From: <a href="mailto:km@iphindia.org">km@iphindia.org</a><br><div class="gmail_quote"> Selected Readings on Indian
Health System <div class="gmail_quote"><div><div><b><span style="font-size:12pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"></span></b><div class="gmail_quote"><div class="gmail_quote">
<div class="gmail_quote">
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 36pt;text-indent:36pt;line-height:normal"><b><span style="font-size:10pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><span> </span>Issue.2 October
2011</span></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:center;line-height:normal" align="center"><b><span style="font-size:8pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> </span></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;line-height:normal"><b><span style="font-size:8pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> </span></b></p>
<div style="border:1pt solid windowtext;padding:1pt 4pt">
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal;border:medium none;padding:0cm"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">We are happy to present you with the second issue of ‘selected readings
on Indian health systems’. You can check out the earlier one <a href="https://docs.google.com/a/iphindia.org/viewer?a=v&pid=sites&srcid=aXBoaW5kaWEub3JnfGtub3dsZWRnZS1tYW5hZ2VtZW50fGd4OjIzNmQzZjMyN2U4OTE3OTU&pli=1" target="_blank">here</a>.
This is one of the initiatives of the <a href="http://www.iphindia.org/resources/ihhs" target="_blank">Indian Hub on Health Systems</a>
at </span><span style="font-size:9pt" lang="EN-US"><a href="mailto:www.iphindia.org" target="_blank"><span style="font-family:"Arial","sans-serif"">Institute of Public Health</span></a></span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">, supported by </span><span style="font-size:9pt" lang="EN-US"><a href="mailto:http://www.itg.be/itg/generalsite/Default.aspx%3FWPID=705%26MIID=528%26L=E" target="_blank"><span style="font-family:"Arial","sans-serif"">SWIHPS</span></a></span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> (</span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Switching International
Health Policies & Systems) network</span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">. We compile
selected recent articles on Indian health system from national and
international journals and get it reviewed by public health experts for your
ease in selecting the relevant readings. This issue carries six scientific
papers and a few relevant news items. This time, we have included two papers
about health insurance, much talked about issue in the country; one on
evaluation and another more broadly on providers’ perceptions of insurance. We
have one paper each on public-private partnership and reforms (needed) in
community health education. Finally we included couple of papers health services/challenges
in general. We welcome your feedback as well as volunteers to suggest/review
papers for future issues. You can reach us at <a href="mailto:dipalee@iphindia.org" target="_blank">dipalee@iphindia.org</a>. Wish you
happy reading!</span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal;border:medium none;padding:0cm"><span style="font-size:8pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> </span></p>
</div>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:center;line-height:normal" align="center"><b><u><span style="font-size:8pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><span style="text-decoration:none"> </span></span></u></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:center;line-height:normal" align="center"><b><u><span style="font-size:10pt;font-family:"Arial","sans-serif";color:rgb(148,54,52)" lang="EN-US">Scientific
articles</span></u></b><b><u><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(148,54,52)" lang="EN-US"></span></u></b></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US"><span>1.<span style="font:7pt "Times New Roman""> </span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">Evaluating the RSBY:
lessons from an experimental information campaign </span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">[Reviewed by Tanya Seshadri]<span></span></span></b></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Jishnu Das and Jessica
Leino</span></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Economic
& Political Weekly August 6, 2011 vol xlvi no 32</span></p><p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">In
this paper, the authors use the experimental nature of information, education,
and communication (IEC) campaign and a household survey to estimate the causal
effects of IEC on enrolment and hospital claims. After a brief review of the
rollout of Rastriya Swasthya Bima Yojana (RSBY) in India and its important
shortcomings, authors describe the issues with implementation of the scheme in
Delhi, thus, providing the context of this study. In the remaining sections,
the empirical strategy, research methodology, and results have been clearly
described in detail.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Interestingly,
the study finds that IEC by itself had no impact on enrolment in the scheme
while it did have an impact on utilisation among enrolled households. The
household survey itself was found to increase enrolment possibly attributed to
the ‘hawthorne effect’. From administrative issues to methodological issues,
the findings have been discussed keeping the limitations and possible
implications in mind. The results of this study also have implications for the
design of evaluations of the RSBY programme not only in Delhi but across the
nation. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">This
paper is useful for programme managers and health researchers who are involved
in planning, implementation, and particularly evaluation of IEC campaigns for
any programme.</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://beta.epw.in/static_media/PDF/archives_pdf/2011/08/SA_XLVI_32_060811_Jishnu_Das.pdf" target="_blank">Click
here for full text article</a></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://beta.epw.in/static_media/PDF/archives_pdf/2011/08/SA_XLVI_32_060811_Jishnu_Das.pdf" target="_blank"><br>
</a></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:1pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-left:18pt"><b><span style="font-size:9pt;line-height:115%;color:rgb(79,98,40)" lang="EN-US"><span>2.<span style="font:7pt "Times New Roman"">
</span></span></span></b><b><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">Health Insurance in India—A Study of
Provider’s Perceptions in Delhi & the NCR [Reviewed by Thriveni BS]</span></b><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"><br>
<span>Rohit Kumar, K. Rangarajan, and Nagarajan
Ranganathan</span><br>
<span>Journal of Health Management 2011; 13 259-277</span></span></p><p class="MsoNormal" style="margin-left:18pt"><br><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"><span></span></span><span style="font-size:9pt;line-height:115%" lang="EN-US"></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">In
this study, researchers attempt to understand healthcare providers’ perceptions
about their relationship with insured, the insurer and the third party
administrators (TPAs). Study specifically looks at the awareness among the
insured people and their attitude towards treatment cost and moral hazards as
well as the role of TPAs and impact of cashless services on the cost of
treatment. The researchers study selected hospitals that provided cashless
services using a mixed method design (i.e. unstructured interview with the
insured and providers, and Likert scale to study the perception of the health
care providers).</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Authors
report that 63% of hospitals felt that patients with cashless card were more
demanding and 61% of them did not care for the cost of treatment. Patients with
a cashless card preferred better category hospital rooms than those without.
Nearly 53% respondent did not agree that the hospitals were making
false/inflated bills or medical documents. Study revealed little contradictory
notion in those 64% providers strongly agreed that the TPAs model is a
successful model while on the other side 69% strongly disagreed that payments
by the TPAs were done within 20 days. Study discovered that all categories of
hospital preferred individuals from middle-income groups for cashless benefits
with less preference for those from lower and high-income groups.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">The
study shows that the level of awareness among the insured population is low
with regard to policy terms and conditions. This study has not attempted to go
beyond numbers to explore reasons for each finding. Finally this study shows
that the TPA model has not been successful in bringing down the claim cost but
has definitely helped in providing unbiased services to the insured population,
including cashless benefits.</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://jhm.sagepub.com/content/13/3/259.abstract?etoc" target="_blank">Click her for
abstract</a></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://jhm.sagepub.com/content/13/3/259.abstract?etoc" target="_blank"><br>
</a> </span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US"><span>3.<span style="font:7pt "Times New Roman""> </span></span></span></b></span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">Predicting performance
in contracting of basic health care to NGOs: experience from large-scale
contracting in Uttar Pradesh, India [Reviewed by Prashanth NS]</span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(49,132,155)" lang="EN-US"><span>
</span></span></b><span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"><br></span></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> Anna Heard, Maya Kant Awasthi, Jabir Ali, Neena Shukla and Birger C
Forsberg</span></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> Health Policy and Planning, July 2011; 26 (1): i13-i19</span></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><br><span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"></span></span><span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(49,132,155)" lang="EN-US"></span></b></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Anna
Heard and colleagues present the findings of a study of public-private
partnership (PPP) scheme in Uttar Pradesh (UP), where basic health services
provision has been contracted out to 294 non-governmental organisations (NGO)
since 2003 to till date. The scheme has seen high rates of discontinuation and
non-renewal and they undertake the study to understand better the performance
of such contracting initiatives. UP being the largest state in the country “…has
a considerable problem with the health infrastructure”. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">In
2003-04, UP chose 73 NGOs and assigned one health post to each NGO under a
contract. The details of the PPP are provided in the paper. Researchers
explicitly defined outcomes that were assessed by a third party using
field-tested questionnaires with data analysed using factor analysis. They
perform a series of regression tests to understand the performance. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">The
authors find that NGOs, which had experience in training field staff, and the
ones that had better quality project proposals, were more likely to perform
better. Interestingly, the assets of an organisation, its financial turnover
and number and volume of previous projects were not found to be associated with
a good outcome score. So was the case with previous experience with health
projects. The authors emphasised the training skills of the NGO as an important
predictor of good performance.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">The
authors clarify that they did not assess whether contracting with NGOs was
better or worse than expanding government services. The paper is an important
contribution to the scarce literature on contracting-out and PPP, which is
being either increasingly advocated or criticised with hardly any evidence
either way.</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://heapol.oxfordjournals.org/content/26/suppl_1/i13.short" target="_blank">Click here
for abstract</a></span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(49,132,155)" lang="EN-US"> </span></b></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 17.85pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US"><span>4.<span style="font:7pt "Times New Roman""> </span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">A Study of
Determinants of Use of Healthcare Services in India [Reviewed by Maya Annie
Elias]</span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(0,0,144)" lang="EN-US">
</span></b><span style="font-size:9pt;font-family:"Arial","sans-serif"" lang="EN-US"><br></span></p><p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 17.85pt;line-height:normal">
<span style="font-size:9pt;font-family:"Arial","sans-serif"" lang="EN-US"> Gulrez Shah Azhar, Ali Amir, Najam
Khalique, and Zulfia Khan</span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(0,0,144)" lang="EN-US"></span></b></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 17.85pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif"" lang="EN-US">International Journal of Medicine and Public
Health July-September 2011; 1(3): 62-66</span></p><p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 17.85pt;line-height:normal"><br><span style="font-size:9pt;font-family:"Arial","sans-serif"" lang="EN-US"></span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(0,0,144)" lang="EN-US"></span></b></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">In
this paper the authors have presented the findings of a study on the health
service utilisation patterns conducted in the district of Aligarh.<span> </span>The burden of illness and the healthcare
seeking behavior were assessed both in rural and urban settings. Household was
used as the sampling unit for the study. Authors report that presence of
illness was high in the above-60 year age group followed by below-5 year age
group both in rural as well as urban areas. Researchers found that prevalence
of illness was higher among females in all age groups except below-5 years. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Only
about 20% illnesses were perceived to be severe, and the perception about the
severity of illness was the main reason in determining the utilisation of
services in rural areas. In urban areas, people did not seek treatment due to
poverty (58%). Of those seeking care, 44% of people had the first contact with
government facilities and 30.8% had visited private facilities. The government
facilities in the study area provided care at no direct cost and authors
attribute this as the reason for preference for government facilities. Study
found that the urban population used government facilities more compared to
rural, and authors discusses issues in terms of access to services to explain
this difference. Though the authors themselves have raised concerns over the
generalisability of the study findings, the results show a similar pattern of
the utilisation of the health care services, as reported by many other studies.</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://www.ijmedph.org/files/issue3/ijmedph07-092011_v1_3_p062-066.pdf" target="_blank">Click
here for full text article</a></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://www.ijmedph.org/files/issue3/ijmedph07-092011_v1_3_p062-066.pdf" target="_blank"><br>
</a></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US"><span>5.<span style="font:7pt "Times New Roman""> </span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">Public Health
Challenges in Kerala and Sri Lanka [Reviewed by Raveesha MR]</span></b><span style="color:rgb(79,98,40)" lang="EN-US"></span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> C U Thresia, K S
Mohindra<br>
Economic & Political Weekly 2011;XLVI (31): 99-107</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><br><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"></span><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(49,132,155)" lang="EN-US"></span></b></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">This
paper is about public health scenario in Sri Lanka and a south Indian state of
Kerala, both having excellent health indicators similar to that <span> </span>of wealthiest countries in the world. Authors
deliberate on factors that led to these health achievements as well as current
challenges and suggestions for the future research/policy in Sri Lanka and
Kerala.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Authors
summarises that historically the early health achievements were mainly due to
indigenous healthcare provision, and investment in education; in colonial
period due to efforts of the missionaries to adopt western education and health
care; and in post-independence period due to governments pursuing free
healthcare services, free education, widespread public distribution systems,
and land reforms. These consistent efforts contributed for reduction of infant
and maternal deaths and increase in life expectancy. From the past three
decades, shift in policies leading to reduction in public investments in
health, education, and public distribution systems has adversely affected access
to healthcare by poor.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Authors
highlight the persisting burden of Infectious diseases (namely dengue, malaria,
tuberculosis, and re-emerging infectious diseases) along with poor sanitation, urbanisation,
and environmental degradation worsening impact of these diseases. Chronic
diseases like diabetes, hypertension, and cancers are on rise due to unhealthy
diet, physical inactivity, and tobacco use. Economic deprivation, suboptimal
use of health services and psychological stress contributed to chronic
diseases. These societies carry high burden of mental illness to the tune of 20
per 1000 population.<span> </span>Suicide rates in
these regions are highest in the world, with Kerala reporting 26.8 per 1,00,000
and Sri Lanka reporting 23.9 per 1,00,000 populations per year. These high
suicide rates are associated with depression, family stress, alcohol
dependence, gender discrimination, and marital problems. Rigid hierarchical structures
and conflicts between individualism and collectivism have been cited as other
reasons for high suicide rate. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Highest
reduction of public health expenditure has happened in the recent past in
Kerala. On the contrary, highest increase has happened in private funding in
health care leading to substantial growth of private sector. Private sector poorly
regulated causing rapid increase in the medical expenditure for users.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">In
summary, authors have portrayed changing health scenario and outlined public
health challenges for Kerala and Sri Lanka through exhaustive literature review.
Regulation of private sector, increase in public financing of health, attention
to social determinants of health in various domains including infectious
diseases, chronic diseases, and psychiatric illnesses are the apt agends for
the policy makers and researches in the near future in these settings.</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://beta.epw.in/static_media/PDF/archives_pdf/2011/07/SA_XLVI_31_300711_C_U_Thresia_K_S_Mohindra.pdf" target="_blank">Click
here for full text article</a></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://beta.epw.in/static_media/PDF/archives_pdf/2011/07/SA_XLVI_31_300711_C_U_Thresia_K_S_Mohindra.pdf" target="_blank"><br>
</a></span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US"><span>6.<span style="font:7pt "Times New Roman"">
</span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(79,98,40)" lang="EN-US">Are we really producing public health
experts in India? Need for a paradigm shift in postgraduate teaching in
community medicine? [Reviewed by Kavya Rangaswamy]</span></b><span lang="EN-US"><br>
</span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Rajesh Garg, Sanjeev
Gupta<br>
Indian Journal of Community Medicine 2011; 36 (2): 93-97</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Authors
in this paper evaluates the design, curriculum, course content, the teaching
methodology of the current post graduate course in community medicine offered
in India. Absence of a uniform curriculum across various medical colleges, lack
of clinical skill enhancement, limitation of course content to text book
learning and in addressing current and emerging public health issues, scarce
knowledge on existing field realities and prevailing government
programmes/policies are some of the important shortcomings put forth in the
paper. Authors argue that as a result of this deficient course, the qualifying
postgraduates are ill equipped to face the existing and forthcoming health care
challenges. They lack the skills and knowledge to analyse problems, evaluate
programmes and propose recommendations. <br></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">Furthermore,
authors advocate need for a paradigm shift in postgraduate training. Major
recommendations for such shift include: student-centered, practice based
curriculum addressing the current public health issues, liaising with government
departments and officers, exposure to diverse departments within the hospital,
enhancing skills on communication, leadership, data analysis and journal
writing skills, problem based learning with integrated teachings and periodical
revision of the curriculum.</span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">This
paper provides a very good insight about gaps in the current Indian medical
education especially on community medicine but the issues raised are quite
common to both undergraduate and post graduate education. While the paper does
mention the changing role of educator particularly in reference to pedagogy, it
does not recommend ways of improving their current skills and knowledge and
motivating them to bring about this change.</span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://www.ijcm.org.in/temp/IndianJCommunityMed36293-245813_064941.pdf" target="_blank">Click
here for full text article</a></span></p><p class="MsoNormal" style="margin-left:18pt;margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><a href="http://www.ijcm.org.in/temp/IndianJCommunityMed36293-245813_064941.pdf" target="_blank"><br>
</a></span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:center;line-height:normal" align="center"><b><u><span style="font-size:10pt;font-family:"Arial","sans-serif";color:rgb(148,54,52)" lang="EN-US">News</span></u></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><b><span style="font-size:18pt;font-family:"Arial","sans-serif";color:rgb(54,95,145)" lang="EN-US"> </span></b></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US"><span>1.<span style="font:7pt "Times New Roman"">
</span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US">Private sector involvement in women’s and children’s health is
crucial to saving 16 million lives, says UN Secretary-General</span></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;line-height:normal"><b><span style="font-family:"Arial","sans-serif";color:rgb(54,95,145)" lang="EN-US"> </span></b></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;text-align:justify;line-height:normal"><span><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(51,51,51);background:none repeat scroll 0% 0% white" lang="EN-US">The UN Secretary-General
Ban Ki-moon today praised the involvement of leading businesses in the UN’s
effort to tackle women’s and children’s health. During the Every Woman Every
Child meeting attended by Heads of State, CEOs of the Private Sector and NGOS,
and other UN and government officials, the Secretary-General announced progress
in the effort to save women’s and children’s lives, and highlighted new and
game-changing commitments made during the past year. <b><a href="http://www.who.int/pmnch/media/press_materials/pr/2011/20110920ewecpressrelease.pdf" target="_blank">Read
more…</a></b></span></span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;line-height:normal"><span><b><span style="font-family:"Arial","sans-serif";color:rgb(51,51,51);background:none repeat scroll 0% 0% white" lang="EN-US"> </span></b></span></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US"><span>2.<span style="font:7pt "Times New Roman"">
</span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US">India to roll out world’s largest non-communicable diseases
drive</span></b></p>
<p class="MsoNormal" style="margin-left:18pt;text-align:justify"><span><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(51,51,51);background:none repeat scroll 0% 0% white" lang="EN-US">As many
as 26 "mini interventions" will make up the world's largest programme
to combat</span></span><span><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(51,51,51)" lang="EN-US"> <span style="background:none repeat scroll 0% 0% white"><span style="color:rgb(51,51,51);text-decoration:none">non-communicable
diseases</span></span> <span style="background:none repeat scroll 0% 0% white">(NCDs) that will
be launched by India soon.</span> <span style="background:none repeat scroll 0% 0% white">The
"New Delhi Call for Action on combating NCDs in India" initiative
will be against specific diseases, and some will exclusively address major risk
factors like obesity, junk food and tobacco consumption.</span></span></span><span><span style="font-size:9pt;line-height:115%;font-family:"Georgia","serif";color:rgb(63,63,63);background:none repeat scroll 0% 0% white" lang="EN-US"> </span></span><span><b><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(63,63,63);background:none repeat scroll 0% 0% white" lang="EN-US"><a href="http://timesofindia.indiatimes.com/india/India-to-roll-out-worlds-largest-non-communicable-diseases-drive/articleshow/10163952.cms" target="_blank">Read
more…</a></span></b></span></p><p class="MsoNormal" style="margin-left:18pt;text-align:justify"><br><span><b><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(63,63,63);background:none repeat scroll 0% 0% white" lang="EN-US"></span></b></span><span><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:rgb(63,63,63);background:none repeat scroll 0% 0% white" lang="EN-US"></span></span></p>
<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt 18pt;line-height:normal"><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US"><span>3.<span style="font:7pt "Times New Roman"">
</span></span></span></b><b><span style="font-size:9pt;font-family:"Arial","sans-serif";color:rgb(227,108,10)" lang="EN-US">Implement law against sex selection stringently: Azad</span></b></p>
<p class="MsoNormal" style="margin-left:18pt;text-align:justify"><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US">Health Minister Ghulam Nabi Azad raised concern over gender imbalance
in India and appealed to the states for a stringent implementation of the law
against sex determination.</span><span><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> Speaking at a meeting of health ministers from
18 states, where recent census figures show a declining child sex ratio, Azad
said declining sex ratio is a matter of grave concern. <b><a href="http://www.deccanherald.com/content/194310/implement-law-against-sex-selection.html" target="_blank">Read
more… </a></b></span></span><b><span style="font-size:9pt;line-height:115%;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"></span></b></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"><br>
</span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US"> </span></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:blue" lang="EN-US"><a href="mailto:http://www.itg.be/itg/generalsite/Default.aspx%3FWPID=705%26MIID=528%26L=E" target="_blank"><span>SWIHPS</span></a></span></i><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"> (Switching International Health Policies & Systems) is </span></i><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US">a network to
disseminate and exchange information, expertise and practice in International
Health Policies and Health Systems, to contribute to stronger health systems
and improved policy making. Both <a href="http://www.iphindia.org/" target="_blank">Institute
of Public Health</a></span></i><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US">
<span style="background:none repeat scroll 0% 0% white">and <a href="http://www.itg.be/" target="_blank">Institute of
Tropical Medicine</a> are SWIHPS members.</span></span></i></p><p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black" lang="EN-US"><span style="background:none repeat scroll 0% 0% white"><br>
</span></span></i></p>
<p class="MsoNormal" style="margin-bottom:0.0001pt;text-align:justify;line-height:normal"><i><span style="font-size:9pt;font-family:"Arial","sans-serif";color:black;background:none repeat scroll 0% 0% white" lang="EN-US">This issue of Sel Red on IHS is compiled and
coordinated by Ms. Dipalee Bhojani and edited by Upendra Bhojani. We thank all
the reviewers. We welcome your feedback at <a href="mailto:dipalee@iphindia.org" target="_blank">dipalee@iphindia.org</a>. Suggestions
for the recent papers and volunt<a name="1341d71ad0b81148_1341d6e359b69e63_1341d6ce232e73c7_1341d6b38e7aa668_133f0537f86df9fa__GoBack"></a>eers to review papers for
future issues are welcome.</span></i></p>
<br><br>
</div></div></div>
</div></div></div><br></div><br>