Journal of Health Management

Addressing unmet need for family planning is one of the major immediate objectives of India’s Population Policy, 2000 (Ministry of Health and Family Welfare (MoHFW), National Population Policy, 2000. New Delhi: Department of Family Welfare, Ministry Health and Family Welfare, Government of India). The policy also advocates the involvement of elected leaders of Panchayati Raj Institutions (PRIs) in addressing unmet need for family planning. Besides, the National Rural Health Mission (NRHM) also highlights the importance of PRIs and other community leaders in addressing family planning services. The 73rd Constitutional Amendment Act, 1992, also guarantees panchayats to take responsibility of health and family welfare. To know the actual involvement of community leaders in addressing unmet need for family planning, the field survey was carried out in the coastal part of Odisha. With the help of mixed methods, the actual participation of community leaders in family planning is found negligible. The field study including surveys and in-depth interviews of health workers and community leaders reveals that lack of financial allocation for family planning activities in Gaon Kalyan Samiti (GKS), lack of funds for the village health plans, lack of inter-departmental coordination, lack of trust and confidence between the workers and leaders, lack of initiative by the workers to involve leaders and lack of incentives for community leaders are the major reasons for non-participation of community leaders in family planning activities.

Interdependencies among healthcare providers result in complex healthcare supply chains with fragmented healthcare processes characterized by coordination failure and incentive misalignment. In developing countries where resources are scarce such coordination failures can have a severe impact on patient health. However, limited knowledge exists about how coordination takes place across and within the different healthcare service providers and how this influences hospital transfer time and length of stay. This article research this gap by studying trauma care delivery in India using a patient survey (n = 104). The Indian healthcare system is insightful because India has to provide low-cost care to large populations living in geographically big areas and the healthcare infrastructure struggles to meet increasing demands. The findings suggest mechanisms to better integrate the processes from the accident site to the hospital which include setting up referral processes, 24-hour ambulance services, using third-party coordinators and process improvement within the hospital following lean principles.

This article provides an overview of treatment on medical advice before and after hospitalization in India, using the unit-level data of Social Consumption on Health collected by the National Sample Survey Office (NSSO). The survey began in January 2014 and concluded in June 2014. The authors have used two approaches to analyse the details in the article at an all-India level and also at the state level. In the first approach, discussion about medical advice for treatment before and after the hospitalization of family members has been initiated based on the descriptive analysis. In the second approach, a logistic regression analysis has been done to get the idea about the factors influencing the same. The analysis reveals that a very high percentage of hospitalized family members were not treated on medical advice before hospitalization in India. However, an improved approach towards treatment on medical advice after hospitalization has been observed. The chunk which did not get treated or did not carry out treatment needs to be identified and focused upon to improve the overall health environment of India.

Routine large-scale assessment of the awareness of iron-deficiency anaemia (IDA), a rampant public health challenge in India, is lacking. We conducted a study, among adolescent girls attending government schools in Srikakulam district, South India, to ascertain the awareness of IDA and identify key socio-economic correlates of IDA awareness. We collected biometric, demographic and survey data, from 148 randomly selected schoolgirls, from one urban and one rural school, and conducted t-tests and discriminant function analyses. Participants (mean age of 13.48 (1.08) years; mean body mass index (BMI) of 17.53 (0.21) kg/m²) scored a mean of 24.63 (4.21) out of a possible 41 (rural–urban (95%CI) = (−2.9, −0.2)). Discriminant function loadings revealed age (0.79), mother’s education (0.43) and occupation (0.59), father’s occupation (0.59), number of female siblings (0.36) and BMI (0.78) to be key determinants of IDA awareness. The low scores on IDA awareness and the high proportion of underweight participants highlight the need for targeted health education and nutrition interventions.

This study examines trends in contraception usage using Demographic and Health Survey (DHS) data from Nigeria (2013) and Ghana (2008, 2014). We used a cubic spline to estimate values between intervals, analysed using the time-series neural network model and forecasting till 2030. Results show contraception usage increasing with an average rate of 4.4 per cent, desire not to use declining at an average rate of 0.7 per cent and the use of modern contraception increasing at an average rate of 5.1 per cent. Use of traditional contraception is still increasing in Nigeria at a rate of 0.6 per cent but declining in Ghana at a rate of 0.3 per cent. By 2030, injectables would be mostly used, while the withdrawal method will be preferred among those still in favour of the traditional method. These trends show the readiness of the two countries to embrace the use of modern contraception in an effort to promote the campaign for Planned Parenthood and Family Programme.

Evidence suggests that internal market orientation (IMO) assists companies in targeting their human resources (HR) and has been an important preceding concept in creating competitive advantages for the organizations (Gounaris, Journal of Services Marketing, 2008b, 22(1), 68–90). The objective of this research was to investigate which dimensions of IMO are related to the job satisfaction (JS) and appreciation (AP). The instrument for data collection was a structured questionnaire, which follows the model used by Gounaris (Journal of Business Research, 2006, 59(4), 432–448), and a descriptive quantitative research with 583 participants from a Brazilian healthcare company was conducted. The results of this empirical study found only three sub-dimensions, identification of exchange of value (D1M), job description (D5M) and management concern (D7M), as positively influenced with IMO. The survey indicated that the perception of the employees regarding the IMO is concentrated between 3 and 4 of the Likert scale, representing high levels of IMO in the sample and for JS and AP.

The Mukhyamantri Nishulk Dava Yojna (MNDY) was started across the state since 02 October 2011 in order to distribute most commonly used drugs free of cost to all patients visiting the government hospital. To run the scheme, an advanced inventory management by the name of e-Aushadhi has been developed and implemented across all public health facilities (PHFs). Trained human resources and computers with printers and internet connectivity are provided. In this study, 183 patients and staff responsible for the implementation of the scheme and specialists were interviewed. The study revealed that patients and doctors were highly satisfied with the functioning of the scheme and they are getting the majority of the medicines prescribed by the doctor. The scheme has been able to reduce out-of-pocket (OOP) expenditure on medicines and increased hospital attendance manifold.

Maternal death is an indicator of quality and efficiency of reproductive health services and is regarded as a composite measure of the country’s progress. Reduction in maternal mortality is one of the eight globally accepted Millennium Development Goals (MDGs). To achieve the goal of 109, by 2015, the developing world needs to take challenge where the burden of maternal mortality is 99 per cent. This study attempts to understand the strength of relationship of the correlates of maternal mortality with actual maternal mortality ratio (MMR) to come out with policy implications to lessen maternal deaths. Based on the National Family Health Survey (NFHS)-3 data on maternal health indicators and sample registration systems (SRS) estimates of maternal mortality, the relationships are explored. Maternal deaths would significantly reduce when fertility declines, that is, when contraception increases, when status of women enhances, they are sufficiently fed to have normal body mass index (BMI) and have awareness of reproductive health issues. The most prominent correlate is utilization of reproductive health care services. When all antenatal, natal and postnatal services are utilized to a large extent, maternal deaths would diminish significantly. Effective implementation of services is a key to trim down maternal mortality.

Infant mortality rate (IMR) is one of the most important development indicators. In India, there is a severe interstate disparity regarding IMR. Kerala registers a very low IMR; whereas in Odisha it is pretty high. It is somewhat paradoxical as Odisha fares substantially better than many other states with lower IMR regarding total fertility rate, antenatal care and in many other aspects. The present article attempts to investigate the applicability of usually perceived major determinants of IMR as evidenced in the existing literature for Odisha. The panel data multiple regression carried out with data of 30 districts of Odisha over three years indicates that physiological and behavioural factors together with maternal and demographic factors are perhaps more important than the health programmes for reduction of IMR in Odisha. Moreover, many of the usually perceived major determinants of IMR including economic betterment are statistically insignificant for Odisha. The policymakers should take into account these facts and instead of a series of health programmes, they might resort to awareness building regarding breastfeeding and birth spacing. Mother’s nutritional status should also be strengthened so that they can sustain exhaustive breastfeeding for first six months after the birth of the child.

This case study examines the performance of public hospitals in Tamil Nadu in delivering emergency obstetric care services over a period of 8 years as well as to investigate from provider’s perspective the issues and constraints that affect performance. A mixed method approach has been adopted, integrating the descriptive analysis of administrative data on performance reports (2006–2007 to 2013–2014) of emergency obstetric and newborn care services in 46 public hospitals, along with primary study comprising of semi-structured interviews of 27 health personnel across selected public hospitals. Examination of trends in selected performance indicators shows that utilization of public hospitals for emergency obstetric and newborn care services has improved; a number of complicated and critical cases revived in the comprehensive emergency obstetric and newborn care (CEmONC) centres of public hospitals have gone up. The capability to treat complicated maternal and neonatal cases, however, is limited by inadequacy of specialist doctors, equipment maintenance issue and lack of hospital management. This case study is of interest to both public hospital administrators and health care policymakers who want to improve and develop strategies for better management in public hospitals. Specifically, there is an urgent need to (a) readdress human resource policy for health care personnel, (b) devise appropriate mechanisms for periodic inspection and preventive maintenance of hospital equipment and (c) develop management capabilities and leadership skills within public health system.

Reducing maternal mortality is the fifth goal among the millennium development goals and subsequent sustainable development goals. Complete antenatal care (ANC) and institutional delivery are two process indicators advised in all interventions related to reduction of maternal mortality. A study is conducted to know the ANC profile of the women and factors associated with it and their birth preparedness for delivery in a rural tribal area of Vikramgad taluka in the Indian state of Maharashtra.

 A community-level descriptive cross-sectional study was conducted among the women those who recently experienced delivery of baby. Simple random sampling method was used to select the respondents.

 The result of the study shows women follow specific practices related to diet, personal hygiene, physical activity and rest with neonatal feeding and care practices in the month following delivery, to keep themselves and their baby healthy. The significant factors found to be associated with ANC visits were the age of the women (p = 0.001), education (p = 0.03), husband’s education (p = 0.002), monthly household income (p = 0.11) and distance of site of ANC from home in time measured in minutes (p = 0.047).

The article provides estimates of economic burden of diabetes among women. The study was based on primary data collected from Jalandhar. The article examines the direct, indirect and intangible cost of diabetes. The result indicates that mean cost of outpatient care of consultation, lab investigations, medicines, special diet and transport was ₹203.53, ₹535.50, ₹515.0, ₹258.80 and ₹120.30, respectively. While, mean cost of inpatient care of consultation, lab investigations, room charges, medicines, special diet and transport was ₹1157.00, ₹1468.75, ₹1354.50, ₹4175.50, ₹680.0 and ₹278.65, respectively. The analysis shows that the mean cost of inpatient care was higher than that of outpatient care. Intangible cost of diabetes involved reduced food consumption, borrowing from neighbours/relatives, decreased non-food consumption, decreased savings, decreased social obligations/functions, stopped purchase/expansion of house, sale of household assets, stopped medical treatment of other members in the family and stopped the purchase of consumer durables. These figures are compelling enough to stimulate government to take corrective actions to address the risk factors that contribute to diabetes. Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment to reverse this trend. Healthcare policy planners must anticipate and respond to socio-economic implications, ideally through preventive as well as curative measures.