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Despite substantial strides to improve cancer control in India, challenges to deliver oncology services persist. One major challenge is the provision and accessibility of adequate infrastructure. This paper offers ethnographic insight on the conceptual and material conditions that are currently shaping the delivery of oncology in Mumbai, focusing specifically on the way India's socio-economic context necessitates non-biomedical acts of voluntarism or 'seva' (selfless service). Developing the premise that hospitals are not identical clones of a biomedical model, detailed attention is paid to the way 'care' emerges through 'praxis of place' (Casey, 2003) within the cancer hospital as a multi-scalar 'heterotopic' (Street and Coleman, 2012) site. Such a perspective enables global/local tensions to come into view, together with the heterogeneous confluence of juxtaposing materialities, imaginations, social practices and values that both propels and constrains the everyday delivery of care. The paper reflects on the theoretical implications of hospital seva in Mumbai in light of social science studies of hospital ethnography and health activism and contributes important ethnographic insight into the current global health debates regarding effective implementation of cancer services in India. [ABSTRACT FROM AUTHOR]

Individuals in developing countries often engage in paid and unpaid work till late in life due to low household savings and limited welfare provisions. Yet, physical disabilities associated with aging can limit their ability to work. While work can be beneficial for economic and psychological well-being, this paper investigates whether engagement in paid and unpaid work mediates the impact of physical disabilities on quality of life for older adults. We exploit the different levels of health services and social security in rural and urban China and India to examine the effect of public provisions in the process. We use nationally representative data of individuals aged 50 and above from the World Health Organization Study on Global Ageing and Adult Health Wave 1, conducted in 2008–10 in China and in 2007–08 in India. Using a causal mediation analysis framework, we find that paid work plays a minor role in mediating the effect of physical disabilities on quality of life in all societies, and the mediated effect is smaller in urban China than in other societies. Unpaid work is beneficial only in urban China, and it does not mediate the impact of physical disabilities on quality of life elsewhere. The findings indicate that promoting productive engagement alone, without improving basic public provisions, will have limited impact on improving quality of life of the aging population in developing countries. • In developing countries, both paid and unpaid work is common out of necessity. • Older adults bear a double burden of paid and unpaid work in rural China and India. • Productive aging has limited impact on quality of life in developing countries. • Impact of productive aging on quality of life varies with public provisions. • Physical disabilities associated with aging is less consequential in urban China. [ABSTRACT FROM AUTHOR]

In developing countries, including India, the role of the private sector in the provision of basic healthcare services is gradually expanding, since the public sector provides limited services and covers only limited areas. Using location-allocation models (LAM), this paper (1) examines the changing geographic access to and locational efficiency of basic public healthcare vis-a`-vis private healthcare services in two districts located in northwestern part of India, and (2) interrogates the factors that govern their geographic accessibility and locational-efficiency.Although this research confirms regional inequalities in geographic accessibility and locational efficiency of both public and private healthcare services in the selected districts, the locational efficiency of private health services is significantly lower than that of public health services. This paper further demonstrates the use of LAM for new site identification (keeping the existing healthcare sites intact) that will, in the future, improve locational efficiency of these services. This paper not only recommends improved geographic access to both public and private health services and their enhanced complementary role, but also stresses the need to evaluate geographic access from the service-users’ perspective and the use of more realistic data on demand and supply in future research. The findings of this paper can be extended to areas with similar geographic settings, and socio-economic and demographic conditions. [Copyright &y& Elsevier]

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992–93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels. [Copyright &y& Elsevier]

Summary The paper evaluates an Indian maternal conditional cash transfer scheme. Launched in 2005, the program gives women cash transfers for receiving maternal and child health care services. Data are drawn from India’s District Level Household Survey to evaluate the program’s impact. Results indicate that the program had a limited overall effect: relative to the broader population, the targeted population experienced a 3 percentage point increase in medically supervised births, but no increase in ante-natal or post-natal care. We do however, find evidence of heterogeneity of impact. Women without any formal education and women in rural areas experience disproportionate gains. [ABSTRACT FROM AUTHOR]

Abstract: This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazil''s universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities. [Copyright &y& Elsevier]

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]

Abstract: In spite of growing interest in socioeconomic differentials in health outcomes and access to health services, little has been written about methodologies for assessing the impact of equity-enhancing policies or programs. This paper describes three methodological challenges involved in designing a randomised trial with an equity outcome, and how these were met in a trial of alternative strategies to improving the uptake of benefits of a health insurance scheme among its poorest members. The Vimo SEWA trial is nested within a community-based insurance scheme in rural India. While conducting this trial, three methodological problems were encountered: (i) measuring poverty (or “wealth”, or “socioeconomic status”) (ii) assessing beneficiaries against an appropriate reference standard population and (iii) settling on an appropriate equity measure as an outcome indicator. These problems are likely to arise in any policy or program assessment that has an equity outcome. In the Vimo SEWA trial, the socioeconomic status of beneficiaries (claimants) is assessed relative to that of all scheme members living in same sub-district by applying a rapid assessment questionnaire – which reduces to an integrated index of socioeconomic status – to both a random sample of members in each sub-district, and to all claimants. The results are used to estimate the full distribution of socioeconomic status of members in each sub-district, with each member given a rank score between 0 and 100. Interpolation is used to estimate the rank scores of claimants relative to the membership base. The primary outcome measure for the trial is the mean socioeconomic rank score of claimants. In developing country settings, using an index of socioeconomic status is simpler than assessing household income or the value of household consumption. It is also relatively straightforward to compare the socioeconomic status of health program beneficiaries with a relevant reference population, although two independent surveys are required. Expressing relative wealth on a scale from zero to 100 is conceptually appealing, and the mean value of this rank score provides an equity-specific outcome measure readily integrated into the usual analytic framework for cluster-randomised trials. [Copyright &y& Elsevier]

The primary objective of this paper is to examine the relationship between the status of women in the household, the use of health care (demand for prenatal care and hospital delivery) and child mortality in India. Parents care about the health of their children but cannot directly affect child health by their actions. Instead they can, through their actions, control the use of health inputs. I jointly estimate the decision to use prenatal care, the decision to deliver the baby in hospital and child mortality. The estimation methodology allows us to account for unobserved heterogeneity and self-selection in the use of health inputs. The estimation results show that: (1) a woman’s education has a stronger effect on health care usage relative to that of her husband; (2) a woman’s control over household resources (ability to keep money aside) has a significant effect on health care usage; (3) both prenatal care and hospital delivery significantly reduces the hazard of child mortality; and (4) not accounting for unobserved heterogeneity and self-selection in the use of health inputs results in under-estimation of the effect of health inputs on child mortality. [Copyright &y& Elsevier]

This paper examines the political embeddedness of public-sector primary care in urban India. The low quality of urban healthcare in many low- and middle-income countries is well documented. But there is relatively little analysis showing how the politics of urban healthcare delivery contribute to quality shortfalls. This study integrates urban and political theory and draws on ethnographic fieldwork in municipal government-run primary care clinics in Pune, India. I conceptualize Pune's municipal doctors as street-level bureaucrats: frontline state agents charged with delivering public services, who regularly confront conflicts between their mandate and its realization in practice. I observe how the municipal doctors experience and respond to these conflicts; delineate the historical design of the municipal institutions in which they operate; and interview doctors, nurses, nonclinical staff, administrators, and elected officials, who collectively shape primary care delivery in municipal clinics. My findings show how the doctors' work is characterized by routine departures from public service ideals. The departures stem from local electoral politics (politicians' patronage and clientelistic relations with municipal employees and patients) and weak administrative capacity (misuse and incompetent planning of public resources). The doctors are compelled to follow extra-policy directives, meaning instructions that have little to do with healthcare goals and that emphasize the political utility rather than medical purpose of their work. In response, the doctors circumscribe their clinical practice. They aim, as one doctor put it, only to "ensure the ordinary," or to sustain a deficient status quo. In these conditions, improving quality of care requires not just behavioral interventions targeted at doctors. It requires normative, social, and organizational shifts in public service planning and delivery so that doctors are positioned – materially and affectively – to meet urban healthcare challenges in low-resource contexts. • Urban politics and corruption can contribute to low quality of public healthcare. • Doctors in municipal primary care clinics in India confront politics in everyday work. • Ethnography can show how doctors experience and respond to political directives. • Doctors receive directives to accommodate patronage, clientelism, and mismanagement. • Regularly facing deficits in public integrity, doctors sustain low-quality care. [ABSTRACT FROM AUTHOR]