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This paper aims to demonstrate the implications of health mobility on language practices in the medical tourism industry in India and on the ways, language workers become entrepreneurs. Drawing from ethnographic fieldwork that traces the trajectories of three former students of Russian, we highlight their future aspirations as language learners and entrepreneurs and show, how they attempt to capitalize on language skills and respond to changing conditions and patient movements within the structures, constraints and uncertainties of the linguistic market. Here, it is our aim to illustrate what it takes to become an enterprising and successful language worker and at the same time highlight their current positioning as emblematic yet subordinate figures within a fast-growing service industry in an emerging economy. We further demonstrate, how language skills not only become commodities to serve existing or future markets, but instead are recast as tools that can be strategically employed to secure recognition and access to prestigious and lucrative professional networks. In doing so, this paper illustrates how linguistic value is produced in a service industry that to date only received little attention in sociolinguistic research.

In order to make the existing MBBS curriculum more effective as per the health care needs of the nation, Medical Council of India (MCI) has taken a bold step by proposing new teaching-learning approaches including a structured longitudinal programme on attitude, ethics and communication, which is named as the Attitude, Ethics and Communication Module (AETCOM). AETCOM which is a case-based module offers a framework of competency-based learning in the AETCOM domains that a medical professional must possess at the time of graduation to effectively fulfill the functions of an Indian Medical Graduate. Before implementing the AETCOM, the MCI introduced a mandatory training for the faculty of medical colleges through its nodal and regional centres. The authors of this paper analysed the open-ended feedback received from the participants participated in the nine AETCOM sensitisation workshops conducted in a tertiary care teaching hospital which is also an MCI Regional Centre for conducting faculty development programmes. The feedback from the faculty participants of AETCOM were compiled and analysed for better understanding of their concerns regarding AETCOM. Based on these compilations, the authors have discussed about the organisation of AETCOM module and the anticipated challenges as perceived by the faculty participants with suggested measures for encountering the challenges in transacting the module at undergraduate level under selected headings.

Purpose: The level of mother's health knowledge influences not only her health, but also significantly predicts her children's health and medical care, and spending on medical care. This relationship has not yet been empirically assessed in India. The purpose of this paper is to measure the level of health knowledge of mothers in India and its association with the short-term illness in their children, medical care and medical care expenditure. Design/Methodology/ Approach: The authors used data from India Human Development Survey, 2004-2005. An index of "health knowledge" was constructed by using factor analysis. Multivariate binary logistic regression, multinomial logistic regression and multiple classification analysis were employed to analyze the relationship between mother's health knowledge and child illness. Pearson's ?2 test and ANOVA test were used to estimate levels of statistical significance in bivariate analyses. Findings: The results revealed that children of mothers with medium and high-health knowledge were significantly less likely to have short-term illness (OR = 0.390, p <0.01 and OR = 0.543, p <0.01) than those children whose mothers had no or low-health knowledge (OR = 1.00, p <0.01) cutting across all background characteristics. Similarly, the attainment of modern medical care for short-term illness of children was nearly two times greater (OR = 1.97, p <0.05) in mothers with higher health knowledge as compared to mothers with no or low-health knowledge (OR = 1.00, p <0.01). The results also showed that mothers with higher health knowledge spent more on medical care for their children's short-term illness than mothers with no and low-health knowledge. Practical Implications: The findings suggested a significant effect of mother's health knowledge on the prevalence of short-term illness among their children, medical care and expenditure on the medical care. Appropriate health knowledge for women is crucial to the wellbeing of their children. Besides, social equity in terms of the distribution of facilities, to gain health knowledge and medical care, are essential to be established in India. Originality/Value: To the knowledge, this study is the first attempt to measure the health knowledge of women in reproductive age and its association with the prevalence of short-term illness, medical care and medical expenditure of their children in India. In general, a health knowledge index could be a significant composite predictor of the health in a population.

This paper presents the results of a referendum-style contingent valuation survey conducted in one of the richest milking states of India. 200 households were surveyed to study the farmer’s preferences and choices for the health, breeding and insurance services. The objective of the survey was to assess the preference structure and the willingness of poor farmers to pay for veterinary health and insurance services. It is a comparative study between the existing situation and improved situation, that how the willingness to pay (WTP) will change if the quality of the health, breeding and insurance services will improve. The results show that farmers are willing to pay for assured access to veterinary services. Majority of the households value these services tremendously and are not looking for subsidies provided by the government institutions. It was noticed that farmer’s willingness to pay was much higher than the amount government institutions were presently charging for improved livestock support services, e.g. health and AI services. Though the coverage of Livestock insurance was low but it was found that farmers were ready to pay high amount of premium charges if the insurance services are easily available to the farmer’s door step with very less paper work and other formalities. Combining the findings of this survey with other closely related studies and the changing structure the input and output markets for livestock sector, the paper suggests specific policy measures to more effectively meet the expanding livestock services needs of poor livestock farmers. [ABSTRACT FROM AUTHOR]

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

Introduction: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Government of India to become a strategic purchaser of health care services from private providers. To generate base cost evidence for evidence-based policymaking the Costing of Health Services in India (CHSI) study was commissioned in 2018 for the price setting of health benefit packages. This paper reports the findings of a process evaluation of the cost data collection in the private hospitals., Methods: The process evaluation of health system costing in private hospitals was an exploratory survey with mixed methods (quantitative and qualitative). We used three approaches-an online survey using a semi-structured questionnaire, in-depth interviews, and a review of monitoring data. The process of data collection was assessed in terms of time taken for different aspects, resources used, level and nature of difficulty encountered, challenges and solutions., Results: The mean time taken for data collection in a private hospital was 9.31 (± 1.0) person months including time for obtaining permissions, actual data collection and entry, and addressing queries for data completeness and quality. The longest time was taken to collect data on human resources (30%), while it took the least time for collecting information on building and space (5%). On a scale of 1 (lowest) to 10 (highest) difficulty levels, the data on human resources was the most difficult to collect. This included data on salaries (8), time allocation (5.5) and leaves (5)., Discussion: Cost data from private hospitals is crucial for mixed health systems. Developing formal mechanisms of cost accounting data and data sharing as pre-requisites for empanelment under a national insurance scheme can significantly ease the process of cost data collection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this paper, we study the incidence of COVID-19 and the associated fatality with altitude using high frequency, district level data from India. To understand the implications of the nationwide lockdown after the outbreak, we use data for about four months- two from the lockdown period starting from March 25 till May 31, 2020 and about two months after unlocking was initiated (June 1-July 26, 2020). The multivariate regression result indicates slower growth in average rate of infection during the lockdown period in hilly regions, the gains of which attenuated after the unlocking was initiated. Despite these early gains, the rate of fatalities is significantly higher during the lockdown period in comparison to the plains. The findings remain robust to multiple alternative specifications and methods including one that accounts for confounding possibilities via unobservable and provides consistent estimates of bias adjusted treatment effects. The evidence supports the need for provisioning of public health services and infrastructure upgradation, especially maintenance of adequate stock of life support devices, in high altitude regions. It also underscores the necessity for strengthening and revising the existing Hill Areas Development Programme and integrating important aspects of public health as part of this policy. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a broad overview of welfare schemes in India and their impact on social protection during a period of high economic growth. It summarizes India's performance with respect to select economic and social indicators relative to select low and middle-income countries in the Asia Pacific region. It further overviews trends in some key select economic and social indicators for India and discusses India's attainment in Social Protection relative to an index of such protection provided by the Asian Development Bank. Design/methodology/approach – This paper uses a comparative statistical approach and evaluates India's performance in key social welfare areas vis-à-vis that of countries with economic performance comparable to that of India. It also evaluates India's progress along these parameters over time. Findings – The basic messages of this paper are: first, compared to low and middle-income countries in the Asia Pacific India's economic performance has outstripped its performance in social and welfare indicators. Second, nevertheless India is spending less on social welfare programs and other welfare schemes than many countries in the Asia Pacific, including some of those whose economic performance has been less impressive than India's. Third, the efficiency and effectiveness of key welfare programs in India need to be substantially improved. Particular attention needs to be paid to female participation in and their access to social welfare programs. Originality/value – Informed analyses of social sector spending in India and their impact on welfare outcomes are relatively scarce although descriptive studies of social sector spending and welfare schemes abound. This paper attempts to fill this gap with a cross-country as well as intertemporal analysis of India's performance in these key areas. [ABSTRACT FROM AUTHOR]

Background: A national study, 'Costing of healthcare services in India' (CHSI) aimed at generating reliable healthcare cost estimates for health technology assessment and price-setting is being undertaken in India. CHSI sampled 52 public and 40 private hospitals in 13 states and used a mixed micro-costing approach. This paper aims to outline the process, challenges and critical lessons of cost data collection to feed methodological and quality improvement of data collection., Methods: An exploratory survey with 3 components-an online semi-structured questionnaire, group discussion and review of monitoring data, was conducted amongst CHSI data collection teams. There were qualitative and quantitative components. Difficulty in obtaining individual data was rated on a Likert scale., Results: Mean time taken to complete cost data collection in one department/speciality was 7.86(±0.51) months, majority of which was spent on data entry and data issues resolution. Data collection was most difficult for determination of equipment usage (mean difficulty score 6.59±0.52), consumables prices (6.09±0.58), equipment price(6.05±0.72), and furniture price(5.64±0.68). Human resources, drugs & consumables contributed to 78% of total cost and 31% of data collection time. However, furniture, overheads and equipment consumed 51% of time contributing only 9% of total cost. Seeking multiple permissions, absence of electronic records, multiple sources of data were key challenges causing delays., Conclusions: Micro-costing is time and resource intensive. Addressing key issues prior to data collection would ease the process of data collection, improve quality of estimates and aid priority setting. Electronic health records and availability of national cost data base would facilitate conducting costing studies., Competing Interests: The authors have declared that no competing interests exist.

This paper is an attempt to find out inter-relationships between customer's perception and customer satisfaction. The purpose of this paper is to find out the patient's satisfaction in private healthcare. A total of 100 participants were selected randomly those visit private hospitals in Raipur city for healthcare facility. This paper reviews and identifies essential service quality that is related with the customer satisfaction in the private hospitals of Raipur city. Customer satisfaction is supposed to imitate the need of healthcare quality demand by the customers, as straight and not direct associations exist between personnel support and customer satisfaction and concentration on customers and hospital amenities and between hospital amenities and customer satisfaction. The most important involvement of this study is that, it proposes a way to evaluate excellent services in the private hospitals. [ABSTRACT FROM AUTHOR]

Background: Poor Maternal and Child Health (MCH) outcomes pose challenges to India's ability to attain Goal-3 of the Sustainable Development Goals (SDGs). The government of India strengthened the existing network of frontline health workers (FHWs), under its National Rural Health Mission in 2005 and subsequent National Urban Health Mission in 2013 as a strategy to mitigate the shortage of skilled health workers and to provide affordable healthcare services. However, there is a lack of robust national-level empirical analysis on the role of maternal engagement with FHWs in influencing the level of maternal and child health care utilisation and child health outcomes in India.Methods: Using data from the nationally representative Indian National Family Health Survey (NFHS) 2015-2016, this paper aims to investigate the intensity of engagement of FHWs with married women of child-bearing age (15-49 years), its influence on utilisation of maternal and child healthcare services, and child health outcomes. Our empirical analyses use multivariate regression analyses, focusing on five maternal and child health indicators: antenatal care visits (ANC) (4 or > 4 times), institutional delivery, full-immunisation of children, postnatal care (PNC) (within 2 days of delivery), and child survival.Results: Our analysis finds that maternal engagement with FHWs is statistically significant and a positive predictor of maternal and child health care utilisation, and child survival. Further, the level of engagement with FHWs is particularly important for women from economically poor households. Our robustness checks across sub-samples of women who delivered only in public health institutions and those from rural areas provides an additional confidence in our main results.Conclusions: From a policy perspective, our findings highlight that strengthening the network of FHWs in the areas where they are in shortage which can help in further improving the utilisation of maternal and child healthcare services, and health outcomes. Also, the role of FHWs in the government health system needs to be enhanced by improving skills, working environment, and greater financial incentives. [ABSTRACT FROM AUTHOR]

Background: Health service and health outcome data collection across many low- and middle-income countries (LMICs) is, to date largely paper-based. With the development and increased availability of reliable technology, electronic tablets could be used for electronic data collection in such settings. This paper describes our experiences with implementing electronic data collection methods, using electronic tablets, across different settings in four LMICs., Methods: Within our research centre, the use of electronic data collection using electronic tablets was piloted during a healthcare facility assessment study in Ghana. After further development, we then used electronic data collection in a multi-country, cross-sectional study to measure ill-health in women during and after pregnancy, in India, Kenya and Pakistan. All data was transferred electronically to a central research team in the UK where it was processed, cleaned, analysed and stored., Results: The healthcare facility assessment study in Ghana demonstrated the feasibility and acceptability to healthcare providers of using electronic tablets to collect data from seven healthcare facilities. In the maternal morbidity study, electronic data collection proved to be an effective way for healthcare providers to document over 400 maternal health variables, in 8530 women during and after pregnancy in India, Kenya and Pakistan., Conclusions: Electronic data collection provides an effective platform which can be used successfully to collect data from healthcare facility registers and from patients during health consultations; and to transfer large quantities of data. To ensure successful electronic data collection and transfer between settings, we recommend that close attention is paid to study design, data collection, tool design, local internet access and device security.

Background: The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening., Methods: This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams' experiences along four potential uses of ToCs, namely planning, communication, learning and accountability., Results: The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams' experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams' initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes., Conclusions: The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

Introduction: In recent years, social media use has been increased by healthcare professionals (HCPs) in their healthcare practice and it has emerged as a new platform for disseminationof knowledge, information exchange, and interpersonal communication. Aim: This study was conducted with an aim to assess the use of social media in dental practice among dental practitioners in India. Materials and Methods: This cross-sectional survey was conducted from October 2019 to March 2020 at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India by implementing a 15-item questionnaire to 36218 dental practitioners in India registered with Indian Dental Association through an Electronic Survey Application. The questionnaire consisted of a section on demographic details of the participants which included their age, gender, type and number of years of practice. Second section consisted of items about the use of social media in dental practice and one open ended question on the topic. Data was analyzed using descriptive statistics and comparisons were made using a chi-square test. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Level of significance was kept at 5%. results: A total of 3180 dentists responded and returned the filled questionnaire. Social media was used by 1980 (62.3%) of dentists in their practice and the most commonly used platform was WhatsApp 1650 (83.3% of social media users). Most common reason for using social media in dental practice was for learning new things related to dentistry and staying updated 1470 (74.2%) followed by participation into discussion related to dentistry 1170 (59.1%). Dentists younger than 45 years (p=0.002), dentists with practice of less than 10 years (p<0.001), dentists with specialty practice (p<0.001) and dentists having practice website (p<0.001) were more likely to use social media in their dental practice. conclusion: Dental practitioners are actively incorporating social media in their practice and non-users also showed interest in incorporating social media into their practice in near future albeit some of them were lacking in the knowledge of the same. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore prisoner dental health in Haryana, India. Design/methodology/approach – The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana. Findings – The mean age of 1,393 subjects examined was 35.26±12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications – Long-standing prisoner dental problems indicated a need for dental treatment in prisons. Originality/value – This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to provide systematic empirical evidence on the health planning through Village Health Sanitation and Nutrition Committees (VHSNCs) in India. Design/methodology/approach - A micro-level study was carried out using qualitative study design. Data were collected through in-depth interviews with 105 respondents selected from 42 VHSNC sites. A thematic analytical framework approach was used to analyse the data. Findings - The research results indicate that VHSNCs are playing a significant role in health planning. However, the committee meetings are not organised by the committee members on the regular basis. Most of the VHSNC members do not make village health plans. There are some challenges associated with the functioning of VHSNCs like insufficient resources, lack of people's interest, insignificant attention and the unfair behaviour of the Panchayati Raj leaders. Practical implications - The implications of the findings suggest that VHSNCs play a significant role in health planning. However, the leadership is ineffective due to their partial capabilities and approach that generate non-conducive environment. Studies of such nature will be helpful for policy makers in understanding the current situation and micro-level picture of VHSNC and also in analysing it in the existing health system. Originality/value - VHSNC functions with a broader concern and cover range of social determinants at the village level. This study provides empirical evidence on the VHSNCs as lowest part of the health system. [ABSTRACT FROM AUTHOR]

Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana ('a scheme for solution'), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana. Methods: A descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process. Results: Forty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a "Below Poverty Line" card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation. Conclusions: Yukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India. [ABSTRACT FROM AUTHOR]

Background: Governing immunization services in a way that achieves and maintains desired population coverage levels is complex as it involves interactions of multiple actors and contexts. In one of the Indian states, Kerala, after routine immunization had reached high coverage in the late 1990s, it started to decline in some of the districts. This paper describes an application of complex adaptive systems theory and methods to understand and explain the phenomena underlying unexpected changes in vaccination coverage., Methods: We used qualitative methods to explore the factors underlying changes in vaccination coverage in two districts in Kerala, one with high and one with low coverage. Content analysis was guided by features inherent to complex adaptive systems such as phase transitions, feedback, path dependence, and self-organization. Causal loop diagrams were developed to depict the interactions among actors and critical events that influenced the changes in vaccination coverage., Results: We identified various complex adaptive system phenomena that influenced the change in vaccination coverage levels in the two districts. Phase transition describes how initial acceptability to vaccination is replaced by a resistance in northern Kerala, which involved new actors; actors attempting to regain acceptability and others who countered it created several feedback loops. We also describe how the authorities have responded to declining immunization coverage and its impact on vaccine acceptability in the context of certain highly connected actors playing disproportionate influence over household vaccination decisions.Theoretical exposition of our findings reveals the important role of trust in health workers and institutions that shape the interactions of actors leading to complex adaptive system phenomena., Conclusions: As illustrated in this study, a complex adaptive system lens helps to uncover the 'real' drivers for change. This approach assists researchers and decision makers to systematically explore the driving forces and factors in each setting and develop appropriate and timely strategies to address them. The study calls for greater consideration of dynamics of vaccine acceptability while formulating immunization policies and program strategies. The analytical approaches adopted in this study are not only applicable to immunization or Kerala but to all complex interventions, health systems problems, and contexts.

This paper presents key findings from the first major study of the provision of infertility services to South Asian communities in the UK. The research aimed to explore the social meanings of infertility and to examine the experiences of couples receiving fertility treatment. Focus groups with people from Pakistani, Bangladeshi and Indian communities (n = 93) revealed a strongly pro-natalist ideology and a relatively limited knowledge of infertility and treatments. Interviews with 50 participants from the same communities revealed a general satisfaction with secondary level infertility services. However, a minority felt inadequately informed about their condition, tests undertaken and treatment options; only one-third were given any written information about treatment; many were concerned about delays and waiting times; a minority felt that staff could be more sympathetic in their response to 'failed' treatment and several couples suggested that additional emotional support would be helpful. No information or resources were available in any South Asian language and the arrangements for communication support for non-English speakers were generally less than adequate. There was little evidence of the use of data on ethnic or religious background in infertility clinics. Recommendations for policy and practice are proposed.

Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalisation of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women's access to safe abortion care.

Purpose -- The purpose of this paper is to describe the successful implementation of low cost connected healthcare technologies in developing countries. Design/methodology/approach -- The study has considered the current models of telehealthcare being employed in Western Countries, and how other models of remote access may be relevant to countries in Africa and in the Indian sub-continent. Findings -- The work has demonstrated the significant potential of m-healthcare services for delivering successful outcomes using basic handsets and text messaging. Research limitations/implications -- The technology is changing rapidly, so the field should be reviewed on a regular basis. Practical implications -- This implies that more advanced mcare services using peripheral sensors, smart phones and bespoke "apps" may quickly result in healthcare services being offered to millions of patients who might otherwise have no access to primary care physicians. Social implications -- Rural isolation and loss of access to healthcare should be consigned to history. Originality/value -- This case study is original in that it looks at the successful implementation of low cost connected healthcare technologies in developing countries. [ABSTRACT FROM AUTHOR]

Purpose--The purpose of this study is to develop a performance measurement model for service operations using the analytic hierarchy process approach. Design/methodology/approach--The study reviews current relevant literature on performance measurement and develops a model for performance measurement. The model is then applied to the intensive care units (ICUs) of three different hospitals in developing nations. Six focus group discussions were undertaken, involving experts from the specific area under investigation, in order to develop an understandable performance measurement model that was both quantitative and hierarchical. Findings--A combination of outcome, structure and process-based factors were used as a foundation for the model. The analyses of the links between them were used to reveal the relative importance of each and their associated sub factors. It was considered to be an effective quantitative tool by the stakeholders. Research limitations/implications--This research only applies the model to ICUs in healthcare services. Practical limitations--Performance measurement is an important area within the operations management field. Although numerous models are routinely being deployed both in practice and research, there is always room for improvement. The present study proposed a hierarchical quantitative approach, which considers both subjective and objective perforamnce critera. Originality/value--This paper develops a hierarchical quantitative model for service performance measurement. It considers success factors with respect to outcomes, structure and processes with the involvement of the concerned stakeholders based upon the analytic hierarchy process approach. The unique model is applied to the ICUs of hospitals in order to demonstrate its effectiveness. The unique application provides a comparative international study of service performance measurement in ICUs of hospitals in three different countries. [ABSTRACT FROM AUTHOR]

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

This study investigates disparities in healthcare services in the districts of Uttar Pradesh, the most populous and one of the poorest states of India in the health sector. To measure the disparities in healthcare services, a composite index has been computed using Principal Component Analysis in three domains namely, health availability, health amenities and health affordability and 12 representative indicators. On the basis of the results, districts have been clubbed into five categories, such as high, high-medium, medium, medium–low and low according to their composite scores. The study also uses k-means cluster analysis to find out the set of districts which are similar within the group, but they are different between the groups. Key results indicate that the districts of the western region are more developed in comparison to the districts of the eastern region in terms of three indices such as availability, amenities, affordability of healthcare services and overall composite health index. Also, k-means cluster analysis shows that there are many districts which are identical in many respects; however, they are located in different regions of the state. This study may be helpful to understand the poor availability and affordability of healthcare services in the districts of Uttar Pradesh, which should be improved to meet the objectives of the basic-needs approach and the millennium development goals. [ABSTRACT FROM AUTHOR]

Background: To make informed decisions on fertility treatment, couples need to understand the treatment options available to them. A wide range of treatment options is available from the traditional and biomedical service providers in India. There is a dearth of research to find out factors that influence the treatment-seeking behavior of couples, particularly in rural areas. Objectives: The study aimed to document the treatment-seeking behavior of women for their infertility problems. Further, the research focused on the socio-economic determinants aecting allopathic treatment-seeking of women and the services needed for couples experiencing infertility in rural India. Methods: The study is cross-sectional. Primary data were collected from the two high infertility prevalence districts. Complete mapping and listing were carried out to identify the eligible respondents. A total of 159 ever-married women (20–49 years) out of 172 identified women were interviewed. Bivariate and multivariate analyses were performed. Results: Among 159 interviewed women, only three did not seek any kind of treatment. Of the 156 women, 63, 65, and 28 women (mutually exclusive) received first, second and third-order treatment, respectively. The number of women decreased in the succeeding phases of infertility. Women aged above 35 years, were significantly less (OR = 0.310, p < 0.05) compared to women aged below 30 years to receive allopathic treatment. The use of allopathic treatment was significantly three times higher among women who were educated (OR = 3.712, p < 0.01) and two times higher among those who were exposed (OR = 2.217, p < 0.5) to media. Further, for those who had felt the treatment was necessary, about 30, 44, 10, and 19% mentioned that due to unaordability, inaccessibility, or inconveniences they couldn’t consult allopathic treatment. Conclusions: Timely diagnosis and appropriate treatment play important role in infertility management. Women who are more educated and are exposed to media tend to consult allopathic treatment. Similarly, time and money spent on care vary significantly and independently by type of treatment and socioeconomic factors. There is a need for mandatory insurance coverage for infertility treatment enacted by the state government. In addition to public services, the private sector and the traditional healers are both important alternative sources of first help. [ABSTRACT FROM AUTHOR]

Telemedicine is one of the important developments in recent years. Its use is rapidly growing throughout the world including in India. Telemedicine is the use of Computing and particularly telecommunication and information systems for better clinical services and distance based medical services. It is one of the important tools for patients living in isolated communities and remote regions, who can receive care from doctors or specialists from faraway places without the patient having to travel to visit them. Computing and IT is an important tool for promotion of healthy medical and health services; cloud computing is an important name for much wider Tele-heath service. This paper is about Telemedicine; its need and growth powered by computing and cloud systems. [ABSTRACT FROM AUTHOR]

A survey of perceived morbidity was carried out in rural population in eight villages and four wards of Saoner town, covering a total population of 8,876. The nature of illness was assessed by weekly visits to the families. History regarding treatment taken for disease and its source was taken. The overall incidence of perceived morbidity was 176.35 spells of sickness per 1000 population per month. Health care agency was contacted for 36.7 per cent spells of sickness. Utilisation of health services was found to be affected significantly by factors like age (chi 2 = 138.36), literacy (chi 2 = 14.123), type of occupation (chi 2 = 433.74), nature of illness (chi 2 = 83.578) and accessibility of health services. A health behaviour model of the population has also been discussed in this paper.

Summary: Mental and neurological disorders (MNDs) account for a large, and growing, burden of disease in low- and middle-income countries. Most people do not have access to even basic health care for these disorders. Recent evidence shows that task-shifting to non-specialist community health workers is a feasible and effective strategy for delivery of efficacious treatments for specific MND in low-resource settings. New global initiatives, such as the WHO''s mental health Gap Action Program, are utilizing this evidence to devise packages of care for specific MNDs. This paper describes a plan that seeks to integrate the evidence on the treatment of specific MNDs, based on a task-shifting paradigm, for scaling up services for MNDs at the level of a defined population. The plan was developed by a state government in India in collaboration with technical partners, as a model District Mental Health Program for India''s National Mental Health Program. [Copyright &y& Elsevier]

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

Purpose: The authors intend to assess the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India. Design/methodology/approach: The cross-sectional study, conducted in the states of Uttar Pradesh (five districts), Odisha (two districts) and Rajasthan (two districts), used a quantitative research design. The community health workers of 140 VHSNCs were interviewed using a semi-structured questionnaire. The details about the funds' receipt and expenditures were verified from the VHSNC records (cashbook). Additionally, the authors asked about the role of health workers in the VHSNC meetings, and the issues and challenges faced. Findings: The average number of members in VHSNCs varied from 10 in Odisha to 15 in Rajasthan. Activities were regularly organized in Rajasthan and Odisha (one per month) compared to Uttar Pradesh (one every alternate month). Most commonly, health promotion activities, cleanliness drives, community monitoring and facilitation of service providers were done by VHSNCs. Funds were received regularly in Odisha compared to Rajasthan and Uttar Pradesh. Funds were received late and less compared to the demands or needs of VHSNCs. Research limitations/implications: This comprehensive analysis of VHSNCs' functioning in the selected study areas sheds light on the gaps in many components, including the untimely and inadequate receipt of funds, poor documentation of expenditures and involvement of VHSNC heads and inadequate supportive supervision. Originality/value: VHSNCs assessment has been done for improving community health governance. [ABSTRACT FROM AUTHOR]

The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998–1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n=11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access. [Copyright &y& Elsevier]

In the last two decades, India's central and many state governments launched several public health programs with the goal of improving maternal and child health outcomes. Many individual studies assessed the impact of these programs; however, they focused on select health programs and few specific outcomes. This paper summarizes the literature, published during 2000–2019, investigating the impacts of public health programs on both the uptake of maternal and child health services and the related-health outcomes in India. We followed PRISMA guidelines of systematic review, and carried out a narrative synthesis of the study findings. We found 66 relevant studies covering 11 health programs across India. Most studies had applied non-experimental study designs (n = 50), with few applying experimental (n = 1) and quasi-experimental (n = 15) designs. Most studies (n = 64) assessed the impact on the intermediate outcomes of the uptake of various health services rather on the long-term outcomes of improvement in health. Overall we found studies reporting positive impacts, however, we could not find any strong consensus emerging from these studies about the impact, partly due to differences in: outcome indicators; study designs; study population; data sets. Several studies also reported considerable beneficial impacts among low socioeconomic population groups. However, given that the outreach of the public health programs have been low across the country and population groups, we found that broader objectives of health programs remained unassessed: most studies assessed the impact on who actually participated in the program (average treatment effect on-the-treated) rather on the target population (intent-to-treat effect). Furthermore, there was dearth of research on the impacts of the state-level programs. Future research need to assess the impact of the programs on health outcomes, and on quality adjusted measures of maternal and child health services and its continuum of care. • Most studies have focused on the impact on maternal and child health services. • Most studies reported beneficial impact on health services and the health-related outcomes. • Impact on the intended larger target population remains unassessed. [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]

The World Alzheimer's Report estimates that 4.1 million people in India have dementia. Caregivers of persons with dementia face physical, psychological, social and financial problems related to caring for a person with dementia. Literature on the caregiving experience however is highly specific to the sociocultural context and cannot be generalized. In low and middle income countries much of the caregiving takes place in people's homes and is provided by family caregivers. Aim This study aims to explore the needs and challenges of family caregivers in Chennai, India. Method Focus group discussions and in-depth interviews were conducted using a topic guide. Participants were divided based on socio-economic status to ensure homogeneity. An inductive thematic approach was used to analyse and code the data. A total of 19 participants took part in the study. Results The results capture the experience of caregivers of persons with dementia in seeking help and accessing treatment. Priority caregiver needs were identified, including the need for sensitised, skilled health workers, information on dementia and advanced care needs and cost effective services. Conclusion The findings of this study strongly support the need to strengthen health systems capacity, make the health care services dementia friendly and cost effective. The influence of culture in shaping help seeking was evident in our findings. Interventions for caregivers and persons with dementia need to be developed and tested so they might be made fit for purpose and scaled up. It will be important to identify how these services can be adapted for use in low and middle income country resource setting like India. [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: Emergency Neonatal Care (EmNC) is an important service for the health and survival of newborns. The objective of our study was to assess the availability of emergency neonatal care services in the north-eastern region of Karnataka state in India.Methods: We undertook a cross-sectional epidemiologic study in the year 2010. We assessed the provision of eight life-saving 'signal functions' (Comprehensive EmNC) or at least five 'signal functions' (Basic EmNC) by self-reporting through a structured questionnaire, coupled with verification by direct observation for presence of drugs and equipment in the prior three months. The assessment was undertaken in 443 government and 422 private healthcare facilities of eight districts of Karnataka.Results: There was an average of 3.6 EmNC facilities available per 500,000 population for the entire region. Only three out of eight districts and 10 of 42 sub-districts in the region had the recommended [greater than or equal to 5] EmNC facilities per 500,000. Further, over 95 % of CEmNC facilities and 88 % of BEmNC facilities were within the private sector. About 80 % of government hospitals at district and sub-district levels did not have EmNC capability.Conclusions: This study demonstrates the feasibility of using a simple assessment tool to measure health facility availability of life-saving services for newborn care. EmNC availability was seen to be suboptimal at the regional, district and sub-district levels within the northern part of Karnataka state. There is a need to improve availability of emergency newborn care in health facilities, with special emphasis on equity at population level. [ABSTRACT FROM AUTHOR]

There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world's elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries. [ABSTRACT FROM AUTHOR]

Background: The interrelation between health and academic performance is well established. Academic institutions have a larger mandate, beyond academic instruction alone. The objective is to contribute holistically to student development through various paradigms, ultimately culminating in student success. To meet the global challenges of a changing educational system, educational institutions today are therefore vying to be Centers of Excellence, aiming to develop the overall personality of the student. Fundamental to this ideology and with student success as the common denominator, student Wellness assumes critical significance. Higher education institutions, especially universities offer varying levels of healthcare services. Health Promoting University (HPU) projects have therefore been implemented in the West. Unlike in the West, the concept of a Health Promoting University is nascent in India. Methods: A total of 1071 responses to a structured questionnaire administered to the students were studied. Results: In general, there appears to be a lack of awareness regarding the importance of addressing student healthcare issues. Consequently, the spectrum of healthcare services provided is varied and scattered. This encompasses infrastructure, manpower, resource allocation etc. Conclusions: The collective responses obtained could provide the basis for a policy formulation. The policy formulation in turn could be the basis of a national consensus for health care delivery systems operational at higher educational institutions in India. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this study was to understand the different dimensions patients staying in a hospital perceived as important for satisfaction and how those dimensions affected their overall satisfaction levels. Design/methodology/approach – A scale comprising 21 items to measure patient experience in a hospital was developed based on literature review. After purification of the scale, a field survey was administered to patients who were discharged in the recent past from a public or a private hospital in the city. The data collected were analyzed using multivariate techniques. Findings – The data analysis highlighted four important dimensions of patient satisfaction. The four dimensions significantly and positively affected patient’s overall satisfaction level. Research limitations/implications – This research study was conducted in one of the four major metropolitan cities of India. Nonetheless, the study provides valuable insights into the patient satisfaction dimensions in an Indian context and how those dimensions affected patient’s overall satisfaction. Practical implications – Hospitals, in general, can use the study findings to measure and improve their operational performance. Originality/value – This study was not limited to one or few hospitals, but covered many hospitals in one of the four metropolitan cities of India. It provides a comprehensive picture of how many hospitals in the city fared in terms of satisfying their patients. [ABSTRACT FROM AUTHOR]

Objective To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth).Methods Data from Wave 1 of the Study on Global Ageing and Adult Health (2007–2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent’s last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities.Results Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report ‘very good’ on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities.Conclusion Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level. [ABSTRACT FROM PUBLISHER]