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The disease control program is critical to the agenda of social justice. A generalist approach to the disease control program involves understanding its complexity and prevention from various perspectives, including ecological theory. The integration of the disease control program into the existing healthcare delivery system has been advocated over many decades, with an emphasis on the medical model of disease control. Integration has been widely considered as a means to achieve an effective and efficient health system. This approach has been widely adopted in low-middle-income countries to integrate vertical programs such as leprosy, malaria, HIV/AIDs, and others. However, studies suggest that there is a lack of evidence about the effectiveness of health system integration. The available evidence shows that integration of the health system can have a mixed, negative, or no impact on the health system. This growing enthusiasm toward health system integration is primarily based on the perceived benefits of an integrated approach. This discussion paper draws on the experience of the integration of the National Leprosy Elimination Program in India. It highlights the factors that affected the integration of leprosy programs in Bihar and also affected the pursuit of social justice for people who have been marginalized in our modern world. [ABSTRACT FROM AUTHOR]

Telemedicine is increasingly used across the developing world to expand access to healthcare, to improve outcomes, and to reduce costs. One common model is that of telemedicine centers, which are small primary care facilities run by midlevel (nonphysician) providers who conduct a preliminary examination and then facilitate a telemedicine visit with a remote physician in real time. However, the impact of this channel of care delivery—particularly on existing physical healthcare-delivery channels—has not been thoroughly examined. We use data from one of the largest tele-ophthalmology implementations in the world to examine this issue. Using a quasi-experimental difference-in-differences approach, we find that opening a nearby telemedicine center generates a 31% increase in the overall network visit rate from the population within 10 km of the new center, 62% of which is driven by new patients, suggesting a substantial increase in access. The rate of eyeglasses prescriptions to correct for simple refractive errors increases by 18.5%, whereas the rate of cataract surgery to replace the natural lens in a patient's eye with an artificial lens remains unchanged. The increase in access and treatment rates does not significantly impact the direct costs incurred by patients, but reduces their indirect costs (measured as travel distance) by 30% (12 km). Finally, we find significant spatial heterogeneity in these effects, which vary with the distance of patients to facilities. These results have important implications for the design of telemedicine networks and the portfolio of healthcare services provided through them. This paper was accepted by Stefan Scholtes, healthcare management. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2022.4488. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to examine the linkages of employment, chronic disease prevalence and medical care of the older population in India. Design/methodology/approach -- This study used the India Human Development Survey data for the analysis. Bivariate, multinomial logit regression and multiple classification analysis are used as methods for the study Findings -- The findings suggest a bi-directional relationship between employment and chronic diseases: the older population who are engaged in regular paid work has lower likelihood to the risk of chronic diseases compared to those who are not working. Conversely, the older population with chronic diseases may be unable to work in regular paid jobs. The greater proportions of not-working older population with savings and retirement pensions are more likely to seek modern treatment for the chronic diseases. Overall, the results foster that employment determines and is determined by chronic disease prevalence among the older population in India. Originality/value -- This paper tor the first time presents evidence on the linkages of employment, chronic disease prevalence and medical care of the older population in India by using a unique and comprehensive data source. [ABSTRACT FROM AUTHOR]

Background and Objective Healthcare in India is not a primary right, but is only a constitutional obligation of the State which refers only to a State's duty regarding improvement of primary health amongst its other duties.1 Art 39 : Specifies certain principles of policy to be followed by the State (e) That the health and strength of workers, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength; (f) That children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment. Art. 47: Specifies duty of the State to raise the level of nutrition and the standard of living and to improve public health. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purpose of intoxicating drinks and of drugs which are injurious to health. As per WHO's World Health Statistics of 2007, India ranked 184 among 191 countries in terms of public expenditure on health as a percent of GDP. It is surprising to that despite of all advancements and progress made in the last one decade, public spending on health as a percent of GDP in India has stagnated in the past two decades, from 1990-91 to 2009-10, varying from 0.9 to 1.2 percent of GDP. While public spending on healthcare is low, the out of pocket (OOP) expenditure by individuals, contributes majorly to the expenditure on healthcare, 75% Out of Pocket (OOP) spending. 40% of hospitalised are pushed below poverty line or into lifelong debt due to lack of financial planning. In 2007, private spending in India constituted nearly 74 percent of the total spending on health drastically less in comparison to some other countries. Of all the risks facing poor households, health risks pose the greatest threat to their lives and livelihoods. A health shock adds health expenditures to the burden of the poor. Even a minor health shock can cause a major impact on poor persons' ability to work and curtail their earning capacity. Moreover, given the strong link between health and income at low income levels, a health shock usually affects the poor the most. Thus, in a system that gets dominated by outof- pocket expenditures, the poorer pay disproportionately more on health as compared to their earnings than the rich and this leads to a vicious cycle of ill health as access to healthcare is governed by an individual's ability to pay. The other challenge that India faces today, is Demographic Transition with Low Birth Rate & Low Death Rate. The fact here is that the life expectancy of the people is increasing and, as a result, the number of ageing or elderly population too is proportionately increasing. Demographic Transition has further led to an Epidemiological transition characterized, as a shift away from diseases of famine to receding pandemics to an age of generative and manmade diseases. 3 fundamental changes have taken place with the above transition, namely: 1. Mortality decline due to infectious diseases, injuries. and mental illness. 2. Shift of the burden of death and diseases from the younger to the older groups. 3. Change in health profile from one dominated by death to one dominated by morbidity. In such a scenario, Curative Treatment becomes the mantra to ensure better Health Indices. However, with the polarization being on Curative treatment, the Healthcare Costs have escalated with a Medical Inflation Index hovering around 10-12% YoY (year on year), in addition to this, with Medical Advances, the cost of treatment further escalates. Most of the Public Healthcare in India, in the form of centrally funded schemes, focuses on Preventive & Promotive Care not taking into account, Curative Care. Due to defocused effort on the Curative Cure, healthcare in India has currently become one of the most unregulated sectors with expenses increasing disproportionately. Moreover, even in Public Healthcare units, the curative care is not "all free", with one fourth of the expenses being out of pocket. These factors affect the informal sector of the country who are not protected by any of the financing or government supported schemes like ESIC, CGHS, etc. To counter the above, two broad methods have been proposed as alternatives on optimal resource utilization: Cost Containment l Privatization Community Participation l Cost Sharing l User Financing l Health Insurance Health Insurance has been useful as a tool for augmenting financial resources available for care, and as a means of better linking health demand to the provision of service. Many states have now implemented Health Insurance Schemes to cover the aspects of Curative Care. Most of the State/Central Projects which are currently running, work on the concept of Horizontal Cross Subsidization as opposed to Mediclaim which tends to be run as Vertical Cross Subsidization. The Cross Subsidization is also due to the Risk Solidarity in the schemes (a blend of both high and low risk individuals). Horizontal: Within the economic group Vertical: Across various groups (economic, age, gender, etc.) These schemes are also common on the principle of determining the Premiums. These are based on the Community rating with or without a premise of Experience rating. On the other hand, there are few states where Self Funded Schemes work very well, under the Governance of the State Govt. some examples being the Mukhyamantri Amrutum Yojana in Gujarat, Yeshasvini Cooperative Farmers Healthcare scheme in Karnataka (these schemes may be partly funded by the Government and partly by the beneficiaries). Design and Methods This paper is a comparative analysis of select mass health insurance schemes, both successful & unsuccessful, which have been implemented in India in the past few years. The Scope of the paper will be Comparative Analysis of the following schemes: 1. Rashtriya Swasthya Bima Yojana, Pan India 2. Rajiv Arogyri Scheme, Andhra Pradesh 3. Chief Minister's Comprehensive Health Insurance Scheme, Tamil Nadu 4. Bhai Ghanhya Sehat Sewa Scheme, Punjab 5. National Trust 6. Weavers' & Artisans' & Sericulture 7. Swarnajayanti Aarogya Bima Yojana, Goa 8. Mukhyamantri Amrutum Yojana, Gujarat The Stakeholders for these Schemes share a common relationship: 1. Source of funds: Government and beneficiaries in some instances 2. Beneficiaries- Population below poverty line or a community of similar socio-economic status 3. Fund pooling is often done by an Insurance company 4. Risk Management- Trust/society established by government 5. Service providers: Network Hospitals 6. Implementing Agency: Third Party Administrators These schemes differentiated from each other broadly on the basis of the following parameters: 1. Source of funding: State funded/ Insurance/Centre funded 2. Scope of coverage : Primary or Secondary & Tertiary coverage 3. Grading criteria for hospitals 4. Integration of Hospital Scores & rates for procedures 5. Provider Tendering for Procedures 6. Administration & Implementation of the schemes The various differentiators will be studied and documented as per observations for the purpose of learning what was best implemented, thought of and successful idea for bringing in the latest and quality care to the members of society who need it the most. Results There did not seem to be one scheme which allowed replication Pan India for better Health Indices, some being complementary to the others. This is so because: 1. Selection of packages and disease coverage is a factor that gets determined by the epidemiological trends and characteristics of the target community 2. Provider trends are dependent on local practices and culture. 3. Implementing States have different strategies, cultural practices and political environment. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to take a close look at factors that influence the choice and quality of healthcare received by ailing and elderly people in rural north India. The author is primarily interested in seeing what role is played by the presence of sons in the family, particularly co-residence with sons. In the absence of some broad-based social security arrangement in countries like India, older adults traditionally turn to living arrangement where the older adults are supported by their children or extended family. In a patriarchal society as India, such responsibility lies with the sons if one has son/s. Such dependence on sons explains preferential treatment towards younger sons as a justification for the care parents receive from sons in their advanced years. This culture of son preference behavior provides the context for this paper. Design/methodology/approach -- The empirical model is based on testing three inter-related research questions. First, the author asks whether having grown sons or living with son/s leads to up-front better quality of healthcare for parents. If the empirical analysis does not show support for this research question, the author broadens the research question to ask whether those with grown son/s or those that live with their son/s have a higher probability of seeing a trained medical professional as compared to some traditional healer. If the empirical analysis does not support the second question, the author further broadens the research question and asks whether those elderly who are sick are more likely to receive any healthcare (medical or traditional) if they have grown son/s or live with their son/s. Findings -- The results show that co-residence with a son does not have a statistically significant impact on the quality of healthcare received by the elderly individual. Additionally, not having a son also does not have a statistically significant impact on quality of healthcare received. Research limitations/implications -- For the purpose of the empirical analysis, the author utilizes World Bank's Living Standard Measurement Survey (LSMS) data collected from rural villages in Uttar Pradesh and Bihar in India in 1997-1998. The dataset may be somewhat dated, but it provides relevant information which transcends time. Additionally, with economic growth and modernization, more and more young people in India have migrated away from rural areas in the recent decade. Thus, surveys carried out in the last decade by the National Family Health Surveys in India show very little evidence of elderly parent in rural areas living with their adult children. This practice seemed to be much more prevalent at the time of the LSMS survey of 1997-1998. Practical implications -- Contrary to popular expectation, the results show that co-residing with a son has no statistically significant impact on healthcare received by parents. Additionally, not having sons does not matter either. Originality/value -- The author finds relatively fewer studies done on factors that determine the choice of healthcare for the elderly, particularly relating to those that are ailing (for reasons other than simply aging) and with reference to their living arrangement. The present paper addresses this void in the literature and is expected to make a meaningful contribution in bridging this gap in the literature. [ABSTRACT FROM AUTHOR]

This paper seeks to explore the complex negotiation between mesmerism (as unauthorised medical practice) and the State by analyzing the singular example of Dr. James E. Esdaile, a Scottish civil surgeon stationed in Hooghly, Calcutta, in the 1840-50s; one of the few known medical practitioners of mesmerism in colonial India. His diary titled Mesmerism in India, and its Practical Application in Surgery and Medicine contains a record of every patient who walked into Esdaile's clinic in Hooghly complaining of pain, the subsequent interaction that took place between the doctor and the patient, usually in the form of a simple sequence of questions and answers, and a description of the procedure by which the patient was treated. The documentation of Esdaile's controversial clinical practice offers several important insights into the practice of parrhesia (a theory of truth-telling proposed by Foucault) in conjunction with the practice of mesmerism as medicine. Within the annals of medical history, clinical egodocuments such as Esdaile's surgical diary exemplify the emergence of a difficult relationship between the historical subject and the desire to speak the truth. It reveals how a unique moment in colonial medical history becomes emblematic of a negative relationship with the parrhesiastic act. [ABSTRACT FROM AUTHOR]

The National Family Health Survey (NFHS) data is useful in setting benchmarks and examining the progress of various health indicators over time. The main objective of the present paper is to critically review the findings of NFHS-5 and NFHS-4 regarding the trends on maternal health indicators and implications for India. Data from NFHS-5 (First round 2019-2020) and NFHS-4 (2015-16) for 17 states and five Union territories (UTs) pertaining to maternal health indicators was extracted from the factsheets. Trends and implications in line with Sustainable Development Goals (SDGs) and National Health Policy (NHP) 2017 have been critically appraised. Substantial improvement in maternal health indicators in NFHS-5 over NFHS-4 is noted; however, there is a lot of interstate variation. NFHS-5 findings indicate that the percentage of women in the age group 15-19 years, already mothers or pregnant, has increased in four states while the percentage of mothers who had antenatal checkup in first trimester has increased in 12 states. Percentage of those with anaemia during pregnancy has increased from 15 to 17 states in NFHS-5 as compared to NFHS-4. Institutional births are over 90% in 14 states while only three states have below 79%. Out of pocket expenditure (OOPE) per delivery at public health facilities has increased in 12 states over the time period and it is above 5000 INR in 8 states. In India, improvement in maternal health indicators can be achieved by increasing quality of care, strengthening the Janani Suraksha Yojana (JSY), skilled birth attendants training program, reduction of anaemia among pregnant women and reduction in OOPEper delivery at public health facilities. [ABSTRACT FROM AUTHOR]

Government of India initiatives through implementation of National Rural Health Mission (NRHM) and Janani Suraksha Yojna (JSY) programs from early 2005 has shown a considerable impact on maternal health care utilization in India. Despite the fact that these programs provide the services free of cost, utilization of maternal health care services is still considered an economic burden on some households. Keeping this into our mind, the research study analyzes the different level of payments to procure maternal health care for different socio-economic characteristics in India. Materials and Methods: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January -June, 2014. It is a cross sectional dataset that provides information on Social Consumption and Health scenario of the population. To carry out the research, descriptive statistics, and regression analysis has been used. Findings and Conclusion: The research reveals that women residing at urban place of residence, higher educated, affiliated to other social group and belonging to richest wealth index pay high amount for the maternal healthcare services in India. Indian government need to extend the coverage rendering the services at affordable costs without any further differentiation on the basis of socio-economic characteristics of Indian women. [ABSTRACT FROM AUTHOR]

Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods: Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results: Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion: Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in 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]

Background Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. Methods We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. Results The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Conclusions Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data. [ABSTRACT FROM AUTHOR]

Purpose The primary objective of this paper is to identify and analyze factors that influence choice and quality of healthcare of the elderly population in two northern and two southern states in India. The purpose of this paper is to look beyond the obvious factors that influence choice and therefore the quality of healthcare and seek to find whether there are some additional indirect factors that also influence choice and quality of healthcare.Design/methodology/approach This paper utilizes data from the Longitudinal Aging Study in India pilot project, which was a cross-sectional survey of men and women aged 45 and over focusing on two northern states (Punjab and Rajasthan) and two southern states (Kerala and Karnataka). In this paper the authors carry out a Probit analysis to estimate the factors that influence the elderly’s choice of healthcare.Findings The authors find that social activity via different types of social interactions outside the home and access to a phone (which is one of the cheapest and most commonly used methods of communication used by people in India) are statistically significant in influencing better quality of healthcare for the elderly. Moreover, gender-segregated results suggest that social activity is particularly important for elderly females. Relative price of healthcare is also an important determinant of the quality of healthcare sought. The authors also find some consistent regional influences on healthcare choices by the elderly.Research limitations/implications The main limitation is the data itself which is cross-sectional in nature. However, as further rounds of survey are conducted the authors hope to be able to build on the results of this paper using a longitudinal approach. A second limitation is the lack of variables available for carrying out an instrumental variables analysis. The results imply that elderly males and females are influenced by different things when it comes to healthcare choices. Thus for policy to be effective, the government needs to pursue avenues that would be most likely to succeed.Practical implications One of the most important practical implications of this research is the understanding that informal channels of knowledge transmission are important especially for the elderly in India. Traditional methods of knowledge transmission such as education, media, and income are less likely to be effective in a country where majority of the people are illiterate and poor. Social interactions appear to be most effective in influencing healthcare choices of elderly females.Social implications The most obvious social implications of this paper are the importance of social interactions via social activities outside the home and ability for social communication via access to a phone for the elderly population in India to make better healthcare choices and therefore receive better healthcare.Originality/value The literature on elderly healthcare is limited when it comes to developing countries. What makes matters worse for India is that up until recently there have been no comprehensive efforts to collect reliable data on the elderly population in India. As a result there is extremely limited availability of policy-relevant research dedicated to issues relating to the older population. Most of the existing literature looks at self-reported health and healthcare status or utilization. This paper would be among the first to address factors influencing quality of healthcare received by the elderly population in India. [ABSTRACT FROM AUTHOR]

This paper focuses on telemedicine implementation, which can be used to extend modern medical knowledge to remote areas in developing countries. By examining doctor- patient interactions in the context of a telemedicine program in India, we posit how the behaviour of the actors interacting over virtual media is determined by interplay between two dominant institutional logics, namely logic of care and logic of choice. The paper draws on the tenets of institutional logics to extend the theoretical understanding about processes of engagement of actors with a new technology and explicates how the engagement evolves with the use of technology. The research emphasizes the essential role of considering the dynamics of logic of care and logic of choice in the design and implementation process. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the relationship between authentic leadership (AL) and employee extra role behaviour (ERB) while determining the mediating effect of psychological capital (PC) and moderating effect of autonomy on that relationship.Design/methodology/approach Data were collected from 42 small- and medium-sized hospitals in the state of Uttarakhand, India. The sample for the study included 520 nurses and their 163 supervisors. Process macro (Hayes) was used to examine the mediating role of PC and the moderating role of autonomy in the relationship between AL and ERB.Findings Results indicate that AL is positively linked to ERB of followers. Further, PC was found to mediate the relationship between AL and ERB while autonomy acted as a moderator between PC and ERB.Practical implications Findings of the study would help hospital managements understand the importance of technical and behavioural training of nursing staff and supervisors. The paper draws the attention of hospital administrators towards the need for formulating policies that are less restrictive and allow for greater autonomy to the nursing staff. Further, this study highlights the importance of an effective leadership approach like AL in service-oriented organizations such as healthcare institutions.Originality/value This study contributes to existing research on AL and ERB by showing that PC and autonomy are important and relevant variables that affect the degree of influence that AL has on employee ERB. [ABSTRACT FROM AUTHOR]

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction. [ABSTRACT FROM AUTHOR]

This research paper attempts to collate literature from various sources, in an attempt to answer four pertinent questions related to private health care in India. Firstly, emerging relationship between private health care and market, secondly how the private health care sector is delivering health in terms of its quality; thirdly what is the structure and pattern of health care from the provider's perspective? Finally, the paper tries to highlight some of the dehumanizing issues/aspects in private health care which are relevant for the consumers of health care. Markets in the health care are also governed by the purchasing power of the individuals in society. They are not democratic institutions and it results into the marginalization of the marginal. It is evident that the private health sectors attracts and treat persons who can pay more hence it is selective. Quality of health care in private sector is a myth as in private sector job insecurity and poor working conditions bound to affect the quality of care provided to the patients. Private health care professionals are essentially for the sale and use of goods produced by the health care industry. User charges, usage of high tech diagnostic tools, irrational diagnosis, and technology for money has become a culture of practice for the doctors. Professionals in healthcare defend unfair and trade practices which sometimes leads to the unethical practices under the garb of professional independence. [ABSTRACT FROM AUTHOR]

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients. [ABSTRACT FROM AUTHOR]

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

India has a vast reservoir of highly skilled, semi-skilled, and unskilled labor force and is one of the major source countries in the global labor market. The current paper is the first of its kind to focus primarily on migration of health professionals from India. In the absence of national-level data on migration, the paper uses data from different sources to outline the magnitude and direction of flow of health care providers from India. The paper also assesses the existing global and national policies on migration and discusses their relevance in the context of migration of health professionals from India. [ABSTRACT FROM AUTHOR]

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

Traditional medicine practices are a most ancient health care system being practiced widely in India, Srilanka and other countries. Atharv- Veda and Charak and Sushrut SAmhita (100-500 BC) have given detailed descriptions of over 700 herbs. Out of research of researches carried out on Ayurvedic Medicinal plants, many pharmaceutical corporations have renewed their strategies in favour of natural products drug discovery and numerous drugs have entered the pharmacopoeias from traditional medicines. Allium sativum L. commonly known as Garlic belongs to family Liliaceae is one of the most widely traditional herbs used almost by all the people of India due to its benefits. The present paper focused on the traditional claims, folk lore uses and phytopharmacological significance of Allium sativum Linn. [ABSTRACT FROM AUTHOR]

Kerala being the diabetic capital of India, need to evolve a less expensive method to reduce the tangible and intangible cost of type 2 diabetes mellitus(T2DM). Hospital based single blinded randomised controlled trial was undertaken at Indian Institute of diabetes, Kerala, India with an aim to assess the effect of multilateral health care strategies on metabolic profile. Pre-diabetic individuals were screened using American Diabetic Association criteria and randomly allocated to experimental and control group. Experimental group received 3 weeks training in yoga, exercise and healthy diet preparation. Control group received only heath counselling alone on diabetes prevention. Subjects were followed up for one year. The multiple health strategies were planned based on evidences and successfully implemented to curtail the menace of DM in India. The present paper details the multiple health care strategies and methodology addressing the primary prevention of primary prevention of T2DM. [ABSTRACT FROM AUTHOR]

Introduction: This paper summarizes a structured expert panel session on the subject of barriers in initiating Simulation based andragogy in Healthcare Education in India. The expert panel consisted of members of academia in Medicine, Nursing, paramedical and representatives from the healthcare simulation technology industry. The global burden of unsafe medical care is significant and remains a cause of concern. Studies have shown that majority of medical errors do not result from individual negligence. Majority of the medical errors have been found to be preventable. Simulation Based Medical Education is the way forward in achieving greater patient safety and improving patient outcomes. Hence there is an urgent need to incorporate Simulation into the healthcare education system in our country. Objective: To discuss the current scenario of healthcare education, the role of Simulation and experience sharing on the barriers in its large scale initiation. Result: The key barriers that emerged during the discussion in utilization of Simulation based medical education were capital investment, psychological resistance, difficulty in integrating curriculum and lack of trained man power. Conclusion: This paper attempts to offer pragmatic solutions to the existing barriers and help mitigate medical errors and improve patient safety. [ABSTRACT FROM AUTHOR]

COVID-19 has posed a serious challenge to countries all over the world taking lives, destroying livelihood, bringing down the economies to the ground. The question now is not how soon it will pass away but how effective will it be dealt with it. Nearly 3/4th of the countries which are affected do not have sufficient preparedness to deal with it. It may be the lacking of a Mitigation Plan, or maybe the lack of an effective health care system, or maybe the lacking of an efficient R&D, or it may also be the lack of an efficient farsighted Leader. India has been under the shadow of a few of many problems. The government of the country relies on the Laws to bring out a Preventive Mechanism to deal with the outburst of cases and other effects. One of which is the LockDown order which has been held as one of the first, earliest, and strictest in the World. The paper seeks to analyze critically the legal backing of such Lock Down, testing the nuances of it on the Constitutional Touchstone [ABSTRACT FROM AUTHOR]

Telemedicine and related e-health facilities facilitate care from a distance through electronic information systems. COVID-19 pandemic is establishing telemedicine in the health care delivery system of countries. Telehealth is contributing significantly in health care delivery during the COVID-19 crisis. For mild-to-moderate symptoms of COVID-19 or any illness, telehealth services might represent a better, efficient way to receive initial care and perform triaging. Telemedicine also has a significant role in screening for COVID-19 symptoms and delivering routine needs and follow-up care. The large-scale adoption of telemedicine in public health care delivery is still not visible in low- and middle-income countries like India. Adoption by patients and healthcare professionals is limited and their concerns need to be addressed to ensure its utilization in future of the care continuum. In the current paper, we aim to review recent measures of Telemedicine adopted during the course of pandemic and its impact on public health in lower-middle income countries like India. [ABSTRACT FROM AUTHOR]

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

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI. [ABSTRACT FROM AUTHOR]

Ayurveda is India’s traditional system of medicine. around 80% population, especially using this system of medicine for their health care management. There are many issues and concerns over the usage of Ayurveda, They are simplified and try to deal in this paper. The methodology used to complete this review was through empirical research. This is a cross-sectional study where the use of Ayurveda utilized in this current period is examined. The sources are mostly from a doctor of Ayurvedic medicine and credible online sources. [ABSTRACT FROM AUTHOR]

This present article discusses the rules & regulations which are followed for drug approval process in USA, Europe & ASIAN country and India. Data required for the compilation of the dossier for various countries include the formats like CTD, e-CTD and ACTD.Regulatory affairs as a profession have important positions to play in positively impacting medication policy, use, results and other aspects of medical proper care. In many such cases this will be through cooperation and support with other wellness care professionals at a community stage. Pharmaceutical product approval process should be a critical step in ensuring access to safe and effective drugs. If performed, they will result in added value to medication treatment and development by making a beneficial participation to the safe, inexpensive and affordable use of drugs, leading to significant resources and results and improve the growth of the industry. Obtain and maintain medication records, results and relevant wellness details, if they do not already exist. These detailsare essential to evaluate personalized medication treatment. Identify, develop, evaluate and assess: Medication related problems, Symptoms described by patients, selfdiagnosed conditions. Implementation of CTD is expected to significantly reduce time and resources needed by industry to compile applications and reports for global registration. The pharmacologist must use his clinical reasoning and data to determine the stage of drug proper care and effects that is needed for each patient. [ABSTRACT FROM AUTHOR]

The coronavirus disease (COVID-19) disease has shaken the health-care system globally. It has become a global public health emergency for which scientists and physicians are trying to find an answer. This pandemic at present has no answer, as conventional medicine is trying to put their best foot forward by using hydrochloroquinone. Clinical trials are underway to find the efficacy of hydrochloroquinone or to develop any other possible immunization in COVID-19, which leaves us in an uncertain situation. Treating the existing condition remains a challenge in one side whilst containing the spread of this disease remains another challenge. Though nations across the globe have declared lock-downs to prevent community transmission, this is insufficient, looking at the magnitude of the disease. Host friendly interventions from traditional medicine focused on improving immunity and offering mental strength to cope with this pandemic are the need of the hour. Yoga and Naturopathy, a holistic system of medicine under the ministry of AYUSH operates by adapting the principle of salutogenesis can be easily integrated into the existing standard of care in prevention and management. This paper discusses about the possibility and necessity of integrating yoga and naturopathy interventions like fasting, diet therapy, hydrotherapy, sunbath, and yoga therapy based on its evidence in the management of COVID-19. [ABSTRACT FROM AUTHOR]

This paper analyses the ethical considerations using the stakeholder theory on two specific domains of the newly implemented 'Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (PM-JAY)' scheme by the Government of India. The paper recommends a solidarity-based approach over an entitlement based one that focuses on out-of-pocket expenses for the most vulnerable and a stewardship role from the private sector to ensure equity, accountability, and sustainability of PM-JAY scheme. [ABSTRACT FROM AUTHOR]

Since ancient times, crude drugs have been used as medicines and are of great importance for human beings. However, traditional knowledge about the use of medicinal plants is eroding day by day, and there was a need to document the everyday experience of these indigenous medicinal plants. Ayurveda describes the medicinal values and uses of plants for healthcare. By the course of time, various new plants got added to Ayurvedic material medica, Dravyaguna Vigyan. Tricholepis glaberrima (Brahmadandi) is one of them. This plant has great importance due to its nutritive value and a significant source of medicines as they have been found throughout human history. This plant is mostly used for its aphrodisiac property, but several unknown activities need to be taken seriously. This mini-review paper encompasses the Ayurvedic aspects as well as the phytochemistry structure and pharmacological activities of the Brahmadandi plant. The current review focuses on the updated information from various scientific studies and reports available in the context of the phytoconstituents and pharmacology of this plant. This review also provides adequate information about the use of this plant in an Indian system of medicine, Ayurveda. [ABSTRACT FROM AUTHOR]

The speedy progress of trade in Global Health Services is limited by legal barrier. Advances in technology and cross-border movement of people and health services form legal ambiguities and uncertainties for businesses and consumers involved in transnational medical malpractice disputes. This requires for a uniform means of redress which is more flexible and predictable as compared to litigation in a court room. Therefore, the voluntary, flexible and legally binding nature of arbitration agreements across jurisdictions make this form of dispute resolution efficient and adaptive to changes in the health services industry. With careful making of an approach that accounts for arbitration cost, reasonable recovery amount and complementary mechanisms such as no-fault compensation, international arbitration of medical malpractice disputes will change the legal risks borne by businesses and consumers more fairly and efficiently. This paper argue that most medical disputes are better resolved by alternative dispute resolution mechanisms which will contribute in improving patient safety by encouraging candid and comprehensive reporting of risks. It also argues that medical disputes and patient safety needs to be viewed through a new lens, namely patient autonomy. It discusses the scope of India flourishing in the field of Medical Tourism and also the challenges faced by the foreign patients and the scope of Arbitration in amicably resolving the medical disputes in a cost effective and in a swift manner. [ABSTRACT FROM AUTHOR]

Introduction: The maternal health generally refers to the health of women during pregnancy, childbirth and postpartum period. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. The Maternal Mortality Ratio (MMR) estimate for the country indicates an overall decline from 212 in 2007-09 to 178 per one lack live births in 2012, resulting in saving lives of about 9,000 mothers per year 2. The aim of maternal health care services to reduce infant mortality, maternal morbidity and mortality was recognized at the Cairo Conference on Population. 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 carryout the research, descriptive statistics, bivariate and logistic regression analysis has been used. Findings: The study shows that place of residence, marital status, educational status and wealth index plays an important role in determining the utilization of ante-natal care and post-natal care services. Utilization of services from private sector increases with the increase in the level of socio-economic characteristics. Southern and Western regions of India have 97 percent utilization of ante-natal care and more than 90 percent utilization of post-natal care services in India. Multivariate analysis also depicts close relationship with different predictors as urban place of residence, currently married women, higher educational status and richest wealth category. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the utilization of maternal health care. Western and Southern regions have better utilization of maternal health care services. [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]

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

In this paper attempt is made to assess the expenditure incurred on natal health care services in India at two different socio-economic settings. Data for the analyses are drawn from the 71st round of NSSO held in 2014. A logistic regression model used to assess the determinants such as socio-economic and demographic indicators on expenditure incurred for natal care services. It is found that a major proportion of respondents spent money for their natal care however a wide difference was noticed between high and low HDI states in India. The average amount spent from their pockets for natal care services was Rs.6,685/- for high HDI states. It was almost double times higher than the low HDI sates’ expenditure incurred for natal care (Rs. 3,400). The results of the logistic regression analysis on expenditure incurred for natal care is positively and significantly associated with all the socio-economic, demographic variables (except age, religion). In India, the natal health care services are offered free, yet many families’ average out of pocket natal health care expenditure incurred was relatively high, however, a wide variation is witnessed among high and low HDI states. Hence, it is suggested to increase the share of state’s expenditure on healthcare, especially those states which are socially and economically backward states, to reduce the state differences in the country on health outcomes. [ABSTRACT FROM AUTHOR]

This paper is based on a descriptive research design by secondary data method to describe the factors affecting the elderly quality of life. This review presents challenges faced by ageing elderly and gives a timely warning of the enormous health system challenges alarming in India's near future, at a time when Indian social care and health system are unprepared to handle the existing burden of elderly care of the Indian population. The future burden of elderly care emphasize on the prevention of high risk factors for chronic diseases and mental health disabilities which has great impact on quality of life of elderly and there is urgent need for strong call for action on addressing socio-cultural norms, health service planning and funding, workforce training and preparation for the Indian Ageing society. The challenges for the health and social care services are huge, with substantial financial and workforce planning predicaments. [ABSTRACT FROM AUTHOR]

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

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

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India's extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the adequacy of health workforce in the rural public health sector in Assam. The findings reveal that Assam faces an acute shortage workforce in the rural health sector. Although the position of the state is better than the national average in terms of health workforce density and population coverage by health workforce, the national and global norms that exist in this regard are yet to be satisfied. The findings also suggest that both demand and supply side factors are responsible for the shortages of health workforce in the state. The paper emphasizes the urgent need to create the required number of posts and fill up the vacancies;attractive incentive packages to attract doctors and specialists to the rural areas;training to existing workforce to keep them up-to-date; and suitable human resource management system in recruitment, distribution and management of health workforce in order to resolve the problem of health workforce shortages in the state. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the factors that influence the affective commitment of nursing staff and its subsequent impact on their job performance. Design/methodology/approach – A survey-based study was performed among 349 nursing staff working in Uttarakhand, randomly selected from six public healthcare institutes, using a well-established questionnaire. Structural equation modeling was applied to study the mediating effect of affective commitment and its correlation with the constructs used in research. Findings – The findings of the study revealed that the level of burnout is significantly higher among the nursing staff and had an inverse relation with affective commitment. Further, perceived organizational support and procedural justice showed a positive relation with affective commitment in contrast to burnout. Moreover, affective commitment had a strong impact on job performance of the nursing staff, indicated by direct relation with a value of 0.70. Research limitations/implications – The findings contribute by recognizing the various factors affecting the performance of nursing staff specifically in developing country like India. Limited in geographical area, industry and a self-rated questionnaire are some of the limitations of the present study. Practical implications – To conclude, this study revealed the vital significance of factors affecting the job performance of nursing staff through affective commitment. Based on the findings, healthcare institutions need to reduce the level of burnout, create and enhance a supportive and fair working environment to enhance the level of affective commitment and consequently the job performance of the nursing staff. Originality/value – This study has extended the existing literature by identifying the mediating role of affective commitment on factors affecting job performance of nursing staff specifically in the Indian context. [ABSTRACT FROM AUTHOR]

Background: Equitable access to healthcare for rural, tribal, and underprivileged people has been an emerging area of interest for researchers, academicians, and policymakers worldwide. Improving equitable access to healthcare requires innovative interventions. This calls for clarifying which operational model of a service innovation needs to be strengthened to achieve transformative change and bring sustainability to public health interventions. The current study aimed to identify the components of an operational model of mobile medical units (MMUs) as an innovative intervention to provide equitable access to healthcare. Methods: The study empirically examined the impact of scalability, affordability, replicability (SAR), and immunization performance on the sustainability of MMUs to develop a framework for primary healthcare in the future. Data were collected via a survey answered by 207 healthcare professionals from six states in India. Partial least squares structural equation modeling (PLS-SEM) was conducted to empirically determine the interrelationships among various constructs. Results: The standardized path coefficients revealed that three factors (SAR) significantly influenced immunization performance as independent variables. Comparing the three hypothesized relationships demonstrates that replicability has the most substantial impact, followed by scalability and affordability. Immunization performance was found to have a significant direct effect on sustainability. For evaluating sustainability, MMUs constitute an essential component and an enabler of a sustainable healthcare system and universal health coverage. Conclusion: This study equips policymakers and public health professionals with the critical components of the MMU operational model leading toward sustainability. The research framework provides reliable grounds for examining the impact of scalability, affordability, and replicability on immunization coverage as the primary public healthcare outcome. [ABSTRACT FROM AUTHOR]

Introduction: There is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings. Methods: We nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact). Results: 152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated. Conclusions: This review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs. [ABSTRACT FROM AUTHOR]

Health care sector is a segment within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative and palliative care. It is one of the largest and fastest growing sectors in the world. Health care sector of India constitutes government sector that is financed publicly providing promotive and preventive health services throughout the country from primary to territory level and the private sector providing curative care by levying fee. Health care sector can be expected that the numbers will increase with increased internet penetration and Smartphone usage. This paper provides a critical review of health care sector with reference to problems and prospects and also discusses the significance of the study, recent trends, problems, suggestions and conclusion. [ABSTRACT FROM AUTHOR]

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

Healthcare consumers may be behaving to some extent based on the nature of healthcare being a necessity or otherwise. The choice of either of public and private providers may depend upon factors like availability, accessibility, cost and quality. To some extent, this is revealed through their elasticities based on income, cost, quality and socio-economic factors. Objective of this paper is to explore the demand for healthcare services in India and estimate consumers' elasticities to these factors. Using logit results we find that an individual may choose his preference for private or public based on distance of facility from residence. It may also depend whether it is rural or urban area and whether the income levels of state are below or above all India average. Comparing our results for two all India surveys, it is observed that people's perception and thus preferences are mostly based on choices of nearby location, suitable timings, presence of medical personnel and less waiting time. The presence of insurance either by a national or state sponsored scheme seems to have changed the nature of healthcare demand in India from a stark necessity to a matter of better choice. [ABSTRACT FROM AUTHOR]

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