Issues in the Provision of Health Care in India: An Overview

2020 ◽  
pp. 097674792094518
Author(s):  
Vani Kant Borooah
Keyword(s):  
Health Outcomes ◽  
Rural Areas ◽  
Health Workers ◽  
Tertiary Care ◽  
Health Resources ◽  
Successful Implementation ◽  
Trade Offs ◽  
Vested Interests ◽  
Explicit Recognition ◽  
Optimal Mix

After reviewing health outcomes and policy in India, this paper concludes that there are at least six sets of issues to be addressed about improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private-sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of the policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, a policy it is important to address these governance issues.

scholarly journals Sustainable electricity for sustainable health? A case study in North-western Zambia

2020 ◽  
Vol 31 (4) ◽  
pp. 72-82
Author(s):  
Lizzie Caperon ◽  
Lina Brand-Correa
Keyword(s):  
Health Outcomes ◽  
Health Workers ◽  
Clean Energy ◽  
Hydropower Plant ◽  
Structured Interviews ◽  
Community Members ◽  
Trade Offs ◽  
Health Related ◽  
Development Goals ◽  
The Impact

This study explores the under-researched link between clean energy and public health outcomes, and offers new insights into the link between wider access to clean energy and progress towards health outcomes, in particular the prevention and treatment of non-communicable diseases such as diabetes. This is the first study to consider the impact of a run-of-river hydropower plant (RORHP) in a remote rural community in Zambia in relation to health outcomes. Exploring this relationship establishes how the health benefits which renewable energy can bring can be capitalised upon to meet the health-related objectives of the United Nations sustainable development goals. Workshops and semi-structured interviews were conducted with a range of stakeholders including community members, health workers, business owners, and key people involved with the plant, to establish health and social impacts of the introduction of electricity in the community of Ikelenge. Findings are used to establish both synergies and trade-offs of the RORHP on the health of the community, and recommendations are made for the continued improvement of health following the introduction of the RORHP, to achieve further progress towards meeting SDG targets.

scholarly journals Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Umar Haruna ◽  
Gordon Dandeebo ◽  
Sylvester Z. Galaa
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Health Outcomes ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Transportation Systems ◽  
Successful Implementation ◽  
Maternal Healthcare ◽  
Focused Antenatal Care

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

scholarly journals STUDY OF MATERNAL MORTALITY IN A TERTIARY CARE CENTRE

2020 ◽  
pp. 30-32
Author(s):  
Anamika Anamika ◽  
Amrita Sharan
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Health Workers ◽  
Tertiary Care ◽  
World Health ◽  
Care Hospital ◽  
Contributing Factors ◽  
Tertiary Care Centre ◽  
Maternal Mortality Rate

BACKGROUND Maternal death or maternal mortality is defined by the World Health Organisation (WHO) as the “death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” AIMS AND OBJECTIVES 1. To study the causes of maternal mortality, 2. To identify the deficits to decrease the current rate of maternal mortality. MATERIALS AND METHODS This was a retrospective study done by analyzing hospital records of maternal mortality occurring in the department of obstetrics and gynaecology of a tertiary care hospital of Bihar from January 2019 to December 2019. RESULTS A total of 126 deaths occurred in this period of 1 year. The total number of live births was 5568 in this year making the maternal mortality rate (MMR) to be 2262.93. This may be due to the fact that being a referral institute most of the cases were referred from the peripheries. 76.19% of the women were referred from outside. The most common age group to be affected was 20 to 29 years (79.36%). Multiparous women were more affected than primiparous women (61.9% V/s 38.10%). The most common cause of maternal mortality was eclampsia seen in 26.98% cases followed by PPH seen in 22.22% cases, anemia in 8.73%, medical complications in 7.94% cases , APH in 7.14% cases , rupture uterus in 7.14% cases. The most common type of delay was type 1 and 2. More number of women were from rural areas. More number of women were illiterates. Most of the women had no ANC. CONCLUSION Illiteracy, poverty, lack of knowledge, delayed referrals, lack of ANC are major contributing factors causing such high maternal mortality rate. Health education, strengthening of peripheral health care and availability of trained health workers and essential drugs should be enforced.

scholarly journals Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

2020 ◽  
Author(s):  
Aminu Aliyu Umar ◽  
Saidu Ibrahim ◽  
Idris Liman ◽  
Calvin Chama ◽  
Munirdeen Ijaiya ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Early Warning ◽  
Patient Monitoring ◽  
Health Workers ◽  
Tertiary Care ◽  
Early Warning Systems ◽  
Warning Systems ◽  
Low Resource ◽  
Increased Risk

Background Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to explore the experience of health workers and managers who implemented a low resource setting specific statistically derived and validated EWS and to assess its effectiveness in improving health outcomes. Methods This mixed-method study included 2400 women admitted to inpatient wards between 1 August 2018 and 31 March 2019 at three tertiary Nigerian hospitals (1 intervention and 2 control) with pregnancy and childbirth related complications. The quality of patient monitoring and prevalence of outcomes were assessed through retrospective review of case notes before and 4 months after EWS was introduced. Outcomes were maternal death, direct obstetric complications, length of hospital stay, speed of clinical review, caesarean section(CS) and instrumental birth rates. Qualitative interviews and focus group discussions were undertaken to explore the views of healthcare workers on acceptability and usability of the EWS. Results EWS was correctly used in 51% (n=307) of cases. Of these, 58.6% (180) were predicted to have increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. CS rate dropped from 39.9% to 31.5% (chi-square p=0.002). No statistically significant effect was observed in the other outcomes. Health workers reported positive experience using EWS, with the feeling that it helped cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use, evaluate at a glance, and that scores consistently correlated with the clinical picture of patients. Identified challenges to use included rotation of clinical staff, low staffing numbers and monitoring equipment. Conclusion The implementation of EWS improved the quality of patient monitoring, but a larger study will be required to explore the effect on critical care admission and health outcomes. With modifications to suit the setting, coupled with regular training, the EWS is a feasible and acceptable tool to cope with the unique demands faced in low resource settings.

scholarly journals Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

2020 ◽  
Author(s):  
Aminu Umar ◽  
Saidu Ibrahim ◽  
Idris Liman ◽  
Calvin Chama ◽  
Munirdeen Ijaiya ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Early Warning ◽  
Patient Monitoring ◽  
Health Workers ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Early Warning Systems ◽  
Warning Systems ◽  
Increased Risk

Abstract Background Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to assess the effectiveness of a validated obstetric EWS in improving health outcomes and explore the experience of health workers/managers regarding its use. Methods This mixed-method study included 2400 obstetric admissions to inpatient wards between 1 August 2018 and 31 March 2019 at three tertiary Nigerian hospitals (1 intervention and 2 control). The quality of patient monitoring and prevalence of outcomes were assessed through retrospective review of case notes before and 4 months after EWS was introduced. Outcomes were maternal death, direct obstetric complications, length of hospital stay, speed of clinical review, caesarean section (CS) and instrumental birth rates. Qualitative data was collected to explore the views of healthcare workers on EWS’ acceptability and usability.Results EWS correctly used in 51% (n=307) of cases. Of these, 58.6% (180) predicted to have increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. CS rate reduced from 39.9% to 31.5% (chi-square p=0.002). No statistically significant effect was observed in the other outcomes.Health workers reported that the EWS helped cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use, and that scores consistently correlated with the clinical picture of patients.Identified challenges included rotation of clinical staff, low staffing numbers and monitoring equipment.Conclusion The implementation of EWS improved the quality of patient monitoring, but a larger study will be required to explore the effect on health outcomes. With modifications to suit the setting, coupled with regular training, the EWS is a feasible and acceptable tool to cope with the unique demands faced in low-resource settings. Trial registration: ISRCTN, ISRCTN15568048. Registration date; 9/09/2020- Retrospectively registered, http://www.isrctn.com/ISRCTN15568048

scholarly journals Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

2020 ◽  
Author(s):  
Aminu Umar ◽  
Saidu Ibrahim ◽  
Idris Liman ◽  
Calvin Chama ◽  
Munirdeen Ijaiya ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Early Warning ◽  
Patient Monitoring ◽  
Health Workers ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Early Warning Systems ◽  
Warning Systems ◽  
Increased Risk

Abstract BackgroundObstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to assess the effectiveness of a validated obstetric EWS in improving health outcomes and explore the experience of health workers/managers regarding its use.MethodsThis mixed-method study included 2400 obstetric admissions to inpatient wards between 1 August 2018 and 31 March 2019 at three tertiary Nigerian hospitals (1 intervention and 2 control). The quality of patient monitoring and prevalence of outcomes were assessed through retrospective review of case notes before and 4 months after EWS was introduced. Outcomes were maternal death, direct obstetric complications, length of hospital stay, speed of clinical review, caesarean section (CS) and instrumental birth rates. Qualitative data was collected to explore the views of healthcare workers on EWS’ acceptability and usability.ResultsEWS correctly used in 51% (n=307) of cases. Of these, 58.6% (180) predicted to have increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. CS rate reduced from 39.9% to 31.5% (chi-square p=0.002). No statistically significant effect was observed in the other outcomes.Health workers reported that the EWS helped cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use, and that scores consistently correlated with the clinical picture of patients.Identified challenges included rotation of clinical staff, low staffing numbers and monitoring equipment.ConclusionThe implementation of EWS improved the quality of patient monitoring, but a larger study will be required to explore the effect on health outcomes. With modifications to suit the setting, coupled with regular training, the EWS is a feasible and acceptable tool to cope with the unique demands faced in low-resource settings. Trial registration: ISRCTN, ISRCTN15568048. Registration date; 9/09/2020- Retrospectively registered, http://www.isrctn.com/ISRCTN15568048

The Impact of Social Mobilization on Health Service Delivery and Health Outcomes

2018 ◽  
Author(s):  
Xavier Giné ◽  
Salma Khalid ◽  
Mansuri Ghazala
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Health Outcomes ◽  
Health Workers ◽  
Health Service Delivery ◽  
Health Providers ◽  
Child Health Outcomes ◽  
Rural Pakistan ◽  
Post Natal Care ◽  
The Impact

This chapter uses a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong emphasis on organizing women, who also identified health services as a development priority at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by female health workers, as well as increased utilization of pre- and post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.

scholarly journals Integrating Ecosystem Services and Human Demand for a New Ecosystem Management Approach: A Case Study from the Giant Panda World Heritage Site

2019 ◽  
Vol 12 (1) ◽  
pp. 295 ◽  
Author(s):  
Bin Fu ◽  
Pei Xu ◽  
Yukuan Wang ◽  
Yingman Guo
Keyword(s):  
Ecosystem Services ◽  
Ecosystem Management ◽  
Giant Panda ◽  
Supply And Demand ◽  
World Heritage ◽  
World Heritage Site ◽  
Management Approach ◽  
Successful Implementation ◽  
Heritage Site ◽  
Trade Offs

Ecological management based on the ecosystem approach promotes ecological protection and the sustainable use of natural resources. We developed a quantitative approach to identify the ecological function zones at the country-scale, through integrating supply and demand of ecosystem services. We selected the biologically diverse hotspot of Baoxing County, which forms a part of the Sichuan Giant Panda World Heritage Site, to explore the integration of ecosystem services supply and demand for ecosystem management. Specifically, we assessed the various support, provision, regulating, and cultural services as classified by the Millennium Ecosystem Assessment. We applied the InVEST (Integrated Valuation of Ecosystem Services and Trade-offs) model to spatially map habitat quality, water retention, and carbon sinks, and used statistical data to evaluate food products, animal husbandry, and product supply services. We then quantified the demands for these services in terms of population, protected species, hydropower, water, and land use. The relationship between areas of supply and areas of demand was discussed for each township, and the spatial variability in the supply–demand relationship was also considered. As a result, we spatially divided the county into six ecological functional areas, and the linkages between each region were comprehensively discussed. This study thus provides a detailed methodology for the successful implementation of an ecosystem management framework on a county-scale based on the spatial partitioning of supply and demand.

scholarly journals Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Li ◽  
Jingdong Xu ◽  
Huan Zhou ◽  
Hua You ◽  
Xiaohui Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Status ◽  
Health Outcomes ◽  
Working Conditions ◽  
Health Workers ◽  
Front Line ◽  
Cross Sectional ◽  
Self Rated Health ◽  
Public Health Workers

ABSTRACT Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

scholarly journals Association between perceived discriminations and mental health outcomes among health workers during the initial COVID-19 outbreak

2021 ◽  
Author(s):  
Roberto Mediavilla ◽  
Eduardo Fernández-Jiménez ◽  
Jorge Andreo ◽  
Inés Morán-Sánchez ◽  
Ainoa Muñoz-San José ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Health Workers ◽  
Mental Health Outcomes
Sign in / Sign up

Export Citation Format

Share Document