significant insights for researchers and practitioners working on SA and maternal health to re-articulate SA from the point of politics of empowerment of the marginalized communities. [ABSTRACT FROM AUTHOR]

Background: Rural Indians have higher mortality rates than urban Indians. However, the rural-urban gap in under-five mortality has changed is less researched. This paper aims to assess 1) whether the rural-urban gap in under-five mortality has reduced over time 2) Whether rural children are still experiencing a higher likelihood of death after eliminating the role of other socioeconomic factors 3) What factors are responsible for India's rural-urban gap in under-five mortality.Methods: We used all rounds for National Family Health Survey data for understanding the trend of rural-urban gap in under-five mortality. Using NFHS-2019-21 data, we carried out a binary logistic regression analysis to examine the factors associated with under-five mortality. Fairlie's decomposition technique was applied to understand the relative contribution of different covariates to the rural-urban gap in under-five mortality.Results: India has witnessed a more than 50% reduction in under-five mortality rate between 1992 and 93 and 2019-21. From 1992 to 93 to 2019-21, the annual decrease in rural and urban under-five mortality is 1.6% and 2.7%, respectively. Yet, rural population still contributes a higher proportion of the under-five deaths. The rural-urban gap in under-five mortality has reduced from 44 per thousand live births in 1992-1993 to 30 per thousand in 2004-2005 which further decreased to 14 per thousand in 2019-2021. There is no disadvantage for the rural children due to their place of residence if they belong to economically well-off household or their mothers are educated. It is wealth index rather than place of residence which determines the under-five mortality. Economic (50.82% contribution) and educational differential (28.57% contribution) are the main reasons for rural-urban under-five mortality gaps.Conclusion: The existing rural-urban gap in under-five mortality suggests that the social and health policies need to be need to reach rural children from poor families and uneducated mothers. This call for attention to ensure that the future programme must emphasize mothers from economically and educationally disadvantaged sections. While there should be more emphasis on equal access to health care facilities by the rural population, there should also be an effort to strengthen the rural economy and quality of education. [ABSTRACT FROM AUTHOR]

Background: Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. Methods: This paper uses a national-level data set of both NFHS-3 (2005–06) and NFHS-4 (2015–16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. Results: Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. Discussion and conclusion: It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination. [ABSTRACT FROM AUTHOR]

Introduction: There is a significant lack of palliative care access and service delivery in the Indian cancer institutes. In this paper, we describe the development, implementation, and evaluation of a palliative care capacity-building program in Indian cancer institutes. Methods: Participatory action research method was used to develop, implement and evaluate the outcomes of the palliative care capacity-building program. Participants were healthcare practitioners from various cancer institutes in India. Training and education in palliative care, infrastructure for palliative care provision, and opioid availability were identified as key requisites for capacity-building. Researchers developed interventions towards capacity building, which were modified and further developed after each cycle of the capacity-building program. Qualitative content analysis was used to develop an action plan to build capacity. Descriptive statistics were used to measure the outcomes of the action plan. Results: Seventy-three healthcare practitioners from 31 cancer treatment centres in India were purposively recruited between 2016 and 2020. The outcome indicators of the project were defined a priori, and were audited by an independent auditor. The three cycles of the program resulted in the development of palliative care services in 23 of the 31 institutes enrolled in the program. Stand-alone palliative care outpatient services were established in all the 23 centres, with the required infrastructure and manpower being provided by the organization. Morphine availability improved and use increased in these centres, which was an indication of improved pain management skills among the participants. The initiation and continuation of education, training, and advocacy activities in 20 centres suggested that healthcare providers continued to remain engaged with the program even after the cessation of their training cycle. Conclusion: This program illustrates how a transformational change at the organizational and individual level can lead to the development of sustained provision of palliative care services in cancer institutes. [ABSTRACT FROM AUTHOR]

The unexpected lockdown announced by the Government of India in March 2020 in response to the pandemic left the coastal community in Kerala deprived of not only essential amenities but also healthcare. Some poverty-ridden, over-crowded coastal regions had been declared as critical containment zones with severe restriction of movement, adding to their vulnerability. People with serious health-related suffering (SHS) in this community required urgent relief. A group of educated youth in the community joined hands with a non-governmental organisation specialised in palliative care (PC) services and strived to find the best possible solutions to address the healthcare needs in their community. This paper reports the collaborative activities done during the pandemic in the coastal region and compares the activities with steps proposed by the WHO to develop community-based PC (CBPC). By engaging, empowering, educating, and coordinating a volunteer network and providing the required medical and nursing support, the programme was able to provide needed services to improve the quality of life of 209 patients and their families who would have been left with next-to-no healthcare during the pandemic. We conclude that even in the context of much poverty, delivery of CBPC with the engagement of compassionate people in the community can successfully reduce SHS. [ABSTRACT FROM AUTHOR]

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

This paper presents the findings of a research study in Thane District, Maharashtra, India, on access to sexual and reproductive health and rights (SRHR) for women and girls of Nomadic and Denotified Tribes (NT-DNT). NT-DNT communities face stigma and violence due to their historically criminalised status and nomadic lifestyle. Their precarious legal, social, and economic status has a negative impact on women's SRHR. Existing literature on this subject is sparse, and studies by researchers from within the community, which could bring about organic and community-led change, are almost non-existent. This study, carried out by a woman from a Nomadic Tribe, presents an insider's perspective on the experiences of and factors underlying the violation of the SRHR of girls and women of NT-DNT communities. The study used a human rights-based participatory methodology with qualitative methods including three focus group discussions with 21 women and 10 in-depth interviews with women and key informants from NT-DNT communities. The findings describe the gender, community, and health system barriers which hinder women's and girls' access to SRHR. Issues such as language barriers between the women and medical fraternity, criminalisation by the police, and extreme deprivation – more intense than faced by the general poor – are unique to women of these communities. The NT-DNT communities face extreme deprivation of basic resources such as identity documents, shelter, sanitation, education support, workplace safety, and transportation, which further deny women their sexual and reproductive rights. The paper aims to amplify these women's voices to advocate for better SRHR services for women and girls of NT-DNT communities. [ABSTRACT FROM AUTHOR]

In light of the devastation caused by COVID-19, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and vaccine research and development (R&D) have been occupying a prominent position in the field of global health diplomacy (GHD). Most countries, international organizations, and charitable organizations have been engaged in the R&D of COVID-19 vaccines to ensure timely affordability and accessibility to all countries. Concomitantly, the World Trade Organization (WTO) provides some provisions and enforcements regarding copyrights, patents, trademarks, geographical indications, and industrial designs. Given these safeguards, it is considered that intellectual property rights (IPRs) have become major barriers to the affordability and accessibility of vaccines/medicines/technology, particularly to the developing/least developed countries. Realizing the gravity of the pandemic impact, as well as its huge population and size, India has elevated this issue in its global health diplomacy by submitting a joint proposal with South Africa to the World Trade Organization (WTO) for a temporary waiver of IPRs to ensure timely affordability and accessibility of COVID-19 medical products to all countries. However, the issue of the temporary waive off had become a geopolitical issue. Countries that used to claim per se as strong advocates of human rights, egalitarianism, and healthy democracy have opposed this proposal. In this contrasting milieu, this paper is aimed at examining how the TRIPS has become a barrier for developing countries' development and distribution of vaccines/technology; secondly, how India strategizes its role in the WTO in pursuant of its global health diplomacy? We conclude that the IPRs regime should not become a barrier to the accessibility/affordability of essential drugs and vaccines. To ensure access, India needs to get more engaged in GHD with all the involved global stakeholders to get strong support for their joint proposal. The developed countries that rejected/resisted the proposal can rethink their full support. [ABSTRACT FROM AUTHOR]

Health sector reforms were introduced in several states of India in 1991. The rationale was to increase choice and competition, to improve quality and access to health care Such demand-led incentives were integral to macro-economic stabilization programs world-wide during the 1990s. For a majority of the population of India, health care costs linked to commercialisation of health services were forcing households into serious debt. Using primary data on patterns of utilisation of health services (2002), this paper reports from a systematically collected empirical evidence base, to explore the preliminary impact of changes to the health sector from 1991 to 2000 in West Bengal (WB), Tamil Nadu (TN), and the hospital sector of Andhra Pradesh (AP). The overall aim is to provide historical context to the experience of reforms for poor and vulnerable groups and to understand current discourses on the health system in India, focused on "managed care" through a universal health insurance programme. We explore linkages between the past and present on disinvestment in public provision and its long-term consequences for equity of access to health care in the three states, and elsewhere in the country. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health crisis. During huge surge in COVID-19 cases, most of the patient arrived at Rajiv Gandhi Government General Hospital, Chennai were severe due to late presentation and also available evidence demonstrating that the delay in treatment is directly associated with increased mortality or poor patient outcome. As an innovative concept of Zero Delay COVID-19 Ward were set up to provide the required critical care for all severe COVID-19 cases. The experience of setting up of such Zero Delay COVID-19 Ward and profile of admitted COVID-19 patients were described in this paper. Methods: A total of 4515 laboratory-confirmed COVID-19 patients admitted at Zero Delay COVID-19 Ward was analyzed retrospectively from 7th July to 31st December 2020. Results: At the time of admission the frequency of dyspnea were 85.6% among them 99.1% recovered from dyspnea after the oxygen therapy and other management at Zero Delay COVID-19 Ward. Of the 4515 COVID-19 individuals, about 1829 (40.5%) had comorbidity, 227 (5%) had died. Multivariable logistic regression analysis, COVID-19 death was more likely to be associated with comorbidity (OR: 18.687; 95% CI: 11.229-31.1) than other variables. Conclusions: Comorbidity is an independent high risk factor for mortality of COVID-19 patients. From our observation, it is strongly recommended that effective zero delay covid-19 ward model will help for the prevention of mortality in current/expected waves of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods: Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results: Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions: Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results. [ABSTRACT FROM AUTHOR]

In India, incidence of burn injuries is quite high due to widespread illiteracy, old customs like dowry and use of kerosene for lighting and cooking; poverty, overcrowding and unemployment, other social & emotional factors, lack of safety measures at industrial setup & lack of adequate healthcare services. Although, mortality in cases of burns has been reduced considerably by modern advance healthcare services, yet death due to burns is not an uncommon event. The study was carried out with the aim to study the various demographic parameters related to deaths due to burns such as age, sex, occupation, socio-economic status, marital status, locality and source of fire. It was a 1.6 years prospective study of cases of burns autopsied at the mortuary of Gandhi medical college, Bhopal. The relevant information was obtained from inquest papers, history provided by relatives of the deceased and postmortem examination. On data analysis, it was found that incidence of burns was found to be higher higher in females (55.0%) as compared to males (45.0%). young adults between the age group of 21-30 years have been the major victims of burns (41.00%). In both sexes, majority of the burn cases were married (74%). Most of the burn cases belonged to middle class, were housewives (51 %). and from rural areas (75 %). Hence, steps need be taken by Govt., NGOs and medical professionals to reduce the mortality due to burns. [ABSTRACT FROM AUTHOR]

Background: Health outcomes in India are characterized by pervasive inequities due to deeply entrenched socio-economic gradients amongst the population. Therefore, it is imperative to investigate these systematic disparities in health, however, evidence of inequities does not commensurate with its policy objectives in India. Thus, our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017–18. Methods: The study used cross-sectional data from nationwide healthcare surveys conducted in 2004, 2014 and 2017–18 encompassing sample size of 3,85,055; 3,35,499 and 5,57,887 individuals respectively. Erreygers concentration indices were employed to discern the magnitude and trend in horizontal inequities in self-reported morbidity and untreated morbidity. Need standardized concentration indices were further used to unravel the inter-regional and intra-regional income related inequities in outcomes of interest. Additionally, regression based decomposition approach was applied to ascertain the contributions of both legitimate and illegitimate factors in the measured inequalities. Results: Estimates were indicative of profound inequities in self-reported morbidity as inequity indices were positive and significant for all study years, connoting better-off reporting more morbidity, given their needs. These inequities however, declined marginally from 2004(HI: 0.049, p< 0.01) to 2017–18(HI: 0.045, P< 0.01). Untreated morbidity exhibited pro-poor inequities with negative concentration indices. Albeit, significant reduction in horizontal inequity was found from 2004(HI= − 0.103, p< 0.01) to 2017–18(HI = − 0.048, p< 0.01) in treatment seeking over the years. The largest contribution of inequality for both outcomes stemmed from illegitimate variables in all the study years. Our findings also elucidated inter-state heterogeneities in inequities with high-income states like Andhra Pradesh, Kerala and West Bengal evincing inequities greater than all India estimates and Northeastern states divulged equity in reporting morbidity. Inequities in untreated morbidity converged for most states except in Punjab, Chhattisgarh and Himachal Pradesh where widening of inequities were observed from 2004 to 2017–18. Conclusions: Pro-rich and pro-poor inequities in reported and untreated morbidities respectively persisted from 2004 to 2017–18 despite reforms in Indian healthcare. Magnitude of these inequities declined marginally over the years. Health policy in India should strive for targeted interventions closing inequity gap. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India's 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations. [ABSTRACT FROM AUTHOR]

Indian roads are deemed to be the most dangerous, considering the number of annual fatalities, which touched 151,113 in the year 2019, the highest in the world. Causes ranging from poorly designed roads, tardy enforcement of traffic rules, delay in giving medical assistance, ill equipped hospitals, refusal of treatment by hospitals, all contribute to this unenviable predicament. A lax regulatory environment with minor penalties, has accentuated the crisis. Having held the pivotal position amongst 199 countries, there is a dire need for concrete action by Government. While 2,211,439 road accidents in the US in the year 2016 took away 37,461 lives,a relatively lower number of 480,652 accidents snuffed out 150,785 lives in India. Creating comparable safety levels could take decades for a developing country. But with the country's share constituting about 11% of road accident casualties worldwide and the estimated social cost hovering around $58 billion, the problem begs for an immediate fix. Tightening regulations would be a practical solution for both short and long-term gains. Enough deterrents need to be put in rules governing road safety; the Motor Vehicles Act to ensure defensive driving. This paper examines how certain loopholes need to be plugged in the new Motor Vehicles Act 2019 to achieve the higher goal of road safety. [ABSTRACT FROM AUTHOR]

Smallholder farmer and tribal communities are often characterised as marginalised and highly vulnerable to emerging zoonotic diseases due to their relatively poor access to healthcare, worse-off health outcomes, proximity to sources of disease risks, and their social and livelihood organisation. Yet, access to relevant and timely disease information that could strengthen their adaptive capacity remain challenging and poorly characterised in the empirical literature. This paper addresses this gap by exploring the role of disease information in shaping the adaptive capacity of smallholder farmer and tribal groups to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We carried out household surveys (n = 229) and in-depth interviews (n = 25) in two affected districts–Shimoga and Wayanad–in the Western Ghats region. Our findings suggest that, despite the generally limited awareness about KFD, access to disease information improved households' propensity to implement adaptation strategies relative to households that had no access to it. Of the variety of adaptation strategies implemented, vaccination, avoiding forest visits, wearing of protective clothing and footwear, application of dimethyl phthalate (DMP) oil and income diversification were identified by respondents as important adaptive measures during the outbreak seasons. Even so, we identified significant differences between individuals in exposure to disease information and its contribution to substantive adaptive action. Households reported several barriers to implement adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. We also found that informal information sharing presented a promising avenue from a health extension perspective albeit with trade-offs with potential distortion of the messages through misinformation and/or reporting bias. Altogether, our findings stress the importance of contextualising disease information and implementing interventions in a participatory way that sufficiently addresses the social determinants of health in order to bolster households' adaptive capacity to KFD and other neglected endemic zoonoses. Author summary: There is widespread consensus that smallholder farmer and tribal communities are highly vulnerable to zoonotic diseases (illness passed between animals and people). This is largely due to their relatively poor access to healthcare and closeness to sources of disease risks. Although access to relevant and timely disease information could enhance their adaptive capacity, remain difficult and poorly understood. Drawing on survey data (n = 229) and in-depth interviews (n = 25) in two affected districts (Shimoga and Wayanad); we explored the role of disease information in shaping adaptation to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We found that despite the limited awareness about KFD, access to disease information improved households' likelihood to implement adaptation strategies as compared to households that had no access to it. Households identified several barriers to implementation of adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. Our findings highlight the relevance of contextualising disease information and implementing interventions in a participatory manner in order to strengthen households' adaptive capacity to KFD and other neglected endemic zoonoses. [ABSTRACT FROM AUTHOR]

Introduction: Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods: The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran's I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results: The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion: It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels. [ABSTRACT FROM AUTHOR]

Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods: Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results: Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion: Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India. [ABSTRACT FROM AUTHOR]

This paper highlights how privatization in healthcare is being promoted and its further growth facilitated through the adoption of neoliberal policies in India. The approach to financing healthcare has been shifting from public provisioning to tax-funded health insurance merely to achieve health coverage. The idea of the strategic purchasing of care from private providers promoted through insurance seems likely to aggravate the crisis in access and healthcare delivery. Such a crisis will escalate costs and promote concentration and monopolies in the healthcare market. Under the recently promoted neoliberal policy, India is compromising the goal of comprehensive provision of public health services, which is essential for creating a healthier society. [ABSTRACT FROM AUTHOR]

Background: Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. Methods: The present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. Results: The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states Category B (richest/poorest = 14.60), followed by (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. Conclusions: In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE. [ABSTRACT FROM AUTHOR]

Background Recent theorisation has pushed stigma research in new directions, arguing for a need to challenge the unequal power relations that impact groups most at risk for HIV-related stigma rather than locate stigma in the individual. Such a conceptualisation resonates with the growing emphasis on structural interventions for HIV prevention that attempt to alter the social context of risk. Methods The paper predominantly relies on longitudinal interviews conducted three times over a 2-year period with sex workers with varying degrees of involvement with the non-governmental organisation (NGO) and community-based organisation. Results Recognising that stigma is socially constructed and structurally reproduced, the NGO helped mobilise marginalised and hitherto scattered female sex workers to form community-based organisations to challenge their disadvantaged status in society. The authors show how stigma alleviation strategies presented a contradiction: emboldening one group of female sex workers to self-identify as sex workers while making others reluctant to access the intervention-run clinic. Conclusion The paper builds on a growing body of research that acknowledges the struggles in implementing structural interventions, particularly for NGOs working in regions with a diverse population of sex workers with varying needs. The authors argue that intervention goals of reducing stigma and increasing the use of sexually transmitted infection services do not have to conflict and, in fact, must go hand-in-hand for an implementation to be considered a structural intervention. [ABSTRACT FROM AUTHOR]

The speedy progress of trade in Global Health Services is limited by legal barrier. Advances in technology and cross-border movement of people and health services form legal ambiguities and uncertainties for businesses and consumers involved in transnational medical malpractice disputes. This requires for a uniform means of redress which is more flexible and predictable as compared to litigation in a court room. Therefore, the voluntary, flexible and legally binding nature of arbitration agreements across jurisdictions make this form of dispute resolution efficient and adaptive to changes in the health services industry. With careful making of an approach that accounts for arbitration cost, reasonable recovery amount and complementary mechanisms such as no-fault compensation, international arbitration of medical malpractice disputes will change the legal risks borne by businesses and consumers more fairly and efficiently. This paper argue that most medical disputes are better resolved by alternative dispute resolution mechanisms which will contribute in improving patient safety by encouraging candid and comprehensive reporting of risks. It also argues that medical disputes and patient safety needs to be viewed through a new lens, namely patient autonomy. It discusses the scope of India flourishing in the field of Medical Tourism and also the challenges faced by the foreign patients and the scope of Arbitration in amicably resolving the medical disputes in a cost effective and in a swift manner. [ABSTRACT FROM AUTHOR]

The Jammu & Kashmir (J&K) Consumer Protection Act, 1987 needs a closer scrutiny from the standpoint of medico-legal services in the wake of J&K Union Territories' (UTs) uneven health profiling and developmental progress. The doctor-patient's relationship needs an analysis in terms of access to health care and medical and para medical services. The consumer rights under Consumer Protection Act, 1986, Jammu and Kashmir Consumer Protection Act, 1987 and Consumer Protection Act, 2019 represents a trajectory of deficiency of medical service and lack of medical professionalism and capacity building among health personnel. The paper is a medico-legal profiling of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar in regard to diligence and negligence of doctors and para legal medical inspectorate in auguring health care and medical services to patients. [ABSTRACT FROM AUTHOR]

A resilient health system necessitates strong governance, political commitment, effective administrative entities and inter-organisational collaboration. This paper examines India's current health policy landscape and explores the analytical and operational capacities required to establish a robust post-pandemic health system using the policy capacity framework described by Wu et al. (2015). We emphasised the need for a coordinated policy response to strengthen health information systems, health service management, human resource management and healthcare financing. The role that the planned implementation of Indian public health management cadres would play in the coming era, the importance of a comprehensive health information management system and the need for operational coordination between government and non-governmental organisations has also been emphasised. [ABSTRACT FROM AUTHOR]

Background Migration and health are increasingly recognised as a global public health priority, but concerns have been raised on the skewed nature of current research and the potential disconnect between health needs and policy and governance responses. The Migration Health South Asia (MiHSA) network led the first systematic research priority-setting exercise for India, aligned with the global call to develop a clearly defined migration health research agenda that will inform research investments and guide migrant-responsive policies by the year 2030. Methods We adapted the Child Health and Nutrition Research Initiative (CHNRI) method for this priority setting exercise for migration health. Guided by advisory groups established at international and country levels, we sought research topics from 51 experts from diverse disciplines and sectors across India. We consolidated 223 responses into 59 research topics across five themes and scored them against five predefined criteria: answerability, effectiveness, feasibility, impact, and effect on equity. We then calculated research priority scores (RPS) and average expert agreement (AEA) each research topic and theme. Results A third of the 59 research topics were on migrants' health and health care access, 12 on social determinants of migrants' health, 10 on policies, law and migration health governance, eight on health systems' responsiveness, and five on migration health discourse. Three of the top five priority topics pertained to migrants' health care access. The policies, law, and governance theme had the highest overall RPS score. Conclusions There is a noticeable gap between research priorities identified by experts at the country-level and the current research focus and priorities set globally. This disconnect between the global and local perspectives in migration health scholarship hinders the development of context-specific and suitable policy agendas for improving migrants' health. Our co-developed agenda emphasises the need to prioritise research on the capacity of existing systems and policies so as to make them more migration-aware and responsive to migrants' health needs. [ABSTRACT FROM AUTHOR]

Background Undiagnosed diabetes is a significant public health concern in India, considering the accumulative burden of diabetes and its long-term complications. We have estimated the prevalence and factors associated with undiagnosed diabetes in India. Methods We used data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) to estimate undiagnosed diabetes prevalence aged under 50 (15-49) years. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence risk ratio (PR) between undiagnosed diabetes and various factors. Multinomial logistic regression analysis was performed to examine the factors associated with diagnosed diabetes (vs. healthy) and undiagnosed diabetes (vs. healthy). All the analyses were survey-weighted and stratified by gender and reported with 95% confidence intervals. Results The prevalence of diabetes for individuals aged 15-49 years was found to be 4.90% (4.80 to 5.00%) from the NFHS-5. Among them, the proportion of individuals with undiagnosed diabetes was 24.82% (24.07 to 25.59%), with higher among males (28.82% (26.45 to 31.30%)) than females (24.22% (23.44 to 25.01%)). The overall prevalence of undiagnosed diabetes was 1.22% (1.18 to 1.26%), with a higher prevalence among males (1.60% (1.46 to 1.76%)) than females (1.17% (1.13 to 1.21%)). Individuals who are middle-aged (45-49), have a higher body mass index (BMI), and are in a lower wealth index group, or live in the southern regions of India are at a higher risk of being undiagnosed for diabetes. Conclusion One in every four having diabetes is undiagnosed. The study highlights the need for public health interventions to improve diabetes screening and access to health care, particularly among middle-aged individuals, and those with higher BMI, as well as addressing lifestyle and dietary factors. The findings also reveal disparities in diabetes burden among population subgroups in India, underscoring the need for targeted efforts. [ABSTRACT FROM AUTHOR]

Background The obstetric transition model suggests that, as countries economically develop, the primary causes of maternal mortality change. Countries are assigned to one of five stages based on their maternal mortality ratio to identify priorities for reducing maternal deaths based on predominant determinants of mortality at each stage. We aim to validate the obstetric transition model using data from six diverse low- and middle-income countries representing self-identified priorities for improving maternal health and measurement compiled in a multi-stakeholder process. Methods We used multiple data sources from Bangladesh, Cote d'Ivoire, India, Mexico, Nigeria, and Pakistan, which included secondary data on country context and primary data derived from two sources: the content of multi-stakeholder meetings, called National Dialogues, which were organised around the 11 key themes identified in the World Health Organization's "Strategies toward ending preventable maternal mortality" (EPMM) and follow-up key informant interviews conducted in five of the seven countries. We conducted the analysis in four phases examining, the country's contextual profile, mapping the key themes and indicators to the model, exploring stakeholder prioritisation, and examining reasons for divergence from the model. Results Our results suggest that the stages of the obstetric transition generally align with the social, epidemiological, and health systems characteristics that the model predicts to be associated with countries at each stage, with some deviation related to health system deficiencies and barriers to access. Stakeholder priorities in maternal health generally align with those predicted by the model. Equity and women's rights emerged as a priority throughout all stages, not only within countries that are more advanced in the transition, as predicted by the model. Deviations between the model's predictions and country-level prioritisation were often explained by context-specific challenges. Conclusions This study is one of the first to validate the obstetric transition model using real data. Our findings support the validity of the obstetric transition model as a useful guide to aid decisionmakers in prioritising attention towards addressing maternal mortality. Country context, including equity, remains important to further inform priority-setting. [ABSTRACT FROM AUTHOR]

Background: Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. Methods: We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Results: Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. Conclusions: With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents. [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]

Background: The Common Risk Factor Approach (CRFA) is one of the methods to achieve medical-dental integration. CRFA addresses shared risk factors among major Non-communicable Diseases (NCDs). This study aimed to explore the perspectives of dental and medical practitioners concerning CRFA for managing NCDs and periodontal diseases and to create and validate a tool to evaluate the Knowledge, Attitude, and Practice (KAP) of medical and dental practitioners in relation to utilization of CRFA for management of NCDs and Periodontal diseases. Methods: This research employed a concurrent mixed-method model and was carried out from January 2021 to February 2022, focusing on medical and dental practitioners in South India. In the qualitative phase, online interviews were conducted with dental and medical practitioners, recorded, and transcribed. Thematic analysis was applied after achieving data saturation. In the quantitative phase, a KAP questionnaire was developed. The sample size was determined by using the G power statistical power analysis program. A sample size of 220 in each group (dentists and medical practitioners) was estimated. Systematic random sampling was used to recruit the potential participants. The data obtained through the online dissemination of KAP tool was analysed and scores were standardized to categorize the KAP. Results: Qualitative thematic analysis identified four major themes: understanding of common risk factors, risk factor reduction and disease burden, integrating CRFA into clinical practice, and barriers to CRFA. In addition, thematic analysis revealed seventeen subthemes. For the quantitative phase, standardization was applied to a 14-item KAP questionnaire for medical practitioners and a 19-item KAP questionnaire for dental practitioners. The total KAP score for medical practitioners in the study was 21.84 ± 2.87, while dental practitioners scored 22.82 ± 3.21, which indicated a high level of KAP regarding CRFA. Meta integration of qualitative and quantitative data identified eight overarching themes: four were concordant, three were discordant, and one theme provided the explanatory component. Conclusion: The study's structured, validated questionnaire showed that both medical and dental professionals had a high knowledge of CRFA. However, they were not appreciably aware of the risk factors that are shared between NCDs and periodontal disease. Both groups were interested in the idea of using CRFA in integrated medical and dental care. [ABSTRACT FROM AUTHOR]

Background: Kerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among 'hard to reach groups' as part of a larger health policy and systems research study, with a focus on public sector health service utilisation. Methods: We conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation. Results: A total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable. Conclusion: The 'Kerala Model of Development' has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated. [ABSTRACT FROM AUTHOR]

Background: This study examines the levels and predictors of malnutrition in Indian children under 5 years of age. Methods: Composite Index of Anthropometric Failure was applied to data from the India National Family Health Survey 2019–2021. A multivariable logistic regression model was used to assess the predictors. Results: 52.59% of children experienced anthropometric failure. Child predictors of lower malnutrition risk included female gender (adjusted odds ratio (AOR) = 0.881) and average or large size at birth (AOR = 0.729 and 0.715, respectively, compared to small size). Higher birth order increased malnutrition odds (2nd-4th: AOR = 1.211; 5th or higher: AOR = 1.449) compared to firstborn. Maternal predictors of lower malnutrition risk included age 20–34 years (AOR = 0.806), age 35–49 years (AOR = 0.714) compared to 15–19 years, normal BMI (AOR = 0.752), overweight and obese BMI (AOR = 0.504) compared to underweight, and secondary or higher education vs. no education (AOR = 0.865). Maternal predictors of higher malnutrition risk included severe anemia vs. no anemia (AOR = 1.232). Protective socioeconomic factors included middle (AOR = 0.903) and rich wealth index (AOR = 0.717) compared to poor, and toilet access (AOR = 0.803). Children's malnutrition risk also declined with paternal education (primary: AOR = 0.901; secondary or higher: AOR = 0.822) vs. no education. Conversely, malnutrition risk increased with Hindu (AOR = 1.258) or Islam religion (AOR = 1.369) vs. other religions. Conclusions: Child malnutrition remains a critical issue in India, necessitating concerted efforts from both private and public sectors. A 'Health in All Policies' approach should guide public health leadership in influencing policies that impact children's nutritional status. [ABSTRACT FROM AUTHOR]

Background: There is a constant search across the globe for optimal healthcare solutions with affordability, accessibility, availability, and quality of healthcare services being the burning issue for mankind. The pandemic has further necessitated the need of use of the Telemedicine platform to address healthcare issues which are also non Covid related. Though Telemedicine has been in use for over two decades in India, there have been various challenges and adoption issues which have not yet made the technology an effective solution to address the current healthcare issues. There has been phenomenal growth in the Information and Communication Technology (ICT) over the last decade and its utilization in the healthcare field. Methods: Internet research on the various adoption strategies by healthcare providers coupled with our own experience for using this technology along with guidelines provided by the information and communication technology providers. The Telemedicine Guidelines of 2020 released by the Ministry of Health and Family welfare, India, provides a framework for the implementation of healthcare delivery through this technology. Results: This paper mentions our telemedicine experience in governmental and private institutes and highlights the implementation challenges of this technology and some solutions that made a difference in the execution. However, we discuss to a larger extent the possible challenges and barriers in the implementation of this technology in India. Conclusion: Despite successful work in the field of telemedicine, it is yet to become an integral part of healthcare system because challenges related to adaptability of healthcare users and lack of proper training to fast growing technologies. The future is going to compel the usage of this kind of technology and it is essential for setting up infrastructure and having trained personnel to man these departments to encash the full potential of the telemedicine technology. [ABSTRACT FROM AUTHOR]

Healthcare consumers may be behaving to some extent based on the nature of healthcare being a necessity or otherwise. The choice of either of public and private providers may depend upon factors like availability, accessibility, cost and quality. To some extent, this is revealed through their elasticities based on income, cost, quality and socio-economic factors. Objective of this paper is to explore the demand for healthcare services in India and estimate consumers' elasticities to these factors. Using logit results we find that an individual may choose his preference for private or public based on distance of facility from residence. It may also depend whether it is rural or urban area and whether the income levels of state are below or above all India average. Comparing our results for two all India surveys, it is observed that people's perception and thus preferences are mostly based on choices of nearby location, suitable timings, presence of medical personnel and less waiting time. The presence of insurance either by a national or state sponsored scheme seems to have changed the nature of healthcare demand in India from a stark necessity to a matter of better choice. [ABSTRACT FROM AUTHOR]

Several conventional approaches have been tried in the past to resolve health inequities in India. However, achieving Universal Health Coverage (UHC) is yet to be fully realized as the benefits have been meager. The recent concept of targeting social determinants of general and oral health in order to achieve health for all has shown positive results in the developed as well as the developing nations. Based on the framework recommended by the Commission on Social Determinants of Health, several policies have been introduced and suitably backed up with the intention of providing health care even to people living in remote sections of the society. This paper intends to highlight the rationale for social determinants approach in Indian context, its application and future recommendations for the same. It is considered as a radical approach, and adequate measures have been implemented by health systems to achieve the desired targets without delay. However, in order to achieve UHC, redistribution of the available resources and converting the “normative” needs into “felt” needs of the people is going to be an uphill task to accomplish. [ABSTRACT FROM AUTHOR]

Background: From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months - about 500 days - is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. Objective and design: This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers. Results: The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron-folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries. Conclusions: This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay. [ABSTRACT FROM AUTHOR]

Background: Rates of cervical and oral cancer in India are unacceptably high. Survival from these cancers is poor, largely due to late presentation and a lack of early diagnosis and screening programmes. Mobile Health ('mHealth') shows promise as a means of supporting screening activity, particularly in rural and remote communities where the required information infrastructure is lacking.Methods: We developed a mHealth prototype and ran training sessions in its use. We then implemented our mHealth-supported screening intervention in 3 sites serving poor, low-health-literacy communities: RUHSA (where cervical screening programmes were already established), Mungeli (Chhattisgarh) and Padhar (Madhya Pradesh). Screening was delivered by community health workers (CHWs - 10 from RUHSA, 8 from Mungeli and 7 from Padhar), supported by nurses (2 in Mungeli and Padhar, 5 in RUHSA): cervical screening was by VIA; oral cancer screening was by mouth inspection with illumination. Our evaluation comprised an analysis of uptake in response to screening and follow-up invitations, complemented by qualitative data from 8 key informant interviews and 2 focus groups.Results: 8686 people were screened through the mHealth intervention - the majority (98%) for oral cancer. Positivity rates were 28% for cervical screening (of whom 37% attended for follow-up) and 5% for oral cancer screening (of whom 31% attended for follow-up). The mHealth prototype was very acceptable to CHWs, who felt it made the task of screening more reliable. A number of barriers to screening and follow-up in test-positive individuals were identified. Use of the mHealth prototype has had a positive effect on the social standing of the CHWs delivering the interventions.Conclusions: mHealth approaches can support cancer screening in poor rural communities with low levels of health literacy. However, they are not sufficient to overcome the range of social, cultural and financial barriers to screening and follow-up. Approaches which combine mHealth with extensive community education, tailored to levels of health literacy in the target population, and well-defined diagnostic and treatment pathways are the most likely to achieve a good response in these communities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has ushered in rapidly evolving developments in digital health, and governments around the world are experimenting with different ways of introducing technological tools in the management and delivery of health care services. India, among the countries that faced one of the most serious outbreaks in the second wave of the pandemic, recently rolled out the National Digital Health Mission, which promises an integrated but federated digital architecture and a digital health ecosystem that will solve the information asymmetries of the health care sector in India. While the promises of the National Digital Health Mission are many, India's experience with using another digital tool during the pandemic--the CoWIN portal for vaccine management--alerts us to the human rights concerns of rapid introductions of digital tools to address infrastructural and governance challenges in health care. This paper attempts to take a closer look at these two digital tools and the potential human rights implications of the National Digital Health Mission, particularly for the right to health. [ABSTRACT FROM AUTHOR]