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This commentary describes how a grassroot-led partnership initiated by members of the organisations World Federation of NeuroRehabilitation and Collaboration of Aphasia Trialists is addressing the marginalisation of people with aphasia, through education and knowledge exchange related to communication partner training of health professionals. A partnership between academics and healthcare professionals across Austria, Denmark, Egypt, Ireland, Greece, India, Serbia and the United Kingdom was established in 2020. Through bimonthly online sessions in 2021–2022 a Danish communication partner training program was introduced while six teams adapted and translated the training and its materials to their local contexts. A collaborative partnership enabled multiple translations of an existing communication partner training program for healthcare professionals working with people with aphasia to support a sustainable delivery model that is linguistic and culturally sensitive. This commentary paper focusses on Sustainable Development Goal (SDG) 17 and also addresses SDG 10. [ABSTRACT FROM AUTHOR]

Decisions that influence health and access to health care are necessarily a matter of ethics. This paper attempts to examine current budgetary allocations and policy shifts in India from the perspective of global ethical values. It also describes how global economic processes may increase health inequity nationally and argues that they should, therefore, be subject to global health ethics. Public health in India is in a state of crisis from a disinvestment in public health care services and persistent neglect, simultaneous to the global push to enhance privatization. National health policies have remained oblivious to the unacceptably high inequity in access to health care on the one hand, and the cautionary analysis of the experience with currently chosen solutions through public-private- partnership and insurance models, which further marginalize the poorest. Global institutions such as the World Trade Organisation (WTO) also influence national policies to benefit global business interests but often with detrimental effect upon equitable access to health and health care. The paper argues that the application of ethics must become more visible in the determination of national policies that are led by the dominant global paradigms of economic development to ensure that equitable access to health is prioritized. [ABSTRACT FROM AUTHOR]

Market-based migrant intermediaries play an important role in skilled migration. Skilled workers, especially in regulated professions such as nursing, face increasingly complex testing and credential assessment systems. 'Regimes of skill' control and filter membership to these professions by reproducing already existing power imbalances in the global regulation of skilled labour. This paper examines these processes in the case of Indian trained nurses who use educational brokers to enrol in Canadian post-graduate programmes with the intention of practising in the Canadian health care system. The study elaborates on the 'regime of skill' in nursing, revealing its maintenance through interactional and transnational connections between intermediaries, educators and regulators in terms of codifying and translating skills and competencies between jurisdictions with different cultural and professional histories and norms of nursing. Findings reveal that intermediaries operate transnationally in a symbiotic manner with more powerful actors in order to exploit regimes of skill and expand their market share. [ABSTRACT FROM AUTHOR]

This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. Although we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another. A systematic and stepwise approach to assessing current AT service delivery processes in the three countries – examining the delivery system as a whole, from initiation to repair and management – can help identify opportunities to improve the process for (prospective) AT users. A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal. [ABSTRACT FROM AUTHOR]

The novel coronavirus that shook the world population has restructured the world order. While the scientists are grappling hard to find a solution to the imminent problem at hand, the pandemic has thrown the human race into a perplexed stage questioning and mostly changing everything they believed in. The pandemic has replaced human beings as social animal to virtual being. The social distancing mandate required for the survival as propounded by WHO has forced individuals to keep the other humans at bay. The present paper is an attempt to look at the changes the world is facing with respect to the social, cultural, economic, and psychological aspects with a special focus on the internationally acclaimed Kerala model of survival. Kerala, a small state located within the southern peninsula of the country has played an important role in containing the spread of the virus despite its larger population density. The paper focuses on the innovative mechanics followed by the state to curtail the spreading. It also attempts to look at the changes that have been brought in the general human behavior. [ABSTRACT FROM AUTHOR]

India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery,monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM. [ABSTRACT FROM AUTHOR]

This paper examines the role of local health systems in developing countries in health biotechnology innovation. The heath systems encompass the final users of health biotechnology products and services. In innovation studies in general, users have been identified as playing vital roles as sources for innovation and in shaping the innovation process. It is therefore of interest to cast light upon the role of users in the health biotechnology innovation in developing countries. This paper briefly reviews literature on science and technology based health innovation in both industrialised and developing countries. It then examines to what extent the focus of developing countries is on their local health problems and explores the linkages between the organisations involved in research and development of health biotechnology products and services with the local health system, and thereby identifies the main roles of their own health systems in the innovation process. The paper bases this analysis on research on publication patterns and case studies on leading developing countries in health biotechnology and focuses particularly on health biotechnology development in Brazil, Cuba and India. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study. Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care. Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults. [ABSTRACT FROM AUTHOR]

The Coronavirus disease 2019 (COVID-19) pandemic has necessitated medical centers across the world to deliver healthcare through telemedicine. We discuss the adoption, delivery of telemedicine services at a tertiary care center and patient satisfaction involving 456 patients in south India. Most respondents had sought telemedicine care at the department of Medicine (16.23%). The maximum satisfaction was reported by patients in OBG (100%). The responses were generally positive across all the age groups. The paper offers insights on best practices adopted at the center, lessons learnt, and provides recommendations for health care systems offering telemedicine during COVID-19 times. [ABSTRACT FROM AUTHOR]

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

With the vital role of patients' involvement and empowerment in selecting the most suitable service provider, this study provides an insight into the patient choice factors that affect them when choosing a hospital for treatment. The patient choice concept is essential to understand in a developing country like India, which struggles to provide public-funded health services to its citizens. This paper uses empirical analysis to evaluate data collected from a diverse patient pool of 258 patients from both public and private sector hospitals in two Indian states (New Delhi and Chandigarh). The study reveals quality of treatment, cleanliness, hospital reputation and amenities like payment and food facilities as important patient choice factors considered while choosing a health service provider in the Indian context. It was also found that service provider's response to majority of patient choice factors was indicated unsatisfactory by the patients, and hence a need for improved service delivery is emphasised for hospitals through this study. [ABSTRACT FROM AUTHOR]

Objective: Despite several government initiatives aimed at improving public healthcare services, private-sector has been a dominant player in most of the Indian states. Limited evidence is available on the factors that influence the choice of using public or private health services, which assume significance in the present context, when the government is willing to purchase care from the private providers. This subject is further explored in the paper by using the 71st round of National Sample Survey, 'Key Indicators of Social consumption in India Health', 2014. Data sources/study setting: The analysis included 15 major states of India, dividing them into three groups: low-, middle- and high-income, using average GSDP per capita. We further used multi-variate regression to examine the factors explaining the utilization of either public or private facility. Findings and conclusion: The utilization of public facilities for outpatient and inpatient services was found to be very low, except Assam and Odisha, which attributed to the poor quality of care and long waiting hours. Caste, education and wealth quintiles were the main factors explaining the choice of either public or private facility and strength of association between socio-economic variables and their utilization that varied across 3-categories of states. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

This paper attempts a sub-state-level analysis of health system for a low-income Indian state, namely, Madhya Pradesh. The objective of our study is to establish efficiency parameters that may help health policy makers to improve district-level and thus state-level health system performance. It provides an idealized yardstick to evaluate the performance of the health sector by using stochastic frontier technique. The study was carried out in two stages of estimation, and our results suggest that life expectancy in the Indian state could be enhanced considerably by correcting the factors that are adversely influencing sub-state-level health system efficiency. Our results indicate that main factors within the health system for discrepancy in interdistrict performance are inequitable distribution of supplies, availability of skilled attention at birth, and inadequate staffing relative to patient load of rural population at primary health centers. Overcoming these factors through additional resources in the deficient districts, mobilized partly from grants in aid and partly from patient welfare societies, may help the state to improve life expectancy speedily and more equitably. Besides the direct inputs from the health sector, a more conducive environment for gender development, reducing inequality in opportunities for women in health, education and other rights may provide the necessary impetus towards reducing maternal morbidity and mortality and add to overall life expectancy in the state. [ABSTRACT FROM AUTHOR]

Family planning programmes in India have historically been target-driven and incentive-based with sterilisation seen as a key component of controlling population growth. This opinion paper uses India as the backcloth to examine the ethics of using incentive policy measures to promote and secure sterilisations within communities. Whilst we acknowledge that these measures have some value in reproductive health care, their use raises specific issues and wider concerns where the outcome is likely to be permanent and life changing for the acceptor. [ABSTRACT FROM AUTHOR]

India has a long history of delivering a western model of social work despite being challenged by unique structural challenges, as well as demographic and social changes impacting the types of presentations to hospitals. This paper reports on a project that explored the professional roles of Indian social workers in hospital settings, and documented some of the critical factors that impede capacity to meet the demands of a changing health care system. Extracted themes from participants identified a lack of role descriptions, professional supervision, and national standards as contributing to a lack of confidence in asserting strong professional identity and contribution to patient care. [ABSTRACT FROM AUTHOR]

The trade in health services for foreign patients, often termed 'medical tourism' or medical travel, is a growing industry being aggressively marketed across Asia. This paper explores the industry development in four countries: Thailand, India, Malaysia, and Singapore, providing a preliminary review of the political economy of the industry, marketing strategies, and linkages. As yet, there has been neither academic work considering the implications of this trade for public health, nor studies on the medical travellers themselves and their experiences. The final part of this paper contemplates some of the implications for public health in the region, and the ethical issues this globalized trade presents. [ABSTRACT FROM AUTHOR]

Following the recognition that ‘culture matters’ in designing effective public health programs, this paper focuses on one refraction of culture within the so-called ‘homosexual’ community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995–1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or ‘men who have sex with men’, the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at ‘high risk’ communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is Lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled. It is argued that this clustering of deaths is partly due to the poor basic abilities of some mothers and other carers. [ABSTRACT FROM AUTHOR]

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism. [ABSTRACT FROM AUTHOR]

The objective of the paper is to assess the usefulness of conceptions of different modes of governance for understanding policy outcomes by studying the experience with hierarchical and non-hierarchical governance modes in the health care sector in China, India, and Thailand. The paper shows their experience with non-hierarchical modes to have been largely disappointing and that all three, but especially Thailand, are in the process of reverting to a more hierarchical mode of service delivery. The conclusion from this study is that non-hierarchical governance is not a substitute for or an improvement upon hierarchical governance in health care due to the many market and government failures that afflict the sector and affect the ability of different governance modes to function effectively. The hierarchical mode of government is also imperfect but less so than the alternatives in delivering health care. [ABSTRACT FROM AUTHOR]

The present study aims to explore perceptions of the women health care providers (Auxiliary Nurse Midwives and Accredited Social Health Activist) and seekers on the basis of their social identity. The health interaction of Dalit health care providers with non-Dalit care seekers and vice versa is studied. Furthermore, this paper discussed the ways by which social identity of the care providers and the care seekers affects rendering and utilisation of health services at grassroots in rural India. A qualitative study design was employed to allow in-depth interviews with the 120 respondents. A thematic analytical framework approach was used to analyse the data. Discrimination in health care access on the basis of social identity was evident. The social identity-based perception which leads to prioritisation and discrimination was visible from both sides - providers as well as seekers. The social identity of the care providers plays an important role in shaping perception of the care seekers about the intent and ability to seek care from them. It has direct implications on health seeking behaviour of the people as it encourages discrimination and widens gap between Dalit and non-Dalit health care providers and seekers both. [ABSTRACT FROM AUTHOR]

The websites present essential healthcare information to patients, from disease symptoms, admission, and discharge to post-care. The present study proposed the CRRAV Model (Credibility, Reliability, Readability, Acceptability, and Validity) for website quality contents of Hospitals, developed from the Expectation Disconfirmation Model, Web QIM, Web Qual Serruni Lucci Model, and Minerva Model. The study also aims to assess the internet information on heart disease and compare and evaluate the quality of HCOs in developed countries like the USA and developing countries like India. The DISCERN instrument, HONcode, and WRAPIN can improve the patient's standard of information and satisfaction and remove the growing skepticism about the website on quality issues. The websites containing heart disease information with HONcode certification and WRAPIN were only four out of 65 in the USA. Out of all the evaluated websites, only a small number meet the criteria of DISCERN instrument and are accredited by HONcode. Besides this, government agencies have no regulation, supervision, or control in USA and India. There are no single quality criteria and international agreement for quality assessment of healthcare websites, except HONcode and WRAPIN. [ABSTRACT FROM AUTHOR]

This paper is a contribution to the growing literature on how best to design and support community health worker (CHW) programmes to maximise their positive impact. CHWs are laypeople trained to promote health among their peers. To do so they are commonly tasked with providing basic curative services, promoting the use of existing health services, facilitating cultural mediation between communities and healthcare providers and encouraging critical reflection and dialogue on social health issues. This paper presents a case study of a CHW project in rural Uttarakhand, north India, called the Accredited Social Health Activist (ASHA) programme. While the ASHA programme is not specifically targeting HIV/AIDS, CHW programmes have been flagged as a key means of addressing health resource shortages in poor countries, especially in relation to HIV/AIDS. This study of the ASHA programme provides insights into how best to support CHW programmes in general, including those focused on HIV/AIDS. The research involved 25 interviews and five focus groups with ASHAs, health professionals and community members as well as over 100 hours of non-participant observation at public health centres. The research investigated contextual features of the programme that are hindering the ASHAs' capacity to increase quantitative health outcomes and act as cultural mediators and agents of social change. Research found that ASHAs were institutionally limited by: (1) the outcome-based remuneration structure; (2) poor institutional support; (3) the rigid hierarchical structure of the health system; and (4) a dearth of participation at the community level. The conclusion suggests that progressive policy on CHW programmes must be backed up by concrete institutional support structures to enable CHWs to fulfil their role. [ABSTRACT FROM PUBLISHER]

This paper presents the results of a study on the indigenous knowledge of local medicinal practitioners known asVaidhyasand other knowledgeable people of Govind Pashu Vihar Wildlife Sanctuary. The purpose was to document indigenous knowledge of medicinal plants and develop strategies for their cultivation to sustain the traditional healthcare system and livelihood of the rural inhabitants. Since knowledge of uses of various medicinal plants is confined to mostly traditional herbal healers, it is of utmost importance to document this knowledge for future generations. We have documented 33 plant species belonging to 32 genera and 28 families used traditionally to cure 28 diseases. The paper also analyses the linkages of various institutions working for medicinal plant cultivation, along with opportunities and constraints in this sector. A survey was conducted to collect information regarding medicinal plant cultivation and the possibilities of cultivating species in the area. The perception of local people on illegal harvesting and cultivation options of medicinal plants in the area is also discussed. [ABSTRACT FROM PUBLISHER]

Based on fieldwork and archival studies carried out since 1995, this paper is an analysis of the dialogue between the Jarwas and the outside world. The Jarwa tribal community on the Andaman Islands has a long history of voluntary isolation and pronounced hostility towards outsiders. This situation only started to change in the mid-1990s, when a young Jarwa was successfully treated at a local hospital. The Jarwas’ sudden fascination with modern medicine was less to do with its therapeutic powers than the fact that, on each visit, hospital staff gave them food, clothes, and various consumer items. This paper describes events in the Jarwas’ ‘junket to modernity’. Before discussing recent events, the paper first retraces the history of relations between the Jarwas and the outside world during the second half of the 19th century, when life on the Andaman Islands was dominated by a British Penal Settlement. In the face of epidemic outbreaks of pneumonia, malaria, and measles, tribal health has become a major concern for the Indian authorities. The paper discusses continuities and discontinuities in medical concerns with the tribal body, and argues that ‘marginalization’ must be understood as a practice of mutual constitution. [ABSTRACT FROM AUTHOR]

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the nongovernmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify different parameters that govern the performance of hospitals in Indian context. Performance of hospital implies that patients are satisfied with the quality of treatment, and cost of treatment is low. Several literatures were reviewed for this purpose, and references were drawn from many countries around the globe to evaluate the extent to which different factors have an impact on the healthcare delivery. Methodology: The methodology involved collecting data through primary survey. Through literature review, a priory factors that impact quality of healthcare were determined. After determining the factors, a theoretical framework was developed. Using this framework, a survey of 162 respondents were conducted and data analysed by structured equation modelling to determine the key factors that impact performances of healthcare in India. This was done by analysing the standardized coefficients of the variables that explained a majority of the variations of the dependent variable. Findings: From the analysis, it was found that technology helped in integrating processes which reduced the cost of healthcare. Also, economies of scale, availability of skilled doctors, nurses, and staff improved quality of healthcare. Using technology to maintain electronic healthcare records (EHR) improved consistency, predictability of healthcare services. Practical implication: The findings, when implemented, can be used by hospitals to focus on the key factors to improve their performance, reduce costs, and enhance performance. This will also help in prioritizing the resource allocations in a hospital. Originality: The framework developed is based on primary survey and is original and not been replicated or copied from other sources. This aims to provide guidance for healthcare providers to assess their performance and thereafter improve upon it. [ABSTRACT FROM PUBLISHER]

Increasing sex workers’ (SWs) access to and utilisation of health care services is a key part of HIV prevention. An HIV prevention project in Mysore, India, has been particularly successful in fostering a new norm of health care seeking among local SWs while facilitating community ownership of health care delivery. This paper describes how the use of occupational health ideologies, along with the creation of enabling environments, facilitated the uptake of project healthcare services and transformed power relationships between SWs and their healthcare providers. These changes led Mysore's SWs to initiate health-enhancing actions that moved beyond project imperatives to serve self-identified community needs. [ABSTRACT FROM PUBLISHER]

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful. [ABSTRACT FROM AUTHOR]

An important issue for health policy and planning is the way in which multiple sources of disadvantage, such as class, gender, caste, race, ethnicity, and so forth, work together to influence health. Although 'intersectionality' is a topic for which there is growing interest and evidence, several questions as yet remain unanswered. These gaps partly reflect limitations in the quantitative methods used to study intersectionality in health, even though the techniques used to analyse health inequalities as separable processes can be sophisticated. In this paper, we discuss a method we developed to analyse the intersections between different social inequalities, including a technique to test for differences along the entire span of the social spectrum, not just between the extremes. We show how this method can be applied to the analysis of intersectionality in access to healthcare, using cross-sectional data in Koppal, one of the poorest districts in Karnataka, India. [ABSTRACT FROM AUTHOR]

Resettlement poses several risks to vulnerable urban populations such as slum dwellers in cities like Mumbai in the Third World. The causes for involuntary resettlement in the urban context, such as the expansion of airports, widening roads, or building of commercial complexes, are often unconnected to the lives of those living in slums. Resettlement is associated with economic hardships, disruption of the social fabric, and a feeling of uprootment, alienation and psychological trauma. This paper is based on the findings of an action-research study conducted in a resettled slum community in Mumbai, India that aimed to understand the implications of involuntary resettlement from a human rights perspective. It focuses on the impact of involuntary resettlement on issues concerning women's health. It discusses gender differentials in morbidity patterns and the access to healthcare. It argues that there is a need for integrated planning to ensure an improvement in overall living conditions, which also include provision and access to health services apart from just the mere allocation of alternate housing. [ABSTRACT FROM AUTHOR]

Situations of chronic conflict across the globe make it imperative to draw attention to its gendered health consequences, particularly the violation of women's reproductive and sexual rights. Since early 2002 in Gujarat, western India, the worst kind of state-sponsored violence against Muslims has been perpetrated, which continues to this day. This paper describes the history of that violence and highlights the mental and physicial consequences of sexual and gender-based violence and the issues that need to be addressed by the police, the health care system and civil society. It draws upon several reports, including from the International Initiative for Justice and the Medico Friend Circle, which documented the reproductive, sexual and mental health consequences of the violence in Gujarat, and the lacunae in the responses of the health system. The paper calls for non-discrimination to be demonstrated by health personnel in the context of conflict and social unrest. Their training should include conflict as a public health problem, their roles and responsibilities in prevention, treatment and documentation of this "disease", and focus on relevant medico-legal methodology and principles, the psychological impact of sexual assault on victims, and the legal significance of medical evidence in these cases. Les situations de conflit chronique dans le monde obligent à attirer l'attention sur les conséquences sanitaires différentes pour les hommes et les femmes, en particulier la violation des droits génésiques des femmes. Depuis le début 2002 au Gujarat, en Inde occidentale, la pire sorte de violence parrainée par l'État a été perpétrée contre les musulmans et se poursuit à ce jour. Cet article retrace l'histoire de cette violence et met en lumière les conséquences mentales et physiques de la violence sexuelle et sexiste, et les questions que la police, le système de santé et la société civile doivent aborder. Il s'inspire de plusieurs rapports, notamment de l'Initiative internationale pour la justice et du Medico Friend Circle, qui ont enquêté sur les conséquences de santé génésique et mentale de la violence au Gujarat, et sur les lacunes des interventions du système de santé. Dans ce contexte de conflit et d'instabilité sociale, l'article demande aux soignants de ne pas faire de discrimination. Leur formation doit étudier le conflit comme problème de santé publique, leur rôle et leurs responsabilités dans la prévention, le traitement et la documentation de cette « maladie », et se centrer sur la méthodologie et les principes médicaux-légaux pertinents, l'impact psychologique de la violence sexuelle sur les victimes et la signification légale des preuves médicales dans ces cas. Debido a las situaciones de conflicto crónico mundialmente, es imperativo señalar las consecuencias para la salud de las mujeres, particularmente la violación de sus derechos sexuales y reproductivos. Desde principios de 2002 en Gujarat, en la India occidental, se ha perpetrado el peor tipo de violencia patrocinada por el estado contra musulmanes, la cual continúa hasta la fecha. En este artículo se describe la historia de esa violencia y se destacan las consecuencias mentales y físicas de la violencia sexual y basada en género, así como los problemas que deben tratar la policía, el sistema de salud y la sociedad civil. Se basa en varios informes, como los de la Iniciativa Internacional por la Justicia y el Círculo de Amigos Médicos, que documentaron las consecuencias de la violencia en Gujarat para la salud reproductiva, sexual y mental, y las lagunas en las respuestas del sistema de salud. Se hace un llamado al personal de salud para que no demuestre discriminación en el contexto de conflicto y descontento social. Su capacitación debe abarcar el conflicto como un problema de salud pública, sus funciones y responsabilidades en la prevención, el tratamiento y la documentación de esta "enfermedad", y centrarse en metodología y principios médico-jurídicos pertinentes, el impacto psicológico de la agresión sexual en las víctimas y la importancia jurídica de la evidencia médica en estos casos. [ABSTRACT FROM AUTHOR]

Different phases of intervention after any disaster bring with them specific issues that policy-makers as well as healthcare deliverers must take into account. There are some specific issues related to aid with dignity and dead-body identification that need to be taken into account. The human and material resources are important in planning and delivering mental healthcare. In India, with each successive disaster, the immediate response in the rescue and relief phase has improved and the administration is able to mobilize a large amount of resources from different sectors quickly, efficiently and in a co-ordinated manner in the immediate and short-term periods after a disaster. That psychological first aid will reduce psychiatric morbidity is now generally accepted as a key principle in interventions immediately after a disaster. In the recent events, large numbers of community-level volunteers have received short-term training and been able to provide effective psychosocial care and support. The paper presents the author's observations and provides an overview of some of the lessons learnt in mental health and psychosocial support care across the several natural and human-made disasters that have taken place in India. While significant progress has been made with respect to the rescue and relief response, there is still a lot to be achieved in the rehabilitation and rebuilding phases that follow a disaster. Disaster prevention and mitigation need global vision combined with local action. Building capacity through careful planning and training potential workers is an important step. The stakeholders must take into account local cultural and social needs. [ABSTRACT FROM AUTHOR]

Due to its large population, India has a substantial proportion of the world's HIV infections. Recent evidence suggests that the virus is moving into the general population from high-risk groups. Despite this, a mentality of ‘us’ and ‘them’ continues to prevail, where PLWHA are marginalised from mainstream society. Focusing on the area of health care, this study, through an analysis of legislative policy, written regulations and interviews with key informants and direct witnesses aims to map the forms of structural discrimination that inform the lives of PLWHA. Study findings indicate that a lack of clearly enunciated and enforced legislation (which is in some instances clearly discriminatory), coupled with an absence of written internal policy, leaves room for selective interpretation, which in turn creates the opportunities for discriminatory behaviours to be perpetuated against PLWHA. The paper concludes with a call for better educational training of medical staff and the improvement of existing legislature. [ABSTRACT FROM AUTHOR]

Recent times are witnessing methods in the various forms of community care for the mentally ill in India. Non-governmental organizations (NGO) play a pivotal role in filling the gap in the existing mental health services in India and the substantial need for these services. Various strategies that have been employed in community care have attempted to utilize existing community resources for implementation. Informal manpower resources incorporated with specialist psychiatric care and integrated with existing health care facilities have been general strategies. While the feasibility and cost-effectiveness of the NGO operated community outreach programs for the mentally ill have been demonstrated, various factors are seen to influence the planning and execution of such programs. This paper elucidates some critical factors that would need to be considered in community mental health care in India. [ABSTRACT FROM AUTHOR]

Limited literature exists in India on WhatsApp use for health communication among frontline health workers like Auxiliary Nurse Midwives (ANM). We conducted this study to assess the adoption of WhatsApp among ANMs and identify factors influencing its adoption. In addition, the study explored the perceptions of ANMs on WhatsApp use for sharing health information. We employed a mixed-method sequential explanatory design. We surveyed 259 ANMs, followed by in-depth interviews with 19 purposively sampled ANMs. We conducted multinomial logistic regression to identify factors associated with WhatsApp adoption and employed thematic analysis to analyze interviews. 257 ANMs responded to the survey questionnaire, of which 18.3%, 48.2%, and 33.5% had low, mid, and high levels of WhatsApp adoption, respectively. Education (AOR = 2.87 [95% CI = 1.20–6.85]), motivation (AOR = 6.31 [95% CI = 1.43–27.80]), and technical awareness (AOR = 2.91 [95% CI = 1.11–7.62]) were significantly associated with WhatsApp adoption. Thematic analysis of the interviews resulted in six themes describing perceptions and experiences of ANMs on WhatsApp use. They are: (i) a way of instant communication, (ii) provision for multimedia messaging, (iii) a quick fix tool for queries and concerns, (iv) make attendance and reporting easy (v) a way of reaching higher officials, and (vi) a cost-saving mechanism. WhatsApp facilitated ANMs' communication and service delivery at the grassroots level. Measures to improve motivation, technical awareness, and digital education will likely improve WhatsApp adoption among health workers. [ABSTRACT FROM AUTHOR]

Background: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. Objectives: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. Methods: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. Results: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. Conclusion: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic. [ABSTRACT FROM AUTHOR]

Research on dementia literacy in Chinese societies is still emerging, and this is especially the case among racially minoritized groups. The present study explored the knowledge, causal beliefs, and help-seeking behaviors of South Asian migrants in Hong Kong about dementia. It also investigated existing community barriers related to dementia knowledge and help-seeking. We conducted a qualitative study from a purposive sample of 38 older people and family caregivers from India, Pakistan, and Nepal who lived in Hong Kong. Focus groups and individual in-depth interviews were used to gather information, while thematic analysis was employed to analyze the data. Five main themes were identified: normalization with stigmatization of dementia; spiritual and psychosocial attributions of dementia; familial responsibility despite potential caregiving burden; uncertainties versus openness to professional care; and barriers and opportunities in dementia literacy. Ethnic minorities recognized dementia as a disease of normal aging or a mental disorder. They also perceived spiritual and psychosocial factors as their main causes. While participants recognized the potential burden of dementia caregiving, families were their first point of help-seeking, as many of them expressed contrasting feelings of confidence or doubt toward professional services. Utilization of health education strategies, together with collaboration with community leaders, could address the barriers to dementia literacy. This is the first study to explore how ethnic minorities in Asia perceive dementia and its related help-seeking behaviors in their communities. South Asian migrants in Hong Kong have a limited understanding of dementia and may experience delays in obtaining relevant community services. While culture influenced their knowledge, health education may address their misperceptions and help-seeking behaviors toward dementia. Culture- and language-specific programs could also improve dementia knowledge and health service access. [ABSTRACT FROM AUTHOR]

India's health care suffers from high out-of-pocket medical expenses that lead to a higher financial burden on poor people. To reduce the health cost burden, the government of India has initiated many governments funded insurance schemes since 2000. Private health insurance also flourished, but the coverage is limited to wealthier households. Many researchers have published many scientific publications on this research domain, but the bibliometric analysis of scientific publications is missing. We have relied on the 'SCOPUS' database for data collection based on the wider availability of literature. 761 documents extracted were journal articles, published between 2000 and 2021 followed by certain inclusion and exclusion criteria. Biblioshiny package of R-Studio has been used for data analysis. Our analysis reflect upon various aspects of Bibliographic analysis like number of articles published, cited, country wise scientific production etc. Our results also reflect on very few studies that relate to Poverty, income, young adults, aged, adolescents, and children, where there is further scope for research. We found that the health insurance-related publication rate has increased over the period. But it requires more research especially the implementation of health insurance mechanisms from the health system perspective. The study will be a policy document to find the research gaps in the healthcare insurance domain. [ABSTRACT FROM AUTHOR]

Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services. [ABSTRACT FROM PUBLISHER]

The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India's current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has seen the advent of novel medical devices and practices. Demand for quality healthcare services rose exponentially which eventually led to accessibility becoming a major issue of concern. In addition to this, in-person consultations and various other conventional treatment methods were proven to be problematic. Limitations of traditional health care systems such as in-person consultations were highlighted, and conventional treatment methods have proven to be problematic. As an alternative approach, telehealth services are now gaining recognition due to their high efficiency, ease of use, and state-of-the-art technology. In this article, trends of telemedicine and its evolving popularity across the medical community due to the pandemic and beyond are studied and highlighted. An online survey form was circulated to 42 medical practitioners and interns to analyse the growing interest in telemedicine. The questionnaire covered the physicians' perspectives, preferences, experiences, and other important aspects of home-based teleconsultation. Based on the responses collected from doctors and medical interns, 14.2% disapproved, whereas 38.1% favoured and 47.6% showed a neutral response to the teleconsultation. More than 50% of the respondents claim the process to be time-consuming and 42% of them perceived it to be the other way round. 4.8% of the doctors preferred it to be only through computers whereas 45.2% per cent preferred consultation through smartphones and 50% of them preferred it be both ways. More than half (59.5%) of the doctors preferred the pandemic scenario and the remaining for its continued usage post-pandemic. Although India has the world's second-largest online market, a major population in India is digitally illiterate according to the Digital Foundation of India. Thus, it is important to devise telehealth technology that is simplest to use to reach also the economically backward patient communities. [ABSTRACT FROM AUTHOR]

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

A pluralistic Health system provides options for people to choose appropriate healthcare approach. However, the ability to make informed decision is infleuenced by many factors. An informed decision is one of the attributes of self-reliance. In this study, through the interactions with smallholder farmers, we tried to travel through the realm of communities' integrative practices and perceptions with a specific focus on traditional medicine concerning animal and human health. We aimed to understand what influences healthcare choices, mainly traditional medicine among people and how it contributes to self-reliance in primary healthcare. We conducted this case study in Aluva taluk of Ernakulam district in Kerala, India. Study participants were selected using the purposive sampling method and the data collected through 22 in-depth interviews and participant observation. Integrative healthcare practice is fragmented due to variations in the evidence perception by the people. Personal experiences, social and cultural factors, and health literacy influence health decisions in practicing integrative healthcare. Therefore, while investigating a concept like self-reliance, there is a need for analytical methods to embrace experiential, textual, inherited, and incorporated forms of learning. This further helps researchers and policymakers to recommend context-specific and sustainable solutions to create self-reliant communities in primary healthcare. [ABSTRACT FROM AUTHOR]

Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers – which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals – are the entry points for standardising, or opening up, Street Medicine practices. [ABSTRACT FROM AUTHOR]

This paper examines the need for health literacy in India. Health literacy is a catalyst that strengthens the individuals’ ability to select the right information and take proper decision over their health. For effective health literacy, the capacity to comprehend the given information and to extract right information is necessary. Nowadays, the dissemination of health messages to public is mostly carried out through Internet. The study looks at Facebook, Twitter, YouTube, and LinkedIn and their role as health communication platforms. As reported in “Mobile Internet in India 2015” released by the Internet and Mobile Association of India (IAMAI) and Indian Market Research Bureau (IMRB), there are 402 million Internet users out of which 306 million are mobile Internet users as on 31 December 2015 registering a growth of 49% over last year. Thus, the need for health literacy cannot be emphasized enough. [ABSTRACT FROM AUTHOR]

To identify the competencies required by Community-Based Rehabilitation (CBR) practitioners in India and determine typical pathways of competency development, including minimum practice standards. Following a literature review of existing frameworks and guidelines for CBR delivery, Delphi methods were used with Indian CBR experts to identify the main competency requirements of CBR personnel. Rubric writing workshops with CBR experts then expressed the performance of these competencies developmentally as learning progressions. The rubrics were converted into an observation form and field tested with 100 CBR personnel of varying expertise levels, through third party assessments by workplace supervisors. Finally, a second Delphi panel determined major competency stages and minimum standards for practice. Three broad job functions pertaining to five focus areas and 37 developmentally described competencies were found important for delivery of quality CBR. Through a standard setting process, for each job function experts reached agreement on major competency stages, including a minimum practice standard. The study suggests India's CBR expertise proceeds in four stages within three broad job functions – Assessment and Intervention, Inclusive Community Development, and Professional and Ethical Behaviour and Practice. The findings have direct implications for designing curricula to facilitate the competency development of CBR personnel. Meeting the rehabilitation and inclusion needs of people with disability in low and middle-income countries requires adequately trained local personnel. Currently, lack of knowledge and understanding of the competencies required of CBR personnel is affecting training and workforce quality. Consensus amongst Indian experts about a CBR learning pathway indicates possibilities for effective competency-based course design. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine how physiotherapy students manage to convert and employ their intrinsic and extrinsic knowledge and skills in clinical contexts abroad outside Europe. The study is based on a qualitative a content analysis of 10 Bachelor theses in the form of case studies written in pairs of Norwegian Bachelor students. Findings that emerged in the document analysis were the students’ uncertainty concerning types of roles and knowledge discourses involved in the interaction. The students who managed to identify critical incidents and apply a cultural relativistic approach managed the converting process. A conscious attitude towards own cultural norms and values opened up for integrating these in the new context. Theory and tools introduced as part of the preparations were shown to be functional when applied in practice. The importance of using critical incidents and culture relativism as methods for the students going abroad will be emphasized in the preparation courses. [ABSTRACT FROM PUBLISHER]

While underscoring the importance of customer (patient) satisfaction in fostering efficient delivery of healthcare services, researchers from the developed world explored the whole gamut of influencing factors, ranging from empathy of physicians and hospital infrastructure to courtesy of paramedical staff and hospital image. The hospitals in the developing world present distinct business models and service quality variations that warrant context-specific examination. In the Indian healthcare system, patients are always accompanied by their attendants who perform a plethora of functions, including facilitating the execution of physicians' recommendations. In many Indian hospitals the presence of an attendant is perceived more as an institutional norm than a personal convenience. The purpose of this paper is to investigate the moderators and mediators in the context of healthcare service quality from the perspectives of patients and their attendants in India. The study employs a questionnaire-survey approach to obtain the perceptions of patients and attendants. The study reveals that attendants play an indispensable role in Indian context. Attendants provide physical and mental support to patients, which result in patients' satisfaction with the hospital's services. Further, attendants, by supplementing hospital activities, serve as a bridge between service providers and patients. The attendants have been found to subordinate their own personal comfort levels to the care provided by the hospital to the patients. The current research is the earliest study that explicitly addresses the role of attendants in the context of healthcare service delivery in India. [ABSTRACT FROM AUTHOR]