Journal of Health Management

In India, 90% of street children are working children with regular family ties who live with their families, but are on the streets due to poverty and their parents' unemployment. The remaining 10% are either working children with few family ties who view the streets as their homes or abandoned and neglected children with no family ties. The National Policy for Children established in 1974 emphasizes the provision of equal opportunities for the development to all children during their growing years. Policy stresses programs to maintain, educate, and train destitute children and orphans. Policy is also to protect children against neglect, cruelty, and exploitation, but this is only on paper. An UNICEF study found that almost 40,000 children die every day in developing countries, 25% of whom are in India. Studies in some major cities indicate that the street children in India are of moderate health status, suffering from various chronic diseases and undernourishment. They are deprived of all health programs, but seem to prefer government hospitals in case of dire need. Street children often have to pay for water. Almost 97% in Calcutta, 99% in Bangalore, and 90% in Madras reported having no access to toilet and bathing facilities; 83% in Kanpur, however, had access to such facilities. Nothing has been heard in recent years of the National Children's Board established in 1975. Apparently the board has gradually waned. Various schemes were planned in 1992 by the Union Welfare Ministry in association with UNICEF. Extending extra health facilities, establishing nutrition programs, providing vocational training, protecting children from abuse, distributing dry-food polypacks, providing night shelters, providing ration cards, and creating bathing and toilet facilities would go far in improving the quality of life and the future of street children in India.

This study focuses on analysing the hospital efficiency of district level government hospitals and grant-in-aid hospitals in Gujarat. The study makes an attempt to provide an overview of the general status of the health care services provided by hospitals in the state of Gujarat in terms of their technical and allocative efficiency. One of the two thrusts behind addressing the issue of efficiency was to take stock of the state of healthcare services (in terms of efficiency) provided by grant-in-aid hospitals and district hospitals in Gujarat. The motivation behind addressing the efficiency issue is to provide empirical analysis of government's policy to provide grants to not-for-profit making institutions which in turn provide hospital care in the state. The study addresses the issue whether grant-in-aid hospitals are relatively more efficient than public hospitals. This comparison between grant-in-aid hospitals and district hospitals in terms of their efficiency has been of interest to many researchers in countries other than India, and no consensus has been reached so far as to which category is more efficient. The relative efficiency of government and not-for-profit sector has been reviewed in this paper. It is expected that the findings of the study would be useful to evaluate this policy and help policy makers to develop benchmarks in providing the grants to such institutions.

The present study was undertaken with the intention of examining the nature of role stress and job satisfaction among doctors, and to explore the relationship between these variables. A group of 35 junior doctors working at the primary health centres and another group of 35 senior doctors attached to various district level hospital served as sample of the study. To attain the objectives of the study, two psychometric instruments – the Organizational Role Stress Scale(Pareek, 1983) and the Employees’ S-D Inventory (Pestonjee, 1981) – were administered to the sample population to obtain data pertaining to role stress and job satisfaction variables. The data were analysed in terms of the t-test and coefficients of correlation. Results of the study revealed no significant differences between the two groups except in the case of management area of job satisfaction and inter-role distance (IRD) dimension of role stress. Further, job satisfaction variables correlated negatively with all the dimensions of role stress in the case of both groups.

Most empirical investigations into economic vulnerability focus on the national level. Although some recent contributions investigate vulnerability from a sub-national perspective they contribute to the literature in an aspatial manner, as they do not explicitly account for the relative locations of areas and for the potential of spillovers between contiguous areas. This paper extends the current literature on a number of important fronts. First, we augment a principle components model to take explicit account of spatial autocorrelation and apply it to South African magisterial district level data. Second, by comparing spatial and aspatial models estimates, our empirical results illustrate the presence and importance of spatial spillovers in local vulnerability index estimates. Third, we augment the methodology on the vulnerability intervention index and present results which highlight areas that are performing better and worse than would be expected. After accounting for spatial spillovers, the results illustrate a clear urban-rural vulnerability divide.

Given the growing complexities and challenges the health sector faces, reforms in this sector are inevitable. Often health sector reforms aimed to address many of these deficiencies and ensuring effectiveness and efficiency of resource use, they focus on making the health systems responsive through strengthening financial systems, ensuring local participation and public private partnerships, and autonomy of health facilities. The reform process, among other things, intrinsically makes some fundamental assumptions some of which are as follows: high organisational commitment of health care providers, high professional commitment of health care providers, and adequate skills of health care providers. This paper examines the commitment of district level health officials in the newly carved out state of Chhattisgarh in India. Since development oriented HR practices (HRD) are powerful tools to commit people working in health sector to enhance the quality of care, we believe that health sector reforms will have to concentrate on human resource issues and practices more than ever before in near future. The papers attempts to examine the following questions: (i) what is status of professional commitment, organisational commitment and technical competencies of health officials? (ii) what are the characteristics of human resource management practices in the health sector in the state? and (iii) how these management practices are linked with professional and organisational commitment? Finally the paper discusses the implications of these to health sector reform process.

The United Nations Development Programme’s Millennium project argues for the importance of sexual and reproductive health in the achievement of all Millennium Development Goals. Sex education programmes, aimed principally at the youth, are thus emphasised and are in line with the specific Millennium Development Goals of reducing the incidence of HIV and improving maternal health. In this paper I analyse recent South African sex education and Life Orientation (a learning area containing sex education) manuals. Danger and disease feature as guiding metaphors for these manuals, with early reproduction and abortion being depicted as wholly deleterious and non-normative relationships leading to disease. I argue, firstly, that these renditions ignore well-designed comparative research that calls into questions the easy assumption of negative consequences accompanying ‘teenage pregnancy’ and abortion, and, secondly, that the persistence of danger and disease in sex education programmes is premised on a discourse of ‘adolescence’. ‘Adolescence’ as a concept is always already saturated with the colonialist foundation of phylogeny re-capitulating ontogeny. Individual development is interweaved with collective development with the threat of degeneration implied in both. This interweaving allows for the instrumentalist goal of sex education in which social changes are sought through changing individuals’ sexual attitudes and behaviour.

A national cross-sectional survey was carried out in South Africa to gain an understanding of the perceptions and priorities of the likely members of a future social health insurance (SHI). More than 1,000 employees were interviewed in a variety of employment sectors, including state and parastatal organisations, formal and informal private sectors. This article reports on respondents’ level of support for a compulsory contribution towards a hospital insurance scheme funding care at public sector hospitals in South Africa. The results showed that only 11 per cent of employees supported an SHI scheme if public hospitals remain as they are. Support increased to 53 per cent if preferential access to treatment was offered to those contributing to the scheme. Support was almost unanimous (87 per cent) if public hospitals were improved. The levels of support differed by current type of health insurance. Thus, support for a compulsory SHI tax to fund care in public hospitals was conditional upon either improving the hospitals or providing differential treatment to contributing members. If one or both of these conditions are not met, its long-term success will be compromised.

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes.

This paper briefly explores the history of quality management principles and their application to health care. Defining some of the principles that have evolved in quality management, especially in health care management, the paper discusses the analysis of and means used to improve quality using structure, process and outcome variables, with special focus on examples of the use of these in developing countries' health care systems. Finally, the paper describes some of the measurement and implementation challenges for those interested in quality management in health care.

This paper uses data from in-depth group interviews with family planning workers in Bangladesh to demonstrate both the dysfunctional influence of family planning targets on quality of care as well as the strong connection between targets and the manage ment system. The findings show that the presence of targets influenced the advice and information workers provided, pushing them towards long-term methods such as steril isation and the IUD rather than helping clients select methods most suited to their needs. The paper then shows the connection between the target system and the struc ture of official and unofficial incentives, the pattern of supervision, the system of accountability and a hierarchically organised and gender-biased organisational cul ture. The authors argue that unless these underlying managerial determinants of qual ity of care are addressed, the hope for reaching the goals of the International Conference on Population and Development (ICPD) will remain illusory. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/69103/2/10.1177_097206349900100206.pdf

The present article discusses the nature of quality of life (QOL) in general and critically evaluates its application in the area of health and illness. As regards health related quality of life (HRQoL), it is now widely recognised that treating a disease in a purely biomedical framework, where emphasis is only on curing the disease and on providing prolonged life to the patient, is not sufficient. Now the focus is also on how to enhance the QOL of patients. In this context this article attempts to identify and critically evaluate some of the contemporary issues relevant in the area of HRQoL. The issues covered in this article include relatively simple issues related to the meaning, importance, usefulness and prevalent approaches in the area of HRQoL research and complex issues such as (i)who would be accountable for a patient's HRQoL (ii)being HRQoL stable or it changing over time (response shift) for people facing chronic diseases and (iii)whether gender differences exist in this regard. Lastly, the article also discusses the implication of HRQoL in the area of health management and intervention.

Over the years various plans and programmes have been initiated and implemented by the state government of Orissa. But, state’s health indicators have not improved substantially. Moreover, in recent years, health seeking behaviour of the people has been affected due to increasing cost of health care. Health care is not free of cost any more due to introduction of user fee, increasing trend of privatization and the technological innovation. As a result, out of pocket expenditure has increased enormously affecting the socio-economically disadvantaged groups the most. In consequence, they tend to depend more upon borrowing, dis-saving, selling valuable assets and curtailing expenditure on education of their children. Hence, in this paper we try to investigate broadly into three main aspects, namely, health seeking behaviour, health care burden and most importantly the source of financing of their health expenditure across socio-economic groups by using bi-variate and regression techniques (logit) to provide policy suggestions with respect to health care financing, especially focusing health insurance. Our findings show that there exists a statistical significant difference in health seeking behaviour, health expenditure and financing health care among socio-economic groups. Socio-economic groups fall behind in terms of health care utilization and experiencing higher health care burden as well as depending more on inefficient mechanism to finance their health expenditure. Hence, we advocate that state government should increase its expenditure share towards health sector substantially to achieve desired outcomes and also provide comprehensive health insurance to the targeted socio-economic backward groups.

The present study was aimed to assess the effect of socio-demographic, economic and dietary factors on nutritional status among children of 6–11 years of age in an urban megacity of India. It was a descriptive cross-sectional study conducted among 251 urban children living in slums, non-slums and squatters of North Kolkata. The study reveals that prevalence of underweight was much higher among children of squatters (66.7%), whereas a significant proportion of children belonged to non-slums were found overweight (23.7%). Although the prevalence of both underweight and overweight was more among girls (16.8% and 34.5%), stunting was found marginally higher among boys (18.9%) than girls (17.7%). The risk of being malnourished increases significantly with increasing number of own siblings, low educational status of mother, improper food intake, etc. Multi-pronged strategies are required to implement comprehensive nutrition–education programme for improving dietary habits among children.

Background The COVID-19 pandemic has profoundly impacted the country’s health systems and diminished its capability to provide safe and effective healthcare. This article attempts to review patient safety issues during COVID-19 pandemic in India, and derive lessons from national and international experiences to inform policy actions for building a ‘resilient health system’. Methods Systematic review of existing published articles, government and media reports was undertaken. Online databases were searched using key terms related to patient safety during COVID-19 and health systems resilience. Seventy-three papers were included dependent on their relevance to research objectives. Findings Patient safety was impacted during COVID-19, owing to sub-optimal infection prevention and control measures coupled with reduced access to essential health services. This was largely due to inadequate infrastructure, human and material resources resulting from chronic underinvestment in public health systems, paucity of reliable data for evidence-based actions and limited leadership and regulatory capacity. Conclusions India’s health systems were found ill prepared to tackle large-scale pandemic, which has major implications for patient safety. The shortcomings observed in the COVID-19 response must be rectified and comprehensive health sector reforms should be initiated for building agile and resilient health systems that can withstand future pandemics.

Discussion of ethics in the public health arena has primarily focused on the practices of public health doctors and professionals. The community could not get the required attention in terms of their role in compliance with the communication in the form of public health advisory in times of public health crisis. Even though public health is the societal approach to protecting and promoting health, ethics in public health have prioritised behaviours of and moral dilemmas faced by public health professionals only. Leaving out the community’s responsibility makes the entire gamut of public health efforts incomplete and deficient. Amid the COVID-19 pandemic, non-compliance to the public health advisory raised an important aspect of expectation of ethical behaviour by the community and what could facilitate and hinder compliance of ethical behaviour ensuring the safety of self and others. Public health ought to consider the community as not only an important but also responsible stakeholder in its pursuit of promotion of health and prevention of disease.

Background The services rendered by hospitals during the pandemic may not be efficient. This might impact the satisfaction of patients seeking healthcare. The aim of this study is to assess the satisfaction level of patients other than those with COVID-19 during the pandemic with different services provided by the hospital. Method A quantitative, analytical and cross-sectional study was carried out in a multidisciplinary hospital. Valid questionnaire, derived from PSQ III and PSQ 18, was used for data collection from 250 outpatients. Ethical approval was obtained. Systematic random sampling was done to enrol patients into the study after taking their consent. Descriptive analysis was performed using frequency, proportion, median and inter-quartile range. Mann–Whitney U test and Kruskal–Wallis test were carried out to find the association between overall satisfaction and different socio-demographic and other variables. Statistical significance was set at p-value < 0.05. Result Almost two-thirds of the respondents visiting the hospital during the pandemic were female (male: 35.6% and female: 64.4%). More than half (50.4%) of the patients reported that access to the hospital was feasible. Of the patients reporting dissatisfaction, most of them (86.4%) considered the establishment of separate COVID-19 hospitals as the best option. The median satisfaction score for the overall satisfaction of patients towards different service domains was 54.0 (45–60). Almost all respondents (95.6%) found that services were easily available. Patient satisfaction score was significantly associated with expenditure ( p < 0.001). Satisfaction score was also significantly associated with the time spent in the hospital by the patients ( p < 0.001). Conclusion Majority of the patients reporting to the multidisciplinary hospital were satisfied with the provisioning of treatment and different services during the COVID-19 pandemic. Relatively lesser satisfaction was reported for the provision of maintenance of social distance, availability of hand washing/sanitisation, overall hospital cleanliness and cost of treatment. Moreover, satisfaction among patients was associated with their perceived fear of the pandemic.

The novel coronavirus disease (COVID-19) pandemic has created a crisis with a severe effect on the masses, particularly the young students across the world. Framed by the transactional theory of stress and coping, this study investigates the factors influencing psychological well-being (PWB) of the students in higher education during the peri-traumatic phase of COVID-19. A cross-sectional survey using a questionnaire was employed. The study aimed at prediction and theory building and was carried out in India. Data were collected online from 173 higher education students. Partial least squares structural equation modelling (PLS-SEM) was used to test the hypothesised relationships among the constructs. Results indicated resilience significantly predicts PWB both directly and indirectly. Further, the study revealed perceived distress and PWB are not on the same continuum. This study has a contribution to theory and health promotion. Furthermore, the findings have several practical implications for counselling psychologists, academicians, and mental health workers associated with the higher education sector. These findings will put them in a better position to design interventions to enhance resilience in students in the backdrop of the relevance of both positive and negative mental health during the outbreak of diseases. Based on the findings, future directions were discussed.

Social distancing refers to a host of public health measures aimed at reducing social interaction between people based on touch or physical proximity. It is a non-pharmaceutical intervention to slow the spread of infectious diseases in the communities. It becomes particularly important as a community mitigation strategy before vaccines or drugs become widely available. This essay describes how a protracted adherence to social distancing guidelines could affect the Indian society. Changes are expected in some of the prevalent cultural norms such as personal space and common good. Gender relations within the family are likely to change in favour of greater sharing of domestic responsibilities between men and women. Older adults may particularly experience stress due to social distancing because of their physical dependency and emotional vulnerability. Working patterns are likely to become more flexible and promotive of social distancing. Human interaction based on digital technology is likely to increase. The implications for public health in India due to such changes are also discussed.