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Abstract: India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India''s future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information. [Copyright &y& Elsevier]

Introduction: The knowledge of morbidity pattern at primary healthcare level plays a key role to plan resources for a community efficiently. Poor living conditions in slums along with the effect of urbanisation makes them peculiar to study. Aim: To study the morbidity pattern of patients who attended a primary healthcare facility in an urban slum of Chandigarh, India. Materials and Methods: Secondary data analysis of outpatients of a primary healthcare facility in a slum area of Chandigarh, India was done. The sample size of the study was 16,483 morbidity for the year 2016. Diseases were categorised according to organ system of the body. Descriptive statistics were used to present the results. Pearson's Chi-square test was used to determine the difference between proportions. Results: In this study, a total of 14,153 patients who suffered from 16,483 total morbidity attended the outpatient department of urban primary care facility. Most common morbidity reported was due to respiratory diseases (6214,37.7%) followed by gastrointestinal (2056,12.5%) and cardiovascular diseases (1253,7.6%). Total morbidity of females (62.2%) was higher than males. Proportion of morbidity was higher in females, except injury, which was predominant in males. In reproductive and urinary tract infections, nutritional disorders, musculoskeletal and cardiovascular diseases groups, morbidity in females constituted more than 80% of total in each group. Communicable Diseases (CDs) constituted approximately two-third of the morbidity while Non Communicable Diseases (NCDs) contributed one-fifth of the disease burden. Seasonal pattern of morbidity showed higher cases in the months of July to October with a peak in September. Conclusion: Predominantly, slum dwellers are still facing burden of CD. Morbidity pattern at a primary care level facility is a valuable tool for program managers and policy makers to plan services at grass root level in fast growing urban areas in India. [ABSTRACT FROM AUTHOR]