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Hasan MZ, Kennedy CE, Adhikari B, Ahuja A, Gupta S. Bridging the gap or widening the divide? Exploring the dual role of social capital in healthcare financing in rural Uttar Pradesh, India. Soc Sci Med 2024; 351:116928. [PMID: 38772211 DOI: 10.1016/j.socscimed.2024.116928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/23/2024]
Abstract
Social capital, defined as the nature of the social relationship and the resources embedded within the social network of an individual or community, influences how individuals within a group interact and collaborate within their communities or organizations. While it is acknowledged that social capital can be drawn from as a coping strategy to mitigate financial stress, there is a notable absence of the lived experience in the literature on how social capital influences households to tap resources from their social network. We have investigated the role of social capital in healthcare financing in rural Uttar Pradesh, India, highlighting the challenges faced by households in managing healthcare expenses. We took a qualitative research approach, conducting in-depth interviews with 24 households in the Hardoi District of Uttar Pradesh in August 2017 to explore participants' lived experience of accruing support from their community during their healthcare crisis. Data analysis followed a thematic content analysis approach. The study finds that households leverage social capital for both financial and non-financial support during health crises. Social networks, trust, and community cohesion play critical roles in resource acquisition. However, overreliance on social capital can be coercive, leading to inequity, privacy invasion, and dependency. Though social capital serves as a crucial resource of support in healthcare emergencies, its unequal distribution and potential for misuse highlight the need for more structured health financing policies in India. The findings underscore the importance of integrating community-driven resources into broader health financing strategies, considering local social structures and community dynamics.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA; BRAC James P. Grant School of Public Health, BRAC University, 28, 6th Floor, Medona Tower, Bir Uttam AK Khandakar Rd, Dhaka, 1213, Bangladesh.
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Binita Adhikari
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Akshay Ahuja
- HCL Foundation, Plot No, 3A, Sector 126, Noida, Uttar Pradesh, 201304, India New Delhi, India.
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Vasanthan L, Natarajan SK, Babu A, Kamath MS, Kamalakannan S. Digital health interventions for improving access to primary care in India: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002645. [PMID: 38743672 DOI: 10.1371/journal.pgph.0002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/25/2024] [Indexed: 05/16/2024]
Abstract
Access to quality healthcare remains a challenge in low-and middle-income countries. Vulnerable populations with unmet needs face the greatest challenge in accessing primary care for appropriate and timely healthcare. The use of digital technologies can not only strengthen health systems but also improve access to health care, particularly for the vulnerable. This scoping review aims to assess the various digital health technologies and interventions available for improving access to primary care for the vulnerable in India. This scoping review employed the Joanna Brigg Institute's (JBI) guidelines and Arksey and O'Malley's methodological framework. The literature search was conducted in Medline/PubMed, Embase, Web of Science-Core Collection, Scopus, AgeLine, PsycINFO, CINAHL, ERIC, Cochrane CENTRAL, and Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register databases, using the keywords, such as 'Access', 'Healthcare', 'Assistive technology', 'Digital health' 'Vulnerable', 'India' and 'Healthcare technology'. A two-staged screening of titles and abstracts, followed by full-text was conducted independently by two reviewers, using the Rayyan software. Subsequently, the data was extracted from selected studies using a pre-designed and approved extraction form. The data was then synthesised and analysed narratively. The protocol for this review has been registered with open science forum (OSF) registries (https://osf.io/63pjw/). The search yielded about 3840 records, 3544 records were eligible for screening of titles and abstracts. We included seven studies after a two-round screening and identified seven different technological innovations developed to bridge gaps in access to primary care. The commonly used digital health interventions for improving access to primary care were virtual tele-health systems and mHealth applications in-built within an android smartphone or a tablet. Digital health interventions was either used as a standalone tele-health aid or a collaborative system for community workers, primary care physicians as well as the health service users. The purpose of these innovations was to increase awareness and knowledge to access support for specific aspects of healthcare. Virtual primary health care with the specialist in the hub supporting general physicians at the primary health centres in blocks and districts was another such model used for improving access to primary care. Digital health interventions was also used for mass community screening of disabilities, such as persons with hearing disability. To re-imagine a digitally empowered health systems in India, also inclusive of the vulnerable, it is important to inclusively conceptualise, systematically develop and rigorously evaluate any public health interventions including those that are enabled by digital health interventions to bridge the gaps in access to primary care in India. Such a strategy could address the paucity of evidence in public health interventions and provide sustainable strategies to strengthen health systems in India. Trial registration: Open Science Framework-Registration Link: https://osf.io/63pjw/.
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Affiliation(s)
- Lenny Vasanthan
- Department of Physical Medicine and Rehabilitation, Physiotherapy Unit, Christian Medical College, Vellore, Tamil Nadu, India
- Department of Physiotherapy, Honorary Clinical Senior Lecturer, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sindhu Kulandaipalayam Natarajan
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Andrew Babu
- Department of Physical Medicine and Rehabilitation, Physiotherapy Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sureshkumar Kamalakannan
- Department of Social Work, Education, and Community Well-being, Northumbria University, Newcastle Upon Tyne, United Kingdom
- Institute of Public Health Sciences, Public Health Foundation of India, Hyderabad, India
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Ziegler S, Srivastava S, Parmar D, Basu S, Jain N, De Allegri M. A step closer towards achieving universal health coverage: the role of gender in enrolment in health insurance in India. BMC Health Serv Res 2024; 24:141. [PMID: 38279165 PMCID: PMC10821565 DOI: 10.1186/s12913-023-10473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/12/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND There is limited understanding of how universal health coverage (UHC) schemes such as publicly-funded health insurance (PFHI) benefit women as compared to men. Many of these schemes are gender-neutral in design but given the existing gender inequalities in many societies, their benefits may not be similar for women and men. We contribute to the evidence by conducting a gender analysis of the enrolment of individuals and households in India's national PFHI scheme, Rashtriya Swasthya Bima Yojana (RSBY). METHODS We used data from a cross-sectional household survey on RSBY eligible families across eight Indian states and studied different outcome variables at both the individual and household levels to compare enrolment among women and men. We applied multivariate logistic regressions and controlled for several demographic and socio-economic characteristics. RESULTS At the individual level, the analysis revealed no substantial differences in enrolment between men and women. Only in one state were women more likely to be enrolled in RSBY than men (AOR: 2.66, 95% CI: 1.32-5.38), and this pattern was linked to their status in the household. At the household level, analyses revealed that female-headed households had a higher likelihood to be enrolled (AOR: 1.36, 95% CI: 1.14-1.62), but not necessarily to have all household members enrolled. CONCLUSION Findings are surprising in light of India's well-documented gender bias, permeating different aspects of society, and are most likely an indication of success in designing a policy that did not favour participation by men above women, by mandating spouse enrolment and securing enrolment of up to five family members. Higher enrolment rates among female-headed households are also an indication of women's preferences for investments in health, in the context of a conducive policy environment. Further analyses are needed to examine if once enrolled, women also make use of the scheme benefits to the same extent as men do. India is called upon to capitalise on the achievements of RSBY and apply them to newer schemes such as PM-JAY.
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Affiliation(s)
- Susanne Ziegler
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Friedrich-Ebert-Allee 32+36, 53113, Bonn, Germany.
| | - Swati Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Divya Parmar
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Sharmishtha Basu
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, B5/1 Safdarjung Enclave, 110029, New Delhi, India
| | - Nishant Jain
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, B5/1 Safdarjung Enclave, 110029, New Delhi, India
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Ecks S, Kulkarni V. 'Having the card makes us feel worthless': the negative value of government-funded health insurance in India. Anthropol Med 2023; 30:380-393. [PMID: 38299487 DOI: 10.1080/13648470.2023.2291738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/28/2023] [Indexed: 02/02/2024]
Abstract
Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.
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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Kalita A, Carton-Rossen N, Joseph L, Chhetri D, Patel V. The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study. Ann Glob Health 2023; 89:69. [PMID: 37841807 PMCID: PMC10573738 DOI: 10.5334/aogh.4120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms. Objectives We seek to understand the views of a diverse group of policy actors in India to address the following research questions: what are the (i) conceptualizations of UHC, (ii) main barriers to realizing UHC, and (iii) policy strategies to address these barriers. Data and Methods We collected data through in-depth interviews with 38 policy actors from diverse backgrounds and analyzed using the Framework Method to develop themes both inductively and deductively using the Control Knob Framework of health systems. Findings There was congruence in the conceptualization of UHC by policy actors. Quality of care, equity, financial risk protection, and a comprehensive set of services were the most commonly cited features. The lack of a comprehensive systems approach to health policies, inadequate and inefficient health financing mechanisms, and fragmentation between public and private sectors were identified as the main barriers to UHC. Contrasting views about specific strategies, health financing, provider payments, organization of the delivery system, and regulation emerged as the key policy interventions to address these barriers. Discussion and Conclusion This is the first systematic examination of a diverse set of policy actors' problem analyses and suggestions to advance UHC goals in India. The study underscores the need to recognize the complex and interlinked nature of health system reforms and initiate a departure from path-dependent vertical interventions to bring about transformative change.
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Affiliation(s)
| | | | - Linju Joseph
- Achutha Menon Centre for Health Science Studies, India
- University of Birmingham, UK
| | | | - Vikram Patel
- Harvard T.H. Chan School of Public Health, USA
- Harvard Medical School, USA
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Mathias K, Jain S, Fraser R, Davis M, Kimijima–Dennemeyer R, Pillai P, Deshpande SN, Wolters M. Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001736. [PMID: 37639400 PMCID: PMC10461838 DOI: 10.1371/journal.pgph.0001736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.
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Affiliation(s)
- Kaaren Mathias
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
| | - Sumeet Jain
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Meghan Davis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Pooja Pillai
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
| | - Smita N. Deshpande
- Department of Psychiatry, St John’s National Academy of Medical Sciences, Bengaluru, India
| | - Maria Wolters
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
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Bailie CR, Pillai PS, Goodwin Singh A, Leishman J, Grills NJ, Mathias K. Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India. Glob Ment Health (Camb) 2023; 10:e47. [PMID: 37854393 PMCID: PMC10579688 DOI: 10.1017/gmh.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
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Affiliation(s)
- Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pooja S. Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Atul Goodwin Singh
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Jed Leishman
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Sferra SR, Guo M, Gonzalez Salazar AJ, Penikis AB, Engwall-Gill AJ, Ebanks A, Harting MT, Collaco JM, Kunisaki SM. Sex-Specific Differences in Congenital Diaphragmatic Hernia Mortality. J Pediatr 2023; 259:113481. [PMID: 37196780 DOI: 10.1016/j.jpeds.2023.113481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To compare disease severity and mortality differences between female and male patients with congenital diaphragmatic hernia (CDH). STUDY DESIGN We queried the CDH Study Group (CDHSG) database for CDH neonates managed between 2007 and 2018. Female and males were compared in statistical analyses using t tests, χ² tests, and Cox regression, as appropriate (P ≤ .05). RESULTS There were 7288 CDH patients, of which 3048 (41.8%) were female. Females weighed less on average at birth than males (2.84 kg vs 2.97 kg, P < .001) despite comparable gestational age. Females had similar rates of extracorporeal life support (ECLS) utilization (27.8% vs 27.3%, P = .65). Although both cohorts had equivalent defect size and rates of patch repair, female patients had increased rates of intrathoracic liver herniation (49.2% vs 45.9%, P = .01) and pulmonary hypertension (PH) (86.6% vs 81.1%, P < .001). Females had lower survival rates at 30-days (77.3% vs 80.1%, P = .003) and overall lower survival to discharge (70.2% vs 74.2%, P < .001). Subgroup analysis revealed that increased mortality was significant among those who underwent repair but were never supported on ECLS (P = .005). On Cox regression analysis, female sex was independently associated with mortality (adjusted hazard ratio 1.32, P = .02). CONCLUSION After controlling for the established prenatal and postnatal predictors of mortality, female sex remains independently associated with a higher risk of mortality in CDH. Further study into the underlying causes for sex-specific disparities in CDH outcomes is warranted.
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Affiliation(s)
- Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew Guo
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andres J Gonzalez Salazar
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashley Ebanks
- Department of Pediatric Surgery, University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX
| | - Matthew T Harting
- Department of Pediatric Surgery, University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Sahoo PM, Rout HS, Jakovljevic M. Contemporary Universal Health Coverage in India - The Case of Federal State of Odisha (Orissa). Risk Manag Healthc Policy 2023; 16:1131-1143. [PMID: 37384257 PMCID: PMC10293795 DOI: 10.2147/rmhp.s406491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose The present study assessed the awareness of the public about Biju Swasthya Kalyan Yojana (BSKY), which is a flagship public-funded health insurance scheme of the Government of Odisha. The study also identified its determinants and examined utilisation of the scheme among households in Khordha district of Odisha. Materials and Methods Primary data were collected from randomly chosen 150 households using a pretested structured questionnaire from Balipatana block of Khordha district, Odisha. Descriptive statistics and binomial logistic regression were used to substantiate the objectives. Results The study found that even though 56.70% of the sample households had heard about BSKY, procedure-specific awareness was low. State government organised BSKY health insurance camp was found to be a major source of knowledge among the sample. The regression model had an R2 of 0.414. The Chi2 value showed that the model with predictor variables was a good fit. Caste, gender, economic category, health insurance, and awareness about insurance were significant determinants of BSKY awareness. A majority (79.30%) of the sample had the scheme card with them. However, only 12.60% of the cardholders used the card and only 10.67% received benefits. Mean out-of-pocket expenditure (OOPE) faced by the beneficiaries is Rs. 15743.59. Among the beneficiaries, 53.80% financed the OOPE from their savings, 38.50% by borrowing, and 7.70% financed the OOPE by both means. Conclusion The study found that even though majority of people had heard about BSKY, they were not aware of its nature, features, and operational procedures. The trend of low benefit received and higher OOPE among the scheme beneficiaries hampers the economic health of the poor. Finally, the study highlighted the need to increase the magnitude of scheme coverage and administrative efficiency.
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Affiliation(s)
- Pragyan Monalisa Sahoo
- Department of Analytical & Applied Economics, Utkal University, Bhubaneswar, Odisha, India
| | - Himanshu Sekhar Rout
- Department of Analytical and Applied Economics & RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar, Bhubaneswar-751 004, Odisha, India
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Wetzel S, Geldsetzer P, Mani SS, Gupta A, Singh K, Ali MK, Prabhakaran D, Tandon N, Sudharsanan N. Changing socioeconomic and geographic gradients in cardiovascular disease risk factors among Indians aged 15-49 years - evidence from nationally representative household surveys. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100188. [PMID: 37384058 PMCID: PMC10305936 DOI: 10.1016/j.lansea.2023.100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 06/30/2023]
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomic and geographic gradients will persist or change. Understanding these social dynamics in CVD risk is essential for mitigating the rising burden of CVDs and to reach those with the greatest needs. Methods Using nationally representative data with biomarker measurements from the fourth (2015-16) and fifth (2019-21) Indian National Family and Health Surveys, we investigated trends in the prevalence of four CVD risk factors: smoking (self-reported), unhealthy weight (BMI ≥25 kgm2), diabetes (random plasma glucose concentration ≥200 mg/dL or self-reported diabetes), and hypertension (one of: average systolic blood pressure ≥140 mmHg, average diastolic blood pressure ≥90 mmHg, self-reported past diagnosis, or self-reported current antihypertensive medication use) among adults aged 15-49 years. We first described changes at the national level and then trends stratified by place of residence (urban versus rural), geographic region (northern, northeastern, central, eastern, western, southern), regional level of development (Empowered Action Group member state or not), and two measures of socioeconomic status: level of education (no education, primary incomplete, primary complete, secondary incomplete, secondary complete, higher) and wealth (quintiles). Findings Unhealthy weight increased among all social and geographic groups but both the absolute and the relative changes were substantially higher among people with low SES (as measured by education or wealth) and in rural areas. For diabetes and hypertension, the prevalence increased for those from disadvantaged groups while staying constant or even decreasing among the wealthier and more educated. In contrast, smoking consumption declined for all social and geographic groups. Interpretation In 2015-16, CVD risk factors were higher among more advantaged subpopulations in India. However, between 2015-16 and 2019-21, the prevalence of these risk factors grew more rapidly for less wealthy and less educated subpopulations and those living in rural areas. These trends have resulted in CVD risk becoming far more widespread throughout the population; CVD can no longer be characterized as a wealthy urban phenomenon. Funding This work was supported by the Alexander von Humboldt Foundation (grant received by NS); the Stanford Diabetes Research Center [grant received by PG] and the Chan Zuckerberg Biohub [grant received by PG].
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Affiliation(s)
- Sarah Wetzel
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Sneha Sarah Mani
- Graduate Group in Demography, University of Pennsylvania, PA, USA
| | - Aashish Gupta
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA
| | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, India
- Public Health Foundation of India, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, India
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
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Mishra PS, Syamala TS. Multiple Vulnerabilities in Access to and Utilising of Maternal and Child Health Services in India: A Spatial–Regional Analysis. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634231152338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction Although there are multiple vulnerabilities in the utilisation of maternal and child health (MCH) services in India, research has always been focused on single-dimension vulnerabilities like economic or social vulnerabilities. Individuals who are poor may also face other types of vulnerabilities that together affect access to health services. This article, therefore, investigates the linkages between multiple vulnerabilities and the utilisation of MCH care services. Materials and Methods Data from National Family Health Survey (2015–2016) for India and states were used for analysing the key outcome variables namely women received four or more antenatal care (ANC), institutional delivery, postnatal care (PNC) and full immunisation for children in the age group of 12–23 months. Bivariate analysis and binomial-logistic regression analysis were employed to examine the multiple vulnerabilities on utilising MCH services across three dimensions of vulnerabilities, such as education, wealth and caste. Results Women with multiple vulnerabilities were less likely to utilise essential MCH services. Women who faced vulnerabilities in all three dimensions were less likely to have received four or more ANC and postnatal care than those who were not deprived of any vulnerabilities (0.3 vs. 0.9 and 0.4 vs. 0.8, respectively). They were also less likely to deliver in health facilities and avail child immunisation (0.5 vs. 0.8 and 0.3 vs. 0.7, respectively). Conclusion A multi-sectoral approach is therefore required to deal with the issues of low access and underutilisation of MCH services.
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Affiliation(s)
- Prem Shankar Mishra
- Population Research Center, Institute for Social and Economic Change, Bengaluru, Karnataka, India
| | - T. S. Syamala
- Population Research Center, Institute for Social and Economic Change, Bengaluru, Karnataka, India
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13
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Lee JE, Goh ML, Yeo SF. Mental health awareness of secondary schools students: Mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Heliyon 2023; 9:e14512. [PMID: 36950622 PMCID: PMC10025912 DOI: 10.1016/j.heliyon.2023.e14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Purpose The mental health situation among adolescents in Malaysia has reached a worrying state with the rising number of cases. Despite a significant increase in the literature on mental health, there is a lack of studies that focused on mental health awareness. Therefore, this study aimed to investigate the factors affecting Malaysian youth's mental health awareness as well as the mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Methods Self-administered questionnaires were distributed to 450 secondary school students aged 15-19 years old in Kuala Lumpur and Melaka who were recruited via purposive sampling. Data analysis was performed using SPSS and SmartPLS to obtain the descriptive analysis, measurement model, and structural model. Results The results indicated that mental health awareness was influenced by knowledge on mental health and attitude towards mental health. The findings also revealed that familiarity and media exposure were important determinants of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Moreover, the results indicated that knowledge on mental health positively mediated the relationship between media exposure and mental health awareness. Besides, attitude towards mental health also found to play mediating roles between familiarity and mental health awareness, as well as between media exposure and mental health awareness. Conclusion This study contributed important knowledge to the limited literature in this contemporary domain. An effective public mental health campaign is needed to reduce the burden of disease and the cost of mental illness.
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Affiliation(s)
- Jia En Lee
- Faculty of Business, Multimedia University, Melaka, Malaysiax
| | - Mei Ling Goh
- Faculty of Business, Multimedia University, Melaka, Malaysiax
- Corresponding author.
| | - Sook Fern Yeo
- Faculty of Business, Multimedia University, Melaka, Malaysiax
- Department of Business Administration, Daffodil International University,Dhaka, Bangladesh
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Nagarajan S, Tripathy S, Sodani PR, Sharma R. Universalising Healthcare in India: Managing the Provider–Purchaser Split. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634231153235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India’s experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm’s length of government; primarily to govern and manage the state’s health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC.
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Ahuja N, Rane SR, Pai SA. Lacunae in Laboratory Medicine Services and in Pathology Education in Medical Schools in India. Arch Pathol Lab Med 2023; 147:236-243. [PMID: 35738003 DOI: 10.5858/arpa.2021-0545-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Laboratories of many medical college hospitals in India do not offer important diagnostic tests, most of which are routine in the West. This detracts from the service as well as the educational function of the college. OBJECTIVES.— To provide the background to pathology and laboratory medicine services and education in India, and to create a questionnaire that will put the lack of tertiary care laboratory services in perspective. This article will help illustrate the lacunae in laboratory medicine services and in the education of students. For this, we present information on the health services and pathology education facilities in India. We propose a questionnaire comprising 30 questions in various disciplines in pathology and laboratory medicine. These questions will help administrators and bureaucrats evaluate the status of the laboratories with respect to the services provided. DATA SOURCES.— Sources include Web sites of the government of India, including that of the National Accreditation Board for Testing and Calibration Laboratories; indexed medical journal articles; and standard books and white papers on health care in India. We also used our personal experiences and interpretations of the laboratory and medical education sector in India. CONCLUSIONS.— Medical colleges in India need to offer specialized diagnostic services if they are to achieve the targets of universal health care as well as turning out competent doctors. The agencies responsible for health care in India should use the questionnaire as a first step toward improving laboratory services. Other low- and middle-income countries should also adopt this method.
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Affiliation(s)
- Nishtha Ahuja
- From the Department of Histopathology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India (Ahuja)
| | - Sharada R Rane
- From the Department of Pathology, Government Medical College, Baramati, India (Rane)
| | - Sanjay A Pai
- From the Department of Pathology and Laboratory Medicine, Manipal Hospital-Yeshwanthpur, Bangalore, India (Pai)
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Shrinivas A, Jalota S, Mahajan A, Miller G. The importance of wage loss in the financial burden of illness: Longitudinal evidence from India. Soc Sci Med 2023; 317:115583. [PMID: 36565513 DOI: 10.1016/j.socscimed.2022.115583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/20/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable - separately - to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. METHODS We use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households. FINDINGS We find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally. CONCLUSIONS Wage loss accounts for a substantial share of the total economic burden of illness in India - and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness - particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.
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Affiliation(s)
| | - Suhani Jalota
- Stanford University, Stanford, USA; Myna Mahila Foundation, Mumbai, India
| | - Aprajit Mahajan
- University of California, Berkeley, USA; National Bureau of Economic Research, USA
| | - Grant Miller
- Stanford University, Stanford, USA; National Bureau of Economic Research, USA.
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Abstract
OBJECTIVES To conduct a comprehensive literature review on the state of population aging, healthcare financing, and provision in India. METHODS To obtain relevant records in the Indian context, multiple publications were searched from databases, such as Scopus, ScienceDirect, Web of Science, Medline/PubMed, JSTOR, and Google Scholar using the following keywords: "Population Ageing," "Population Aging," "Health System," "Demographic Dividend," "Non-communicable Diseases," "Double Burden of Diseases," "Health Spending," "Sustainable Health Financing," and "Health Coverage." Data on different health indices were collected from different websites of the government of India and international organizations (e.g. World Bank, UN, WHO, and Statista). RESULTS As people live longer, India faces a double burden of disease, with the rising incidence of non-communicable diseases (NCDs) amidst the presence of widespread communicable diseases. The combined problem of the double burden of diseases and population aging poses a severe sustainability challenge for its healthcare financing and the entire health system. Healthcare financing based on progressive taxation and large-scale prepayment coverage is an effective solution for sustaining the health system. However, due to the prevalence of indirect taxes, India's tax system is regressive. Hence, community-based health insurance (CBHI) schemes can be a feasible solution to cover the large mass of poor working in the informal sector. CONCLUSIONS India needs to address the alterations in its healthcare needs and demands brought on by the advancing demographic shift. To achieve so, the country's healthcare system must be reformed to accommodate strong national policies focusing on universal access to critical care especially geriatric and palliative care.
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Affiliation(s)
| | - Himanshu Sekhar Rout
- Department of Analytical & Applied Economics, Utkal University, Bhubaneswar, India
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Muacevic A, Adler JR. Challenges for Lower-Middle-Income Countries in Achieving Universal Healthcare: An Indian Perspective. Cureus 2023; 15:e33751. [PMID: 36655151 PMCID: PMC9839153 DOI: 10.7759/cureus.33751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Universal health coverage (UHC) by 2030 is a commitment of the global community adopted as Sustainable Development Goal 3.8. UHC, as defined by WHO, means all people have access to quality health services, when and where they need them, and without financial hardship. However, low-income and lower-middle-income countries, faced with competing priorities, find themselves struggling to muster enough resources to steer towards this goal at the desired pace. India is the largest lower-middle-income country, accounting for almost 18% of the world's population. How it performs in moving towards this goal will have a significant impact on achieving UHC at a global level. India has witnessed noteworthy improvement in several health indicators and the UHC service coverage index in recent decades, but the progress on improving service capacity and access has been rather slow given the enormity of its population, scarcity of funds, grossly inadequate public infrastructure, shortage of trained workforce, disparate needs of various regions of the country, lack of healthcare system integration, changing disease demography, and slack regulatory framework. The recent push through National Health Mission aims to address some of these challenges; however, a fragmented health delivery structure ossified over decades has been slow to keep up with the requirements of the country's massive and diverse population. This paper discusses the inherent characteristics and key challenges faced by the healthcare delivery system of India in achieving UHC.
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Sharma MG, Grover A, Shekhawat K, Popli H. Patient satisfaction with access, affordability and quality of diabetes care at Mohalla Clinics in Delhi, India. Front Public Health 2023; 11:1160408. [PMID: 37139400 PMCID: PMC10149676 DOI: 10.3389/fpubh.2023.1160408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Mohalla Clinics have been set up to provide curative care for minor ailments free of cost within walking distance in the urban slums, thus making primary care more accessible and affordable. Studies evaluating patient satisfaction with treatment of chronic conditions, such as diabetes, in these clinics are lacking. Methods A survey of 400 type 2 diabetes patients was conducted, split equally between Mohalla clinics (MC) and Private clinics (PC) in Delhi. Responses were analyzed using STATA17, applying appropriate statistical tests for the data type (Chi-square test, Mann-Whitney U test, Wilcoxon signed rank test, or two-sample t test). Results Satisfaction level was high in both groups with no significant difference between mean satisfaction scores of MC patients and PC patients (Mean 3.79 vs. 3.85 respectively, p = 0.4). However, MC patients reported a significant improvement in their satisfaction score after switching to MC (Mean 3.79 vs. 3.3 for the previous facility, p < 0.05). Physician interaction with the patients was the most important factor in influencing the satisfaction score. Proximity to the clinic was the second most important factor for MC patients but was not as important for PC patients. Surprisingly, treatment success was considered an important factor for satisfaction level by < 10% MC and < 20% PC patients only, pointing to the need for patient education across both the groups. None of the MC patients mentioned free treatment as a contributory factor to high satisfaction, perhaps because most shifted from a government setup to MC. PC patients had more frequent follow-up visits and blood glucose monitoring, and longer consultation duration compared to MC patients, which were offset by access factors, thus not causing much difference to the satisfaction score between the two groups. Conclusion Mohalla clinics are making diabetes treatment accessible and affordable for the marginalized population of Delhi, despite not being designed or fully equipped to care for chronic diseases such as diabetes that require multi-specialty care to monitor and manage multiple co-morbidities and long-term complications. Positive perception of physician interaction and convenient location of the clinics are the two major contributors to the high satisfaction patients expressed with diabetes care at these clinics.
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Affiliation(s)
- Meenu Grover Sharma
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
- *Correspondence: Meenu Grover Sharma,
| | - Anu Grover
- Strategic Scientific Content, Mangrove Creations LLP, New Delhi, India
| | - Kusum Shekhawat
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harvinder Popli
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Saha A, Rahaman M, Mandal B, Biswas S, Govil D. Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements. BMC Public Health 2022; 22:2175. [PMID: 36434537 PMCID: PMC9700952 DOI: 10.1186/s12889-022-14569-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The rural-urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements. SUBJECTS AND METHODS The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives. RESULTS The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural-urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region). CONCLUSION The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.
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Affiliation(s)
- Amiya Saha
- grid.419349.20000 0001 0613 2600Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088 India
| | - Margubur Rahaman
- grid.419349.20000 0001 0613 2600Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, 400088 India
| | - Bittu Mandal
- grid.450280.b0000 0004 1769 7721School of Humanities and Social Sciences, Indian Institute of Technology, Indore, 453552 India
| | - Sourav Biswas
- grid.419349.20000 0001 0613 2600Department of Population & Development, International Institute for Population Sciences, Mumbai, 400088 India
| | - Dipti Govil
- grid.419349.20000 0001 0613 2600Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088 India
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Fazaludeen Koya S, Hasan Farooqui H, Mehta A, Selvaraj S, Galea S. Quantifying antibiotic use in typhoid fever in India: a cross-sectional analysis of private sector medical audit data, 2013-2015. BMJ Open 2022; 12:e062401. [PMID: 36253043 PMCID: PMC9577907 DOI: 10.1136/bmjopen-2022-062401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the antibiotic prescription rates for typhoid in India. DESIGN Cross-sectional study. SETTING Private sector primary care clinicians in India. PARTICIPANTS The data came from prescriptions of a panel of 4600 private sector primary care clinicians selected through a multistage stratified random sampling accounting for the region, specialty type and patient turnover. The data had 671 million prescriptions for antibiotics extracted from the IQVIA database for the years 2013, 2014 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Mean annual antibiotic prescription rates; sex-specific and age-specific prescription rates; distribution of antibiotic class. RESULTS There were 8.98 million antibiotic prescriptions per year for typhoid, accounting for 714 prescriptions per 100 000 population. Children 10-19 years of age represented 18.6% of the total burden in the country in absolute numbers, 20-29 year age group had the highest age-specific rate, and males had a higher average rate (844/100 000) compared with females (627/100 000). Ten different antibiotics accounted for 72.4% of all prescriptions. Cefixime-ofloxacin combination was the preferred drug of choice for typhoid across all regions except the south. Combination antibiotics are the preferred choice of prescribers for adult patients, while cephalosporins are the preferred choice for children and young age. Quinolones were prescribed as monotherapy in 23.0% of cases. CONCLUSIONS Nationally representative private sector antibiotic prescription data during 2013-2015 indicate a higher disease burden of typhoid in India than previously estimated. The total prescription rate shows a declining trend. Young adult patients account for close to one-third of the cases and children less than 10 years account for more than a million cases annually.
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Affiliation(s)
| | | | - Aashna Mehta
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, USA
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Devassy SM, Scaria L, Cheguvera N. Task sharing and stepped referral model for community mental health promotion in low- and middle-income countries (LMIC): insights from a feasibility study in India. Pilot Feasibility Stud 2022; 8:192. [PMID: 36042504 PMCID: PMC9426017 DOI: 10.1186/s40814-022-01159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is a low-cost community mental health task-sharing model driven by university students to strengthen the mental health workforce in poor resource settings. This article presents the feasibility of a stepped referral model using the community health workforce and university students. The primary feasibility objective is to detect and refer people with mental illness from the community using a task-sharing approach. METHODS We tested the model using a cross-sectional, one-phase door-knock survey in three geographically defined locations in Kerala, India, between May and July 2019. Students surveyed 549 residents above 18 years of age who consented to participate in the study to detect depressive symptoms and suicidality. The feasibility of the current model was evaluated based on four criteria: (a) identification and deployment of untapped human resources, (b) coordination of community health resources, (c) the acceptability of stepped referral pathways, and (d) identification of implementation challenges. RESULTS The mean age of the participants was 38.8, and more than 62% of the respondents were women. The results showed that 11.29%, 8.38%, and 4.91% of people reported mild, moderate, and severe levels of depression, respectively, and suicidal thoughts were found in 6.9% and suicidal ideation in 1.8%. The odds of depression were higher among females compared to males (OR: 1.64 (0.75-2.52), poor people (OR: 2.01 (1.14-2.88), and people with chronic illnesses (OR: 2.03 (1.24-2.81). The agreement of the findings with professional-administered research validated the strategy's efficiency. Twenty-seven patients with severe/extreme degrees of depression were sent for high-intensity interventions led by the mental health team, whereas 135 individuals with mild and above depression were referred for low-intensity interventions. CONCLUSIONS The newly recruited mental health workforce-driven screenings were acceptable and effective in detecting mental illness in the community population. We tested the care coordination systems and processes in creating referral pathways for the detected patients. Further, task-sharing stepped referral model will be tested in five panchayats (the lowest tier of local self-government) before replicating the model across India through Unnat Bharat Abhiyan (UBA) scheme.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, Cochin, Kerala, India. .,Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India. .,Honorary Principal Fellow, Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Lorane Scaria
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, Cochin, Kerala, India.,Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India
| | - Natania Cheguvera
- Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India
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Sharma BB, Singh S, Sharma KK, Sharma AK, Suraj KP, Mahmood T, Samaria KU, Kant S, Singh N, Singh T, Singh A, Gupta R, Koul PA, Salvi S, Singh V. Proportionate clinical burden of respiratory diseases in Indian outdoor services and its relationship with seasonal transitions and risk factors: The results of SWORD survey. PLoS One 2022; 17:e0268216. [PMID: 35981008 PMCID: PMC9387816 DOI: 10.1371/journal.pone.0268216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background The Global Burden of Disease data suggest that respiratory diseases contribute to high morbidity in India. However, the factors responsible for high morbidity are not quite clear. Therefore, the Seasonal Waves Of Respiratory Disorders (SWORD) study was planned to estimate the point prevalence due to respiratory diseases in Indian OPD services and its association with risk factors and change in seasons. Methods In this point prevalence observational multicenter study conducted during 2017–18, participating physicians recorded information of consecutive patients in response to a questionnaire. The study was conducted on four predetermined days representing transition of Indian seasons i.e., February (winter), May (summer), August (monsoon), and November (autumn). Results The eligible number of patients from across 302 sites in India was 25,177. The mean age of study population was 46.1±18.1 years, 14102(56.0%) were males and 11075(44.0%) females. The common diagnoses were: asthma(29.8%), chronic obstructive pulmonary disease (COPD),15.6%, respiratory tract infections (RTIs),11.3%, and tuberculosis(8.7%). All these conditions showed significant seasonal trends (Asthma 31.4% autumn vs. 26.5% summer, COPD 21.1% winter vs. 8.1% summer, RTIs 13.3% winter vs. 4.3% summer, and tuberculosis 12.5% autumn vs. 4.1% summer, p<0.001 for each respectively). After adjustment for risk factors, asthma was significantly associated with exposure to molds (OR:1.12,CI:1.03–1.22), pet animals (OR:1.07,CI:1.01–1.14), recent-travel (OR:1.22,CI:1.13–1.32), and rain-wetting (OR:1.27,CI:1.15–1.40); and RTIs with rain-wetting (OR:1.53,CI:1.34–1.74), and recent-travel (OR:1.17,CI:1.05–1.30). Conclusions The SWORD study showed wide seasonal variations in outpatient attendance of patients with common respiratory conditions. Novel risk-factors associated with respiratory diseases were also identified.
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Affiliation(s)
- Bharat Bhushan Sharma
- Department of Medicine, Division of Allergy and Pulmonary Medicine, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Sheetu Singh
- Department of Respiratory Medicine, Lung Center, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Krishna Kumar Sharma
- Department of Pharmacology, Lal Bahadur College of Pharmacy, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Arvind Kumar Sharma
- Department of Community Medicine, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - K. P. Suraj
- Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Tariq Mahmood
- Department of Pulmonary Medicine, MLN Medical College, Prayagraj (Allahabad), Uttar Pradesh, India
| | | | - Surya Kant
- Department of Respiratory Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Nishtha Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Tejraj Singh
- Department of Research Division, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Aradhana Singh
- Department of Medicine, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Rajeev Gupta
- Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, Rajasthan, India
| | - Parvaiz A. Koul
- Department of Internal and Pulmonary Medicine, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, Maharashtra, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Director, Rajasthan Hospital & Asthma Bhawan, Jaipur, Rajasthan, India
- * E-mail:
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Singh P, Chakraborty B, Sarkhel S, Ray S, Patra PS, Das K. Indian Outpatients with Idiopathic Chronic Pancreatitis Have Catastrophic Healthcare Expenditure, Malnutrition, Anxiety/Depression and Work-Impairment. Dig Dis Sci 2022; 67:3612-3622. [PMID: 34581905 DOI: 10.1007/s10620-021-07255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is paucity of data regarding economic burden, employment affection, psychological and nutritional status of CP patients, of non-alcoholic etiology, especially during their periods of stable disease, i.e., without any complications and/or recent endoscopic/surgical interventions. METHODS In a prospective cohort study, conducted in outpatient clinic of a tertiary-care hospital, 66 consecutive adults with Idiopathic CP (± diabetes) and 152 matched (by age, socioeconomic status and monthly income) healthy controls were assessed for: (1) healthcare expenses in previous month by recall (catastrophic if > 40% of income); (2) nutritional status by anthropometry and food frequency questionnaire; (3) psychological status by Hospital Anxiety and Depression Scale (HADS); and (4) work-impairment by work productivity and activity impairment questionnaire: general health (WPAI-GH). CP patients were again reassessed for the above parameters after 6 and 12 month, respectively. RESULTS Seventy-six percent CP patients (vis-à-vis 0% controls) had catastrophic healthcare expenditure. Forty-nine percent of CP patients(vis-à-vis 0% controls) met their healthcare expenses by either selling assets or obtaining loans at high-interest or from charitable donations. CP patients had lower BMI, were more likely to be malnourished and had a lower calorie intake vis-à-vis controls (median (IQR) recommended daily allowance (RDA): 71(19)% vs 97(23)%; [p < 0.0001]). Their median HADS Anxiety and depression scores were significantly higher than controls. Thirty-one (47%) CP patients were employed vis-a-vis 102 (67%) controls (p = 0.006); they had significantly higher work impairment. After one year, there was improvement in some of these above parameters in CP patients. CONCLUSION Idiopathic CP outpatients had catastrophic healthcare expenditure, malnutrition, abnormal psychological scores and work-impairment vis-à-vis healthy controls. Some of these parameters improved on follow-up.
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Affiliation(s)
- Pankaj Singh
- Division of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India
| | - Bidhan Chakraborty
- Division of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India
| | - Sujit Sarkhel
- Department of Psychiatry, Bangur Institute of Neurosciences, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India
| | - Sukanta Ray
- Division of Gastrointestinal Surgery, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India
| | - Partha Sarathi Patra
- Division of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India
| | - Kshaunish Das
- Division of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India.
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Rymbai MS, Thangkhiew DW. Does health financial resource correlate with physical health infrastructure? Indian J Public Health 2022; 66:287-291. [PMID: 36149106 DOI: 10.4103/ijph.ijph_535_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Is building physical health infrastructure (PHI) a priority for state governments within the northeastern states (NES) of India? The decentralization mechanism initiated by the government of India to synergize health care across states seems highly unequal. Certain Indian states such as Kerala, Uttarakhand, and Himachal Pradesh have achieved phenomenal progress in the health-care system through a decentralized mechanism. Objectives The study attempts to examine the PHI of NES and public health resources. Methods The study has employed the Euclidian Distant Method (EDM) which fulfills various compulsive and instinctive properties; specifically, normalization, symmetry, monotonicity, proximity, uniformity, and signaling inclusively. This method ranks the states in terms of infrastructure availability and public health resources. Second, the correlation was done to see the relationship between the PHI of NES and public health resources. Results The results of the EDM show that Arunachal Pradesh ranked the highest in the Index of Public Health Infrastructure, whereas Assam ranked the lowest. The Index of Public Health Resource shows interesting results. Assam has remained at the lowest rank and inconsistency of ranks among the other NES. The correlation between the indices is positive, yet not encouraging. Conclusion This implies that building up health infrastructure and responding to the demand for health-care infrastructure still stands ignored and rather remained stagnant.
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Affiliation(s)
- Motika Sinha Rymbai
- Research Scholar, Department of Economics, North Eastern Hill University, Shillong, Meghalaya, India
| | - Darishisha W Thangkhiew
- Assistant Professor, Department of Economics, North Eastern Hill University, Shillong, Meghalaya, India
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Banerjee S, Dave S, Siddiqui IN. Improved Yet Unsafe: At the Light of NFHS-V. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following UNICEF’s analysis of National Family Health Survey-III Data (NFHS-III), it was opined that households with access to better sanitation and better access to improved water sources have much better infant survival rates than the others. Sahu et al. (2015, The Indian journal of medical research, 141(5), 709), Arun et al. (2017, International Conference on Cognitive Computing and Information Processing (pp. 81–92), Springer) and Tripathy and Mishra (2017, Journal of Tropical Pediatrics, 63(6), 431–439) supported these findings. However, Banerjee (2020a , Journal of Health Management, 22(1), 57–66), analysing NFHS-IV data, has vehemently criticised such findings and showed using regression with robust standard errors that improved access to better water sources leads to higher infant mortality. In another article published in the same year, Banerjee (2020b , Journal of Health Management, 22(3), 466–471) explained this paradox. Now with NFHS-V data coming out, time is apt to test the robustness of Banerjee’s findings (2002a). However, owing to the incomplete NFHS-V data published so far, unlike Banerjee (2002a) that has used data of 29 states, the present analysis is based on only 17 states. The findings support that the findings of Banerjee (2002a) were robust.
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Affiliation(s)
| | - Sumita Dave
- Amity Business School, Amity University Chhattisgarh
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Garg S, Tripathi N, Ranjan A, Bebarta KK. How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state. HEALTH ECONOMICS REVIEW 2022; 12:27. [PMID: 35522382 PMCID: PMC9078002 DOI: 10.1186/s13561-022-00372-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/26/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. METHODS For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities). RESULTS Taking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9, p < 0.001). Hospitalisations in private hospitals were more likely to result in a PFHI claim (adjusted-odds-ratio = 1.45, p = 0.02) and involve a greater amount than public hospitals (coefficient = 0.27, p < 0.001). Propensity-score matching models confirmed the above results. Overall, supply-side public spending contributed to 16% of total spending, demand-side spending through PFHI to 16%, cash incentives to 1% and OOPE to 67%. OOPE constituted 31% of total spending per episode in public and 86% in private hospitals. CONCLUSIONS Government and households put together spent substantially more per hospitalisation in private hospitals than public hospitals in Chhattisgarh. This has important implications for the allocative efficiency and the desired public-private provider-mix. Using public resources for purchasing inpatient care services from private providers may not be a suitable strategy for such contexts.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh India
| | | | - Alok Ranjan
- Indian Institute of Technology, Jodhpur, India
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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Chakrabarti P, George B, Shanmukhaiah C, Sharma LM, Udupi S, Ghanima W. How do patients and physicians perceive immune thrombocytopenia (ITP) as a disease? Results from Indian analysis of ITP World Impact Survey (I-WISh). J Patient Rep Outcomes 2022; 6:24. [PMID: 35303181 PMCID: PMC8933602 DOI: 10.1186/s41687-022-00429-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Immune thrombocytopenia (ITP) is primarily considered a bleeding disorder; its impact on patients’ health-related quality of life (HRQoL) is under-recognized. We aimed to assess how aligned patient and physician perceptions are regarding ITP-associated symptoms, HRQoL, and disease management in India. Methods Patients and physicians (hematologists/hemato-oncologists) from India who participated in the global ITP World Impact Survey (I-WISh) were included in this subgroup analysis (survey). Physicians were recruited via a local, third party recruiter in India. In addition to completing a survey themselves, physicians were asked to invite consulting patients on a consecutive basis to complete a survey. All surveys were completely independently by the respondents online in English. The respondents took 30 min to complete the questionnaire. Patients also completed the newly developed ITP Life Quality Index (ILQI) that included 10 questions on the impact of ITP on the following: work or studies, time taken off work or education, ability to concentrate, social life, sex life, energy levels, ability to undertake daily tasks, ability to provide support, hobbies, and capacity to exercise. Results A total of 65 patients and 21 physicians were included in this study. Average disease duration from diagnosis-to-survey-completion was 5.3 years. The most severe symptoms reported by patients at diagnosis were menorrhagia (15 of 19 patients [79%]), anxiety surrounding unstable platelet counts (17 of 28 patients [61%]), and fatigue (27 of 46 patients [59%]); these were also the key symptoms they wanted to be resolved. In contrast, physicians perceived petechiae (19 of 21 patients [90%]), bleeding-from-gums (8 of 21 patients [86%]), and purpura (16 of 21 patients [76%]) as the most common symptoms. While the important treatment goals for patients were healthy blood counts (42 of 65 patients [65%]), improved QoL (35 of 65 patients [54%]), and prevention of worsening of ITP (33 of 65 patients [51%]), physicians’ goals were reduction in spontaneous bleeding (17 of 21 physicians [81%]), better QoL (14 of 21 physicians [67%]), and symptom improvement (9 of 21 physicians [43%]). More than half the patients reported that ITP affected their work life/studies, social life, and energy levels, thereby negatively impacting their QoL. Patients were almost entirely dependent on family and friends for support. Conclusions This survey highlights the substantial discrepancy in patients’ and physicians’ perceptions regarding ITP-associated symptoms and treatment goals in India. Based on the identified gaps, educating physicians on aspects of ITP beyond bleeding, and highlighting patients’ under-recognized symptoms/needs through support-systems should be prioritized in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00429-y.
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Affiliation(s)
- Prantar Chakrabarti
- Department of Hematology, Vivekananda Institute of Medical Sciences, Machan, L 16 Panchasayar, Kolkata, West Bengal, 700094, India
| | - Biju George
- Department of Hematology, CMC Vellore, Vellore, Tamil Nadu, 632004, India
| | - Chandrakala Shanmukhaiah
- Department of Clinical Hematology, KEM Hospital, 1902, 19th floor UG PG hostel, KEM Hospital Campus, Parel, Mumbai, Maharashtra, 400012, India
| | - Lalit Mohan Sharma
- Department of Medical Oncology, MG Medical College, 67/166, Sector 6, Pratap Nagar, Jaipur, Rajasthan, India
| | - Shashank Udupi
- Medical Affairs, Oncology (Hematology), Novartis Healthcare Private Limited, Inspire BKC, Part of 601 & 701, 7th Floor, Bandra Kurla Complex, Bandra (East), Mumbai, Maharashtra, 400051, India
| | - Waleed Ghanima
- Departments of Research and Hemato-Oncology, Østfold Hospital, Østfold Hospital, PB 300, 1714, Grålum, Norway.
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Garg S, Bebarta KK, Tripathi N, Krishnendhu C. Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey. BMC Res Notes 2022; 15:86. [PMID: 35241144 PMCID: PMC8892404 DOI: 10.1186/s13104-022-05977-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The COVID-19 pandemic has caused widespread illness and a significant proportion of the infected required hospitalisation for treatment. People in developing countries like India were vulnerable to high hospitalisation costs. Despite its crucial importance, few primary studies are available on this aspect of the pandemic. This study was aimed at finding out the out of pocket expenditure (OOPE) and incidence of catastrophic expenditure on hospitalisation of persons infected with COVID-19. A primary survey of 492 randomly selected hospitalisations of individuals tested positive for COVID-19 in high-burden districts during August to November 2020 was carried out telephonically in Chhattisgarh state of India. Results Public hospitals accounted for 69% of the hospitalisations for COVID-19 treatment. Mean OOPE per hospitalisation was Indian Rupees (INR) 4871 in public hospitals and INR 169,504 in private hospitals. Around 3% of hospitalisations in public hospitals and 59% in private hospitals resulted in catastrophic expenditure, at a threshold of 40% of non-food annual household expenditure. Enrolment under publicly or privately funded health insurance was not effective in curtailing OOPE. Multivariate analysis showed that utilisation of private hospitals was a key determinant of incurring catastrophic expenditure. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05977-6.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh, India.
| | | | | | - C Krishnendhu
- State Health Resource Centre, Raipur, Chhattisgarh, India
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Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Hu P. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study. PLoS Med 2022; 19:e1003855. [PMID: 34982770 PMCID: PMC8726460 DOI: 10.1371/journal.pmed.1003855] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. METHODS AND FINDINGS We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017-2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%-46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%-56.5%) had been diagnosed, 38.9% (95% CI 38.1%-39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%-32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14-1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61-0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68-1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86-1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00-1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10-1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017-2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. CONCLUSIONS Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.
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Affiliation(s)
- Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Jenny Wilkens
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - T. V. Sekher
- International Institute for Population Sciences, Mumbai, India
| | - David E. Bloom
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Peifeng Hu
- Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
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Rela M, Rammohan A. Why are there so many liver transplants from living donors in Asia and so few in Europe and the US? J Hepatol 2021; 75:975-980. [PMID: 34111504 DOI: 10.1016/j.jhep.2021.05.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
Acceptance of liver transplantation (LT) as an established treatment modality for end-stage liver disease has led to an exponential increase in the demand for organs, resulting in an ever-increasing gap between the availability of organs and the number of sick patients waiting for them. Interestingly, influenced by cultural, socio-economic and other constraints, the West and the East have attempted to address this problem of shortage in different ways. Living donor LT (LDLT) became polarised to the East with over 90% of LT in this region being LDLT. On the other hand, the West chose to concentrate their efforts on optimising the use of cadaveric livers with techniques such as split LT, or by using extended criteria donors (including donation after cardiac death donors) and machine perfusion devices etc. Consequently, LDLT did not find the widespread acceptance it did in the East and hence over 90% of all LT are DDLT in this region. We review each regions' perspective and attempt to provide a globally viable roadmap to bridge the widening gap between the demand and availability of livers for LT.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
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Haldar J, Kamath R, Stallone D'lima K, Nazareth J. An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India. Glob Health Epidemiol Genom 2021; 2021:1158533. [PMID: 34631112 PMCID: PMC8487842 DOI: 10.1155/2021/1158533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India's employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. This is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees' State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy, vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. The patient records were examined from the hospital's Medical Records Department (MRD). The patients' bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor's fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT, manpower cost-nursing, and allocated indirect costs associated with the medical treatment. These were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.
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Affiliation(s)
- Jatoveda Haldar
- Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Kamath
- Department of Health Innovation, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Jossil Nazareth
- Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
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Hasan MZ, Story WT, Bishai DM, Ahuja A, Rao KD, Gupta S. Does social capital increase healthcare financing's projection? Results from the rural household of Uttar Pradesh, India. SSM Popul Health 2021; 15:100901. [PMID: 34466652 PMCID: PMC8383105 DOI: 10.1016/j.ssmph.2021.100901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022] Open
Abstract
In the absence of adequate social security, out-of-pocket health expenditure compels households to adopt coping strategies, such as utilizing savings, selling assets, or acquiring external financial support (EFS) by borrowing with interest. Households' probability of acquiring EFS and its amount (intensity) depends on its social capital – the nature of social relationships and resources embedded within social networks. This study examines the effect of social capital on the probability and intensity of EFS during health events in Uttar Pradesh (UP), India. The analysis used data from a cross-sectional survey of 6218 households, reporting 3066 healthcare events, from two districts of UP. Household heads (HH) reported demographic, socioeconomic, and health-related information, including EFS, for each household member. Self-reported data from Shortened and Adapted Social Capital Assessment Tool in India (SASCAT-I) was used to generate four unique social capital measures (organizational participation, social support, trust, and social cohesion) at HH and community-level, using multilevel confirmatory factor analysis. After descriptive analysis, two-part mixed-effect models were implemented to estimate the probability and intensity of EFS as a function of social capital measures, where multilevel mixed-effects probit regression was used as the first-part and multilevel mixed-effects linear model with log link and gamma distribution as the second-part. Controlling for all covariates, the probability of acquiring EFS significantly increased (p = 0.04) with higher social support of the HH and significantly decreased (p = 0.02) with higher community social cohesion. Conditional to receiving any EFS, higher social trust of the HH resulted in higher intensity of EFS (p = 0.09). Social support and trust may enable households to cope up with financial stress. However, controlling for the other dimensions of social capital, high cohesiveness with the community might restrict a household's access to external resources demonstrating the unintended effect of social capital exerted by formal or informal social control. Social support assists household head to acquire external financing for healthcare payment. But higher social support may not secure higher intensity of receiving external financing. However, trust is a catalyst to acquire more financing conditional of any external financing was acquire in the first place. Living in a cohesive community may restrict access to external financial resources.
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Affiliation(s)
- Md Zabir Hasan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - William T. Story
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
| | - David M. Bishai
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Daniel S, Venkateswaran C, Singh C, Hutchinson A, Johnson MJ. "So, when a woman becomes ill, the total structure of the family is affected, they can't do anything…" Voices from the community on women with breast cancer in India: a qualitative focus group study. Support Care Cancer 2021; 30:951-963. [PMID: 34420101 PMCID: PMC8636417 DOI: 10.1007/s00520-021-06475-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
Background Psychological symptoms are common in women with breast cancer and profoundly affect their role in the family and wider community, varying across cultural backgrounds. Breast cancer is becoming the most common cancer among women in India. We aimed to understand the cultural context within which Indian women with breast cancer living in India, experience psychological concerns from the perspectives of healthcare professionals, volunteers and church members. Methods Five focus groups were conducted in South India (clinicians (2 groups)) lay public (3 groups). A topic guide was explored: understanding of breast cancer, experiences of patients with regard to diagnosis and treatment and psychological impact. Groups were audio-recorded and verbatim transcribed. Lay groups were conducted in Malayalam with translation and back-translation. Transcripts were subjected to thematic analysis using “cultural task analysis” as a lens for analysis. Results Forty-five (oncologists (5), nurses (10), church members (16) and community volunteers working in a palliative care unit (14) participated. Three major themes psychosocial issues related to diagnosis, psychosocial impact of cancer treatment and coping with diagnosis and treatment and nine subthemes emerged from the two groups. All described psychological impact on women with breast cancer including body image, change of family role and their need for support. Family and faith were recognised as the major framework providing key support but also significant stress. Clinicians were also concerned about financial implications and issues around early cancer detection. Laypeople and nurses also commented that poor communication and lack of empathy from doctors aggravated distress. Conclusion Clinical and lay communities were aware of the widespread psychological impact affecting women with breast cancer which are amplified by the patriarchal context within which they live, which extends into clinical practice. Family and faith provide a strong support structure and are a cause of distress, as core roles and expectations are challenged by this disease of womanhood.
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Affiliation(s)
- Sunitha Daniel
- General Hospital, Ernakulam, Kochi, India. .,Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK.
| | - Chitra Venkateswaran
- Department of Psychiatry, Palliative Care and Psycho Oncology, Believers Church Medical College, Thiruvalla, Kerala, India
| | - Charu Singh
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
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Mishra A, Elias MA, Sriram V. A Draconian Law: Examining the Navigation of Coalition Politics and Policy Reform by Health Provider Associations in Karnataka, India. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2021; 46:703-730. [PMID: 33493290 DOI: 10.1215/03616878-8970895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A comprehensive picture of provider coalitions in health policy making remains incomplete because of the lack of empirically driven insights from low- and middle-income countries. The authors examined the politics of provider coalitions in the health sector in Karnataka, India, by investigating policy processes between 2016 and 2018 for developing amendments to the Karnataka Private Medical Establishments Act. Through this case, they explore how provider associations function, coalesce, and compete and the implications of their actions on policy outcomes. They conducted in-depth interviews, document analysis, and nonparticipant observations of two conferences organized by associations. They found that provider associations played a major role in drafting the amendments and negotiating competing interests within and between doctors and hospital associations. Despite the fragmentation, the associations came together to reinterpret the intentions of the amendments as being against the interests of the profession, culminating in a statewide protest and strike. Despite this show of strength, provider associations only secured modest modifications. This case demonstrates the complex and unpredictable influence of provider associations in health policy processes in India. The authors' analysis highlights the importance of further empirical study on the influence of professional and trade associations across a range of health policy cases in low- and middle-income countries.
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Butola S, Bhatnagar S, Rawlinson F. Caring and Conflict-Palliative Care in the Armed Forces: The Challenges for Caregivers. Indian J Palliat Care 2021; 27:405-418. [PMID: 34898934 PMCID: PMC8655645 DOI: 10.25259/ijpc_393_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In India, Palliative care remains inaccessible, especially in remote areas. This study aimed at exploring the experience of caregivers related to arranging palliative care at home, for personnel and family members of an armed force. MATERIALS AND METHODS Qualitative study based on thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. RESULTS Lack of palliative care in rural areas makes arranging home care challenging for Indian caregivers, especially in armed forces. The families stay alone and personnel cannot be there to look after loved ones. Constraints of leave, financial and legal problems, frequent movement and social isolation disrupt care as well as family and community support systems, leading to psycho-social problems and stress for the serving personnel as well as families. Educating staff, integrating palliative care into existing medical services, coordinating with other agencies to increase awareness and provide care at home, access to opioids, timely leave, reimbursement of expenses, increased family accommodation, guidance about benefits, and considerate implementation of transfer policy can help mitigate some of their problems. CONCLUSION These caregivers face physical exhaustion, psycho-social, financial, legal, and spiritual issues- some common to all rural Indians and others unique to the armed forces. Understanding their experiences will help the providers find solutions, especially in relation to the unique needs of the men in uniform.
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Affiliation(s)
- Savita Butola
- Border Security Force, Gwalior, Madhya Pradesh, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B.R.A IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Fiona Rawlinson
- Centre for Medical Education, Cardiff university, Wales, United kingdom
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Dwivedi R, Pradhan J, Athe R. Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India. Int J Health Plann Manage 2021; 36:1887-1915. [PMID: 34196030 DOI: 10.1002/hpm.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Science and Humanities, Indian Institute of Information Technology, Trichy, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
| | - Ramesh Athe
- Department of Humanities and Sciences, Indian Institute of Information Technology, Dharwad, Karnataka, India
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Sharma V, Kumar N, Gupta B, Mahajan A. Impact of COVID-19 pandemic on orthopaedic surgeons in terms of anxiety, sleep outcomes and change in management practices: A cross-sectional study from India. J Orthop Surg (Hong Kong) 2021; 29:23094990211001621. [PMID: 33779373 DOI: 10.1177/23094990211001621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sleep outcomes and change in clinical management practices among orthopaedic surgeons following a nation-wide lockdown. METHODS We conducted an online cross-sectional study using piloted structured questionnaires with self-reported responses from Indian orthopaedic surgeons. Study participants were identified through social networking sites: Facebook and WhatsApp. The extent of anxiety and sleep quality was assessed by the standardised seven-item Generalised Anxiety Disorder (GAD-7) scale, single-item sleep quality scale, questions on unavailability of personal protective equipment, training module on COVID-19 and change in orthopaedic patient management. RESULTS One hundred male orthopaedic surgeons responded to the survey with majority (79%) in 30-44 years age group. Severe anxiety scores were observed in 8%; moderate, mild and minimal anxiety was observed in 12%, 27% and 53% surgeons respectively. Changes in management practice due to the pandemic was admitted by 65% respondents. We also observed an association between higher anxiety among surgeons and primary or secondary level of healthcare facility: (p = 0.04). Sleep disturbance was significantly associated with change in management practice to non-operative procedures (p = 0.03). CONCLUSION Anxiety among orthopaedic surgeons during the COVID-19 pandemic is related to factors like younger age group, working in a primary or secondary healthcare facility. Early recognition of anxiety is essential to prevent serious psychological sequelae.
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Affiliation(s)
- Vyom Sharma
- Spinal Cord Injury Centre, 76290Military Hospital Kirkee, Pune, India
| | - Narinder Kumar
- Department of Orthopaedics, 204687Medanta Hospital, Lucknow, India
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Patel V, Mazumdar-Shaw K, Kang G, Das P, Khanna T. Reimagining India's health system: a Lancet Citizens' Commission. Lancet 2021; 397:1427-1430. [PMID: 33308485 PMCID: PMC9752001 DOI: 10.1016/s0140-6736(20)32174-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Vikram Patel
- Harvard Medical School and Harvard T H Chan School of Public Health, Boston, MA, USA; Sangath, Goa, India
| | | | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Tarun Khanna
- Harvard Business School and Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA 02138, USA.
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Chauhan A, Campbell C. Risk, trust and patients' strategic choices of healthcare practitioners. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:82-98. [PMID: 33034906 DOI: 10.1111/1467-9566.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/04/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Research on patients' choice of healthcare practitioners has focussed on countries with regulated and controlled healthcare markets. In contrast, low- and middle-income countries have a pluralistic landscape where untrained, unqualified and unlicensed informal healthcare providers (IHPs) provide significant share of services. Using qualitative data from 58 interviews in an Indian village, this paper explores how patients choose between IHPs and qualified practitioners in the public and formal private sectors. The study found that patients' choices were structurally constrained by accessibility and affordability of care and choosing a practitioner from any sector presented some risk. Negotiation and engagement with risks depended on perceived severity of the health condition and trust in practitioners. Patients had low institutional trust in public and formal private sectors, whereas IHPs operated outside any institutional framework. Consequently, people relied on relational or competence-derived interpersonal trust. Care was sought from formal private practitioners for severe issues due to high-competence-based interpersonal trust in them, whereas for other issues IHPs were preferred due to high relationship-based interpersonal trust. The research shows that patients develop a strategic approach to practitioner choice by using trust to negotiate risks, and crucially, in low- and middle-income countries IHPs bridge a gap by providing accessible and affordable care imbued with relational-interpersonal trust.
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Affiliation(s)
- Apurv Chauhan
- School of Applied Social Science (SASS), University of Brighton, Brighton, UK
| | - Catherine Campbell
- Department of Psychological and Behavioural Science, London School of Economics & Political Science (LSE), London, UK
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George Joseph R, Kallivayalil RA, Rajeev A. Pathways to care in children- perspectives from a child guidance clinic in South India. Asian J Psychiatr 2020; 54:102310. [PMID: 32739861 DOI: 10.1016/j.ajp.2020.102310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In India the pathways to care in children with mental health problems remain relatively unexplored. Investigating the factors that drive the pathway will help determine interventions and also draft policies for a streamlined Child and adolescent mental health service. METHOD Children who attended the Child Guidance Clinic sampled by WHO Pathways Encounter questionnaire. Statistical tests applied to find key influencers like gatekeepers, intermediate points of care, symptoms initiating referral, duration of untreated illness, time to arrive at appropriate care and primary diagnosis. RESULTS The most common diagnostic category was externalizing disorder 51(37.5 %). The gatekeepers identified were 111(81.6 %) Parents/Relatives/Guardians and teachers 25 (18.3 %). Academic concerns identified by teachers took a mean of 72 months (30.271) to arrive at appropriate care versus 50.4 months (23.18) when identified by Parents/Relatives/Guardians group. Significant delays were observed with Neurodevelopmental disorders arriving to care with delays up to 130.2 (70.11) months (p < 0.001) and having 64.2 (33.7) months (p < 0.001) duration of untreated illness. Externalizing disorders took a duration of 94.08 (54.17) months (p < 0.001) to arrive to appropriate care and had 54.2 (36.33) months (p < 0.001) duration of untreated illness. Teachers took longer time in detecting the indicators and this caused duration of untreated illness of 73.44 (36.05) months (p < 0.001) and a delay of 128.08 (71.23) months (p < 0.001) to arrive to appropriate care. CONCLUSIONS The pathways to care in children are characterized by long duration of untreated illness and undue time to care. Gatekeepers like teachers and intermediary points of care were associated with inadvertent delays along the pathway.
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Affiliation(s)
- Rachna George Joseph
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; Christian Medical College Vellore, Department of Psychiatry, Vellore, India; Cumberland Hospital, The New South Wales Department of Health, Sydney, Australia.
| | - Roy Abraham Kallivayalil
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India
| | - A Rajeev
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; All India Institute of Medical Sciences, Department of Community and Family Medicine, Mangalagiri, India
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Downey L, Dabak S, Eames J, Teerawattananon Y, De Francesco M, Prinja S, Guinness L, Bhargava B, Rajsekar K, Asaria M, Rao N, Selvaraju V, Mehndiratta A, Culyer A, Chalkidou K, Cluzeau F. Building Capacity for Evidence-Informed Priority Setting in the Indian Health System: An International Collaborative Experience. HEALTH POLICY OPEN 2020; 1:100004. [PMID: 33392500 PMCID: PMC7772949 DOI: 10.1016/j.hpopen.2020.100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/09/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022] Open
Abstract
India's rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.
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Affiliation(s)
- L.E. Downey
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Corresponding author at: Imperial College London, St Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - S. Dabak
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - J. Eames
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - Y. Teerawattananon
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - M. De Francesco
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - S. Prinja
- School of Public Health, Post Graduate Medical Institute of Health Education and Research (PGIMER) Chandigarh, India
| | - L. Guinness
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - B. Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - K. Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - M. Asaria
- London School of Economics and Political Science, London, United Kingdom
| | - N.V. Rao
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - V. Selvaraju
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Mehndiratta
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - K. Chalkidou
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Global Development Europe, London, United Kingdom
| | - F.A. Cluzeau
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
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Nambiar D, Bhaumik S, Pal A, Ved R. Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling. BMC Health Serv Res 2020; 20:1077. [PMID: 33238995 PMCID: PMC7687829 DOI: 10.1186/s12913-020-05914-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS). Methods LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined. Results A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level. Conclusion CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05914-y.
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Affiliation(s)
- Devaki Nambiar
- George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India. .,Faculty of Medicine, University of New South Wales, Sydney, Australia. .,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India. .,Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Soumyadeep Bhaumik
- George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anita Pal
- Department of Education and Education Technology, University of Hyderabad, Hyderabad, India
| | - Rajani Ved
- Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan School of Public Health, Boston, USA.,National Health Systems Resource Centre, New Delhi, India
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Prinja S, Rajsekhar K, Gauba VK. Health technology assessment in India: Reflection & future roadmap. Indian J Med Res 2020; 152:444-447. [PMID: 33707385 PMCID: PMC8157896 DOI: 10.4103/ijmr.ijmr_115_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001, India
| | - Vijay Kumar Gauba
- Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001, India
- Formerly Senior Deputy Director General, Indian Council of Medical Research, New Delhi 110 029, India
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Bhargava A, Bhargava M, Juneja A. Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India. Expert Rev Respir Med 2020; 15:867-883. [PMID: 33016808 DOI: 10.1080/17476348.2021.1832469] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Social determinants are involved in the causation of TB and its adverse outcomes. This review was conducted to evolve a framework for action on social determinants with special reference to India in the context of the new END TB strategy. AREAS COVERED We reviewed the social context of TB in India as a neglected disease of the poor, its emergence in epidemic form in the colonial period, and the factors that resulted in its perpetuation and expansion in post-independence India. We examined the role of social determinants in two key pathways - the pathway of TB causation and its outcomes, and the care cascade for patients with TB, and its consequences. We reviewed the most important social determinants of TB including poverty, membership of certain castes and indigenous population, undernutrition and poor access to healthcare, especially in rural areas. EXPERT OPINION We suggest that TB elimination will require an optimal mix of enhanced biomedical and social interventions. TB elimination strategy in India needs a pro-poor model of patient - centered care inclusive of nutritional, psycho-social and financial support, universal health coverage, and social protection; and convergence with multi-sectoral efforts to address poverty, undernutrition, unsafe housing, and indoor pollution.
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Affiliation(s)
- Anurag Bhargava
- Department of General Medicine, Yenepoya Medical College, (Yenepoya Deemed to Be University), Mangalore, Karnataka, India.,Center for Nutrition Studies, (Yenepoya Deemed to Be University), Mangalore, Karnataka, India.,Department of Medicine, McGill University, Montreal, Canada
| | - Madhavi Bhargava
- Center for Nutrition Studies, (Yenepoya Deemed to Be University), Mangalore, Karnataka, India.,Department of Community Medicine, (Yenepoya Deemed to Be University), Mangalore, Karnataka, India
| | - Anika Juneja
- Center for Nutrition Studies, (Yenepoya Deemed to Be University), Mangalore, Karnataka, India
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Gupta P, Singh K, Shivashankar R, Singh K, Vamadevan A, Mohan V, Kadir MM, Tandon N, Narayan KM, Prabhakaran D, Ali MK. Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study. BMJ Open 2020; 10:e036317. [PMID: 32998917 PMCID: PMC7528361 DOI: 10.1136/bmjopen-2019-036317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs-hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney disease) in three metropolitan cities in South Asia. DESIGN Cross-sectional surveys. SETTING We analysed community-based baseline data from the Centre for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study collected in 2010-2011 representing Chennai and New Delhi (India), and Karachi (Pakistan). PARTICIPANTS We used data from non-pregnant adults (≥20 years) from the aforementioned cities that responded to a cost-of-illness questionnaire. We estimated health utilisation and expenditures among those reporting taking treatment(s) for the aforementioned CMDs in the last 1 year. We converted all costs to International Dollars (Int$ 2011) and inflated to 2018 values. The annual costs per person were stratified by city, sociodemographic characteristics, contributor of costs and financing methods. The total economic burden of CMDs for each city was projected using age-standardised prevalence and per-person costs of diseases reported in CARRS, applying these to population data from the most recent census. We also calculated distress financing (DF) as having to borrow or sell assets to pay for CMD treatment and identified sociodemographic groups at most risk of DF using multiple regression. RESULTS Of 16 287 CARRS participants, 2883 (17.7%) reported receiving treatment for CMDs. The total annual expenditures reported per patient for CMDs ranged from Int$358 to Int$2425. Medications constituted 46% of total direct expenditures and out-of-pocket (OOP) expenditures accounted for nearly 80% of financing these health expenditures. Total economic burdens of CMDs were Int$0.42 billion, Int$3.4 billion and Int$1.4 billion in Chennai, New Delhi and Karachi, respectively. Overall, 36.1% experienced DF, and women (OR=4.4), unemployed (OR=10.7) and uninsured (OR=8.1) adults experienced higher odds of DF. CONCLUSION CMDs are associated with large economic burdens in South Asia. Due to most payments coming from OOP expenditures and limited insurance, the odds of DF are high.
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Affiliation(s)
- Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Kavita Singh
- The Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, New Delhi, India
| | | | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Nikhil Tandon
- Department of Endocrinology, Metabolism & Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - K M Narayan
- Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- The Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, New Delhi, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Banerjee S, Singh A, Bhattacharya S, Koner S. Demystifying the Aquatic Paradox: The Infant Mortality in India. JOURNAL OF HEALTH MANAGEMENT 2020. [DOI: 10.1177/0972063420942854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is evident that better access to improved water sources will lead to the lessening of infant mortality rate (IMR). However, for India, such inference is ambiguous. There is a strong group of academicians such as Sahu et al. (2015) , Arun et al. (2017) and Tripathy and Mishra (2017) and organizations such as UNICEF that firmly believe that if access to the improved water sources can be improved, then there would be tremendous social welfare and much betterment to the IMR. On the other hand, Banerjee et al. (2020) have refuted such claims and opined that access to improved water sources increases the IMR. The empirical validation of their claim has been flawless, but they are somewhat silent on why such a direct relationship between IMR and improved water source exists. They have made a comment based on assumptions that it might be complacency that develops with access to improved water sources that refrain the people to consider any type of water treatment before passing it to infants for drinking. Such a comment might be valid, but neither is it built upon a sound literature review nor does it stand on strong empirics. At this juncture, the present article tests the claim of Banerjee et al. (2020) based on pure empirics.
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Reddy NKK, Bahurupi Y, Kishore S, Singh M, Aggarwal P, Jain B. Awareness and readiness of health care workers in implementing Pradhan Mantri Jan Arogya Yojana in a tertiary care hospital at Rishikesh. Nepal J Epidemiol 2020; 10:865-870. [PMID: 32874700 PMCID: PMC7423403 DOI: 10.3126/nje.v10i2.27941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background Right to health is one among the important components of basic human rights. The Government of India had announced “Ayushman Bharat for a new India-2022”, during 2018-19 parliament budget sessions with two components namely, Health and wellness centers for strengthening primary care and national health protection scheme now known as “Pradhan Mantri Jan Arogya Yojana (PMJAY)” for enabling access to secondary and tertiary healthcare services. Current study was conducted to assess awareness and readiness of the health care workers in implementation of Pradhan Mantri Jan Arogya Yojana Materials and Methods A hospital based cross sectional study was conducted with estimated sample size calculated of 236, with treating consultants and residents as study participants. Participants filled a self-administered pretested semi-structured questionnaire to assess the level of awareness and readiness in implementing PMJAY. Data was entered and analyzed using EPI Info 7 software. Results Total number of participants were 181. Mean awareness score was 4.5±1.96 and mean readiness score was 16±5. Mean awareness and readiness score among medical and surgical branches was not statistically significant. There was significantly high awareness score among faculty as compared to senior residents. Relationship between awareness and readiness was found to be correlated with Pearson’s correlation of 0.206 and was statistically significant. Linear regression model demonstrated an increase of 0.531 units in readiness for every unit increase in awareness score. Conclusion Mean awareness score of doctors was just around half of maximum possible score. Awareness is more among faculty members than residents. With increase in awareness there is an increase in readiness among the study population. There is a need to organize workshops on PMJAY for stakeholders.
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Affiliation(s)
- Navuluri Kranthi Kumar Reddy
- Junior Resident, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Surekha Kishore
- Professor and Head, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mahendra Singh
- Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pradeep Aggarwal
- Associate Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhavna Jain
- Senior Resident, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Dutta U. Indigenous Health Organizing at the Margins: Creating Access to Health by Building Health Infrastructure. HEALTH COMMUNICATION 2020; 35:1177-1189. [PMID: 31124386 DOI: 10.1080/10410236.2019.1622065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Socio-economic challenges, communicative barriers, and the lack of health infrastructure constitute and reinforce obstacles to health for all, especially for those who live in the underserved spaces of the Global South. This research addresses such contextual adversities by investigating how indigenous people in a remote Himalayan village collectively took ownership of a health-organizing initiative. The result of this initiative was the creation of a four bed mini-hospital designed to increase community members' access to basic curative and preventative health care. Grounded in praxis-based critical health communication approaches, this research challenges top-down and externally-dictated interventions by placing subalterns at the forefront of a bottom-up and community-led health initiative. The centrality of discursive engagements and local-centric participatory actions of marginalized indigenous participants in this research calls for culture- and communication-centric research initiatives for increasing access to health at the margins.
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Affiliation(s)
- Uttaran Dutta
- Hugh Downs School of Human Communication, Arizona State University
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