Politics of Rural Health in India

Banerji, Debabar

doi:10.2190/1g7y-kve3-b6yv-ane9

Cited by 14 publications

(11 citation statements)

References 10 publications

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“…While the Indian health system was working well in early years after independence, the focus on family planning in the late 70s destabilized it and emergence of private providers inflated the costs albeit with somewhat improved quality of care [18]. Admitting the disparity in healthcare in 2002 [19], Indian Government launched National Rural Health Mission in 2005 with many schemes to improve healthcare in India [20].…”

Section: Discussionmentioning

confidence: 99%

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

Devpura

Bhadesia

Nimbalkar

et al. 2016

International Journal of Pediatrics

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Objective. We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods. Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results. The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions. The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.

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Section: Discussionmentioning

confidence: 99%

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

Devpura

Bhadesia

Nimbalkar

et al. 2016

International Journal of Pediatrics

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“…Several committees articulated this vision for improving the health of the people of India through community-based initiatives. In 1940, the National Health (Sokhey) Sub-Committee of the National Planning Committee called for a CHW program that would provide one worker for every 1000 village population to provide basic curative and preventive services [6]. Like the Sokhey Subcommittee, the Bhore Committee advocated for the integration of preventive and curative services in its influential report published in 1946 [7].…”

Section: Case Presentationmentioning

confidence: 99%

The National Village Health Guide Scheme in India: lessons four decades later for community health worker programs today and tomorrow

Strodel

Perry

2019

Hum Resour Health

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BackgroundBased in part on the success of India’s early community health worker (CHW) programs, the Government of India launched in 1977 a national CHW scheme—the Village Health Guides (VHGs)—to provide preventive, promotive, and basic curative care to rural populations. Although this program had promising origins in smaller demonstration projects, it failed to deliver the hoped-for impact at scale and was abandoned. Based on extensive evidence and experience, the World Health Organization and the World Health Assembly have strongly endorsed the value of national CHW programs and their integration into national health systems. Surprisingly, given the scale and importance of the VHG program and its pioneering nature as a national CHW program, little has been published describing this experience. This article is the second in a series that focuses on critical issues that face the effectiveness of large-scale CHW programs.Case presentationSeveral systemic factors emerge as main contributors to the failure of the VHG Scheme, namely, a lack of support from the formal health sector, an overly hasty implementation of the scheme, and poor communication between the government and health centers about the role of the VHGs. The remuneration structure and the VHG selection process were at the root of the program’s shortcomings at the implementation level.ConclusionNational CHW schemes are an increasingly important tool for achieving universal health coverage and ending maternal and child deaths by 2030. Although the VHG Scheme was initiated over 40 years ago, the lessons described in this case highlight important considerations to help both current and future large-scale CHW programs avoid the same pitfalls.

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“…As has happened so often in the past, NRHM is based on questionable premises (5,73). It adopts a simplistic approach to a highly complex problem.…”

Section: Yet Another Questionable Promise To Improve Rural Health Sermentioning

confidence: 99%

Reconstructing the Critically Damaged Health Service System of the Country

Banerji

2012

Int J Health Serv

Self Cite

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India's ruling class, in association with international agencies, bureaucrats, and business interests, has formed a powerful syndicate that has been imposing its will on the country to the detriment of public health. After gaining independence, India developed a body of knowledge suited to its social, cultural, economic, and epidemiological conditions. This led to an alternative approach to public health education, practice, and research that foreshadowed the Alma Ata Declaration on Primary Health Care of 1978. In the early 1980s, global power shifts undermined national and international commitment to the Declaration. Wealthy countries' response to the declaration of self-reliance by economically disadvantaged countries was swift: an effort to suppress the Declaration's ideals in favor of an unscientific, market-driven agenda. As a result, public health practice in India virtually disappeared. Responding to growing restiveness among a population in need, political leaders have launched the foredoomed National Rural Health Mission and pursued an American brand of public health through the Public Health Foundation of India. Reconstructing the damaged public health system will require pressure on the syndicate to ensure India's public health heritage will be used to effectively transfer "People's health in people's hands" according to the guidelines set down at Alma Ata.

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Politics of Rural Health in India

Cited by 14 publications

References 10 publications

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

The National Village Health Guide Scheme in India: lessons four decades later for community health worker programs today and tomorrow

Reconstructing the Critically Damaged Health Service System of the Country

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