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Background: Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information. Objective: To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020). Method: A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded. Results: A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors. Conclusion: A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control. Implications: This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors. [ABSTRACT FROM AUTHOR]

Background: In 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified 'health systems strengthening' as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey − 4), to assess structural capacity and continuum of snakebite care in primary health care system in India. Methodology: We evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not. Results: No state excelled (front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains. Conclusion: Comprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose. [ABSTRACT FROM AUTHOR]

Blockchain technology has recently been at the center stage of academic discussions. This is owing to its use in the financial sector and the rise of cryptocurrencies like Bitcoin. In essence, digital ledger technology (DLT) is shared digital data spread across multiple sites. A blockchain is a type of DLT consisting of a growing list of records, called blocks, securely linked with a time stamp. Maintaining data privacy and security is one of the core benefits of using the blockchain network. In healthcare, efficient data sharing is desirable with secure long-term access to data. In recent years, numerous applications built on blockchain infrastructure have been introduced in the healthcare sector. In this narrative review, we intend to introduce the science of blockchain technology, its core concepts, and its application to healthcare. We also describe current instances of its application in the healthcare sector, its application from the Indian perspective, and its limitations and future possibilities. [ABSTRACT FROM AUTHOR]

In an era where every public health action is expected to be backed by credible evidence, health policy-making has also been increasingly seen to follow the same. The general consensus across the globe is to strengthen health information systems and the decisions of the policy makers are increasingly relying on the information provided to them through such systems. COVID-19 has clearly brought out the need for accurate, timely and relevant information in planning for and responding to public health emergencies that can be equally devastating, if not more. It is crucial for information providers to understand the importance of communicating and disseminating it in a timely manner so that it leads to public health action for the larger good of the population. [ABSTRACT FROM AUTHOR]

Context: Electronic health record (EHR) has the potential to make available the real-time data of the patient to the healthcare professionals by connecting all levels of the public health system, irrespective of their geographical boundaries. Aim: This study aims to test the capturing and sharing of real-time patient data at primary, secondary, and the tertiary level. Settings and Design: The cloud-based EHR system developed earlier was used to capture real-time data of the patient visiting a primay health center (PHC) in Udupi District of Karnataka. Subjects and Methods: About 100 patient records including laboratory and pharmacy data have been captured into the EHR system. The confidentiality of patient data is assured. Results: The result of the study indicated no errors while capturing and sharing the patient data in real time. The system also evidenced the availability of vital statistics about the patient visiting PHCs. The system also allowed the professionals at referral level to view patient data for providing quality healthcare. Conclusion: EHR plays a vital role in capturing, storing, and sharing patient data for providing quality healthcare and it should be made mandatory by the central health agencies in the provision of patient care and reporting of notifiable communicable diseases at all levels. [ABSTRACT FROM AUTHOR]

Nameless nursing informaticians have been part of the tech-culture for more than two decades imbibing it like a sponge and have muddled through the successful and not so successful initiatives in healthcare. With the changing times and recognition of efforts that nurses continue to put in digital patient care, universally nursing informatics has grown as a separate field. In India, Health Information Technology (HIT) has made the nursing fraternity to adopt digital healthcare, however the extent of percolation remains questionable until we measure it as objectively as possible. The only way to do so is educate and check the skill competencies of nursing students and practicing nursing professional including researchers, educators, administrators and clinical nurses. The article explores the nursing informatics curriculum taught to student nurses in India. The basic and advance competencies in computer application, information literacy and management have been proposed for nursing students and nursing professionals in Indian setting. [ABSTRACT FROM AUTHOR]

Objectives: In India, integrated biological and behavioral surveillance was carried out in 2014–2015 among high-risk key population as a part of second-generation HIV surveillance system. Computer-assisted personal interviewing and integrated information management system were used for the first time in this large national field based survey. We evaluated the strengths and weaknesses of technology use in this survey. Methods: Mixed methods comprising of the key informant's interviews and structured data collected from field interviewers were used to do the strengths, weaknesses, opportunities, and threats analysis with defined attributes. Results: Despite the challenges, the technology use in this survey was a huge success with respect to data coverage, response rates, real-time data, and acceptance by respondents. However, such techniques require more focus on the competency of human resource, training, and concurrent evaluation systems to get better data quality, time adherence, and effective use of technology. Conclusion: The recommendations resulted from this analysis will help for strategic management while designing such systems in field-based community surveys. [ABSTRACT FROM AUTHOR]

India has a long history of the Health Management Information and Evaluation System (HMIES). Though it has well served its purpose of administrative reporting, however, it has failed to provide relevant and sufficient information to users of health services, planners and policy makers as available information is fragmented, incomplete and sometimes inconsistent. The National Health Policies of 1983 and 2002 and the National Statistical Commission of India 2005 have laid down clear benchmarks for HMIES. In spite of several efforts in the past, the national HMIES does not fully conform to ‘International Data Quality Frameworks, Systems and Standard Practices’. In this article, efforts are made to compare information collection and governance system, its standardization and extent of utilization for decision-making in Australia and India and give recommendations to transform our national HMIES to be compatible with international standards, frameworks and practices. [ABSTRACT FROM AUTHOR]

This section offers news briefs. These include findings by researchers that most clinical practice guidelines for procedural pain in children are of average quality and do not provide tools to help clinicians apply recommendations in practice settings, victory of Pfizer Inc. in a court ruling in February 2014 that blocks generic versions of Lyrica in the U.S. until December 2018 and findings that the drug EMA401 was found to reduce without causing any serious side effects.

A small-scale research/intervention project that aimed to develop and test an integrated package of communication campaign on health awareness among women belonging to the marginalized community was implemented in an underdeveloped setting of West Bengal, India during 2010–11. A quasi-experimental research design, with cross-sectional surveys conducted in six intervention and control villages at the baseline and endline, was used to evaluate the outcome of intervention among 1,196 respondents. This article examines the impact of behaviour change communication intervention on knowledge, reporting of illnesses and treatment-seeking of symptoms of general and gynaecological morbidity. Analyses included multiple, binary logistic and multinomial logistic regressions using a Difference-in-Difference estimator. Results of the evaluation suggest that the net effect of exposure to the intervention had a positive and significant impact on most of the indicators reflecting an increased level of awareness about signs and symptoms of general and reproductive complications. However, the net effect of exposure was mixed for the indicators of reporting of illnesses, pattern and sources of seeking treatment. The experience of implementing the project demonstrates that it is possible to improve women’s general and reproductive health awareness and practices which could have resulted in positive health outcomes in the long run. [ABSTRACT FROM PUBLISHER]

Background: A complete, accurate, adequate and timely medical documentation helps in reducing medical errors and serves as important medical–legal evidence.Objective: To evaluate Oncology Medical Records based on the National Accreditation Board of Hospitals Information Management System (NABH.IMS) and Patient Rights and Education (NABH.PRE) standards.Methods: This retrospective study was conducted to assess the policies and procedures in relation to medical documentation against NABH.IMS 1–7 standards and NABH.PRE-3 Standards. A total of 520 discharged inpatient records were analyzed to understand the quality of medical documentation in practice.Results: The existing policies and procedures were found to be compliant with NABH.IMS and NABH.PRE standards. The analysis of medical records showed maximum compliance in Nurse’s records, Doctor’s order forms, Anaesthesia reports of Breast and Head & Neck Cancer and Radiotherapy Charts in Cervical Cancer.Conclusion: Overall documentation was found to be satisfactory as per the standards set by NABH. The study results revealed that the attention to compulsorily document patient clinical data in the respective forms of the medical records will enhance the completeness and accuracy of medical documentation of the hospital. [ABSTRACT FROM PUBLISHER]

This study investigates the implementation of a recent health management information systems (HMIS) policy reform in Uttar Pradesh, India, which aims to improve the quality and use of HMIS data in decision-making. Through in-depth interviews, meeting observations and a policy document review, this study sought to capture the experiences of district-level staff (street-level bureaucrats) who were responsible for HMIS policy implementation. Findings revealed that issues of weak HMIS implementation were partly due to human resources shortages both in number and technical skill. Delays in recruitment and the presence of inactive staff overburdened existing staff and weakened the implementation of HMIS activities at the block- and district-levels. District staff also explained how inadequate computer literacy and limited technical understanding further contributed to low HMIS data quality. The organizational culture was even more constraining: working within a very rigid and hierarchical organization was challenging for district data staff, who were expected to manage day-to-day HMIS activities, but lacked the discretion and authority to do so effectively. Consequently, they had to escalate minor issues to district leadership for action and were expected to follow their supervisors' directives– even if they contradicted HMIS policy guidelines. High performance pressures associated with achieving top district rankings deviated focus away from HMIS data quality issues. Many district-level respondents described their superiors' "fixation" with becoming a top-ranking district often resulted in disregard for the quality of data informing district rankings. Furthermore, the review of district rankings only partially encouraged district-level leadership to investigate reasons for low-performing indicators. Instead, low district rankings often resulted in punitive action. The study recommends the importance of incorporating the perspectives of district staff, and recognizing their discretion, and authority when designing policy implementation processes, and finally concludes with potential strategies for strengthening the current HMIS policy reform. • Well-designed policies are insufficient for successful HMIS policy implementation. • Attention needs to be paid to organizational cultural factors. • Strict organizational hierarchy and punitive work culture weaken HMIS implementation. • Incorporating perspectives of policy implementers is critical for HMIS policy design. [ABSTRACT FROM AUTHOR]

• Implementation of Maternal Death Reviews (MDR) at the community level and deaths reviews by CMO found to be poor in India. • One-third of maternal deaths are reviewed at the community level in India. • The Chief Medical Officer reviewed 39% deaths during past three years in India. • Postpartum haemorrhage tolled 15% maternal deaths followed by severe hypertension/fits (10%), and high fever (3%). • Strategic intervention based on the identified causes may reduce maternal deaths in India particularly in Empowered Action Groups states. Maternal Death Review (MDR) is a continuous effort of identification, notification, and review of maternal deaths for possible causes followed by actions to improve quality of care for preventing future deaths. The present study has used three consecutive years' data of MDR and assessed the causes of maternal death which are available in the Health Management Information System (HMIS) for years 2017–18, 2018–19 and 2019–20. A total 61,472 maternal deaths occurred in India during the past three years. A higher proportion of these deaths occurred particularly in Uttar Pradesh (22.9%) followed by Madhya Pradesh (9.8%), Rajasthan (6.3%), Maharashtra (6.2%), Bihar (5.8%), West Bengal (5.3%) and Assam (5.1%). The Community Based Maternal Death Reviews (CBMDR) revealed that only one-third (32.6%) of maternal deaths are reviewed at the national level out of total deaths. The Empowered Action Group (EAG) states such as Bihar has the lowest MDR followed by Madhya Pradesh, Rajasthan, Jharkhand and Uttar Pradesh. Likewise, the chief medical officer (CMO) at the district level reviewed 39.4% of deaths during the past three years in India. Haemorrhage causes 15 percent of maternal deaths followed by severe hypertension/fits (10%), high fever (3%) in India. Bihar has the highest maternal deaths due to postpartum hemorrhage followed by Meghalaya, Manipur, Uttar Pradesh, Jharkhand and Mizoram. The study concludes that the implementation of MDR at both the level (CBMDR and reviews by CMO) are found to be poor in India. Strategic interventions based on the identified causes at both levels may help to reduce the maternal deaths in India, particularly in EAG states. [ABSTRACT FROM AUTHOR]

Background: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. Objectives: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. Methods: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. Results: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. Conclusion: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic. [ABSTRACT FROM AUTHOR]

The article discusses need for an national health data agency (HDA) in India for disseminating and maintaining health data within the country; and need for HDA to coordinate with existing data-holders, such as the Indian Ministry of Health and Family Welfare and Dept. of Health Research.

The article discusses the legal aspects of radiology practice in India. One of the rules and regulations framed by the government for doctors of all disciplines are mandatory registration of medical professionals with the Medical Council of India (MCI) or with state medical councils. It advises the practice doctor to be prudent and manage patient records with sincerity to prevent litigation. Also stressed is the need for radiologists to establish rapport with the patients and their attendants.