ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Decoding the Million Death Study

The lack of reliable, cause-specific mortality statistics is considered a major obstacle to the improvement of public health in many low- and middle-income countries. Researchers and government officials in India have set up the Million Death Study to address this situation. First, how the study produces quantitative estimates of the burden of mortality in India is explored by collecting symptomatic data, using that data for diagnostic purposes, and aggregating those diagnoses into an overview of mortality in India. Second, the limitations of the perspective on public health based on discrete and specific diseases that result from this approach are addressed. Numbers alone cannot solve the public health issues India faces, rather cognitive justice towards a broader range of perspectives on major public health problems is required to develop effective political interventions.

Neglect of Household Biomedical Waste

While India has had a biomedical waste management rule since 1998, which was modified for ease in 2016, household biomedical waste has been neglected. Increased lifespan, rise of non-communicable diseases, the growing buying power, and better access to healthcare have resulted in the increased generation of household biomedical waste. This poses serious challenges to a frail public health system. This growing problem needs to be tackled by acknowledging it, introducing guidelines, and decentralising solutions, including facilitating recycling.

Child Undernutrition in India

The child undernutrition estimates from the Comprehensive National Nutrition Survey, 2016–18 reveal that many Indian states have made substantial decline, reversing their poor past record in wasting, ranging from 7 to 14 percentage points within just 30 months. Is it really possible to make such a large decline in such a short span of time? Or, does this point to an anomaly in data or estimation?

Ayushman Bharat

Taking into consideration the model of the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, some valid questions regarding the operationality and feasibility of the scheme are examined. The shortcomings of the scheme are brought forth and a solution is offered so that the scheme does not stand in contradiction to various health schemes of the past.

Non-communicable Diseases, Affluence, and Gender

Whether the burden of non-communicable diseases has shifted to older men and women, and whether it varies by marital status and affluence of the household has been examined. The analysis is based on the 60th and 71st rounds of the National Sample Survey for 2004 and 2014. Even though comparisons of prevalence and shares between men and women are relied on in the analysis, some glaring disparities emerge. The growing menace of NCDs in the context of a rapidly increasing older population calls for bold policy initiatives, which are currently either underfunded or limited in coverage and uncoordinated. A drastic overhaul of the health system and behavioural changes are thus emphasised.

NITI Aayog’s Health Index

Based on a critical review of the NITI Aayog’s recently published “Healthy States, Progressive India,” it is argued that the report provides only a superficial insight into the overall health attainment. Much deeper and careful analysis is required if one aims to unfold the complexity and varied contexts provided by Indian states, let alone ranking them on health attainment. The method of calculating the index in the report compromises scientific rigour, and the inferences drawn are highly misleading.

Reconciliations of Caste and Medical Power in Rural Public Health Services

Drawing from an ethnographic study conducted in a Karnataka village, the unfavourable differential treatments against Dalit patients in rural public health services are delineated. An analysis of medical interactions shows that as compared to non-Dalits, Dalit patients experienced more apathy, denial, and avoidance behaviours from service providers. Surprisingly, most Dalits did not attribute this to their caste, but to the flaws of the public health delivery system. Caste and allopathic medical practice are embedded in the rural public health delivery system, and both camouflage and normalise discrimination in paternalistic medical interactions. This sustains the favourable environment for caste-based discrimination in rural public health services even in places where Dalit consciousness is strong.

Has the National Health Mission Improved Utilisation of Maternal Healthcare Services in Bihar?

Based on data from the National Sample Survey Office’s surveys on healthcare, this study critically evaluates the impact of the National Health Mission on improving utilisation of maternal healthcare services in Bihar, which had very poor maternal and child health outcomes at the start of the mission. In particular, it investigates factors affecting the utilisation of maternal care services and choice of facilities between the pre- and post-NHM periods; assesses the success of the Janani Suraksha Yojana in enhancing institutional delivery, particularly in public facilities; and estimates the out-of-pocket expenditure on maternal care in the pre- and post-NHM periods and identifies factors affecting such expenditure levels.

Designing a Framework for Benefit Packages

Development of an essential health package requires explicit prioritisation on the basis of a country’s characteristics. A practical framework is presented to determine an EHP, considering coverage and equity perspectives for service delivery, financial protection and morbidity burden in the population. An analysis of morbidity data, unmet need for treatment, and impoverishment due to out-of-pocket spending reveals that a significant reduction in oop expenditure and impoverishment is possible through targeted inclusion of potentially high impoverishment-causing morbidities in EHPs. Such an approach may offer the desired flexibility in decision-making to policymakers, without compromising on benefits transferred to the needy.

Harvest of Uteruses

Forced to migrate to sugar belt for work, women face multiple reproductive health problems, due to the back-breaking work and poor sanitation and hygiene conditions, including menstrual hygiene. This situation along with an absence of public health facilities, allows a fertile and lucrative ground to the private healthcare facilities to provide unnecessary and extreme treatments even for minor gynaecological ailments, including the removal of their wombs. More than 4,605 hysterectomies are said to have been performed in the Beed district alone in the last three years.

Has Disability Risen among the Elderly in India?

An analysis of disability among the elderly and its covariates during the period 2005–12 is provided using data from the two rounds of the nationally representative India Human Development Survey, conducted in 2005 and 2012. The increase in life expectancy has not translated into a healthier life, as prevalence of disabilities, their severity, and their association with non-communicable diseases have risen. Given the lack of access to assistive devices, specialised medical services, rehabilitation, and stigma attached to disability, the temptation to offer simplistic but largely medical solutions must be resisted. Instead, a multidimensional strategy is needed that helps the elderly overcome physical and socio-economic barriers as well as address the issues related to prevention and treatment of their underlying health conditions.

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