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The paper examines the growth of private health care in India in the context of its regulatory provisions and questions the work and employment conditions of female care workers (nurses) employed there. Nurses constitute 80% of the total workers in each nursing home/hospital. In the wake of increased demand for private health care since mid‐1990s, insertion of technology and investment is inducing transformation of nursing homes into multi‐ and super‐speciality hospitals resulting in changes in work organization of nurses. This has led to demand for larger numbers of workers. Employers gain by the segmentation in the nursing labor market, paying low wages. Workers face widespread social discrimination, long working hours, and high work intensity. The deplorable situation of a significant section of workers employed in this sector indicates state failure to control the private health sector. Lack of effective standards of work impacts nature of work of the workforce employed in various levels in the healthcare system. [ABSTRACT FROM AUTHOR]

Organized medicine is the academic guild of professional medical organizations in India. It was founded at the annual conference of Indian Academy of Pediatrics (PEDICON) on January 7, 2018. Organized medicine is constituted by leading professional medical organizations and mandated to support the sustainability of health agenda of the Government of India. A group of experts on behalf of Organized Medicine Academic Guild (OMAG) of India was constituted to facilitate adequate theories and models on how to make primary care integral to participation of people and intersectoral collaboration in equitable delivery of health care. A subtle, flexible, and comprehensive approach instead of a "compartmentalized existing in silos" approach is likely to be needed. This paper is a formal recommendation on behalf of OMAG with an aspiration to deliver to the people of India, what they need, focusing on discrete objectives with long-term plans. [ABSTRACT FROM AUTHOR]

In the absence of a universal health insurance mechanism, the increasing burden of out‐of‐pocket (OOP) health expenditure has become a growing concern in India. To cope with the cost of illness, people use either their savings and income, or they have to rely upon distress means of finance such as depletion of household assets, borrowings from banks and moneylenders, and contributions from family and friends. This paper analyses the changes that have taken place in the incidence and covariates of distress financing in India by using data from National Sample Survey Organisation for the years 2004 and 2014. Results indicate that during this period the incidence of distress sources as a means to finance OOP health expenditure has hovered around 50%. Further, the results reveal a significant socioeconomic gradient in the incidence of distress financing. Socioeconomic and health‐related covariates significantly impact the likelihood of distress financing as a means to cope with OOP health expenditure. The results indicate the need for government action to formulate a comprehensive plan through an increase in public spending on health care that will improve the quantity and quality of the public health‐care system and enhance the scope of health insurance in India. [ABSTRACT FROM AUTHOR]

Background: A peculiar phenomenon of engaging insurance intermediaries for government funded health insurance schemes for the poor, not usually found globally, is gaining ground in India. Rajiv Aarogyasri Scheme launched in the Indian state of Andhra Pradesh, is first largest tax funded community health insurance scheme in the country covering more than 20 million poor families. Aarogyasri Health Care Trust (trust), the scheme administrator, transfers funds to hospitals through two routes one, directly and the other through an insurance intermediary. The objective of this paper is to find out if engaging an insurance intermediary has any effect on cost efficiency of the insurance scheme.Methods: We used payment data of RAS for the period 2007-12, to find out the influence of insurance intermediary on the two variables, benefit cost ratio defined as benefit payment divided by premium payment, and claim denial ratio defined as benefit payment divided by treatment cost. Relationship between scheme expenditure and number of beds empanelled under the scheme is examined. OLS regression is used to perform all analyses.Results: We found that adding an additional layer of insurance intermediary between the trust and hospitals reduced the benefit cost ratio under the scheme by 12.2% (p-value = 0.06). Every addition of 100 beds under the scheme increases the scheme payments by US$ 0.75 million (p-value < 0.001). The gap in claim denial ratio between insurance and trust modes narrowed down from 2.84% in government hospitals to 0.41% in private hospitals (p-value < 0.001).Conclusions: The scheme is a classic case of Roemer's principle in operation. Introduction of insurance intermediary has the twin effects of reduction in benefit payments to beneficiaries, and chocking fund flow to government hospitals. The idea of engaging insurance intermediary should be abandoned. [ABSTRACT FROM AUTHOR]

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

The 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]

The introduction of information and communication technology (ICT) has altered the service delivery around the world by making it more accessible and cost effective across e-service markets. In a country like India the problem of health is an enormous one where a majority of poor are outside the effective medical network. In order to address these problems many information and technology (IT) oriented new ventures have been established to eliminate the gap in health inequity by creating network of hospitals exclusively in non-urban areas. Despite of huge popularity of these services, identifying the quality of such services need careful attention. Exhaustive review of literature highlights that there exists little understanding for such a study in IT enabled Indian healthcare domain in context to new ventures/start-ups with an emergence of a gap. With the increasing rise of technology enabled new healthcare ventures there have been high rates of failure too due to lack of providing quality service, so it has become imperative to prioritize the contextual and sectoral specific settings of service quality issues as it is being felt increasingly that it is the quality that would ultimately decide the value of services. This paper thus attempts to prioritize the context specific service quality dimensions in IT enabled scalable healthcare ventures from Indian context with focus in non-urban regions by deploying technique for order preference by similarity to ideal solution (TOPSIS) methodology as multi-criteria decision making technique. Further this paper proposed a conceptual model as conjectural understanding of the antecedents to the start-ups and as a guide that can provides new entrepreneurial insights to the service managers who can better apportion their resource in order to build quality and scalability. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has ushered in rapidly evolving developments in digital health, and governments around the world are experimenting with different ways of introducing technological tools in the management and delivery of health care services. India, among the countries that faced one of the most serious outbreaks in the second wave of the pandemic, recently rolled out the National Digital Health Mission, which promises an integrated but federated digital architecture and a digital health ecosystem that will solve the information asymmetries of the health care sector in India. While the promises of the National Digital Health Mission are many, India's experience with using another digital tool during the pandemic--the CoWIN portal for vaccine management--alerts us to the human rights concerns of rapid introductions of digital tools to address infrastructural and governance challenges in health care. This paper attempts to take a closer look at these two digital tools and the potential human rights implications of the National Digital Health Mission, particularly for the right to health. [ABSTRACT FROM AUTHOR]

Corporate Social Responsibility is the mechanism through which the corporate organisations have executed their philanthropic vision for social welfare. Commercial banks in India also have their own corporate social responsibility towards society. Now banks in India lead to divert their available resources to do more social responsible activities, to attract more and more customers. Most of the commercial banks social responsible activities include supporting education, supporting healthcare, supporting sanitation, livelihood creation and assistance during natural calamities like floods/droughts etc. SBI is the largest bank in India with refers to its deposits, advances, profit, branches and employees etc. At the time of formation of SBI in 01.07.1955 it has only 477 branches with Rs 1 crore net profits, now it has 16333 branches all over India with Rs 13102 crore net profits during the FY 2014-2015 (SBI-various annual report). This figures show that SBI is more socially responsible than any other banks in India with refers to its rural branch expansion, financial inclusion programmes and financial literacy etc. The main objective of the paper is to examine the corporate social responsibilities of commercial banks in India with special emphasis to SBI. [ABSTRACT FROM AUTHOR]

This paper attempts to elaborate oral health disparities persisting in the Indian population because of web of influences that include complex cultural and social processes. This will affect both oral health & access to effective dental health care. It discusses oral health care services to the general population and how some sections of the population are systematically excluded from oral health care services. This paper gives overview of six strategic areas which will have significant role in making oral health care affordable for all sections of society. Strategies should be made according to unique needs of people & resources that exist in India. [ABSTRACT FROM AUTHOR]

Using the consumption expenditure data, National Sample Survey, 2009-2010, this paper test the hypothesis that the monthly per capita household health spending of elderly households is significantly higher than non-elderly households in India. The households are classified into three mutually exclusive groups; households with only elderly members (elderly households), households with elderly and non-elderly members and households without any elderly member. The health spending include the institutional (hospitalization) and non-institutional health expenditure of the households, standardized for 30 days. Descriptive statistics and a two part model are used to understand the differentials in health expenditures across households. Results indicate that the monthly per capita health spending increases with economic status, occupation, age and educational attainment of the head of the household. The monthly per capita health spending of elderly households is 3.8 times higher than that of non-elderly households. While the health spending accounts 13 % of total consumption expenditure for elderly households, it was 7 % among households with elderly and non-elderly members, and 5 % among non-elderly households. Controlling for socio-economic and demographic correlates, the per-capita household health spending among elderly households and among household with elderly and non-elderly members was significantly higher than non-elderly households. The health expenditure is catastrophic for poorer households, casual labourer and households with elderly members. Based on the finding we suggest to increased access to health insurance and public spending on geriatric care to reduce the out-of-pocket expenditure on health care in India. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has forced substantial changes in the practice of psychiatry, including that of electroconvulsive therapy (ECT). There is higher risk of transmission of the SARS-CoV-2 virus during ECT unless due care is taken. However, in many cases, ECT cannot be avoided. In this paper, we discuss various measures that may be adapted to reduce the risk of transmission of the virus during ECT. We also suggest certain modifications to the practice of ECT in order to achieve a balance between risks and benefits of the procedure during the pandemic. [ABSTRACT FROM AUTHOR]

The oral health delivery strategies are taking back seat in the universal health coverage scheme in India. This paper highlights the personal experience of a dental professional from India as an educator, motivator, and collaborator to nullify or minimize social policy challenges faced by medical health providers in the administrative cadre to strengthen the oral care delivery model in the health services department in Kerala state. The author has nevertheless persisted with positive educational, motivational, and collaborative approaches with medical health providers in the administrative cadre, general cadre, and specialty cadre in the health services department in Kerala state to change the current climate. [ABSTRACT FROM AUTHOR]

In recent times, the technical and legal standards of blood transfusion in US and European nations have undergone significant change but in India, the quality and standardization of blood transfusion have not changed much and thereby the patients are exposed to risks. The present paper considers incidents of blood transfusion process errors in India, identification of causes of errors, and presents an overview of Indian laws relating blood transfusion and the judicial approach towards errors in blood transfusion process. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explored.Design/methodology/approach This is a secondary statistical analysis of a subset of IEN application data from a previous study in combination with assessment data from an additional database. Application data between 2008 and 2011 were analyzed using univariate/bivariate analyses and regression models to explore the relationship of performance in the assessment process and outcomes of the registration process.Findings Competency categories IEN applicants had difficulties with (from least to most) were Professional Responsibility and Accountability, Ethical Practice, Self-Regulation, Service to the Public, Knowledge-Based Practice: Specialized Body of Knowledge and Knowledge-Based Practice: Competent Application of Knowledge. IENs educated in the UK and USA had the highest scores and odds of meeting competencies. Applicants educated in India and Asia had lower scores and odds ratios. All national entry-to-practice examination and registration eligibility competencies were significantly related to registration outcomes. Applicants passing the exam had higher competency scores while applicants ineligible for registration had lower competency scores.Research limitations/implications Limitations include integrity of data extracted from active databases, IEN motivation to complete the RN registration process and conversion of assessment scales for research analysis.Originality/value Results inform regulation policies that improve IEN registration processes and may be informative to regulators, assessment centers, educational institutions and IENs. [ABSTRACT FROM AUTHOR]

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the drivers of healthcare waste management from literature review and field survey and model these drivers for understanding the inter-relationships among the drivers to enhance healthcare waste management in the Indian context.Design/methodology/approach In view of the need of the study, the interpretive structural modelling (ISM) method has been applied to model the drivers. The ISM method helps in depicting the relationships among the drivers and filtration of drivers on the basis of their driving and dependence power.Findings The findings of the study reveal that the type of a healthcare facility and its management structure, size of a healthcare facility, human resource management of a healthcare facility, healthcare facility’s management monitoring and control, and the effective re-enforcement of government regulation and policy implementation in a healthcare facility play a vital role in the enhancement of HCWM.Research limitations/implications The application of the findings of this study would enhance the hospital’s waste management by ultimately leading to a good ambience and satisfied patients and personnels. Additionally, the study would aid in the policy formulation by government and decision making of medical facilities, thereby strengthening HCWM scenario in the country.Practical implications The drivers filtered in this study would be useful for ranking the hospitals’ healthcare waste management in a region/country. This ranking may play a vital role in earmarking the hospitals which are managing their healthcare waste according to the guidelines of Central Pollution Control Board (CPCB) and Ministry of Environment and Forest (MoEF) of a country. With the help of this study, the problem of inadequate human resource can be effectively addressed for CPCB and MoEF, in India.Originality/value Healthcare waste management is a vital issue which needs attention from the management perspective in India. Therefore, an interpretive structural model, i.e. ISM digraph, has been developed which would help in the filtration of drivers and attaining the better healthcare waste management in an economically and timely manner. [ABSTRACT FROM AUTHOR]

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

Consumerism camouflaged in welfares, beeping autonomy of individual choice and financial interests and integrity, embraced health sector with an astounding assurance of 'health for all'. Consumerism in no time swiftly drifted from 'vendor-centric' to 'vendee-centric' for opulent and high income brackets. Health became a 'product' and patient transformed into a 'consumer' , mauling the mutual loyalty and trust between the 'health provider' and 'health seeker', and eventually engendered health consumerism since medical service got converted into industrial imperialism. Oceanic literature on right to health stuffed with legal, moral and social obesity could see only slack and sick human race, far from the enforcing executive regimes, and 'healthcare' became 'health scare' in terms of price and performance. Right to health cannot be construed to be a package of services, and according to WHO, "the right to the highest attainable standard of health" requires a set of social criteria that is conducive to the health of all people, including the availability of health services, safe working conditions, adequate housing and nutritious foods. Healthcare consumerism is about transforming health benefit plans by putting economic purchasing power and decision making into the hands of participants. Consumerism in the healthcare industry is an inescapable growing trend. Healthcare is not the same as the purchase of a TV set. This paper casts a cursory glance at the emerging era of health consumerism and the situation obtaining in India. [ABSTRACT FROM AUTHOR]

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

Background: Health is an important aspect of a society, which needs proper care through governmental and non-governmental interventions. Objectives: The paper tried to examine the determinants of health status and health care services in Kerala State. Method: This empirical study is categorised as explanatory and comparative analysis based on national and state level secondary data. Findings: Some of the health indicators like birth rate and child mortality rate in Kerala showing an unfavourable trend, and in many cases, they are getting lower than the national average. The morbidity rate, especially due to non-communicable diseases is high in Kerala when compared to national level. Malnutrition and under nutrition started rising, which shows that 32.7 percent of women aged between 15-49 years old with anemia, 13 percent children under 3 years who have low birth weight (<2.5 kg), 48.5 percent of children between 6-59 months old with anemia, 34.8 percent adolescent girls 15-18 years old with low BMI (<18.5). [ABSTRACT FROM AUTHOR]

Background: Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE. Methods: Data was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January-June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury. Findings: Binary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE. Conclusion: Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households. [ABSTRACT FROM AUTHOR]

Background: Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Few have examined changes in individual provider performance with an intervention encompassing post-training support contacts to improve their clinical practice and resolve programmatic problems. This paper reports the results of an intervention with 3471 abortion providers in India, Nepal and Nigeria. Methods: Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period, designed to address their individual practice issues. The intervention also included technical assistance to and upgrades in facilities where the providers worked. Quantitative measures to assess provider performance were established, including: 1) Increase in service provision; 2) Consistent service provision; 3) Provision of high quality of care through use of World Health Organization-recommended uterine evacuation technologies, management of pain and provision of post-abortion contraception; and 4) Post-abortion contraception method mix. Descriptive univariate analysis was conducted, followed by examination of the bivariate relationships between all independent variables and the four dependent performance outcome variables by calculating unadjusted odds ratios, by country and overall. Finally, multivariate logistic regression was performed for each outcome. Results: Providers received an average of 5.7 contacts. Sixty-two percent and 46% of providers met measures for consistent service provision and quality of care, respectively. Fewer providers achieved an increased number of services (24%). Forty-six percent provided an appropriate post-abortion contraceptive mix to clients. Most providers met the quality components for use of WHO-recommended abortion methods and provision of pain management. Factors significantly associated with achievement of all measures were providers working in sites offering community outreach and those trained in intervention year two. The number of in-person contacts was significantly associated with achievement of three of four measures. Conclusion: Post-training support holds promise for strengthening health worker performance. Further research is needed to compare this intervention with other approaches and assess how post-training contacts could be incorporated into current health system supervision. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine innovation in the resource-constrained context of India’s healthcare industry. It is argued that the process of innovation in addressing healthcare management challenges in such a context occurs through organisational ambidexterity and that human resource management (HRM) plays an important role.Design/methodology/approach A qualitative research methodology is applied to explore the role of HR practices in facilitating contextual ambidexterity and subsequent innovations in healthcare in India. The unit of analysis is the “case” of healthcare providers in India and in-depth interview and documentary data in two case sites are analysed to reveal the role of HRM in facilitating contextual ambidexterity and innovation. Data analysis was undertaken first at a within-case and then at a cross-case analysis level using interpretive manual coding based on how the data explained the role of HRM in delivering innovative outcomes and supporting organisational ambidexterity.Findings The authors found evidence of the use of sets of high-involvement HRM practices for exploration of new ideas and efficiency-driven HRM practices for creating contextual ambidexterity in the case organisations. Further, managerial/leadership style was found to play an important role in creating cultures of trust, openness, risk-taking and employee empowerment, supported by an appropriate mix of intrinsic and extrinsic rewards. Finally, training was also reported as being central to creating an ambidextrous context for delivering on various innovations in these healthcare providers.Originality/value This study represents an exploration of innovation in the context of India’s healthcare sector through intersecting literatures of ambidexterity, innovation and HRM practices. In light of the emerging economy research context, an important empirical contribution is palpable. Moreover, through a study design which included collecting data from multiple informants on the role of human resources in facilitating innovative outcomes, the authors reveal the role of HR-related initiatives, beyond formal HR practices in creating contextual ambidexterity. This study also reveals the degree to which contextual idiosyncrasies enhance our understanding of the role of HR in facilitating innovation in emerging economies. [ABSTRACT FROM AUTHOR]

There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these pressing issues and achieve universal health coverage (UHC), a national health initiative named Ayushman Bharat (AB) was launched in September 2018, as a part of India's National Health Policy 2017. AB has two main components, first, the health insurance scheme named the National Health Protection Mission (NHPM), which is also branded as 'Pradhan Mantri Jan Arogya Yojana' (PMJAY) and second, transforming the existing primary healthcare centers (PHC) under the control of State Governments. AB aims to transform nearly 150,000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. PMJAY is designed to cover the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. For the first time, attempts have been made to provide affordable healthcare services to the population under a single common initiative in a big, democratic and diverse country like India. This paper provides an overview of the healthcare scheme. We have also analyzed some of its salient features and summarized them for an international audience which is inclusive of academics and public policy researchers. [ABSTRACT FROM AUTHOR]

Background: Digital health, aiming to boost healthcare accessibility, is an emerging concept in the domain of healthcare administration and delivery in developing countries. In India, according to the National Family Health Survey (NFHS-5), more than half (55%) of the men have reported ever using the internet, while only one-third (33%) of the women have done so. This gendered digital divide is further complicated and worsened by the fact that individuals in the lowest wealth quintile exhibit significantly lower internet usage rates, with only 9% of women and 26% of men. Such intersectionality of the gendered digital divide might prove a barrier to realizing the full potential of digital health in India. Eliminating digital inequalities in all forms and ensuring universal digitalization is essential for desired digital health outcomes. Methods: This study aims to explore India's readiness for digital health in terms of access to basic digital infrastructure, i.e., the internet. We analyze access to the Internet among Indian women of reproductive age using pan-India survey data from the fifth round of the National Family Health Survey (2019–21). We investigate predictors of Internet use in a regression model and apply the Erreygers Concentration Index (ECI) to examine inequalities in Internet access. Using decomposition analyses, we analyze factors contributing to digital inequality in terms of internet use. Results: Our inequality analysis based on the ECI [ECI- 0.4444 (p < 0.001)] suggests that a significant inequality exists in internet access. Furthermore, the decomposition analyses in the study find women's educational level to be the most prominent (28.19%) contributing factor to internet inequality, followed by wealth (25.67%), place of residence (23.16%), and caste (1.10%). Recommendation: We suggest a comprehensive readiness and need assessment, revamping of digital infrastructure, and moving with caution in implementing digital health innovation in the country as it may further exacerbate the existing healthcare access inequities. [ABSTRACT FROM AUTHOR]

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

Background: Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world's most populous county, India's surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning. Aim and method: This mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region. Results: Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients' care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities. Discussion and conclusion: Skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action. [ABSTRACT FROM AUTHOR]

Introduction: Robots present an opportunity to enhance healthcare delivery. Rather than targeting complete automation and nurse replacement, collaborative robots, or "cobots", might be designed to allow nurses to focus on high-value caregiving. While many institutions are now investing in these platforms, there is little publicly available data on how cobots are being developed, implemented, and evaluated to determine if and how they support nursing practice in the real world. Methods: This systematic review investigates the current state of cobotic technologies designed to assist nurses in hospital settings, their intended applications, and impacts on nurses and patient care. A comprehensive database search identified 28 relevant peer-reviewed articles published since 2018 which involve real studies with robotic platforms in simulated or actual clinical contexts. Results: Few cobots were explicitly designed to reduce nursing workload through administrative or logistical assistance. Most included studies were designed as patient-centered rather than nurse-centered, but included assistance for tasks like medication delivery, vital monitoring, and social interaction. Most applications emerged from India, with limited evidence from the United States despite commercial availability of nurse-assistive cobots. Robots ranged from proof-of-concept to commercially deployed systems. Discussion: This review highlights the need for further published studies on cobotic development and evaluation. A larger body of evidence is needed to recognize current limitations and pragmatic opportunities to assist nurses and patients using state-of-the-art robotics. Human-centered design can assist in discovering the right opportunities for cobotic assistance. Committed research-practice partnerships and human-centered design are needed to guide the technical development of nurse-centered cobotic solutions. [ABSTRACT FROM AUTHOR]

India's vast and diverse population strains its healthcare system. Amidst these complexities, Artificial Intelligence (AI) emerges as a beacon of hope. This transformative technology promises to revolutionize healthcare, starting with early disease detection and accurate diagnoses. AI, driven by vast medical data, paints a deeper picture of individual health. By analyzing health patterns, it can detect hidden cancers and tuberculosis early, saving lives through proactive treatment. AI's power extends beyond individual diagnoses. It can scan populations, identifying risk factors and predicting outbreaks before they erupt. This foresight allows for targeted resource allocation and preventive measures, mitigating outbreak impact. AI can even personalize healthcare, shaping treatment plans based on a patient's unique lifestyle and medical history. This maximizes treatment efficacy, minimizes adverse reactions, and improves patient's well-being. Imagine AI as a trusted medical advisor, suggesting the most effective treatment options for each individual. However, AI's promise comes with challenges. Data privacy, reliable infrastructure, and biased algorithms need effective solutions. India, with its strong tech ecosystem and commitment to innovation, is well-positioned to tackle these challenges. By investing in AI research, strengthening data infrastructure, and establishing ethical frameworks, India can unlock AI's immense potential to revolutionize its healthcare landscape. This will be a dividend for millions, ensuring India's healthcare system transforms with the brushstrokes of AI, leading to a healthier and more affordable future for all. [ABSTRACT FROM AUTHOR]

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

Background: Nonpharmacological interventions, such as personal protective equipment for example, surgical masks and respirators, and maintenance of hand hygiene along with COVID-19 vaccines have been recommended to reduce viral transmission in the community and health care settings. There is evidence from the literature that surgical and N95 masks may reduce the initial degree of exposure to the virus. A limited research that has studied the cost-effective analysis of surgical masks and N95 masks among health care workers in the prevention of COVID-19 in India. The objective of this study was to estimate the cost-effectiveness of N95 and surgical mask compared to wearing no mask in public hospital settings for preventing COVID-19 infection among Health care workers (HCWs) from the health care provider's perspective. Methods: A deterministic baseline model, without any mask use, based on Eikenberry et al was used to form the foundation for parameter estimation and to estimate transmission rates among HCWs. Information on mask efficacy, including the overall filtering efficiency of a mask and clinical efficiency, in terms of either inward efficiency(ei) or outward efficiency(e0), was obtained from published literature. Hospitalized HCWs were assumed to be in one of the disease states i.e., mild, moderate, severe, or critical. A total of 10,000 HCWs was considered as representative of the size of a tertiary care institution HCW population. The utility values for the mild, moderate and severe model health states were sourced from the primary data collection on quality-of-life of HCWs COVID-19 survivors. The utility scores for mild, moderate, and severe COVID-19 conditions were 0.88, 0.738 and 0.58, respectively. The cost of treatment for mild sickness (6,500 INR per day), moderate sickness (10,000 INR per day), severe (require ICU facility without ventilation, 15,000 INR per day), and critical (require ICU facility with ventilation per day, 18,000 INR) per day as per government and private COVID-19 treatment costs and capping were considered. One way sensitivity analyses were performed to identify the model inputs which had the largest impact on model results. Results: The use of N95 masks compared to using no mask is cost-saving of $1,454,632 (INR 0.106 billion) per 10,000 HCWs in a year. The use of N95 masks compared to using surgical masks is cost-saving of $63,919 (INR 0.005 billion) per 10,000 HCWs in a year. the use of surgical masks compared to using no mask is cost-saving of $1,390,713 (INR 0.102 billion) per 10,000 HCWs in a year. The uncertainty analysis showed that considering fixed transmission rate (1.7), adoption of mask efficiency as 20%, 50% and 80% reduces the cumulative relative mortality to 41%, 79% and 94% respectively. On considering ei = e0 (99%) for N95 and surgical mask with ei = e0 (90%) the cumulative relative mortality was reduced by 97% and the use of N95 masks compared to using surgical masks is cost-saving of $24,361 (INR 0.002 billion) per 10,000 HCWs in a year. Discussion: Both considered interventions were dominant compared to no mask based on the model estimates. N95 masks were also dominant compared to surgical masks. [ABSTRACT FROM AUTHOR]

Digital transformation in the health sector can revolutionize a country's healthcare system. However, the effective sustainability of digital health relies on various factors that influence its implementation. Addressing such implementation challenges is crucial in designing and delivering digital health services. Therefore, this systematic review attempted to identify the potential barriers to the implementation of digital transformation in the health sector of India. Systematic searches were employed across databases PubMed, PsycINFO, Science Direct, Web of Science, and Google Scholar for studies that reported digital transformation in India from inception to December 2022. Following narrative synthesis, studies were assessed for quality using JBI and the Mixed Methods Appraisal Tool (MMAT). Out of 1129 initially identified records, 26 studies that met the inclusion criteria were deemed eligible for final analysis. Although digital transformation in India's health sector occurred rapidly, especially during the COVID-19 pandemic, there are still potential barriers that impede its successful implementation in the country. Barriers identified are mainly associated with limited technological and medical infrastructure, data security and privacy, and a lack of physical examination. The need to address these barriers, recommendations for government and healthcare practitioners, and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. Methods: A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Results: Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct 'problems' is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Conclusion: Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest. [ABSTRACT FROM AUTHOR]

India is currently experiencing a demographic and epidemiological transition characterized by an aging population and an increase in chronic diseases, resulting in a greater demand for home healthcare services. Despite the critical nature and expansion of this area, home healthcare delivery in India remains under-researched. There is a dearth of information about the services, providers and organizations that offer services at home. There are various concerns in the provision of home healthcare services. These relate to accessibility and availability, information on providers, regulatory issues, standards of care, costs, safety concerns, and grievance redressal mechanisms for providers and users, which are among the topics discussed in this article. The article concludes that there is a need to recognize the "home" as a place for providing healthcare and as a "workplace" of care providers, develop standardized processes and guidelines for delivering care for different conditions at home, adopt standard human resource practices in deployment of care providers, bring transparency in the calculation of the cost of services and regulation of costs, and establish grievance redressal mechanisms for users, providers, and organizations. Further research is recommended on aspects such as user and provider perspective, training and supervision of providers, and financing, accreditation, and quality of services. [ABSTRACT FROM AUTHOR]

Background: A 2019 survey by the United Nations showed that the proportion of the world's population aged 65 and above was 9% in 2019. This is expected to increase to 16% by 2050, making 1 in 6 people over 65 years. Gerontology is a multidisciplinary field that deals with the cultural, psychological, social and biological aspects of ageing. Geriatrics, a component of gerontology, is not simply internal medicine of older people, but addresses the often-present morbidity and disability to ultimately provide holistic medical care. With the steady increase in the proportion of older people, particularly in India with over 104 million older people as per the latest National Census, the importance given to gerontology ought to proportionately increase to establish a decade of 'healthy ageing' as proposed by the World Health Organization. Methods: In this scoping review we have analyzed literature surrounding medical gerontology, from its inception, its various branches and future scope alongside geriatric medicine which is a pertinent component of gerontology. In this paper I aim at discussing the role, scope and difficulties of this rather nascent field of medical gerontology-providing an Indian view with a global background. Results: The natural process of ageing is riddled with medical comorbidities, disability and frailty which is compounded by social and environmental factors like the loss of autonomy, neglect and abuse. However, the steady establishment of elder-care centric organizations and geriatricians have helped meet some of the medical, social and environmental needs of our older persons, with there being tremendous scope for further progress. Conclusion: It is therefore imperative for the next generation of healthcare care providers and students alike to consider medical gerontology as a potential area of growth and research. As this will help provide the highest possible quality of care, thus ensuring dignified, independent and healthy lives to our nation's older persons population. [ABSTRACT FROM AUTHOR]

This paper examines how actors construct the public problem of multi-drug resistant tuberculosis (MDR-TB) in India. MDR-TB has been framed by the World Health Organization as a pressing, global public health problem. The responses to MDR-TB are complicated as treatment takes longer and is more expensive than routine TB treatment. This is particularly problematic in countries, such as India, with high patient loads, a large and unregulated private sector, weak health systems and potentially high numbers of MDR-TB cases. This paper analyses how actors struggle for control over ownership, causal theories and political responsibility of the public problem of MDR-TB in India. It combines Gusfield’s theory on the construction of public problems with insights from literature on the social construction of diseases and on medical social control. It highlights that there are flexible definitions of public problems, which are negotiated among actor groups and which shift over time. The Indian government has shifted its policy in recent years and acknowledged that MDR-TB needs to be dealt with within the TB programme. The study results reveal how the policy shift happened, why debates on the construction of MDR-TB as a public problem in India continue, and why actors with alternative theories than the government do not succeed in their lobbying efforts. Two main arguments are put forward. First, the construction of the public problem of MDR-TB in India is a social and political process. The need for representative data, international influence and politics define what is controllable. Second, the government seems to be anxious to control the definition of India’s MDR-TB problem. This impedes an open, critical and transparent discussion on the definition of the public problem of MDR-TB, which is important in responding flexibly to emerging public health challenges. [ABSTRACT FROM AUTHOR]

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. [ABSTRACT FROM AUTHOR]

Background: Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services. Methods: We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children's receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents' exposure to CGPP, communication activities against their children's receipt of key vaccinations in order to identify determinants of routine immunization coverage. Results: Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children's receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers' exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT. Conclusions: A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage. [ABSTRACT FROM AUTHOR]

This paper aims to review health outcomes in Madhya Pradesh, paying particular attention to the influence of inequity on community. The paper identifies some core issues to improve accessibility, coverage and service quality in Madhya Pradesh. We draw on the available evidence in published literature, vital statistics and reports published by state, national and international organizations. The paper is organized as follows. First, we give a brief background of the health sector in MP. Second, we outline the situation of inequity and growing health challenges. Finally, we conclude with suggestions to improve overall health scenario of the state. [ABSTRACT FROM AUTHOR]

Capitalizing on the hype surrounding stem cell research, numerous clinics around the world offer 'stem cell therapies' for a variety of medical conditions. Despite questions about the safety and efficacy of these interventions, anecdotal evidence suggests a relatively large number of patients are traveling to receive these unproven treatments - a practice called 'stem cell tourism.' Because these unproven treatments pose risks to individual patients and to legitimate translational stem cell research, stem cell tourism has generated substantial policy concern and inspired attempts to reduce these risks through the development of guidelines for patients and medical practitioners. This paper examines the roles and responsibilities of physicians in patients' home countries with respect to patients' decisions to try unproven stem cell therapies abroad. Specifically, it examines professional guidance from two organizations - the American Medical Association and the International Society for Stem Cell Research - and assesses physicians' professional and legal obligations to patients considering unproven stem cell therapies. Then, drawing on qualitative interviews conducted with patients who traveled abroad for unproven stem cell treatments, it explores the roles that physicians actually play in patients' decisions and compares these actual roles with their professional and legal responsibilities. The paper concludes with a discussion of strategies to help improve the guidance physicians provide to patients considering unproven treatments. [ABSTRACT FROM AUTHOR]

This paper considers how changes in urban governance in Delhi over the last two decades have influenced the provision of health care services. It begins by describing the introduction of, or return to, elected governments for the National Capital Territory of Delhi and for the Municipal Corporation of Delhi. It then discusses public health care, which in effect serves low-income groups as most higher-income groups now use private services, and how this has changed, drawing on interviews and direct observations of elected representatives and officials at state and municipal levels, political cadres, NGOs, members of residential welfare associations and public health care users. The research focused on four municipal wards that included a middle-class area, a mixed-income area, a ward where many slum communities had been relocated and an “urban village”. The research also included an analysis of the priority given to health care issues (and what those issues are) in the Legislative Assembly and in the Municipal Health Department and Municipal Health Committee. The paper suggests that the opening by state government of new invited spaces for resident welfare associations meant that the elected members of the Legislative Assembly and of the municipal government were by-passed. It increased the influence of resident welfare associations, but these are a feature of middle-class areas whose inhabitants use private health care. It avoided contestation, as the state could decide who was invited. The role of NGOs as advocates for the urban poor also diminished, as many were drawn into becoming implementers of government programmes. In effect, this increase in participation can be seen as a new form of centralization, strengthening the position of senior bureaucrats and by-passing the elected politicians. [ABSTRACT FROM PUBLISHER]

The aged in India have conventionally enjoyed privileges within the framework of a social economy where the needs of the old remained a moral responsibility of family, kith and kin. However the present changing times have forced a shift in the approach to old age care. e old person finds him- or herself in a sticky situation, in between an insensitive state and the demands of globalization. e present paper situates this problem within the framework of globalization and systematically measures the strategic response of the state to this daunting challenge, with respect to economic security and health care in particular. In the conclusion, the paper argues for a rejection of the conventional welfare approach and it advocates an integrated approach based on a coherent social development perspective within the valuation framework of social quality. [ABSTRACT FROM AUTHOR]

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

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

Oral health inequity- inequitable access to oral health services contributes to the health inequity of the population and further exasperates the socio- economic inequity. This paper attempts to elaborate the nature of oral health inequity in India, by exploring the process and trajectories of oral health inequity. This paper also attempts to provide an over view of oral health care services to the general population and how some section of the population are systematically excluded from the oral health care services. Considering the oral health burden in India, this paper argues that, oral health care in India must be integral part of primary health care. The current national dental health policy needs urgent revision. Customize strategies to the unique needs and resources that exist in India. This is what is most likely to work and have a positive impact on the oral health of Indian population. [ABSTRACT FROM AUTHOR]