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Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems ‘hardware’ issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems ‘software’ aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework. [ABSTRACT FROM AUTHOR]

Introduction: Stereotypes have been a barrier to providing patients a diverse orthopaedic workforce. Our goal was to identify stereotypes and disparities among doctors and their patients regarding the attributes that should determine a competent orthopaedic surgeon. Materials and Methods: A cross-sectional descriptive multicenter study was conducted in India. Tailored questionnaires were administered to patients and orthopaedic postgraduates to determine the attributes they believe patients prefer in their orthopaedic surgeon. Likert data and data on preferred sex of the surgeon were analyzed as categorical data sets using frequency statistics. Participants were asked to rank surgeon attributes and analysis was based on frequency of an item among top 5 surgeon attributes. Results: 304 patients and 91 orthopaedic postgraduates participated in the study. 70.4% and 73% of patients and 27.5% and 29.6% of postgraduates preferred an orthopaedic surgeon with greater physical strength as an outpatient consultant or operating surgeon respectively. 81% of patients had no preference of the sex of their doctor. 56% of postgraduates felt patients would prefer a male operating surgeon, none felt their patient would prefer female orthopaedic surgeon. 92.3% of the female postgraduates felt patients would prefer a male orthopaedic surgeon. Patients most often ranked years of experience, surgical outcomes, time spent with patients, reputation, and physical strength in their top 5 surgeon attributes and sex, religion, and community were given least importance. Conclusion: Diversity among the orthopaedic workforce is necessary to optimize patient care. It is our collective responsibility to educate our patients and trainees and redress the misconceptions and stereotypes that plague our profession. [ABSTRACT FROM AUTHOR]

Background: This article presents evaluation findings of the India English Language Programme, an innovative programme aimed at providing Indian nurses with an opportunity to participate in an ethical and mutually beneficial learning programme aimed at supporting migration into the United Kingdom's National Health Service (NHS). The programme provided 249 Indian nurses wishing to migrate to the NHS on an 'earn, learn, and return' basis with funding to support English language learning and accreditation sufficient to apply for Nursing and Midwifery Council (NMC) registration. The Programme provided English language training and pastoral support to candidates, in addition to the availability of remedial training and examination entry for those not meeting NMC proficiency requirements on their first attempt. Methods: Descriptive statistical analysis of programme examination results and cost-effectiveness analysis is presented to demonstrate programme outputs and outcomes. Descriptive economic analysis of programme costings is presented alongside programme results to investigate the value-for-money provided by this programme. Results: A total of 89 nurses were successful in meeting NMC proficiency requirements, representing a pass rate of 40%. Those undertaking OET training and examination(s) were more successful, compared to those undertaking British Council provision, with over half of candidates passing at the required level. This equates to an overall programme cost-per-pass of £4139 and represents a model to support health worker migration, in line with WHO guidelines, delivering individual learning and development, mutual health system gain, and value-for-money. Conclusions: Taking place during the coronavirus pandemic, the programme evidences the effective delivery of online English language training to support health worker migration during a highly disruptive period for global health. This programme demonstrates an ethical and mutually beneficial pathway for English language improvement amongst internationally educated nurses to facilitate migration to and global health learning in the NHS. It provides a template through which healthcare leaders and nurse educators, working in policy and practice environments in the NHS and other English-speaking countries, can design future ethical health worker migration and training programmes to strengthen the global healthcare workforce. [ABSTRACT FROM AUTHOR]

Background: Indo-US Masters in Emergency Medicine (MEM) certification courses are rigorous three-year emergency medicine (EM) training courses that operate as a partnership between affiliate hospitals or universities in the United States with established EM training programs and local partner sites in India. Throughout their 15 years of operation, these global training partnerships have contributed to the EM workforce in India. Our objective in this study was to describe Indo-US MEM program graduates, their work environments, and their contribution to the growth of academic EM and to the coronavirus disease 2019 (COVID-19) response. Methods: An electronic survey was created by US and Indian MEM course stakeholders and distributed to 714 US-affiliated MEM program graduates. The survey questions investigated where graduates were working, their work environments and involvement in teaching and research, and their involvement in the COVID-19 response. We consolidated the results into three domains: work environment and clinical contribution; academic contribution; and contribution to the COVID-19 response. Results: The survey response rate was 46.9% (335 responses). Most graduates reported working within India (210, 62.7%) and in an emergency department (ED) setting (304, 91.0%). The most common reason for practicing outside of India was difficulty with formal MEM certificate recognition within India (97, 79.5%). Over half of graduates reported dedicating over 25% of their work hours to teaching others about EM (223, 66.6%), about half reported presenting research projects at conferences on the regional, national, or international level (168, 50.5%), and almost all graduates were engaged in treating COVID-19 patients during the pandemic (333, 99.4%). Most graduates agreed or strongly agreed that they were satisfied with their overall MEM training (296, 88.4%) and confident in their ability to practice EM (306, 91.6%). Conclusion: Indo-US MEM graduates have made a notable contribution to EM in India through clinical service delivery, teaching, and research, even more essential in the context of the COVID-19 pandemic. The roles of these graduates should be acknowledged and can contribute further to expandEM specialty and systems development across India. [ABSTRACT FROM AUTHOR]

The article focuses on the low representation of female orthopedic surgeons in India and how this gender gap can be addressed. The authors conducted a study to find possible causes for the low number of female orthopedic surgeons, by examining the perceptions of orthopedics as a specialty among undergraduate medical students.

Background: Poverty is directly linked to public health care delivery in many ways and dimensions. Every aspect of the human sphere is preplanned, but a health crisis is the only emergency which pushes humanity into severe economic stress. Therefore, every nation aims to safeguard its citizens from a health crisis. In this aspect, India needs to improve its public health infrastructure in order to protect its citizens and save them from poverty. Objectives: (1) To assess the current pitfalls in public critical health care delivery, (2) to analyze whether the health care delivery matches the requirements of its population in every state, (3) to produce solutions and guidelines to overcome the stress in this priority area. Materials and methods: Data regarding the critical care workforce, which includes critical care doctors and nurses, were taken from official websites and other sources. Critical care infrastructure data were retrieved from the Internet sources. Data were validated by consulting state government sources and cross-checked for bias elimination. The data were analyzed using the "Statistical Package for Social Sciences" software version 20, and were presented using descriptive statistics. Results: There is a 1:10 percentage of deficit in the case of critical care workforce and infrastructure when compared with its need analysis. Critical care medicine specialists are in 1:75 when compared to other specialties. Conclusion: Overall, the public sector critical care needs a total boost through out of box solutions. According to the Stockholm International Peace Research Institute (SIPRI), India spent the third most on defense in the world in 2021. India spent 76.6 billion dollars on its military in 2021, up 33% from 2012 and 0.9% from 2020. However, since India is considered a fast-growing economy, there is still a huge disparity in critical care. Without resetting critical health care, India cannot grow in welfare indices even if it is among the top gross domestic product (GDP) countries. [ABSTRACT FROM AUTHOR]

A global goal for early childhood education and care is to ensure universal, "quality" provision that reaches all children. Achieving this goal requires a well-prepared workforce that is equipped to adapt to and deliver early childhood programs across the vastly diverse contexts and communities where children are growing up around the world. Yet currently there is a severe shortage of early childhood workers, particularly in "low resource" and complex communities. Evidence to support appropriate training for such workers is also lacking. In response, this paper presents findings from a case study of a large-scale training program for community-based early childhood workers in central-east India. A total of 650 community-based Village Communicators were trained to deliver a responsive caregiving package to parents of young children. Data collected over 3 months highlight how the unique contextually grounded, caring and reflexive approach to training resulted in profound personal and professional change among training participants. The findings are of significance in informing policy and practice associated with global goals for early childhood. First, they challenge the technical, programmatic approaches to training that are commonly adopted for preparing this workforce. Second, they evidence the potentially transformative, long-term impact of person-centered approaches to training that facilitate knowledge-sharing to understand local needs and attitudes. Third, they provide insight into ways in which training programs can support enhanced local relevance and effectiveness of early childhood services implemented for children and families across diverse contexts. Highlights: Caring, consultative approaches to training support transformative changes in knowledge and practice among community-based early childhood workers. Community-based workers comprise a crucial yet under-researched workforce globally. Active contribution to adapting early childhood interventions for greater local relevance empowers community-based workers as well as enhancing program content. Training for community-based workers in early childhood needs to shift away from overly programmatic, technical approaches. Meeting global goals for early childhood development requires localized responses. [ABSTRACT FROM AUTHOR]

Objective To implement rehabilitation services in a rural area of Raigad district, Maharashtra, India. Methods We piloted a rehabilitation service delivery model through the Mahatma Gandhi Mission Institute of Health Sciences, in five villages. The institute performed participatory rural appraisal and focus group discussions with stakeholders to identify general issues in village life that could affect delivery. To integrate rehabilitation service delivery into the existing primary care system, a team from the institute developed a strategic plan through multidisciplinary clinical meetings. A rehabilitation team conducted a door-to-door survey and referred people needing rehabilitation services to the outreach visits the team was making to the primary health centre twice a week. If needed, patients could be referred to a university teaching hospital for tertiary-level care. Findings The rural appraisal identified lack of awareness, inadequate workforce and infrastructure as key issues for rehabilitation services delivery. In response, we conducted awareness campaigns and formed a rehabilitation team consisting of personnel and students from the institute. Between 2018 and 2021, the team provided care to 1800 patients, of which half (900 patients) had musculoskeletal disorders. After rehabilitation, 360 (40%) of these 900 patients performed daily-living activities and continued to work with reduced pain within 2-3 days after rehabilitation. The team provided antenatal care to 1629 pregnant women with musculoskeletal pain or stress urinary incontinence. Conclusion Provision of rehabilitation services built awareness about physiotherapy, developed a rehabilitation care pathway and established a need for regular services. Using existing resources of the institute and involving students rendered the model sustainable. [ABSTRACT FROM AUTHOR]

Purpose: This study on spatial analysis of child labour in India is a macro level analysis on child labour using the census data, 2011 of Government of India. The population census which is conducted once in 10 years only provides district level data on work-force distribution. The study has spatial analysis of child labour in the age group of 5–14 years in India. To assess the magnitude of the children in the labour force, district level data of Census 2011 has been used in the study. The study has made an attempt to identify the districts where there is high level of children in the labour force. This paper aims to estimate the magnitude and trends of children's workforce participation using the census data as it is the only data base, which is available at the district level since 1961 onwards. The study has made an attempt to identify the clustering of child labour across districts in India and how child labour is clustered by different background characteristics. Design/methodology/approach: The study has used ArcGIS software package, GeoDa software and local indicator of spatial association test. Findings: The findings of study reveal that the proportion of rural, total fertility rate (TFR) and poverty headcount ratio is positively associated, whereas female literacy and the pupil-teacher ratio are negatively associated with child labour. It suggests that in the hot-spot areas and areas where there is a high prevalence of child labour, there is need to increase the teacher's number at the school level to improve the teacher-pupil ratio and also suggested to promote the female education, promote family planning practices to reduce TFR in those areas for reducing the incidences of child labour. Research limitations/implications: The study also recommends that the incidences of child labour can be controlled by a comprehensive holistic action plan with the active participation of social workers. Practical implications: The promulgation of effective legislation, active involvement of judiciary and police, political will, effective poverty alleviation and income generation programmes, sensitisation of parents, corporates and media can play effective role in mitigating the incidences of child labour in India. To achieve the sustainable development goals (SDGs) adopted by world leaders in 2015 to eradicate child labour in all its forms by 2025. Social implications: The study aims to achieve the SDGs adopted by world leaders in 2015 to eradicate child labour in all its forms by 2025. Originality/value: The study is purely original and there are no such studies in Indian context by using the latest software. [ABSTRACT FROM AUTHOR]

Background: A large number of government primary health-care facilities (GPHCFs) in India do not have access to the regular electricity supply. Objectives: To assess the status and change in electricity access, sources, and reliability at primary health centers (PHCs) in India; and to understand the effect of regular electricity supply on health services provision and on workforce availability and retention. Materials and Methods: Secondary analysis of data from the lastest two rounds of district-level household survey (DLHS) in India, conducted in 2007-2008 and 2012-2013. Results: Data of 8619 PHCs from DLHS-3 and 8540 PHCs from DLHS-4 were analyzed. The proportion of PHCs with access to electricity increased from 87% to 91%. However, regular electricity supply was available at only 50% of PHCs in 2012-2013, which was an increase from 36% such PHCs in 2007-2008. PHCs with regular electricity supply provided services to 50% more beneficiaries (deliveries and vaccination) than PHCs without regular or no electricity (P ≤ 0.001). Increased access to regular electricity was associated with improved availability and retention of health staff (P = 0.001). Conclusion: Government policies should aim to ensure access to regular electricity-supply-beyond just connection from grid-at all GPHCFs, including health sub-centers, PHCs, and community health centers. Indicators on electricity access at GPHCFs could be standardized and integrated into regular health and facility-related surveys as well as in the existing dashboards for real-time data collection. Health policy interventions should be informed by regular data collection and analysis. Improving access to regular electricity supply at GPHCFs can contribute to achieve the goals of National Health Policy of India. This will also help to advance universal health coverage in the country. There are lessons from this study, for other low and middle income countries, on improving health service provision at government health care facilities. [ABSTRACT FROM AUTHOR]

Background: Occupational therapy (OT) practice in India is yet to be regulated at the national level. This presents a significant challenge to the OT community in India as it would be difficult for them to defend themselves if other professionals violate the scope of practice (SOP) boundaries. Objectives: The aim is to explore the views of occupational therapists (OTs) related to the issue of SOP boundary violation in OT practice in India. Study Design: An online survey research design was chosen to conduct this study. A 10-item electronic survey (9 with response options and one open ended) was developed based on the research question. Methods: An online survey link generated through SurveyMonkey was E-mailed to 760 OTs in India, identified through convenient sampling. The survey link was also shared on four WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, Clinic OT, and IPOTPDG1) with many Indian OTs (snowball sampling). Data were collected from January 29, to February 29, 2020. Results: The number of responses received was 126. One hundred and nine (87%) respondents believed that other professionals encroach OT's SOP boundaries knowingly or unknowingly. This belief is strong among all OTs across the nation, regardless of gender and practice experience. Conclusions: Many OTs in India believe that individuals belonging to other professions step into the domain of OT knowingly or unknowingly. Enacting an OT practice legislation, establishing a regulatory body at the national level and increasing them at state levels, endorsing an official SOP document, educating stakeholders, and engaging in awareness promotion initiatives would help mitigate the issue to a great extent. Ongoing and strategic efforts by the OT community in India are warranted. [ABSTRACT FROM AUTHOR]

Background: The prevalence of violence against Health Care Workers (HCW) is showing a rising trend. Various studies have been done in the recent past shows that the prevalence of violence against HCW s ranged from 27.4% to 67%. The present study was done to compare and analyze the underlying causes of violence against HCW in a Non COVID and COVID situation to identify the commonality if any, and to suggest any remedial measures. Methodology: This was cross-sectional analytical design and was carried out in inpatient care areas of a tertiary care hospital. The study subjects comprised of Doctors, Nurses, Group C employees. Data was collected using direct interview method on a standard questionnaire. In addition, various media reports were collected and analyzed through internet. Results: Maximum incidents were experienced in emergency and OPD, where staff patient's ratio is less. 39.4% incidents were experienced by the staff who were providing care to the Terminally ill patients, Mentally and Physically disabled persons & Psychiatric patients. Suggestion which emerged to reduce WPV are, triage in casualty, availability of trained security guards, CCTV, restricted visiting hours and limited attendants with the patients, improvement in patient amenities etc. Whereas in COVID situation the major reason is the religious and social belief, poor dietary services and lack of hygiene and sanitation. Conclusion: There is an urgent and inescapable requirement that the healthcare administrators should address the underlying precipitating factors of violence, for delivery of quality healthcare services to the patients in a safe environment. [ABSTRACT FROM AUTHOR]

This paper examines the role of service climate (SC) in the link connecting human resource management practices (HRMP) to commitment to service quality (CSQ). Data were collected from 1236 hospital staff working in different private hospitals in India. The model linking HRMP to CSQ with the moderation of SC was tested using Hayes PROCESS. Results revealed that human resource management practices found to be influencing CSQ and with the interaction of SC the effect is further augmented. The interacting role service climate has been found to be significant at mean and high levels. [ABSTRACT FROM AUTHOR]

Introduction: Mining industry has grown sharply to satisfy demands of metal and minerals for rising infrastructure. Mining is hazardous, although it is among major occupations in India involving large work force. This study was conducted to assess sociodemographic profile of sandstone mine workers in Jodhpur and to identify their major social issues. Material and Methods: A cross-sectional study was conducted among mine workers of Jodhpur, Rajasthan. Data on socioeconomic status, and occupation of each family member were collected. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 23.0. A value of P < 0.05 was considered as statistically significant. Results: A total of 1604 workers were enrolled in study. More than three fourth (78.7%) of them were male. Their age ranged between 14 and 82 years with a mean age of 37.62 ± 12.30 years. Mean age of female workers was significantly higher than of male workers. Average years of working for males were significantly higher than females. Majority were illiterate, proportion being higher in females. Approximately 13% mine workers married before legal age. Approximately 2.68% children under 14 years of age were involved in income generation activity. Conclusion: More than three fourth of workers were male. Mean age of female workers was significantly higher than males. Illiteracy, child marriage, and child labor were present among mine workers. Strengths and Limitations: Robust dataset, complete enumeration, large sample size. [ABSTRACT FROM AUTHOR]

Context: Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India - the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 - mandate specific arrangements and provisions for evaluation and treatment of children and adolescents. A separate inpatient Adolescent Psychiatry Center (APC) was started at National Institute of Mental Health and Neurosciences, Bangalore, in 2016. Aims: (a) The aim of this study is to present the need for, development, infrastructure and workforce at APC; (b) to describe clinical profile of adolescents admitted to APC and (c) to identify clinical and psychosocial challenges in the management of older adolescents. Setting and Design: The paper covers consecutive inpatient admissions over the first 7 months of APC. Materials and Methods: Data were gathered from a review of hospital records, staff meetings, and case files. Statistical Analysis: Qualitative data, such as clinical management challenges, are summarized under major emergent themes. Quantitative data are summarized as means with standard deviations and frequencies with percentages. Results: Males, from urban, nuclear family background constituted the majority admissions. Family stressors and risk behaviors were prevalent. Unique clinical challenges included - risk behaviors, issues related to autonomy, conflict with family and conflict with the legal system. Conclusions: Older adolescents need to be treated in an environment appropriate to their age and developmental stage. Restructuring of spaces, routines, and creative inputs to interventions strategies must be made for healing environments for youngsters. APC could be a model for the development of other similar centers. [ABSTRACT FROM AUTHOR]

The pulmonary function impairment is the most common respiratory problem in industrial plants and their vicinity. Therefore, the purpose was to study the effects of furnace smoke and flue and its duration of exposure on lung function. This was a matched cross-sectional study of Spirometry in 100 bangle workers with age range 20 - 60 years, who worked without the benefit of smoke control ventilation or respiratory protective devices. Pulmonary function test was performed by using Digital Spirometer (Spiro-excel). Significant reduction was observed in the mean values of Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Forced Expiratory Ratio (FEV1/FVC), Forced Expiratory Flow (25%-75%) and Peak Expiratory Flow Rate (PEFR) in bangle workers relative to their matched controls. This impairment was increased with the duration of exposure to fumes in bangle industries. It is concluded that lung function in bangle workers is impaired and stratification of results shows a dose-response effect of years of smoke and flue exposure on lung function. [ABSTRACT FROM AUTHOR]