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Corona virus disease, COVID-19, has emerged as a pandemic covering the entire world, almost every country is effected by COVID-19. Numbers of infected people across the world are increasing at an exponential rate. Such large number of patients put extra ordinary demand of health care facilities. Although every country is putting tremendous efforts in frontline to fight with this pandemic but shortage of medical facilities, especially for densely populated countries like India, it becomes a serious challenge. The fear of pandemic has arrested everyone in homes due to which various sectors are affected badly. Pandemic situations are badly deteriorating the hospitality and tourism business. Smart healthcare tourism is the new prominence application of IoT based healthcare tourism. This paper presents an IoT based health monitoring framework, which may be helpful for medical tourists as well as the hotel management to monitor the health of guests and staff. The framework will detect and check the various vital signs of body and then report to the admin about health status of persons. The paper focuses on use of Internet of Things technology involving wearable sensors for monitoring the health status, detecting the disease and providing online health services for medical tourism sector. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic lockdown introduced to break the chain of disease transmission brought numerous challenges to people living with Type 2 diabetes. The present paper attempts to explore and understand the challenges faced by people living with diabetes and the variation in experiences based on their socioeconomic context. This qualitative study was conducted during the pandemic’s first and second waves in rural areas of West Jaintia Hills District, predominantly inhabited by the Pnar tribe. In-depth interviews with 90 Pnar men and women living with diabetes were undertaken. Findings from the present study reveal the perception that COVID-19 is not severe, limited knowledge about complications of diabetes, and impact of the COVID-19 pandemic lockdown, multiply to increase the vulnerability of the tribal populations living in the hilly and difficult terrain of the district. Therefore, addressing the burden of chronic illnesses in rural tribal areas in times of emerging infectious pandemics by providing comprehensive care and services at public health facilities is the need of the hour. The COVID-19 pandemic lockdown introduced to break the chain of disease transmission brought numerous challenges to people living with Type 2 diabetes. The present paper attempts to explore and understand the challenges faced by people living with diabetes and the variation in experiences based on their socioeconomic context. This qualitative study was conducted during the pandemic’s first and second waves in rural areas of West Jaintia Hills District, predominantly inhabited by the Pnar tribe. In-depth interviews with 90 Pnar men and women living with diabetes were undertaken. Findings from the present study reveal the perception that COVID-19 is not severe, limited knowledge about complications of diabetes, and impact of the COVID-19 pandemic lockdown, multiply to increase the vulnerability of the tribal populations living in the hilly and difficult terrain of the district. Therefore, addressing the burden of chronic illnesses in rural tribal areas in times of emerging infectious pandemics by providing comprehensive care and services at public health facilities is the need of the hour. [ABSTRACT FROM AUTHOR]

Introduction: It is well acknowledged that India's community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. Many ASHAs are currently working in fragile and conflict-affected settings. No efforts have yet been made to understand the challenges and vulnerabilities of these female workers. This paper seeks to address this gap by bringing attention to the situation of ASHAs working in the fragile and conflict settings and how conflict impacts them and their work.Methods: Qualitative fieldwork was undertaken in four conflict-affected villages in two conflict-affected districts -Kokrajhar and Karbi Anglong of Assam state situated in the North-East region of India. Detailed account of four ASHAs serving roughly 4000 people is presented. Data transliterated into English were analysed by authors by developing a codebook using grounded theory and thematic organisation of codes.Results: ASHAs reported facing challenges in ensuring access to health services during and immediately after outbreaks of conflict. They experienced difficulty in arranging transport and breakdown of services at remote health facilities. Their physical safety and security were at risk during episodes of conflict. ASHAs reported hostile attitudes of the communities they served due to the breakdown of social relations, trauma due to displacement, and loss of family members, particularly their husbands.Conclusions: Conflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict. [ABSTRACT FROM AUTHOR]

Technology has played a role in the quality and assurance of life. Application of technology in the healthcare field has increased manifolds in past decade with the development of new devices and IT. Telemedicine - a technology for remote diagnosis of diseases provides health care facilities to the remote area. In the context of India, telemedicine can be an option to provide healthcare facilities to last mile, the interior villages with the help of technology. Although it is a conceptual paper, the paper investigates the enabler of telemedicine technology adoption and implementation and ends up with the proposed model with the constructs and constructs definitions with the proposed items which are useful for telemedicine implementation. Through the systematic literature review followed by one to one interaction with the physicians, patients and telemedicine experts who all are currently using the technology the propositions are made which are likely to affect the implementation and adoption of telemedicine technology. telemedicine is a useful technology, when it comes to the affordability, quality and reach of healthcare services in India. Private hospitals as well as government both have to work together to provide the better healthcare for better India. [ABSTRACT FROM AUTHOR]

Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015–16 and District Level Household and Facility Survey (DLHS) 2012–13. The study is limited to only districts whose data are available in both DLHS 2012–13 and NFHS 2015–16. The methods of analysis include bivariate statistics, Pearson's chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client's confidence in the services, which is the key to success for any voluntary family planning program like in India. [ABSTRACT FROM AUTHOR]

Introduction: Catastrophic health expenditure is defined as payments for health services exceeding 40% of household disposable income after subsistence needs are met. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. India continues to account for a quarter of all maternal and child deaths at the world level. The cost of health care is comparatively higher in private sector than the public health facilities. Households using private inpatient services are more likely to face catastrophic expenditure. Materials and Method: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January-June, 2014. It is a cross sectional dataset available in public domain. The dataset provides information on Social Consumption and Health scenario of the population. To carry out the research, descriptive statistics, bivariate and logistic regression analysis has been used. FINDINGS The study shows that urban sector, primary educated and women belonging to poorest wealth quintile bear high catastrophic health expenditure than their other counterparts. Western and Southern region have low percentage of women going for catastrophic expenditure on maternal health care. The likelihood of catastrophic health expenditure on maternal health care decreases with the increase in wealth quintile from poorest to richest. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the catastrophic health expenditure on maternal health care. Further research needs to be done in exploring the factors that leads to inequity of the expenditure used in the utilization of maternal health care. [ABSTRACT FROM AUTHOR]

A sound health care system is the prime requisite for the effective health conditions of the people of a nation. But unfortunately the performance of India in this respect is quite disappointing. Evidences showed that studies on public health care delivery system are limited both in Indian as well as in the context of the North Eastern Region. This paper is an attempt to assess the pattern of utilization of primary health care. The study is based on primary data. The study found that there are problems associated with health care delivery system like lack of accessibility to the public health care facilities, shortage of medical equipment, shortage of medicines in government hospitals, lack of infrastructural facilities, low seat capacity and over crowdedness etc. [ABSTRACT FROM AUTHOR]

The effectiveness of skilled health workforce is most influencing factor to the health status of the population and its ratio to population across space and regions. This paper explores the availability of health care institutions as per Indian Public Health Standards (IPHS) norms and the nature of shortfall and surplus of health workforce in accessing health care services to the people of North-East India. The region is considered to be one of the economically depressed regions in India and has low health workforce-population ratio and unskilled due to absence of training centres. Health Care Institutions consists of Sub- Centres (SCs), Primary Health Centres (PHCs) and Community Health Centre (CHCs) that provide complete health care delivery to the population. The deficit of health care institutions is very high in densely populated states like Assam and it is favourable in lower density states i.e. Arunachal Pradesh. The numerical deficits are greatest in case of specialized doctors and numerical surpluses realised for Para-medical staffs which is likely to affect adversely the utilization of health care services in CHCs in North-East India. The co-efficient of variation for health workforce shows that the regional disparities is widening and worsening because of uneven health workforce availability in the health care institutions. [ABSTRACT FROM AUTHOR]

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [ABSTRACT FROM AUTHOR]

Out-of-pocket spending at out-patient departments (OPD) by households is relatively less analyzed compared to hospitalization expenses in India. This paper provides new evidence on the levels and drivers of expenditure on out-patient care, as well as choice of providers, using household survey data from 8 districts in 3 states of India. Results indicate that the economically vulnerable spend more on OPD as a proportion of per capita consumption expenditure, out-patient care remains overwhelmingly private and switches of providers—while not very prevalent—is mostly towards private providers. A key result is that choice of public providers tend to lower OPD spending significantly. It indicates that an improvement in the overall quality and accessibility of government facilities still remain an important tool that should be considered in the context of financial protection. [ABSTRACT FROM AUTHOR]

Primary healthcare systems worldwide suffer from major gaps in infrastructure and human resources. One key infrastructure gap is access to reliable electricity, absence of which can significantly affect the quantity and quality of healthcare services being delivered at rural primary health facilities. However, absence of granular empirical evidence is a barrier for quantitatively understanding the significance of electricity access as one of the determinants of access to reliable primary healthcare. Using data from India's District Level Household and Facility Survey, we develop zero-inflated negative binomial models with co-variates and state-level fixed effects to estimate the relationship between levels of electricity access and the quantity of basic health services delivered at Primary Health Centers (PHCs). We find that lack of electricity access is associated with a significant and large decrease in the number of deliveries (64 percent), number of in-patients (39 percent), and number of out-patients (38 percent). We further find that lower level of electricity access at primary health centers is disproportionately associated with adverse effects on women's access to safe and quality healthcare. [ABSTRACT FROM AUTHOR]

Background: Small-scale fishers of Indian Sundarbans depend on open-water fisheries for their livelihoods. They often face health, occupational, and safety issues in their profession due to environmental, socio-economic, and policy changes. The morbidity pattern and related risk factors are important indicators of well-being for any community, hence applicable to small-scale fishers of Sundarbans. The present study was designed to assess patterns of morbidities, associated risk factors including occupational health hazards, and treatment-seeking behavior of small-scale fishers in the Indian Sundarbans. Material and Methods: Household surveys, focused group discussions, and personal interviews were conducted through a predesigned pretested structured questionnaire. Associated risk factors and the nature of seeking treatment were considered during the data collection covering 650 individuals from 132 fishers' families. Results: Morbidities were more frequent in males (39.33%) than in females (28.5%). The fever (31%) was the most dominant reason for morbidities followed by ocular ailments (23%), musculoskeletal disorder (20%), dermatological ailments (17%), and respiratory illness (9%). The highest morbidities (25%) were recorded in the age group of 21-30 years in males while that was 20% in the 11-20 years age group in the case of the females. Physical labor for fishing activities predisposes to health ailments of the studied population. Conclusions: The prevalence of morbidity among the fishermen community was found to be 28.5%. The understanding of the morbidity profile of a population in general and specific age groups of both sexes in specific sheds light on the vulnerability of working groups that will help for effective healthcare planning and resource allocation. [ABSTRACT FROM AUTHOR]

Background: In 2005-06, only 39 % of Indian women delivered in a health facility. Given that deliveries at home increase the risk of maternal mortality, it was in this context in 2005, that the Indian Government implemented the Janani Suraksha Yojana program that incentivizes poor women to give birth in a health facility by providing them with a cash transfer upon discharge. JSY helped raise institutional delivery to 74 % in the eight years since its implementation. Despite the success of the JSY in raising institutional delivery proportions, the large number of beneficiaries (105 million), and the cost of the program, there have been few qualitative studies exploring why women participate (or not) in the program. The objective of this paper was to explore this.Methods: In March 2013, we conducted 24 individual in-depth interviews with women who delivered within the previous 12 months in two districts of Madhya Pradesh, India. Qualitative framework analysis was used to analyze the data.Results: Our findings suggest that women's increased participation in the program reflect a shift in the social norm. Drivers of the shift include social pressure from the Accredited Social Health Activist (ASHA) to deliver in a health facility, and a growing individual perception of the importance for 'safe' and 'easy' delivery which was most likely an expression of the new social norm. While the incentive was an important influence on many women's choices, others did not perceive it as an important consideration in their decision to deliver in a health facility. Many women reported procedural difficulties to receive the benefit. Retaining the cash incentive was also an issue due to out-of-pocket expenditures incurred at the facility. Non-participation was often unintentional and caused by personal circumstances, poor geographic access or driven by a perception of poor quality of care provided in program facilities.Conclusions: In summary, while the cash incentive was important for some women in facilitating an institutional birth, the shift in social norm (possibly in part facilitated by the program) and therefore their own perceptions has played a major role in them giving birth in facilities. [ABSTRACT FROM AUTHOR]

In recent years, there has been renewed emphasis on efficiency in resource utilization in the healthcare sector. Most studies in the Indian context have focused on state level analysis. This paper explores sub-state level health system efficiency in Orissa, a low-income state in India. Our analysis estimates the efficiency of the healthcare system at sub-state level using 2012 district level data. We explore the reasons for relative performance of different districts using a frontier estimation technique. There is a substantial difference in performance between the most efficient district of Jharsuguda and the least efficient district of Balangir, resulting from inadequate utilization of available health care resources. Our study also identifies complementarity of private health care resources and the role of other factors, such as sanitation facilities, village electrification, and rural population growth. Our results suggest a need for better utilization of budgetary resources, both under the state department of health and the National Rural Health Mission, to increase health manpower and improve quality through training and better management resources in order to improve district health systems in Orissa. [ABSTRACT FROM AUTHOR]

In the present era, economic development has shifted to human development paradigm where human beings are considered as the means and end of development. Health is considered as one of the important means of human development. Health has direct relation with increasing productive capacity of a person, reducing poverty of a person and enhancing economic growth of a country. Considering health as a right the WHO committed to provide health for all by 2000 and India being a signatory member launched the primary healthcare services for the improvement of health for all. In this paper attempt is made to study the changes in the health scenario of the people after the launching the healthcare services like National Rural Health Mission. Thus, Barak Valley, the remotest part of the country situated in the southern most part of Assam with a very weak socioeconomic infrastructure is considered as the study area. The study is mainly based on primary and secondary data. Primary data is collected on the basis of random sampling. A health index is prepared to look upon the health status of the people. It is found that launching of the healthcare delivery services has lead to the reduction of morbidity occurred by the diseases known as public health problem. Moreover, changes with regard to maternal and infant mortality are also found. [ABSTRACT FROM AUTHOR]

Background: To achieve the Sustainable Development Goals, Indian States have implemented different strategies to arrest high out-of-pocket expenditure (OOPE) and to increase equity into healthcare system. Tamil Nadu (TN) and Rajasthan have implemented free medicine scheme in all public hospitals and West Bengal (WB) has devised Fair Price Medicine Shop (FPMS) scheme, a public-private-partnership model in the state. In this background, the objectives of the paper are to - 1. Study the utilization pattern of public in-patient care facilities for the states, 2. Examine the effectiveness of the strategies adopted by the states to arrest high OOPE and 3. Analyze the extent of equity in public in-patient care services in the states.Methods: National Sample Survey (71st and 60th round) data, Detailed Demand for Grants of the state governments and the National Rural/Urban Health Mission data have been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, OOPE and extend of equity in the states.Results: The results show that overall utilization of public facilities in TN and Rajasthan has increased substantially; whereas, utilization of public facility has decreased in WB even among the poorest. In addition, OOPE for both medical and medicine is the highest in WB among three states for public sector hospitalizations. Surprisingly, OOPE on medicine is the highest for the poorest class of WB. Analysis showed that the mismatch between actual need and FPMS drug-list has led to high OOPE in the state. Overall, benefit incidence of public subsidy is the highest among the poorest class in all the states. However, geographical sector-wise inequity in public subsidy distribution persists in the states. Analysis of cost of inpatient care shows that TN provides the maximum subsidy for hospitalization and WB provides the minimum. An inverse relationship between utilization of inpatient care and public subsidy has been observed from the analysis.Conclusion: In conclusion we could say that TN & Rajasthan have successfully implemented their health financing strategies to reduce the health expenditure burden. However, policy-level changes are required to improve the situation in WB. [ABSTRACT FROM AUTHOR]

The development of health care facilities in a nation improves the quality of life of its citizens, and enhances their efficiency and productivity; eventually, reducing poverty. This paper proposed a methodology that uses GIS and multi-criteria decision-making technique for development of health care units (HCUs), to attain spatial efficiency in the distribution of facilities. The methodology assigns spatial weightage to the suitability index of the candidate locations in the objective function of maximizing coverage location-allocation problem embedded in ArcGIS. Habitations unserved by the existing HCUs are considered as candidate locations. The five criteria considered to determine the suitability index of a location are: Access distance to nearest existing HCU (C 1) , Accessibility index of habitations to existing HCUs based on service to population ratio (C 2) , Connectivity to all-weather roads (C 3) , Population of neighborhood (C 4) , and Health care requirement of a zone (C 5). The proposed methodology is applied in Jhunjhunu district, India as a case study, for the development of Community Health Centers (CHCs). Accessibility of habitation to facilities (jointly C 1 , C 2, and C 4) found to be the most influencing criteria in deciding the suitability of a candidate location to site the CHCs. The proposed methodology enables maximization of coverage, minimization of needless competition within CHCs, and satisfaction of the zonal requirement for health. Study findings would be helpful to national policymakers for developing HCUs by prioritizing fund allocation to shortage areas to improve the health index as well as the quality of life. • A generic practice ready methodology is proposed to develop healthcare units in rural area • GIS and Multi-criteria technique are used concurrently for location-allocation • Spatial weightage is assigned to the suitability index of the candidate location in MCLP • Proposed methodology ensures spatial efficiency in the distribution of facilities • Findings would help policy makers for fund allocation to improve quality of life [ABSTRACT FROM AUTHOR]

Objective: This paper examines the availability of basic and comprehensive emergency obstetric care (EmOC), interventions used to treat direct obstetric complications. Determining what interventions are provided in health facilities is the first priority in analyzing a country's capabilities to treat obstetric emergencies. There are eight key interventions, six constitute basic EmOC and all eight comprehensive EmOC.Methods and Results: Based on data from 24 needs assessments, the following global patterns emerge: comprehensive EmOC facilities are usually available to meet the recommended minimum number for the size of the population, basic EmOC facilities are consistently not available in sufficient numbers, both in countries with high and moderate levels of maternal mortality, and the majority of facilities offering maternity services provide only some interventions indicating an unrealized potential.Conclusion: Upgrading maternities, health centers and hospitals to at least basic EmOC status would be a major contributing step towards maternal mortality reduction in resource-poor countries. [ABSTRACT FROM AUTHOR]

This paper offers cross tabulations between parameters on family planning and other health practices. The findings indicate that people who act positively with respect to health practices are similarly motivated in family planning. This point lends support to the policy of integrating family planning services with health services. [ABSTRACT FROM AUTHOR]

Respecting patients' rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients' rights was independent of gender, socio-economic and educational status. Doctors were found to be the most common source of information for patient's about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services. [ABSTRACT FROM AUTHOR]

Background: The private health sector has a significant role in the delivery of health services in India. However, given fast changing COVID-19 pandemic, it is critical to understand the role of the private health sector in delivery of services going forward. The supply of COVID-19 vaccines is firmly regulated by the Government of India and the private sector received unrestricted access to vaccine supply directly from manufacturers from June 2021 onwards. Materials and Methods: PATH carried out a rapid assessment of private health facilities in the state of Maharashtra to understand the challenges faced by private facilities in providing COVID-19 vaccination. Results: During the assessment it was found that 100% of the private health facilities have a robust cold chain system which is essential for safe storage of COVID-19 vaccines and delivery of immunization services. The in-charges of the health facilities reported difficulty in estimating requirement of COVID-19 vaccines doses, as 67% of the beneficiaries in Mumbai and Nashik were direct walk-ins. During the assessment 93.3% of the facilities were observed to have adequate availability of COVID-19 vaccines doses, based on the beneficiary registration data for the day. Ministry of Health, Government of India, recommends a trained 5-member vaccination team for providing services at each vaccination site. Conclusion: The key challenges faced by private health facilities during delivery of COVID-19 immunization were associated with differential vaccine pricing, time taken to receive supply of vaccines, difficulties in accurately estimating vaccine demand, multiple record keeping at the facility level and declining vaccine demand. [ABSTRACT FROM AUTHOR]

Background: Coronavirus diesease (COVID-19) led to increased demand on the Indian health system due to the pandemic as well as other communicable and non-communicable diseases. Guidance was thus issued by the Ministry of Health and Family Welfare (MoHFW), India, in April 2020 to maintain the delivery of essential health services. Objectives: To determine the extent of disruptions of essential healthcare services, identify associated factors, and establish pertinent correlations to address specific needs. Methods: The Mother and child tracking facilitation centre (MCTFC) conducted a telephonic survey with the front-line workers (FLWs) and beneficiaries in 21 Indian states. The sample size was determined using the infinite population sample size formula, and respondents were selected through a computer-generated random sequence technique. Data were quantitatively analysed using STATA-16. Descriptive univariate analysis was conducted using the Chi-square test. Findings: The majority of the essential health services were being satisfactorily delivered by FLWs (N = 1596; accredited social health activist (ASHA) = 798, auxiliary nurse midwife (ANM) = 798), where most of the beneficiaries (N = 1410; Pregnant Women = 708, Postnatal Women = 702) continued accessing services with minor issues concerning referral transport. FLWs reported issues in the provisioning of medicines (P = 0.000) for patients with non-communicable diseases and more ANMs than ASHAs reported it. FLWs commonly experienced challenges in extending services due to community resistance and unavailability of general health services at healthcare facilities, where a greater number of ASHAs faced it (P = 0.000). Both FLWs and beneficiaries (N = 3006; FLWs = 1596, beneficiaries = 1410) demonstrated appropriate COVID-19 knowledge and behavior. Conclusion: Although overwhelmed, the Indian health system performed satisfactorily well during pandemic in terms of essential health services. [ABSTRACT FROM AUTHOR]

With the presence of western nations in India, a change started appearing in the medical scenario. The civilians and soldiers had to suffer from many endemic diseases like fever, cholera, plague, small pox etc. prevalent in India and it caused great loss to the new comers. To protect the life and properties and to gain a firm ground in the Indian soil, Europeans established various medical institutions that provided western medical care. In the course of time British got hold of the power in most part of this country. As the administrators were more engaged with the fatal endemic diseases, cutaneous disorders with lower mortality got less importance. Tilbury Fox, a distinguished British physician accompanied the Earl of Hopetoun in a tour to the East and reached India in 1864. Fox noticed the chaotic situation in the systematic study of dermatological disorders. He proposed a scheme to study the proper situation in this country which laid the beginning of systematic study of dermatology in India. Though his study was the steppingstone of Indian dermatology, but Fox got little attention in the history of dermatology in India. This article discusses about a brief overview of the scheme and the contribution of Tilbury fox. [ABSTRACT FROM AUTHOR]

India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Primary data on resources used to provide services in 93 sub-health centres (SHCs) and 38 primary health care centres (PHCs) were obtained from the National Health System Cost Database. The cost of additional infrastructure and human resources was assessed against the normative guidelines of Indian Public Health Standards and the HWC. The cost of other inputs (drugs, consumables, etc.) was determined by undertaking the need estimation based on disease burden or programme guidelines, standard treatment guidelines and extent and pattern of care utilization from nationally representative sample surveys. The financial cost is reported in terms of the annual incremental cost at health facility level, as well as its implications at national level, given the planned scale-up path. Secondly, economic cost is assessed as the total annual as well as annual per capita cost of services at HWC level. Bootstrapping technique was undertaken to estimate 95% confidence intervals for cost estimations. Scaling to CPHC through HWC would require an additional ₹ 721 509 (US$10 178) million allocation of funds for primary healthcare >5 years from 2019 to 2023. The scale-up would imply an addition to Government of India's health budget of 2.5% in 2019 to 12.1% in 2023. Our findings suggest a scale-up cost of 0.15% of gross domestic product (GDP) for full provision of CPHC which compares with current public health spending of 1.28% of GDP and a commitment of 2.5% of GDP by 2025 in the National Health Policy. If a capitation-based payment system was used to pay providers, provision of CPHC would need to be paid at between ₹ 333 (US$4.70) and ₹ 253 (US$3.57) per person covered for SHC and PHC, respectively. [ABSTRACT FROM AUTHOR]

Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions. [ABSTRACT FROM AUTHOR]

The newly emerged public health crisis threatening the world with emergence or spread of a novel coronavirus named SARS - CoV-2 associated with higher infection rates and deaths especially elderly people and people with Hypertension, Diabetes Mellitus, Cerebrovascular and Cardiovascular diseases throughout the world. As of 17thJune 2020, 216 countries were affected with 83,26,825 confirmed cases including 4,48,081 total deaths. India has reported around 3.6 lakh confirmed cases with more than 12 thousand total deaths. To respond this pandemic, India needs to set-up an adequate, well equipped and dedicated health care facility to contain the spread of infection and manage the infected patients as well as providing protection to the healthcare workers (HCW). Quality management and preventive strategies of a hospital plays very important role for this purpose. Quality management is the fundamental feature of a hospital to establish customer satisfactions and desired outcomes. High quality care health services involve doing the right things, for the right patient, at the right time, in the right way to minimise the harm and resource waste. Preventive strategies especially infrastructure development & Infection prevention and control policies (IPC) are very crucial. The effective, safe, people centred, timely, equitable, integrated and efficient heath care delivery improvement with appropriate quality management system and preventive strategies will be helpful to combat with “COVID-19”. This study highlights the “Quality management and Preventive Strategies of a Hospital responding to COVID-19” for providing better healthcare services in Indian healthcare management system. [ABSTRACT FROM AUTHOR]

Objectives: The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions. Methods: This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment. Results: A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. Conclusion: Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases. [ABSTRACT FROM AUTHOR]

Background: In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India's guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country's primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India.Method: The data for this study were collected in 2016-2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization.Result: Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider's adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures.Conclusion: The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention. [ABSTRACT FROM AUTHOR]

Health is a state of wellbeing both physically as well as mentally. It is basic human right to seek access to affordable healthcare. Universal healthcare essentially means equity in access to quality of healthcare without putting financial hardship. It is government which steer the goal of Universal healthcare towards realisation through various available means. Our constitution also calls for affirmative action by State to provide for good health of the subjects. We in India have inherited rich traditional medicine system of Ayurveda as well as Yoga. Modern medicine was introduced by Europeans and today India has robust modern medicine infrastructure and trained manpower. The public system of healthcare in India consists of Primary level healthcare which includes Sub centres and Primary health centres, Secondary Level and Tertiary Healthcare. The sub centres, primary health centres and community health centres are mostly to serve the rural India at local level. The government initiated healthcare services focussing on reproductive and child care as well as communicable diseases like vector borne diseases, tuberculosis, leprosy and HIV/AIDS. With time, India witnessed epidemiological transition from communicable diseases to non-communicable diseases like cardiovascular disease, diabetes, accidental deaths and disabilities. The burden of disease shifted more ton on-communicable diseases for which public health system failed to address due to its inherent focus and design to tackle reproductive and child care and various communicable diseases. Private sector developed at much faster rate to fill this service gap but it concentrated more in urban and big towns. The costly private healthcare due to lack of public healthcare facilities and erosion in quality, lack of insurance coverage led to self- financing of health care expenditures. The out of pocket expenses formed major share of health expenditure pushing millions of people into poverty. With formulation of New Health Policy 2017, Ayushman Bharat Scheme was envisaged and started implementing from Sep 2018. It consists of two parts: Health and Wellness Centres to provide comprehensive primary healthcare to all citizens by transforming existing sub-centres and PHCS and Pradhan Mantri-Jan ArogyaYojana (PMJAY) to provide five lakh financial protection to economically vulnerable 10.74 Crore families, as per latest social and economic caste census for seeking secondary and tertiary care at public and private empanelled hospitals. There is no limit on family size, almost all diseases are covered which are divided into more than 1350 packages, no exclusion of pre-existing diseases and free care includes medicines, procedures and diagnostics. The health and wellness centres will be equipped to provide existing healthcare services as well as basic healthcare for non-communicable diseases, geriatric care and availability of essential medicines. National Health Authority is responsible for guiding the implementation of Ayushman Bharat in alliance with states. With the level of healthcare provided under Ayushman Bharat at no cost to beneficiaries, is path breaking initiative by government in direction of universal health care. [ABSTRACT FROM AUTHOR]

Introduction: India has a plurality of health care with different systems of medicine delivered by government and local bodies in hospitals and clinics. Public hospitals provide 60% of all hospitalizations, while the private sector provides 75% of all routine care. Utilization is the actual attendance by the members of the public at health care facilities, which measures the number of visits per year or the number of people with at least one visit during the previous year, serves as an important tool and acts as a guiding path in understanding disease profile and also helps resource allocation. Materials and Methods: A cross-sectional study was done using the National Pathfinder survey (stratified cluster random sampling) to know the health care utilization, profile, and pattern in Tenali Mandal, Guntur, Andhra Pradesh. Results: The study sample comprised of 1,500 subjects who were equally divided among 5 age groups. Out of 1,500 participants, 52.8% were females and 47.2% were males. In total, 71.7% of the study participants have utilized health services, with majority of them (44.5%) had availed services within the last 6 months with prime reason of fevers (15.8%), while the main barrier for not seeking care was distance (17.03%), almost an equal proportion of the population sought care for their problems through home remedies and over-the-counter. Conclusion: There is an utmost need to minimize barriers of utilizing by making them aware of the health problems, so that they develop a positive attitude toward health care utilization. Therefore, knowledge of utilization of health services and associated factors is important in planning and delivery of interventions by the primary care physicians to improve health services coverage. [ABSTRACT FROM AUTHOR]

Background: Low birth weight is an important predictor of maternal and child health. Birth weight is likely to be affected by maternal health, socioeconomic status and quality of health care facilities. Objective: To assess trends in the birth weight, the proportion of low birth weight, maternal factors and health care facilities for delivery in villages of Western Maharashtra from the year 2004 to 2016 and to analyze factors associated with low birth weight for total birth data of 2004–2016. Methods: Data collected for 19244 births from 22 villages in Vadu Health and Demographic Surveillance System (HDSS), Pune, Maharashtra, India from the year 2004 to 2016 were used for this analysis. Results: There was an overall increase in the annual mean birth weight from 2640.12 gram [95% CI 2602.21–2686.84] in the year 2004 to 2781.19 gram [95% CI 2749.49–2797.95] in the year 2016. There was no secular trend to show increase or decrease in the proportion of low weight at birth. Increasing maternal age (>18 years) compounded with better education, reduced parity and increasing number of institutional deliveries were significant trends observed during the past decade. Low birth weight was found to be associated with female gender, first birth order, poor maternal education and occupation as cultivation. Conclusion: Changes in maternal age, education, occupation, and increased institutionalized deliveries contributed in to increasing birth weights in rural Maharashtra. Female gender, first birth order, poor maternal education and occupation of cultivation are associated with increased risk of low birth weight. [ABSTRACT FROM AUTHOR]

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]

Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. Results: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in <42% at DHs and 8% at CHCs. Diagnostic laparoscopy and hysteroscopy were available in 25% and 8% of DHs, respectively. Ovulation induction with clomiphene was practiced at 83% and with gonadotropins at 33% of DHs. Conclusion: The district health infrastructure in India has a potential to provide basic services for infertility. With some policy decisions, resource inputs and capacity strengthening, it is possible to provide advanced services for infertility in the district health system. [ABSTRACT FROM AUTHOR]

Background: In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.Methods: This was a retrospective cohort study of multiparous eligible women (after excluding abortions and births at public facility). A structured questionnaire was administered by trained research assistant to those with recent delivery between Jan and Jul 2013. Outcome of interest was CY utilization in subsequent child birth (Jan-Jul 2013). Explanatory variables included socio-demographic characteristics (including category of eligibility), pregnancy related characteristics in previous child birth, before Jan 2013, (including CY utilization, out of pocket expenditure) and type of child birth in subsequent birth. A poisson regression model was used to assess the association of factors with CY utilization in subsequent child birth.Results: Of 997 multiparous eligible women, 289 (29%) utilized and 708 (71%) did not utilize CY in their previous child birth. Of those who utilized CY (n = 289), 182 (63%) subsequently utilized CY and 33 (11%) gave birth at home; whereas those who did not utilize CY (n = 708) had four times higher risk (40% vs. 11%) of subsequent child birth at home. In multivariable models, previous utilization of the scheme was significantly associated with subsequent utilization (adjusted Relative Risk (aRR): 2.7; 95% CI: 2.2-3.3), however previous out of pocket expenditure was not found to be associated with retention in the CY scheme.Conclusion: Women with previous CY utilization were largely retained; therefore, steps to increase uptake of CY are expected to increase retention of mothers within CY in their subsequent child birth. To understand the reasons for subsequent child birth at home despite previous CY utilization and previous zero/minimal out of pocket expenditure, future research in the form of systematic qualitative enquiry is recommended. [ABSTRACT FROM AUTHOR]

Introduction: For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC) of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, one very very important person observation area, one perioperative management cubicle, and one fully modular and integrated operating room. Objective: The objective of this study was to calculate the cost of disaster facility at JPNATC, All India Institute of Medical Sciences, New Delhi. Methodology: Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of these services by this facility. Results: The annual cost of providing services at disaster facility at JPNATC, New Delhi, was calculated to be INR 61,007,334.08 (US$ 983,989.258) while the per hour cost was calculated to be INR 7061.03 of the total cost toward the provisioning of services by disaster facility where 26% was the capital cost and 74% was the operating cost. Human resource caters to maximum chunk of the expenditures (47%). Conclusion: The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 62 in the year 2013). [ABSTRACT FROM AUTHOR]

Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making. [ABSTRACT FROM AUTHOR]

The article describes the implementation of a mobile-clinic based diabetes screening program from India. A significant number of people with diabetes remain undiagnosed because of a lack of awareness and access to health care facilities. A Mobile Diabetes Clinic (MDC) was established to provide basic diabetes screening to the underprivileged rural population with the help of Accredited Social Health Activists (ASHAs).

Introduction: Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. Aim: To assess the quality of FPS services by audit of case records at selected health care facilities. Materials and Methods: This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results: Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Conclusion: Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care. [ABSTRACT FROM AUTHOR]

The article discusses the paper by author on policy and programmes for mental health in Kerala, India, presented at IndoSwiss Symposium on Cohorts and Biobanks (ISSCB) held in Trivandrum, India from January 27-28, 2012. It mentions the challenges for lack of professional manpower faced by mental health care facilities and the National mental health programme that aims to assure mental health care for all. It adds the district-based suicide prevention programme.

According to census report, India's urban population is expected to rise to 182 million by 2026. The unprecedented growth in the population poses challenges for the government in providing basic services in urban areas. Rapid urbanization and tourism has resulted into growth of many congested and slum-like areas in different parts of Gangtok town. Objective: To study health seeking behavior of residents of underprivileged areas of Gangtok. Methodology: The present study was a descriptive study. A total of 136 households were included in the study, which were selected by stratified random sampling. The predesigned, field tested instruments were used for data collection. The information was obtained by conducting household survey, interviewing the eligible woman in the reproductive age group and / or head of the family. Results: The total population from 136 houses was 608.average family size was 4.47. 18 % of the households had monthly income more than Rs. 5000/-For the management of common ailments, 28 per cent households used Government health facilities, where as 35.6% and 35.2 % services used were from chemist and local healers respectively. 81.6% of households used government facility for Obstetric & Gynecological reasons. Only 91.3% of females utilized health services during antenatal period. Maximum number of deliveries took place at government health facility (67.7 %). 50.8% of households informed that delivery was conducted by the government doctor. 84.1% of the households utilized government health facilities for family welfare services. Conclusion: The government health services were maximally used for gynecological problems, health issues during pregnancy, for child birth, family welfare, neonatal and childhood illnesses. For management of common illnesses, private chemists and local healers played a significant role as a source of health advice. The utilization of health facilities in private sector was very low. [ABSTRACT FROM AUTHOR]

The article presents a study on high rates of adherence and treatment success in a public and public-private HIV clinic in India. Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. The study showed that adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities.

The public Indian health care system is plagued by high staff absence, low effort by providers. and limited use by potential beneficiaries who prefer private alternatives. This article reports the results of an experiment carried out with a district administration and a nongovernmental organization (NGO). The presence of government nurses in government public health facilities (subcenters and aid-posts) was recorded by the NGO, and the government took steps to punish the worst delinquents. Initially, the monitoring system was extremely effective. This shows that nurses are responsive to financial incentives. But after a few months, the local health administration appears to have undermined the scheme from the inside by letting the nurses claim an increasing number of "exempt days." Eighteen months alter its inception, the program had become completely ineffective. [ABSTRACT FROM AUTHOR]

Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services. Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews. Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly. Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability. [ABSTRACT FROM AUTHOR]

Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns and villages coexist, with variety of health care facilities and almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centres and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems. Although injury is a major public- health problem, the government, medical fraternity and the society are yet to recognize it as a growing challenge. [ABSTRACT FROM AUTHOR]