Search

Background: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach. Methods: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. Results: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. Conclusions: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Bioethics / Revue canadienne de bioéthique is the property of Ecole de Sante Publique de l'Universite de Montreal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

India is currently in a good position to design a particularly Indian set of health reforms to help the health system meet the growing demands of its consumers and personnel. There are several managerial obstacles to ensuring availability, access, affordability, and equity in delivering health services to fulfil community requirements efficiently and effectively for Healthy India's Sustainable Development. In this paper, an attempt has been made to analyse the opinions of users who avail of services offered by Primary Health Centres (PHCs) in selected villages of Vadodara District. The data were analysed using descriptive statistics and the hypothesis is assessed by using Chi Square test as well as Friedman Rank Test was applied to know the preferences and measure perception of users considering the selected criteria of services offered by the PHCs. [ABSTRACT FROM AUTHOR]

Background: In the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India.Data: Data from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis.Results: A strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066).Conclusion: The utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India. [ABSTRACT FROM AUTHOR]

Balanced Mutual Funds were established with an objective of generating regular income and long term capital appreciation by investing in shares, bonds and sometimes money market instruments in a single portfolio. Balanced Mutual Fund is an avenue which offers an investor the opportunity to invest in equity as well as fixed income securities. All Balanced Mutual Fund schemes have the similar objective but each differs in terms of return generation and risk involved. As such, an analysis have been made in this paper for Balanced Mutual Funds in Indian mutual fund industry using Fama French three factor model. In particular 24 regular-growth oriented Balanced Mutual Funds have been taken for this study. The wide array of funds often makes it a little difficult for investors to choose the best scheme for them. The present study will act as a guide to overcome such problem and to make good investment decision regarding Mutual fund selection. [ABSTRACT FROM AUTHOR]

In India, marginalised people with serious or chronic illness face particular challenges to finding sustainable treatment, and often experience financial devastation. One state welfare scheme (the EWS hospital bed quotas) holds the promise of treatment for those in Delhi's margins, through partnerships with corporate hospitals. Yet, the process of gaining access to treatment via the scheme is very frustrating. This ethnography illustrates the ways in which low-income patients' attempts to lay claim to state services often bring them into play with a mode of the state that is, in anthropologists' conceptions, opaque, arbitrary and erratic. In response to the 'illegible' modes of access to the scheme, patients and their families are compelled to construct and reproduce their eligibility to access treatment, through a repertoire of intricate and entwined practices, namely: the attainment of credible low-income documentation, the use of big men to leverage resources, and different kinds of performance. The burden of enacting these practices is further compounded and troubled by the state scheme's blurry entanglement with the private sector, in which roles and responsibilities for a 'duty of care' to citizens with illness are elusive. This paper therefore aims to be an original contribution to the social sciences, in interpreting health-seekers' experiences of state-private schemes in Delhi within anthropological understandings of the state and marginalised people's meaning-making of illegible state processes. [ABSTRACT FROM AUTHOR]

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

Background: This research article examines the efficiency with which the Indian family planning programme provides care to Muslim women who opt to undergo tubectomies from public health facilities in terms of access to benefits/compensation as well as quality of services. The research subsequently intends to suggest suitable policies of affirmative action if required. Methods: The research uses data from the women's file from the latest round of the National Family Health Survey (NFHS-5, 2019–21). Adjusted odds ratios are used to examine the likelihood of Muslim women (i) receiving compensations offered for undergoing tubectomies in public health facilities by the government, (ii) receiving comprehensive information prior to their tubectomies and (iii) reporting a good quality of care during their procedures, in comparison with non-Muslim women. Results: The findings from the research indicate that Muslim women in India have lower odds of receiving state sponsored compensations in comparison with non-Muslim women in India (AOR = 0.67; CI: 0.60—0.76). Consequently, a lesser proportion of Muslim women reported receiving compensations in comparison with non-Muslim women. The difference in the receipt of compensations was 18 percentage points between both cohorts. Critically, despite their challenges in obtaining compensations, the findings from this research also indicate how Muslim women in India have higher odds of receiving comprehensive family planning information prior to their operation in comparison with non-Muslim women (AOR = 1.15; CI: 1.02—1.29). Discussion: Given the existing dearth of evidence in family planning literature on the issue, this research article calls for greater attention and investments in understanding the reproductive health vulnerabilities of Indian Muslims, especially in the context of increasing social hostilities towards the community in India. In this regard, to promote the equitable delivery of family planning services, the findings from this research highlight the urgent need for institutional reforms that facilitate an easier access to public benefits among Indian Muslims. [ABSTRACT FROM AUTHOR]

Introduction: The Indian healthcare system is evolving towards better healthcare implementation and coverage. However, even today, the health-care system faces several challenges, a few of which are yet to be addressed. The present review is aimed to delineate the past and present healthcare scenarios in India, health-care policies, and other initiatives for achieving universal health coverage (UHC). Methods: A literature search was done on various government databases, websites, and PubMed for obtaining data and statistics on healthcare funding, health insurance schemes, healthcare budget allocations, categories of medical expenses, government policies, and health technology assessment (HTA) in India. Results: The available data indicates 37.2% of the total population is covered by any health insurance of which 78% are covered by public insurance companies. Around 30% of the total health expenditure is borne by the public sector, and there is high out-of-pocket (OOP) expenditure on healthcare. Discussion: Several new health policies and schemes, an increase in 2021 budget for healthcare by 137%, vaccination drives, augmenting manufacturing of medical devices, special training packages, Artificial Intelligence/Machine Learning (AI/ML)-based standard treatment workflow systems to ensure proper treatment and clinical decision-making have been initiated by the government for improving healthcare funding, equity, and access. [ABSTRACT FROM AUTHOR]

This research investigation aims to evaluate the performance of the Right Main Canal (RMC) of the Bhimsagar medium irrigation scheme in Rajasthan, India, employing water delivery and water use indicators, such as adequacy, equity, dependability, relative water supply, and relative irrigation supply. The three minors chosen were Ratanpura at the head, Chaplada at the middle, and Maraita II at the tail reach on RMC. The volume of water diverted into the selected minors from the right main canal was measured during crop season, and crop water demand in the command area of each minor was computed using the CROPWAT 8.0 software. Overall, RMC adequacy was adequate at the head, and middle reach minors but inadequate for the tail reach minor. The water distribution system was determined to be unreliable regarding water supply concerning time, with a dependability value of 0.49. Overall equity was determined to be good to fair for the head and middle reach minors but poor for tail reach minor due to disparity in water distribution. In 2013–14, RWS and RIS showed insufficiency in the command system. The average values of RWS and RIS were found to be 1.00 and 1.43, respectively. [ABSTRACT FROM AUTHOR]

Countries around the world established immunization programs over 40 years ago to reach all infants. The maturity of these preventive health programs offers some useful learning on the importance of, and components needed for, population-based services to reach all communities. A public health success, ensuring equity in immunization, requires a multi-faceted approach that includes sustained government and partner commitment and human, financial, and program operational resources. Evidence from India's Universal Immunization Program (UIP) across stabilizing vaccine supply and services, enhancing access, and generating demand for vaccines in the community provides a useful case study. The political leadership in India took advantage of the two decades of learning from polio eradication and focused initiatives, such as the National Health Mission and Intensified Mission Indradhanush, to reach populations with immunization services. With a goal of leaving no one behind, India's UIP and partners are bringing essential rotavirus and pneumococcal vaccines nationwide, upgrading vaccine cold chain and supply systems with technologies, such as the electronic Vaccine Intelligence Network (eVIN), and optimizing funding for local needs through the Program Implementation Plan (PIP) budgetary processes and building health worker capacities through training, awareness, and e-learning. [ABSTRACT FROM AUTHOR]

There is near consensus that early childhood education and care (ECEC) is essential to children's early development. A common corollary is that early learning will be pivotal to helping redress inequities in educational outcomes. We examine whether this is true among rural communities in the Indian states of Assam, Rajasthan, and Telangana. Specifically, we assess whether learning gains for the most disadvantaged are retained in comparison to more advantaged children who had lower initial learning levels. We find that lower-achieving, more advantaged children (as measured by mother's education) soon overtake higher-achieving but less advantaged children. In contrast, higher-achieving girls remain ahead of lower-achieving boys in Assam and Telangana, although they are caught up in Rajasthan. Given the differing patterns across the states, we explore the extent to which these may be shaped by their respective social and policy contexts. [ABSTRACT FROM AUTHOR]

The small finance banks in India play a prominent role as these banks provide services to the financially unincluded population. These banks provide basic services to the small-scale farmers and micro and small-scale industries. These banks will help in boosting the economy of the country as they provide services to major population of the country. [ABSTRACT FROM AUTHOR]

Learning is a fundamental human right, the basis of developing human capital and the foundation of human development. Basic skills provide individuals, their families and communities with the foundations needed to participate in society and to achieve better life chances. The shift in focus from mass access to mass learning has drawn attention to the question of who is and is not attaining these skills, and why. Opportunities to learn depend on access to schooling, but also the effectiveness of that schooling. There is considerable evidence of learning inequalities, both across and within countries. However, less is known about whether these patterns of inequality are rooted in variations in school effectiveness. In this paper we use evidence from Young Lives school surveys in Ethiopia, India and Vietnam to consider differences in girls' and boys' learning outcomes and progress and investigate how these patterns relate to school effectiveness. We explore whether girls or boys are 'sorted' into more or less effective schools and whether the same schools are differentially effective for boys and girls. Findings from India are perhaps closest to the 'typical' story that is often heard, in which girls, particularly those in rural areas, have lower attainment and attend less effective schools. In comparison, in Vietnam, girls have higher test scores and attend more effective schools on average, with this pattern driven by the higher performance of girls in rural areas. In Ethiopia, the divide between urban and rural areas is predominant in this context, over and above other areas of inequality including gender. Comparing results from these different areas of analysis and from three very different countries reveals the complexities of understanding how gender relates to educational outcomes. It demonstrates the importance of understanding gendered outcomes and school effectiveness in context. • Educational outcomes depend on access to education and the quality of that education. • Cross-country analysis reveals the complexities of how gender and school effectiveness relate to educational outcomes. • In India, where there is greatest school choice, girls have lower attainment and attend less effective schools than boys. • In Vietnam, the opposite is true - girls perform better and attend more effective schools. • In Ethiopia, the divide between urban and rural areas is predominant, over other axes of inequality including gender. [ABSTRACT FROM AUTHOR]

Competing and coexisting policies (CACPs) may arise from the incompatibility of incentives, standards, and regulatory models between a local state and a federal government, or between two government jurisdictions across which supply networks operate. Traditional studies of supply chain dynamics typically explore the impact of policy regimens as standalone instruments. This study explores how the interplay between CACP regimens can affect the supply dynamics between producers, customers, and their intermediaries. We use a supply network configuration lens to assess implications for supply chain actors and system‐level outcomes. Our work is motivated by the federal‐state dissonance in the current dispute between India's farmers and the federal government regarding new laws that impact agricultural supply chains in India. In this case, alternative and coexisting policy interventions, ostensibly aimed at modernizing and transforming production and distribution, can lead to significant supply chain netting and inventory pooling reconfigurations in terms of material, information, and financial flows among Indian agricultural stakeholders, along with inventory repositioning and market creation options. In addition, of significance is the consequent shift in the balance between state/nation and federal/supranational equity and bargaining power, an increasingly relevant context where supply chains operate across a common but multi‐jurisdictional territory, and implications for system‐level outcomes, in this particular case equity, welfare economics, and food security. We conclude by pointing to the implications of CACP regimens, and their interplay, for the broader field of operations management and supply chain research. [ABSTRACT FROM AUTHOR]

Estimation of multi-dimensional welfare measures are gaining popularity. Health is multi-dimensional and efforts to estimate multi-dimensional health inequality are fairly nascent. I estimate inequality in health using a normative index and decompose it into component parts. Inequality increases as health attributes become complementary. Inequalities at the state level as well as by caste and gender, are negatively associated with the level of social and economic development. [ABSTRACT FROM AUTHOR]

Background: Kangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce mortality among infants up to 180 days of life by 25% (hazard ratio (HR) 0.75). With the current analysis, we aimed to explore if ciKMC promotion leads to increased inequity in survival. Methods: In the trial we randomized 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. We estimated the difference in concentration indices, which measure inequality, between babies in the ciKMC and control arms for survival until 180 days of life. Further, we compared the effect of ciKMC promotion across subgroups defined by socioeconomic status, caste, maternal literacy, infant's sex, and religion. Results: Our intervention did not increase survival inequity, as the concentration index in the ciKMC arm of the trial was 0.05 (95% CI -0.07 to 0.17) lower than in the control arm. Survival impact was higher among those belonging to the lower two wealth quintiles, those born to illiterate mothers and those belonging to religions other than Hindu. Conclusions: We found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival. Trial registration: ClinicalTrials.gov, NCT02653534. Registered January 12, 2016—Retrospectively registered. [ABSTRACT FROM AUTHOR]