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Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio‐demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research. [ABSTRACT FROM AUTHOR]

Background: Speech–language pathologists are often involved in the assessment and management of communication, cognition and swallowing deficits in people with Parkinson's. However, speech–language pathologists' self‐perceived competency levels in serving people with Parkinson's remain elusive, especially in the Indian context where there is an increasing disability burden due to Parkinson's disease. Additionally, the challenges faced by speech–language pathologists in India to provide efficient services to this population are unidentified. Aims: To determine speech–language pathologists' self‐perceived competence and challenges faced when providing services to people with Parkinson's in India. Methods & Procedures: A survey questionnaire was sent to speech–language pathologists through emails and social media asking them questions to evaluate self‐perceived competency in serving people with Parkinson's and to identify the challenges to their service delivery. A total of 69 speech–language pathologists responded to the survey. Outcomes & Results: The majority of respondents reported to be competent in dealing with various domains of assessment and management of people with Parkinson's. Although competent, they reportedly faced a few challenges during their service delivery. Conclusions & Implications: This study provides an insight into the speech–language pathologists' self‐perceived competency in serving people with Parkinson's in India, and also identifies the challenges related to interprofessional service delivery. The findings of the study have educational and clinical implications. What this paper adds: The study delineates speech–language pathologists' self‐perceived competency in working with people with Parkinson's in India, a nation that is seeing a constant rise in the incidence of Parkinson's disease.The study the unique challenges within India to speech–language pathologists' service delivery for people with Parkinson's, thus having educational and clinical implications in Parkinson's disease care. [ABSTRACT FROM AUTHOR]

The concept of networks has gained interest in public administration and management. They address concerns such as the coordination of multiple actors within the policy process. Networks take both formal and informal forms. As the integration of formal and informal networks in public service delivery is gaining traction, this paper uses the example of diabetes care in Australia and India to provide an analytical framework to examine one of the ways such integration of networks take place. Diabetes, a chronic long‐term disease, poses to be a global problem with a high rate of diagnosis with implications for public health expenditure. A multi‐disciplinary team, which comprises both formal and informal categories, is required to manage diabetes. This paper highlights the integration of networks in diabetes care in different institutional and cultural settings. For such form of integration of networks to work, collaboration among the various actors is important. Lessons learnt from diabetes care will be relevant for other long‐term chronic conditions to help reduce the human resource and financial burden. The analytical framework developed based on the example of diabetes care will provide useful lessons for examining the mechanics and dynamics of the integration between formal and informal networks in the field of public administration and management. The concept of networks is gaining prominence as a useful model. This paper supports the existing literature on the need for both formal and informal networks using the example of diabetes care. It develops an analytical framework to examine the interactions of formal and informal networks, which will be relevant for similar studies related to other long‐term chronic conditions and for public administration and management. [ABSTRACT FROM AUTHOR]

Legislations for persons with disabilities emerged in the 1990s in India, providing them with rights and entitlements. Aligned with the UNCRPD, the Rights of Persons with Disabilities Act (2016) supports improved programmes and services. There are no exclusive policies for those with intellectual and developmental disabilities. Different government departments and non‐government organisations provide services including centrally sponsored programmes to persons with disabilities and enable them to exercise their rights. For example, rehabilitation and provision of aids and appliances lie with the Ministry of Social Justice and Empowerment, right to education is with the Ministry of Education, and, early intervention and health services and related supports are with the Ministry of Health. In India, non‐government organisations also play a vital role in health care services. In this paper, we discuss the existing health care systems including medical services in India for persons with disabilities with a specific focus on persons with intellectual and developmental disabilities. The discussion include how the system was evolved and what is in place today, the coverage, strengths, and limitations in the system. We have tried to provide a comprehensive description of existing policies, and practices of health care as well as the cultural influences with regard to health care for people with intellectual and developmental disabilities in India. [ABSTRACT FROM AUTHOR]

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]

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]

This paper attempts a sub-state level analysis of health system efficiency, focusing on West Bengal, a low income Indian state. Using a stochastic frontier model, it provides an idealized yardstick for evaluation. Our results suggest that overall efficiency of the public health delivery system remains low due to considerable disparities across districts. This is owing to differentials in availability and utilization of inputs such as the per capita availability of hospitals, beds, and manpower, and adversely affects life expectancy. Overcoming these factoral disparities may help the deficient districts to improve life expectancy. It may require a considerable increase in medical and public health expenditure in rural areas in the state and especially calls for resource mobilization to improve infrastructure facilities and maintain essential supplies at primary health centers. This could be attempted partly through funds from the National Rural Health Mission (NRHM) and by improving rural sanitation in poorer districts. [ABSTRACT FROM AUTHOR]

The paper examines the effect of inequality on growth among the subnational states in India. Theoretically, growth of the regional economy is driven by productive public investment in the provision of health and education services financed by a linear output tax, and the optimum tax rate is determined by the median voter. In contrast to existing results, the authors obtain an ambiguous relationship between initial inequality and subsequent economic growth. Analysis of the Indian state-level data suggests that rural inequality influences growth of total output more than urban inequality, and does so negatively. The indicator of intersectoral inequality is more important in explaining sectoral output growth. [ABSTRACT FROM AUTHOR]

Existing research on the formation of Asian medical travel destinations has highlighted a variety of activities that attract and accommodate patients from abroad. This paper contributes to the literature by drawing insights from an Indian case study, a major transnational health-care hub in Asia that has gained little scholarly attention thus far. Using connectivity as an analytical lens, we understand medical travel destinations as a contingent product of relating, connecting and assembling. We study how connectivity is embodied and how it unfolds in care encounters at corporate hospitals in the capital of New Delhi and surrounding urban areas. The following entities are the most effectual in the networks that constitute medical travel destinations in the National Capital Region: (i) circulating narrations of personal experiences; (ii) language interpreters; and (iii) commission fees. We further elaborate on how these connectors work to link foreign patients with Indian hospitals and how they affect itineraries as well as patients and other involved actors. Finally, we suggest that the approach deployed provides a suitable framework for future research aimed at gaining a better understanding of the wider impacts of medical travel by following these connections and examining their workings at places both close and distant. [ABSTRACT FROM AUTHOR]

This paper raises questions about the impacts of one of India's most ambitious cash conditional transfer programs, Janani Suraksha Yojana. It incorporates the perspectives of a practitioner working on maternal health issues and discusses the importance of considering alternative explanations as part of any patterns of observed results. It argues for exploring the impacts of interventions on the most vulnerable and marginalized as an essential aspect of an equity evaluation and for exploring impacts on inequities from a human rights lens. It also discusses some of the core competencies that might be needed for evaluations of equity initiatives. [ABSTRACT FROM AUTHOR]

The non‐governmental but non‐profit organisations seem to have occupied a critical space in financing and delivery of health care services at societal needs with limited but critical resources to bridge the gap between deficiency in public sector facilities and unaffordability of for‐profit operations. Present study based on a national level primary survey of non‐governmental sector in India finds that they are imperative in filling the void, especially providing preventive and promotive health care services. It is observed that this sector contributed around 2.1% of overall health financing in country with a wide variation across subnational states. These organisations generate resources largely from the governments and development partners to facilitate achieving key goals and deliver outcomes to targeted beneficiaries. [ABSTRACT FROM AUTHOR]

This paper examines interrelationships between health status, access and utilization. Indicators for each of these are measured for China and India. It is shown that China, both during Mao and Deng periods, scores over India in the provision of health services to the rural population. Differences in economic inequalities, organization of health services and motivation account for this. Contrary to the prevailing view there is no conclusive evidence that the post-Mao reforms have lowered the access of rural people to health services. The decline of barefoot doctors has been accompanied by an increase in private medical practitioners, and a decline in rural health insurance has coincided with new and alternative experiments in this domain. [ABSTRACT FROM AUTHOR]

Background: In July 2022, self‐collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self‐collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self‐collection among this population. Methods: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. Results: Women were motivated by the choice to self‐collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient‐centred models of care. Perceived barriers to self‐collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self‐collection. Conclusion: Self‐collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self‐collection can play in increasing equity in Australia's cervical screening programme. Patient or Public Contribution: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research. [ABSTRACT FROM AUTHOR]

In recent years, there has been renewed emphasis on efficiency in resource utilization in the healthcare sector. Most studies in the Indian context have focused on state level analysis. This paper explores sub-state level health system efficiency in Orissa, a low-income state in India. Our analysis estimates the efficiency of the healthcare system at sub-state level using 2012 district level data. We explore the reasons for relative performance of different districts using a frontier estimation technique. There is a substantial difference in performance between the most efficient district of Jharsuguda and the least efficient district of Balangir, resulting from inadequate utilization of available health care resources. Our study also identifies complementarity of private health care resources and the role of other factors, such as sanitation facilities, village electrification, and rural population growth. Our results suggest a need for better utilization of budgetary resources, both under the state department of health and the National Rural Health Mission, to increase health manpower and improve quality through training and better management resources in order to improve district health systems in Orissa. [ABSTRACT FROM AUTHOR]

Background Despite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low- and middle-income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems ( CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India. Methods CAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment. Results CAP is a 3-phase treatment delivered over 1 to 4 sessions based on a motivational interviewing ( MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem-solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol-dependent patients and the extension of the delivery settings to include home-based delivery. There was preliminary evidence of the effectiveness of CAP. Conclusions CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, e308-e311 (2012) Abstract As diabetes prevalence shifts from affluent to lower-income groups in India, focus on depression in diabetes will become essential. This paper describes four perspectives through which depression and diabetes should be understood in the Indian context. We consider (1) how rapid socio-economic and demographic changes contribute to increased co-occurring diabetes and depression; (2) how social, cultural and economic factors in the Indian context contribute to depression and therefore play an important role in diabetes care; (3) biological and behavioural pathways between depression and diabetes; and (4) the role of health systems in depression, diabetes and their overlap. We conclude with recommendations for future research and policy on this topic in India. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Raven J, Utz B, Roberts D, van den Broek N. The 'Making it Happen' programme in India and Bangladesh. BJOG 2011;118 (Suppl. 2):100-103. A training package designed to train health care providers in the management of common obstetric and newborn complications using a competency based 'skills and drills' approach is used in Bangladesh and India as one of the interventions under the 'Making it Happen' programme. The programme was commenced in 2009 and aims to reduce maternal and newborn mortality and morbidity by improving health care providers' capacity to deliver Essential (Emergency) Obstetric and Newborn Care (EOC&NC) thus increasing the availability and quality of these services. Preliminary results indicate that the training package has improved knowledge and skills of trained health care providers and ensures more signal functions of EOC are provided. [ABSTRACT FROM AUTHOR]

El rápido envejecimiento de la población de la India, así como el éxodo rural y la constante concentración de la población activa en el sector no estructurado han puesto de manifiesto la necesidad de mejorar los acuerdos de seguridad económica para la tercera edad. Los lazos familiares tradicionales, esenciales como garantía mínima de seguridad económica, comienzan debilitarse y la longevidad creciente incrementa los costos de mantenimiento de las personas mayores. Como consecuencia, los ancianos corren más riesgos de permanecer o de caer en la pobreza. Paralelamente a sus esfuerzos por resolver esta situación, el Gobierno nacional y algunos estados de la India han lanzado una serie de programas para ofrecer a la gran mayoría de los indios sin acceso a servicios médicos o a un seguro de salud algún tipo de acceso a los mismos. Los trabajadores del sector estructurado reciben más prestaciones de seguridad social que los del sector no estructurado pero son sólo una pequeña proporción de la población activa. Las mujeres son particularmente vulnerables a la inseguridad económica. La experiencia de la India ofrece lecciones para otros países. Si bien el sector de la seguridad social ofrece espacio para iniciativas privadas, no cabe duda de que la mayoría de los emprendimientos en este ámbito deberán financiarse con los impuestos. Los proveedores del sector privado pueden desempeñar un papel importante, incluso si la mayor parte de los fondos proceden de fuentes públicas. Sin embargo, a medida que aumente el número de solicitudes de prestaciones, la actividad de los proveedores del sector privado se topará con mayores escollos. La India también ha demostrado que los estados pueden ejecutar correctamente las tareas de implementación, usando fondos del Estado nacional y con la serie de ventajas y desventajas que aporta la descentralización. Por último, la experiencia de este país en materia de implementación puede servir de guía para la búsqueda de beneficiarios, el uso de las tecnologías de la información en los sistemas de seguridad social y la gestión de los recursos humanos. [ABSTRACT FROM AUTHOR]

Objective: This paper examines the availability of basic and comprehensive emergency obstetric care (EmOC), interventions used to treat direct obstetric complications. Determining what interventions are provided in health facilities is the first priority in analyzing a country's capabilities to treat obstetric emergencies. There are eight key interventions, six constitute basic EmOC and all eight comprehensive EmOC.Methods and Results: Based on data from 24 needs assessments, the following global patterns emerge: comprehensive EmOC facilities are usually available to meet the recommended minimum number for the size of the population, basic EmOC facilities are consistently not available in sufficient numbers, both in countries with high and moderate levels of maternal mortality, and the majority of facilities offering maternity services provide only some interventions indicating an unrealized potential.Conclusion: Upgrading maternities, health centers and hospitals to at least basic EmOC status would be a major contributing step towards maternal mortality reduction in resource-poor countries. [ABSTRACT FROM AUTHOR]

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links. [ABSTRACT FROM AUTHOR]

The present paper describes various kinds of surgery carried out with great success in 16 cases which included both severe and moderate Haemophilia patients with modest amounts of factor concentrates and antifibrinolytic drugs. This is very important in developing countries where factor concentrates are not easily available. In one patient Haemophilia was diagnosed only after surgery. None of the patients had inhibitor pre- or post-operatively. One patient who was HIV positive underwent orchidectomy successfully with only 6000 IU of factor VIII concentrate. [ABSTRACT FROM AUTHOR]

The healthcare sector is increasingly facing changing demand patterns and escalating pressures for innovative services during the COVID‐19 pandemic. Market‐focused flexibility refers to the capabilities of adaptation and facilitating the innovative performance of the firm. Accepting the overall role of innovation in COVID‐19 response, this study aims to explore how public healthcare organizations exhibit market‐focused flexibility to introduce new and innovative services. This study conducts an exploratory case study in a national‐level healthcare firm in India. This study identifies four specific dimensions of market‐focused flexibility that healthcare firms execute to deliver customized services. The study's findings contribute to an integrative framework of market‐focused flexibility and innovative performance in public healthcare. The mechanisms of market‐focused flexibility are unearthed and explained how the different facets influence innovative services in various manners. The implications to theory and practices are discussed, and future research avenues are sketched. [ABSTRACT FROM AUTHOR]

There is building evidence in India that the delivery of health services suffers both from an actual shortfall in trained health professionals and from unsatisfactory results of existing service providers working in the public and private sectors. This study focuses on the public sector and examines de facto institutional and governance arrangements that may give rise to well-documented provider behaviors such as absenteeism that can adversely affect service delivery processes and outcomes. We analyze four human resource management (HRM) subsystems: postings, transfers, promotions and disciplinary practices from the perspective of front-line workers-physicians working in rural healthcare facilities operated by two state governments. We sampled physicians in one 'post-reform' state that has instituted HRM reforms and one 'pre-reform' state that has not. The findings are based on both quantitative and qualitative measurements. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Health care decisions in many low‐income countries often require a close political agency relationship between healthcare decision makers and constituents. This is especially the case for maternal and child care as well as preventative interventions when resources are scarce. This article examines the effect of the introduction of the National Rural Health Mission in India, introducing Village Health, Sanitation and Nutrition Committees (VHSNC), a self‐governance mechanism to strengthen the political agency in village health care decision making. We study the effect of exposure to VHSNC on both maternal and preventative child health care. We find that exposure to VHSNC's increase the utilization of several maternal health care services, but does not systematically increase the uptake of preventive health care. The effect of VHSNC is more intense in larger villages and areas closer to district headquarters, and is driven by an increase in the utilization of the public healthcare network. [ABSTRACT FROM AUTHOR]

Decisions within the household determine the allocation of resources. Theory suggests that the more autonomous women are within the household, the greater influence they will have in that allocation. This paper utilizes several measures of a woman's autonomy within the household. It is hypothesized that the greater the woman's autonomy, the more likely she will be to visit a doctor, rather than other traditional sources of healing/care, when ill. This hypothesis is tested using data drawn from Uttar Pradesh and Bihar in India. The results lend support to the importance of autonomy for a woman in increasing her likelihood of visiting a medical doctor when ill. Additionally, the results show that socio-economic differences go a long way in explaining differences in healthcare choices for the sick. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the quality of care in known diabetes patients of Delhi. Methods: A cross‐sectional survey was conducted using a two‐stage cluster design. In all, 30 of 150 wards were chosen in Stage 1 (using a random computer‐generated seed value and then selecting wards at a predefined sampling interval; Probability Proportionate to Size—Systematic) and one colony from each ward was selected randomly in Stage 2. The selected areas were surveyed house‐to‐house in one‐of‐four random directions to recruit a minimum of 25 subjects (known diabetes ≥1 year; 35–65 years of age) per area. Data were collected by interview, blood sampling and from medical records by specifically trained research staff. Results: A total of 843 subjects (of 1315 eligible) were enrolled from 11,490 houses. For the intermediate outcome measures, an estimated 33.5% (95% CI 27.3–40.2) had an HbA1c value >10%, 67.2% (95% CI 62.8–71.4) had an LDL cholesterol level >100 mg/dl and 57.3% (95% CI 50.4–63.9) had BP levels >140/90 mmHg. For the processes of care in the last 1 year, 25.6% (95% CI 19.7–32.6) of the patients had an HbA1c (A1c) estimation and 2.4% (95% CI 1.1–4.9) had a dilated eye examination and 4.1% (95% CI 2.6–6.2) had foot examination. Diabetes self‐management education was provided to only 11.3% (95% CI 8.6–14.7) while nutrition counselling was provided to 56.0% (95% CI 51.7–60.2). Conclusions: The glycaemic control, lipid control and BP management of known diabetes patients in Delhi are unacceptably poor and a wide gap exists between practice recommendations and delivery of diabetes care in Delhi. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the effects of Education, Employment, Economic Status and Empowerment (introduced as the 4Es) and other explanatory socio‐demographic factors on the utilization of maternal health care services in India. This study used data from the National Family Health Survey‐4 (2015–2016). Separate logistic regression models were fitted for four or more antenatal care visits, skilled birth attendance and postnatal care to understand the effects of 4Es on the utilization of maternal health care services in India. The findings indicate positive effects of education on antenatal care, skilled birth attendance and postnatal care, the effects of higher education being even stronger in case of antenatal care. Education leads to employment, economic status and empowerment which in turn are significantly associated with the use of antenatal care and skilled birth attendance. Interestingly, in case of postnatal care, while controlling for economic status and empowerment, the effects of education vanish. Overall, education, employment, greater economic status and empowerment emerged as reliable predictors of the use of all three maternal health care services. The positive association between the 4Es and maternal health care services utilization reiterates the need for rigorous monitoring and evaluation of the existing policies and programs, coupled with efforts to change societal attitudes toward females through political advocacy and commitment which is reflected in parallel investment in girl education, job creation for poverty reduction to facilitate women empowerment. [ABSTRACT FROM AUTHOR]

India is the second most populous country in the world, with a population of about 1.3 billion in 2017.[1] The maternal mortality ratio is estimated to be 174 per 100 000 live births, and similarly the neonatal mortality rate remains high, with the most recent estimate at 25.4 per 1000 live births.[2] Given India's increasing socioeconomic status, these indicators are still comparatively high. This is despite strong government support and several innovative initiatives that have been introduced in India to improve maternal and newborn health outcomes, including dedicated strategic funding through the National Rural Health Mission and the introduction of accredited social health activists, auxiliary nurse-midwives and Anganwari workers. There is large variation in coverage and health outcome indicators across the various states, and generally, urban populations and those in the higher wealth quintiles are better served than are those who have low incomes and live in rural areas. [Extracted from the article]

Maternal death review (MDR) is an important strategy to improve the quality of obstetric care and reduce maternal morbidity and mortality. MDR provides detailed information on various factors at community, facility, and district levels that influence maternal health outcomes. One of the key challenges is to analyze large volumes of data collected via a paper-based system that uses facility and community level forms. This database continues to expand quantitatively (multiple forms and data elements), which makes analysis of data increasingly difficult for timely management and analysis. The present paper describes the development process involved in linking the paper-based system with an electronic system for MDR in India. The lessons learnt from this experience can contribute to understanding how innovative technologies can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health. [ABSTRACT FROM AUTHOR]

Many public sector programs, such as those directed at public health, are often multiagency tasks where structural incongruity in the program design is liable to emerge over time from changing operational requirements. Yet, successful implementation remains possible because of the interactions and relationships between implementation parties that encourage cooperation and collaboration despite incongruence in the program design. We examine how the dynamics of these interparty relationships influence implementation success in a comparative study of India's National Health Insurance Scheme. We find that implementation parties exhibiting support and complementarity in their interactions created a virtuous cycle of continually encouraging better performance and vice versa. Thus, our findings exhibit a distinct functionary role of interparty interactions and relationships for eliciting effective implementation and governance. The analysis also showcases the need for policy makers and policy designers to be cognizant of the inadvertent introduction of structural inconsistencies and veto points into program designs and their potential influence on implementation outcomes. We examine the role of interparty relationships for successful implementation in India's national health insurance scheme. In a comparative analysis, we find that mutually supportive and complimentary interparty relationships were more likely to lead to successful implementation, and vice versa. This is despite the presence of explicit veto points in the program's design. [ABSTRACT FROM AUTHOR]

Abstract: Integrating political, bureaucratic, industrial and healthcare systems has been a major challenge for politics of innovation and development policy in low‐ and middle‐income countries. This challenge has so far been understood in terms of separate industrial and health‐related innovation policies without paying adequate attention to the institutional roles of biopharmaceutical and other umbrella associations. This article seeks to examine such roles in the developmental contexts of South Africa and India. The argument put forward is that, in both countries, biopharmaceutical and umbrella associations have evolved from lobbying organizations to institutional partners who influence the politics of innovation and development—and therefore the degree of integration and fragmentation—of political, bureaucratic, industrial innovation and health systems. [ABSTRACT FROM AUTHOR]

The article focuses on a review read by Gemellus regarding the risks of ileal pouch neoplasms in patients with familial adenomatous polyposis (FAP). The 25 reports which tried to find clear risk patterns to allow for more rational follow-up after restorative polypectomy for patients with FAP had been reviewed by the authors from Japan and India. The conclusions had been summarised.

This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature - the Registered Medical Practitioner ( RMP) - who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India - one Sarah Pinto's, the other Ananya Roy's. [ABSTRACT FROM AUTHOR]

The article describes the implementation of a mobile-clinic based diabetes screening program from India. A significant number of people with diabetes remain undiagnosed because of a lack of awareness and access to health care facilities. A Mobile Diabetes Clinic (MDC) was established to provide basic diabetes screening to the underprivileged rural population with the help of Accredited Social Health Activists (ASHAs).

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This article evaluates the efforts underway in India to achieve universal health care coverage and the conditions that fostered its contemporary evolution. It finds that India's health system is characterized by private provision and financing, horizontal and vertical fragmentation, and weak governance arrangements. The article argues that these defining characteristics, which have solidified over time, account for poor health outcomes and make the system impervious to reforms as they deny the government levers to intervene and shape outcomes in the sector. While the government's recent efforts of increased public funding of national programmes have helped to reduce out of pocket spending, these are unlikely to work in the long run unless the government addresses the sources of the problems. The article argues that building health care governance, strengthening regulatory architecture, and stewardship over the system, in conjunction with increased public spending, are essential if the health care system is to provide affordable care to the entire population. [ABSTRACT FROM AUTHOR]

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget-financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015-16 budget. Both are voluntary co-contributory initiatives aimed at providing access to retirement income to low-income individuals (government co-contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance-based and aims to provide hospital care to low-income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology-enabled platforms such as Aadhaar, will be needed. [ABSTRACT FROM AUTHOR]

Background: India has a diabetes population that is growing and alongside this, the incidence of limb threatening foot problems is increasing. Foot health care provision does not yet meet this demand. In one locality in India, clinicians had an unstructured approach to foot health assessments resulting in poor adoption of evidence based guidelines from the West and a persistence of serious foot complications. There was the perception that existing assessment tools did not take into account the local cultural, organizational and professional needs and there was a lack of ownership of any potential solution to the problem. Therefore, the aim of this work was to facilitate the ownership and development of a foot health assessment tool for use in the Indian context. In order to achieve this an action research approach was chosen. Methods: Participants were facilitated through the action and implementation phases of the action research cycle by the researchers. The action phase included generating a list of potential items for inclusion in the tool from a review of the literature to provide an evidence based foundation for the foot health assessment tool. A modified Delphi method was used to further refine the contents of the tool. Members of the Delphi Panel (n = 8) were experts in their field of medicine and experts in delivering health care within services in India. Results: The outcome of the study was the adoption of a locally developed foot health assessment tool (Salford Indian Foot Health Assessment Tool, SIFT). It contains thirteen sections, which reflect the risk factors identified for assessing foot health agreed by the participants to fit the Indian context. The SIFT is supported with evidence based guidelines from the West and a training program was delivered by the researchers in order to support its implementation into clinical practice. Conclusion: An action research approach has facilitated the development and implementation of a locally created and owned foot health assessment tool. This in turn has resulted in the integration of evidence-based guidelines from the West with consideration to local cultural, organizational and professional needs and ultimately the needs of their patients. Further work is underway evaluating the outcomes of the SIFT in practice. [ABSTRACT FROM AUTHOR]

Background Variations in healthcare provision around the world may impact how patients with functional gastrointestinal disorder ( FGIDs) are investigated, diagnosed, and treated. However, these differences have not been reviewed. Purposes The Multinational Working Team of the Rome Foundation, established to make recommendations on the conduct of multinational, cross-cultural research in FGIDs, identified seven key issues that are analyzed herein: (i) coverage afforded by different healthcare systems/providers; (ii) level of the healthcare system where patients with FGIDs are treated; (iii) extent/types of diagnostic procedures typically undertaken to diagnose FGIDs; (iv) physicians' familiarity with and implementation of the Rome diagnostic criteria in clinical practice; (v) range of medications approved for FGIDs and approval process for new agents; (vi) costs involved in treating FGIDs; and (vii) prevalence and role of complementary/alternative medicine ( CAM) for FGIDs. Because it was not feasible to survey all countries around the world, we compared a selected number of countries based on their geographical and ethno-cultural diversity. Thus, we included Italy and South Korea as representative of nations with broad-based coverage of healthcare in the population and India and Mexico as newly industrialized countries where there may be limited provision of healthcare for substantial segments of the population. In light of the paucity of formal publications on these issues, we included additional sources from the medical literature as well as perspectives provided by local experts and the media. Finally, we provide future directions on healthcare issues that should be taken into account and implemented when conducting cross-cultural and multinational research in FGIDs. [ABSTRACT FROM AUTHOR]

The article throws light on a national nursing research conference, held for the first time in India on October 1982 at Bangalore. The theme of the conference was "Nursing research in India -- prospect and retrospect." The association plan to do a thorough study, develop recommendations and hold discussions with nurses throughout the country on the appropriate future preparation of nurses in Japan. Many distinguished women attended as observers the committee meeting at which this legislation was presented to show support for the proposal.

ABSTRACT This article assesses the impact of rural-urban migration on gender disparities in children's access to healthcare in China and India. Much research has shown widespread discrimination against girl children in both countries, including in health investments, contributing to the well-known problem of Asia's 'missing' women. Much less clear is the impact of the massive rural-urban migration now occurring in China and India on discrimination against daughters. Migration is usually thought to have a positive effect on child health, because of improved access to healthcare facilities, but this is not necessarily equally beneficial for both sons and daughters. Based on fourteen months of fieldwork with rural migrant families in Shenzhen (China) and Mumbai (India), this article argues that where migration improves access to healthcare, it may increase rather than decrease the gender gap in treatment of child illness in the short term, as resources are concentrated on the treatment of sons. Furthermore, it is not the case that rural-urban migration necessarily leads to better access to healthcare even for sons: some forms of migration may actually have an overall negative effect on child health outcomes. For these two reasons, development strategies focusing on large-scale rural-urban migration should not be seen as a short-term solution to problems of gender inequity in child health. [ABSTRACT FROM AUTHOR]

Introduction: HIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. Methods: This cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and nongovernmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure. Results: High levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs "got what they deserved" (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in lowrisk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions. Conclusions: Stigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught. [ABSTRACT FROM AUTHOR]

Cross-country learning in healthcare is not one way, as developed economies have much to learn from emerging economies and vice versa. [ABSTRACT FROM AUTHOR]

Background The UAB-ITREOH program has initiated a skill-based MPH program at Manipal University (MU), India, in 2009, to address the critical need for trained public health professionals and build institutional public health training capacity in the country. Methods Funds from Fogarty have supported the curriculum development and specialized training of MU faculty to teach in the MPH program. Results The program has been successfully launched and is gaining momentum. The lessons learned from our experiences as well as several challenges faced from the initialization to execution of the program are described in the article. Conclusions Government support is crucial for raising the profile of this program by accreditation, creating job opportunities and by recognizing these professionals as leaders in the public health sector. Am. J. Ind. Med. 56:20-28, 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In the language of the medical file, 'complaint' refers to the symptoms and ailments reported by the patient. In this article, I draw on ethnographic fieldwork conducted between 2004 and 2007 in the mental healthcare setting in South India to argue that the typology of 'complaint' and the dialogic exchanges involved in its production mark a far wider catchment area for the allegations and grievances that circulate between patient, kin, clinician, and observing anthropologist. I propose the notion of the register of complaint as a hermeneutic for grappling with the emotionally charged, interactional processes of accusation, arbitration, and reportage that drive clinical modes of inquiry and evaluation in the South Indian mental health encounter. Ethnographic case studies suggest that grievance and accusation command both a vital directive force and evidentiary role in the social, moral, and emotional work of psychiatric diagnosis.[complaint, diagnosis, kinship and family, emotion, psychiatry, South India] [ABSTRACT FROM AUTHOR]

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The rapid ageing of India's population, in conjunction with migration out of rural areas and the continued concentration of the working population in the informal sector, has highlighted the need for better economic security arrangements for the elderly. Traditional family ties that have been key to ensuring a modicum of such security are beginning to fray, and increased longevity is making care of the elderly more expensive. As a result, the elderly are at increased risk of being poor or falling into poverty. In parallel with its efforts to address this issue, the Government of India and some of the Indian states have initiated an array of programmes for providing some level of access to health care or health insurance to the great majority of Indians who lack sufficient access. Formal-sector workers have greater social security than those in the informal sector, but they only represent a small share of the workforce. Women are particularly vulnerable to economic insecurity. India's experience offers some lessons for other countries. Although there is space for private initiatives in the social security arena, it is clear that most such efforts will need to be tax-financed. The role that private providers can play is substantial, even when most funding comes from public sources, but such activity will face greater challenges as more individuals seek benefits. India has also shown that implementation can often be carried out well by states using central government funds, with a set of advantages and disadvantages that such decentralization brings. Finally, India's experience with implementation can offer guidance on issues such as targeting, the use of information technology in social security systems, and human resource management. [ABSTRACT FROM AUTHOR]

Increasing access to essential medicines has become an international priority, given the rapid spread of intractable diseases such as HIV/AIDS, tuberculosis and malaria. It follows that the quests to improve the global quality of healthcare and achieve health equity present a challenge for many countries, especially those that have been hard hit by deadly pandemics and whose populations are also still without essential drugs. Consequently, many countries have stepped up efforts to remove the obstacles to the availability and affordability of essential medicines. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) contains flexibilities that can be used as tools for enhancing access to cheap medicines and for controlling drug pricing. However, these flexibilities are not necessarily a panacea and cannot singly solve the problem of limited access to essential medicines. Put differently, cheaper medicines cannot reach the poor without the infrastructure to deliver them. For this to become a reality, commitment on the part of the member countries to adopt comprehensive and cooperative measures to tackle the burdensome barriers that limit access to critical medicines is needed. It is only then that the flexibilities in TRIPS can be optimized and a real difference made in the lives of poor patients across the developing world. [ABSTRACT FROM AUTHOR]

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India, with its huge population and limited mental health resources, must find alternative ways of delivering its mental healthcare services. Telepsychiatry seems to be a promising option even with no regulatory authority in place or specific laws in India that deal with telemedicine practice, there has been a mushrooming of telemedicine services in India. Healthy cooperation between government organizations such as the Indian Space Research Organization (ISRO) and institutions in the non-government and private sectors is another key feature in India. The experience of the Schizophrenia Research Foundation (SCARF), at Chennai, in South India, in running and establishing a telepsychiatry network is presented in this article. We identified the following tasks as essential to ensure an efficient intervention using telemedicine: identifying a suitable technology, a suitable location, and a local collaborator; providing training and creating awareness; establishing peripheral telepsychiatry centers and ensuring case documentation; and accountability. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]