Challenges and opportunities for policy decisions to address health equity in developing health systems: case study of the policy processes in the Indian state of Orissa

Introduction  

Achieving health equity is a pertinent need of the developing health systems. Though policy process is crucial for planning and attaining health equity, the existing evidences on policy processes are scanty in this regard. This article explores the magnitude, determinants, challenges and prospects of 'health equity approach' in various health policy processes in the Indian State of Orissa - a setting comparable with many other developing health systems.     

Suicide: a disturbing factor in the ‘development model’ of Kerala,India

Aim  

To report the prevalence and causes of suicide in Kerala, which is a well-developed Indian state in terms of better demographic and health indicators.     

Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states

Background  

Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors.     

Can microcredit help improve the health of poor women? Some findings from a cross-sectional study in Kerala,India

Background  

This study examines associations between female participation in a microcredit program in India, known as self help groups (SHGs), and women's health in the south Indian state of Kerala. Because SHGs do not have a formal health program, this provides a unique opportunity to assess whether SHG participation influences women's health via the social determinants of health.     

Indian community health insurance schemes provide partial protection against catastrophic health expenditure

Background  

More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE). We studied two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE.     

Health care utilization and costs in Saskatchewan's registered Indian population with diabetes

Background  

The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan.     

Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans

Background

The Indian Sundarbans is marked by inhospitable terrain and frequent climatic shocks which jointly hinder access to health care. Community members, and women in particular, have few means to communicate their concerns to local decision makers. Photovoice is one way in which communities can raise their local health challenges with decision makers. This study unlocks mothers’ voices on the determinants of their children’s health to inform local level decision-making on child health issues in the Indian Sundarbans.

Methods

Photovoice action research was conducted in three blocks in the Sundarbans region of West Bengal, India. The project involved eight groups of eight to ten mothers who had at least one child below 6 years of age across four villages. The mothers received training on photo documentation and ethical concerns before taking two rounds of photographs within 6 months, interspersed by fortnightly group meetings facilitated by researchers. Photographs and key messages were communicated to local decision makers during block and village level interface sessions with the mothers and researchers.

Results

Mothers’ photos focused on specific determinants of health, such as water and sanitation; health status, such as malnutrition and non-communicable diseases; service accessibility; climate conditions; and social issues such as early marriage and recurrent pregnancy. Some issues were not captured by photos but were discussed in group meetings, including domestic violence and the non-availability of medical practitioners. We found differences by mother’s educational status, livelihood and caste identity in the extent and nature of photographs taken. As a result of the mother’s interface with community decision makers, which included showcasing a selection of their photos, efforts to improve road infrastructure and human resource availability in the primary health centres and local government were realized.

Conclusion

Photovoice has the potential to express the voices of vulnerable communities regarding their health needs and can help them dialogue with local decision makers to inform community health policy and planning. More needs to be done to understand how social differences among photovoice participants influences how they engage with the methodology.

     

Quality of medical training and emigration of physicians from India

Background  

Physician 'brain drain' negatively impacts health care delivery. Interventions to address physician emigration have been constrained by lack of research on systematic factors that influence physician migration. We examined the relationship between the quality of medical training and rate of migration to the United States and the United Kingdom among Indian medical graduates (1955–2002).     

Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan

Background

The maternal, newborn, and child health (MNCH) indicators of Pakistan depict the deplorable state of the poor and rural women and children. Many MNCH programmes stress the need to engage the poor in community spaces. However, caste and class based hierarchies and gendered social norms exclude the lower caste poor women from accessing healthcare. To find pathways for improving the lives of the excluded, this study considers the social system as a whole and describes the mechanisms of exclusion in the externally created formal community spaces and their interaction with the indigenous informal spaces.

Methods

The study used a qualitative case study design to identify the formal and informal community spaces in three purposively selected villages of Thatta, Rajanpur, and Ghizer districts. Community perspectives were gathered by conducting 37 focus group discussions, based on participatory rural appraisal tools, with separate groups of women and men. Relevant documents of six MNCH programmes were reviewed and 25 key informant interviews were conducted with programme staff.

Results

We found that lower caste poor tenants and nomadic peasants were excluded from formal and informal spaces. The formal community spaces formed by MNCH programmes across Pakistan included fixed, small transitory, large transitory, and emerging institutional spaces. Programme guidelines mandated selection of community notables in groups/committees and used criteria that prevented registration of nomadic groups as eligible clients. The selection criteria and adverse attitude of healthcare workers, along with inadequacy of programmatic resources to sustain outreach activities also contributed to exclusion of the lower caste poor women from formal spaces. The informal community spaces were mostly gender segregated. Infrequently, MNCH information trickled down from the better-off to the lower caste poor women through transitory interactions in the informal domestic sphere.

Conclusion

A revision of the purpose and implementation mechanisms for MNCH programmes is mandated to transform formal health spaces into sites of equitable healthcare.

     

Secular trends in height and weight among children and adolescents of the Seychelles, 1956–2006

Background  

Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region).     

Secular trends in cholesterol lipoproteins and triglycerides and prevalence of dyslipidemias in an urban Indian population

Background  

Coronary heart disease is increasing in urban Indian subjects and lipid abnormalities are important risk factors. To determine secular trends in prevalence of various lipid abnormalities we performed studies in an urban Indian population.     

Factors Influencing Utilization of ASHA Services under NRHM in Relation to Maternal Health in Rural Lucknow

Background:

Under National Rural Health Mission (NRHM), ASHA (accredited social health activist) has been identified as an effective link to address the poor utilization of maternal and child health (MCH) services by rural pregnant women.

Objective:

To study the factors influencing utilization of ASHA services in relation to maternal health.

Study Design:

Cross-sectional.

Setting

Primary Health Centre (PHC), Sarojininagar, Lucknow and its rural field area.

Study Period:

September 2007 to August 2008.

Study Unit:

RDW (recently delivered women) were considered as those who delivered a live newborn at PHC Sarojininagar, within a week of interview and belonged to villages within the confines of the PHC being served by ASHA.

Materials and Methods:

350 RDW were interviewed at their bedside, by a preformed and pretested schedule and then were followed-up after six weeks.

Results:

Utilization of ASHA services for early registration was significantly associated with age and religion of RDW. Young, educated and socio-economic class III RDW utilized ASHA services the maximum for early registration. Utilization of ASHA services for adequate ANC or antenatal care (100 iron and folic acid tablets, 2 tetanus toxoid injection and ≥3 antenatal visits) was also inversely associated with age of RDW. Young, Hindu, scheduled caste, middle school pass, Class III RDW and those with birth order one had high odds for utilization of ASHA services for adequate ANC. With regard to postnatal check-up, again young RDW with birth order one, Hindu RDW in reference to Muslim and RDW in socio-economic class III had higher likelihood for utilization of ASHA services. Caste-wise scheduled caste (SC) and other backward caste (OBC) RDW had higher odds for utilization of ASHA services. Educated RDW and those with educated husband had higher odds for utilization of ASHA services for postnatal check-up.

Conclusion:

Young, educated RDW with low parity, educated husband and belonging to higher socio-economic class had higher odds of utilization of ASHA services.     

Exposure to the tsunami disaster,PTSD symptoms and increased substance use – an Internet based survey of male and female residents of Switzerland

Background  

After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms.     

Prevalence of mental disorders and torture among Tibetan refugees: A systematic review

Background  

Rural Indian tribes are anthropologically distinct with unique cultures, traditions and practices. Over the years, displacement and rapid acculturation of this population has led to dramatic changes in their socio-cultural and value systems. Due to a poor health infrastructure, high levels of poverty and ignorance, these communities are highly vulnerable to various health problems, especially, communicable diseases including HIV/AIDS. Our study sought to assess knowledge, attitudes and practices regarding sexuality, and the risk factors associated with the spread of HIV/AIDS and STDs among these communities.     

Persistently elevated T cell interferon-γ responses after treatment for latent tuberculosis infection among health care workers in India: a preliminary report

Background  

T cell-based interferon-γ (IFN-γ) release assays (IGRAs) are novel tests for latent tuberculosis infection (LTBI). It has been suggested that T cell responses may be correlated with bacterial burden and, therefore, IGRAs may have a role in monitoring treatment response. We investigated IFN-γ responses to specific TB antigens among Indian health care workers (HCWs) before, and after LTBI preventive therapy.     

Sentinel surveillance system for early outbreak detection in Madagascar

Background  

Following the outbreak of chikungunya in the Indian Ocean, the Ministry of Health directed the necessary development of an early outbreak detection system. A disease surveillance team including the Institut Pasteur in Madagascar (IPM) was organized to establish a sentinel syndromic-based surveillance system. The system, which was set up in March 2007, transmits patient data on a daily basis from the various voluntary general practitioners throughout the six provinces of the country to the IPM. We describe the challenges and steps involved in developing a sentinel surveillance system and the well-timed information it provides for improving public health decision-making.     

Association of anthropometric,body composition and physiological measures with physical activity level among the children and adolescents of Asian Indian origin: The Calcutta obesity study

Objective  

To look into the association between anthropometric, body compositional and physiological characteristics with physical activity among the children and adolescents of Asian Indian origin.     

Knowledge of modifiable risk factors of Coronary Atherosclerotic Heart Disease (CASHD) among a sample in India

Background  

The prevalence of Coronary Atherosclerotic Heart Disease (CASHD) is increasing in India. Several modifiable risk factors contribute directly to this disease burden. Public knowledge of such risk factors among the urban Indian population is largely unknown. This investigation attempts to quantify knowledge of modifiable risk factors of CASHD as sampled among an Indian population at a large metropolitan hospital.     

Where to deliver? Analysis of choice of delivery location from a national survey in India

Background  

In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.