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ORIGINAL RESEARCH: Composition and distribution of the health workforce in India: estimates based on data from the N...
Krishna D Rao, Renu Shahrawat, Aarushi Bhatnagar
WHO South-East Asia Journal of Public Health, Year 2016, Volume 5, Issue 2 [p. 133-140]
DOI: 10.4103/2224-3151.206250 PMID: 28607241
Background: The availability of reliable and comprehensive information on the health workforce is crucial for workforce planning. In India, routine information sources on the health workforce are incomplete and unreliable. This paper addresses this issue and provides a comprehensive picture of India’s health workforce. Methods: Data from the 68th round (July 2011 to June 2012) of the National Sample Survey on the Employment and unemployment situation in India were analysed to produce estimates of the health workforce in India. The estimates were based on self-reported occupations, categorized using a combination of both National Classification of Occupations (2004) and National Industrial Classification (2008) codes. Results: Findings suggest that in 2011–2012, there were 2.5 million health workers (density of 20.9 workers per 10 000 population) in India. However, 56.4% of all health workers were unqualified, including 42.3% of allopathic doctors, 27.5% of dentists, 56.1% of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners, 58.4% of nurses and midwives and 69.2% of health associates. By cadre, there were 3.3 qualified allopathic doctors and 3.1 nurses and midwives per 10 000 population; this is around one quarter of the World Health Organization benchmark of 22.8 doctors, nurses and midwives per 10 000 population. Out of all qualified workers, 77.4% were located in urban areas, even though the urban population is only 31% of the total population of the country. This urban–rural difference was higher for allopathic doctors (density 11.4 times higher in urban areas) compared to nurses and midwives (5.5 times higher in urban areas). Conclusion: The study highlights several areas of concern: overall low numbers of qualified health workers; a large presence of unqualified health workers, particularly in rural areas; and large urban–rural differences in the distribution of qualified health workers.
REVIEW: Current status of master of public health programmes in India: a scoping review
Ritika Tiwari, Himanshu Negandhi, Sanjay Zodpey
WHO South-East Asia Journal of Public Health, Year 2018, Volume 7, Issue 1 [p. 29-35]
DOI: 10.4103/2224-3151.228425 PMID: 29582847
There is a recognized need to improve training in public health in India. Currently, several Indian institutions and universities offer the Master of Public Health (MPH) programme. However, in the absence of any formal body or council for regulating public health education in the country, there is limited information available on these programmes. This scoping review was therefore undertaken to review the current status of MPH programmes in India. Information on MPH programmes was obtained using a two-step process. First, a list of all institutions offering MPH programmes in India was compiled by use of an internet and literature search. Second, detailed information on each programme was collected via an internet and literature search and through direct contact with the institutions and recognized experts in public health education. Between 1997 and 2016–2017, the number of institutions offering MPH programmes increased from 2 to 44. The eligibility criteria for the MPH programmes are variable. All programmes include some field experience. The ratio of faculty number to students enrolled ranged from 1:0.1 to 1:42. In the 2016–2017 academic year, 1190 places were being offered on MPH programmes but only 704 students were enrolled. MPH programmes being offered in India have witnessed a rapid expansion in the past two decades. This growth in supply of public health graduates is not yet matched by an increased demand. Despite the recognized need to strengthen the public health workforce in India, there is no clearly defined career pathway for MPH graduates in the national public health infrastructure. Institutions and public health bodies must collaborate to design and deliver MPH programmes to overcome the shortage of public health professionals, such that the development goals for India might be met.
ORIGINAL RESEARCH: Health workforce in India: assessment of availability, production and distribution
Indrajit Hazarika
WHO South-East Asia Journal of Public Health, Year 2013, Volume 2, Issue 2 [p. 106-112]
DOI: 10.4103/2224-3151.122944 PMID: 28612768
Background: India faces an acute shortage of health personnel. Together with inequalities in distribution of health workers, this shortfall impedes progress towards achievement of the Millennium Development Goals. The aim of this study was to assess health-workforce distribution, identify inequalities in health-worker provision and estimate the impact of this maldistribution on key health outcomes in India. Materials and Methods: Health-workforce availability and production were assessed by use of year-end data for 2009 obtained from the Indian Ministry of Statistics and Programme Implementation. Inequalities in the distribution of doctors, dentists, nurses and midwives were estimated by use of the Gini coefficient and the relation between health-worker density and selected health outcomes was assessed by linear regression. Results: Inequalities in the availability of health workers exist in India. Certain states are experiencing an acute shortage of health personnel. Inequalities in the distribution of health workers are highest for doctors and dentists and have a significant effect on health outcomes. Conclusion: Although the production of health workers has expanded greatly in recent years, the problems of imbalances in their distribution persist. As India seeks to achieve universal health coverage by 2020, the realization of this goal remains challenged by the current lack of availability and inequitable distribution of appropriately trained, motivated and supported health workers.
ORIGINAL ARTICLE: Single-staged buccal reconstruction with facial artery-based bilateral nasolabial flaps for the m...
Amrita Kaur, Geley Ete, M Kingsly Paul, Elvino Barreto, Gaurav Chaturvedi
Turkish Journal of Plastic Surgery, Year 2021, Volume 29, Issue 2 [p. 90-94]
DOI: 10.4103/tjps.tjps_27_20
Background: Oral submucous fibrosis (OSMF) is a chronic disease of insidious onset predominant in the Asian subcontinent. It is a progressive condition resulting in forced closure of mouth and inability to take solid oral feeds. Having a multifactorial etiology, it is a well-known premalignant condition. Measures such as forcing the mouth open and releasing the fibrotic bands have resulted in aggravated fibrosis and disability. Aim: The aim was to evaluate the outcomes of bilateral inferiorly based nasolabial flaps in the management of severe trismus in patients with submucous fibrosis. Materials and Methods: The study included patients with progressive trismus presenting to the department of plastic surgery who underwent release and cover with nasolabial flap during the period from August 2014 to July 2018 (4 years). A total of eight patients were studied for their offending agents, the progression of the disease, the preoperative and postflap transfer, and inter-incisal distance, and this was followed up for a period of 1 year. Patients were studied for their improvement in mouth opening, flap status, and donor-site scar acceptability. Results: A total of eight patients of submucous fibrosis with severe trismus were treated with nasolabial flaps and followed for an average of 1 year from 2014 to 2018. The mean preoperative inter-incisal opening of 2 mm was treated by the bilateral release of mucosal fibrous bands and covered with tunneled facial artery-based nasolabial flaps. All patients received postoperative mouth-opening physiotherapy. Their inter-incisal opening improved from a mean of 2 mm to a mean of 30.8 mm. Conclusion: Bilateral pedicled nasolabial flaps can be successfully used for long-term relief of severe trismus in OSMF. Our study showed easy elevation of bilateral flaps, adequate postoperative mouth opening, with no recurrence of disease, and no flap contracture. This small-sized flap gives good coverage of the buccal mucosa without flap redundancy and cosmetically acceptable donor site.
SYMPOSIUM: Morphology, epidemiology, and phylogeny of Babesia: An overview
Ramgopal Laha, M Das, A Sen
Tropical Parasitology, Year 2015, Volume 5, Issue 2 [p. 94-100]
DOI: 10.4103/2229-5070.162490 PMID: 26629451
Babesiosis is a tick-borne hemoprotozoan disease of domestic and wild animals. The disease is caused by various species of Babesia and some species of Babesia have also zoonotic significance. The parasite in vertebrate hosts' remains in erythrocytes and the morphology of Babesia spp. is not uniform in all vertebrate hosts. With the advancement of science, particularly the use of molecular techniques made it easy to study the evolution of parasites and thereby reclassifying Babesia spp. as per their phylogeny and to establish the relation of one isolate of Babesia spp. with isolates throughout the world. An attempt also made in this communication to enlighten the readers regarding relationship of one isolate of Babesia spp. of a particular area to another isolate of Babesia spp. of that area or other parts of the world and phylogenetic classification of Babesia spp. was also discussed. It has been concluded that as the study on Babesia is complex in nature so monitoring of the infection with the use of modern techniques is very much needed to control the infection. Second, more research work on phylogenetic relationship of Babesia spp. isolated from different hosts is needed, particularly in India to know the evolution of Babesia spp. of a particular area, as it has great importance to study the trans boundary diseases of animals.
MEDICINE AND SOCIETY: Decoding the black box of health policy implementation: A case of regulating private healthcare e...
Meena Putturaj, Upendra Bhojani, Neethi V Rao, Bruno Marchal
The National Medical Journal of India, Year 2021, Volume 34, Issue 2 [p. 100-106]
DOI: 10.4103/0970-258X.326754
Background. Implementation of healthcare regulatory policies, especially in low- and middle-income countries where the private health sector is predominant, is challenging. Karnataka, a southern state in India, enacted the Karnataka Private Medical Establishments Act (KPMEA) with an aim to ensure quality of care in the private healthcare establishments. After more than a decade the implementation of KPMEA is suboptimal. Methods. We used a case study design. The case was ‘implementation of KPMEA’. The case study site was Bengaluru Urban district in Karnataka. Data from key informant interviews, focus group discussions held at the state, district and subdistrict levels and key policy documents, minutes of the meetings, data from the State Department of Health and Family Welfare, district level KPMEA data and litigations at the High Court of Karnataka were analysed using a framework. Results. The policy (KPMEA) content is inadequate and requires clarity in certain provisions of the Act. There was a lack of coordination between the implementing agencies. Workforce shortages were evident. Factors that impede the enforcement of the Act include poor knowledge and lack of competency of the officials on the content and the implementation mechanics of the policy, insufficient policy oversight from the state on the districts, corruption, political interference and lack of support from the local public, especially during raids on illegal establishments. Conclusions. A regulatory policy such as KPMEA needs a clear, comprehensive content and directions for operationalization. However, improving the content of the policy is not easy as some aspects of the policy remain contentious with the private healthcare providers/ establishments. Addressing health governance issues at all levels is key to effective enforcement.
MEDICINE AND SOCIETY: Indian healthcare at crossroads (Part 2): Social and environmental influences
Anil C Anand
The National Medical Journal of India, Year 2019, Volume 32, Issue 2 [p. 109-112]
DOI: 10.4103/0970-258X.275354 PMID: 31939411
MEDICINE AND SOCIETY: Indian healthcare at crossroads (Part 1): Deteriorating doctor–patient relationship
Anil Chandra Anand
The National Medical Journal of India, Year 2019, Volume 32, Issue 1 [p. 41-45]
DOI: 10.4103/0970-258X.272117 PMID: 31823941
NEWS FROM HERE AND THERE: News from here and there
The National Medical Journal of India, Year 2018, Volume 31, Issue 2 [p. 127-128]
DOI: 10.4103/0970-258X.253160
MEDICINE AND SOCIETY: Using non-communicable disease clinics for tobacco cessation: A promising perspective
Garima Bhatt, Sonu Goel
The National Medical Journal of India, Year 2018, Volume 31, Issue 3 [p. 172-175]
DOI: 10.4103/0970-258X.255763 PMID: 31044768
Globally, non-communicable diseases (NCDs) are responsible for 38 million (68%) of the world’s 56 million deaths, of which 28 million occur in low- and middle-income countries. Tobacco use is a major preventable and modifiable behavioural risk factor for NCDs. It takes annually a toll of over 7 million people and by 2030, it is anticipated to kill over 8 million people every year. Internationally, WHO has advocated the Framework Convention on Tobacco Control and MPOWER policy to combat the tobacco epidemic. As part of its global commitment towards tobacco control, the Government of India has enacted a comprehensive law, namely Cigarette and Other Tobacco Products Act, in 2003, for governing tobacco control in the country followed by launching of the National Tobacco Control Programme for its effective implementation along with strengthening of tobacco cessation facilities at national and sub-national levels. As per the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke, there is a provision of screening of risk factors for NCDs (including tobacco) besides providing treatment and behavioural advice for NCDs. However, presently, tobacco cessation services for NCD patients are under-utilized, probably due to lack of a skilled and dedicated workforce. Delivery of effective patient-centric, disease-specific, culturally sensitive tobacco cessation services at an NCD clinic might efficiently reduce complications of NCDs among patients using tobacco and might further reduce morbidity and mortality attributable to NCDs in India.
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