Public health system in India

Last updated

The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. [1] The need for an efficient and effective public health system in India is large.

Contents

Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people. Indian healthcare system has been historically dominated by provisioning of medical care and neglected public health. [2] 11.9% of all maternal deaths and 18% of all infant mortality in the world occurs in India, ranking it the highest in the world in 2021. [3] [4] 36.6 out of 1000 children are dead by the time they reach the age of 5. [5] 62% of children are immunized. [6] Communicable disease is the cause of death for 53% of all deaths in India. [7]

Public health initiatives that affect people in all states, such as the National Health Mission, Ayushman Bharat, National Mental Health Program, are instilled by the Union Ministry of Health and Family Welfare. [1] There are multiple systems set up in rural and urban areas of India including Primary Health Centres, Community Health Centres, Sub Centres, and Government Hospitals. These programmes must follow the standards set by Indian Public Health Standards documents that are revised when needed. [8]

History

Public health systems in the colonial period were focused on health care for British citizens who were living in India. The period saw research institutes, public health legislation, and sanitation departments, although only 3% of Indian households had toilets at this time. [2] Annual health reports were released and the prevention of contagious disease outbreaks was stressed. At the end of the colonial period, death rates from infectious diseases such as cholera had fallen to a low, although other diseases were still rampant. [2]

In modern-day India, the spread of communicable diseases is under better control and now non-communicable diseases, mostly like cardiovascular diseases, are major killers. [2] Health care reform was prioritized in the 1946 Bhore Committee Report which suggested the implementation of a health care system that was financed at least in part by the Indian government. [1] In 1983 the first National Health Policy (NHP) of India was created with the goals of establishing a system with primary-care facilities and a referral system. In 2002, the updated NHP focused on improving the practicality and reach of the system as well as incorporating private and public clinics into the health sphere. [1] In the context of universal health coverage, the recent policy focus in India, there is an attempt to ensure that every citizen should have adequate access to curative care without any financial hardships. Equally relevant is the acknowledgement of social determinants of health as an important determinant of population health and the need to have a public health cadre within the existing health care system. This call for a need to distinguish [9] between 'Public health' system and 'Public' sector health care system as the latter uses public to indicate the primary role of government and not necessarily as population as used in public health.[ citation needed ]

Public health funding has been directed to helping the middle and upper classes, as it targets creating more health professional jobs, expanding research institutions, and improving training. This creates unequal access to health care for the lower classes who do not receive the benefits of this funding. [2] Today, states pay for about 75% of the public healthcare system but insufficient state spending neglects the public health system in India. [10] This results in the Out-of-pocket health expenditure by households comprising 60.6% of the total health expenditure of India. [11] [12] Thus, a large number of households are pushed below poverty line every year.[ citation needed ]

Facilities

The healthcare system is organised into primary, secondary, and tertiary levels. At the primary level are Sub Centres and Primary Health Centres (PHCs). At the secondary level there are Community Health Centres (CHCs) and smaller Sub-District hospitals. Finally, the top level of public care provided by the government is the tertiary level, which consists of Medical Colleges and District/General Hospitals. [1] The number of PHCs, CHCs, Sub Centres, and District Hospitals has increased in the past six years, although not all of them are up to the standards set by Indian Public Health Standards. [8]

Sub Centres

A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national government. Mandates require health staff to be at least two workers (male and female) to serve a population of 5000 people (or 3000 in a remote or hilly areas). Sub Centres also work to educate rural people about healthy habits for a more long-term impact. [1]

Primary Health Centres

Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve as larger health clinics staffed with doctors and paramedics. Patients can be referred from local sub centres to PHCs for more complex cases. [1] A major difference from Sub Centres is that state governments fund PHCs, not the national government. PHCs also function to improve health education with a larger emphasis on preventative measures. [1]

Community Health Centres

A Community Health Centre is also funded by state governments and accepts patients referred from Primary Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas. [1] Patients from these agencies can be transferred to general hospitals for further treatments. Thus, CHC's are also first referral units, or FRUs, which are required to have obstetric care, new born/childcare, and blood storage capacities at all hours everyday of the week. [1]

Sub-District Hospitals/Taluk Hospitals

Sub District/Sub Divisional/Taluk Hospitals are located in sub-district headquarters and provide more specialized medical services than community health centers. Taluk hospitals are located in taluk headquarters and provide more specialized medical services than community health centers.Taluk Hospital is a secondary healthcare center located in the administrative headquarters of a taluk (Tehsil). Taluk hospitals provide basic medical services to the people of the local community. They have departments for general medicine, pediatrics, obstetrics and gynecology, dermatology, ophthalmology, dentistry, and psychiatry. Taluk hospitals also have a laboratory and a pharmacy that provide diagnostic and treatment services to patients. The hospital has an emergency department that operates 24 hours a day, providing immediate medical attention to patients who require urgent medical care. Taluk Hospitals are set up either by upgrading the existing Community Health Centre (CHCs). They are referred to as Sub-district (sub-divisional) hospital for the purpose of standardisation under the revised guidelines of Indian Public Health Standards (IPHS). Taluk Hospitals are below the district and above the block level CHCs. Taluk Hospital serves as a vital connection between the SC (Sub-Centre), PHC (Public Health Centre), CHC (Community Health Centre), and District Hospital on one end. It reduces the workload at the district hospital and cuts travel time for patients in need of emergency care. Sub District hospitals are below the district and above the block level (CHC) hospitals and act as Referral Units for the Tehsil/Taluk/Block population in which they are geographically located.[ citation needed ]

District Hospitals

District Hospitals are the final referral centres for the primary and secondary levels of the public health system. It is expected that at least one hospital is in each district of India, although in 2010 it was recorded that only 605 hospitals exist when there are 640 districts. [13] There are normally anywhere between 75 and 500 beds, depending on population demand. These district hospitals often lack modern equipment and relations with local blood banks. [13]

Medical Colleges and Research Institutions

All India Institutes of Medical Sciences is owned and controlled by the central government. These are referral hospitals with specialized facilities. All India Institutes presently functional are AIIMS New Delhi, Bhopal, [14] AIIMS Bhubaneshwar, AIIMS Jodhpur, AIIMS Raipur, AIIMS Patna and AIIMS Rishiksh. A Regional Cancer Centre is a cancer care hospital and research institute controlled jointly by the central and the respective state governments. Government Medical Colleges are owned and controlled by the respective state governments and also function as referral hospitals.[ citation needed ]

Government Public Health initiatives

In 2018, Ayushman Bharat, a flagship scheme of the Government of India, was launched by the Prime Minister of India as recommended by the National Health Policy 2017 to achieve the vision of Universal Health Coverage (UHC). It includes two interrelated components: Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). [15]

In 2006, the Public Health Foundation of India was started by the Prime Minister of India as both a private and public initiative. The goal of this organisation is to incorporate more public health policies and diverse professionals into web the healthcare sphere. It also collaborates with international public health organisations to gather more knowledge and direct discussions around needs and improvements to the current system. [16] Oftentimes officials in policy making positions have a gap in their education about public health, and MPH and PhD programs in public health are lacking in their number of students and resources. The Public Health Foundation aims to further these programs and educate more people in this field. The research discovered would be made transparent to the Indian public at large, so that the entire nation is aware of health standards in the country. [16]

Community Health Workers

The Indian government first began to implement community health worker programs in 1977. [17] Community health workers provide advice and support to other women in their community. Sometimes referred to as sakhis, these women capitalize on their familiarity with the community to gain credibility and promote public health measures, usually by leading participatory groups. [18] Community health workers also function to mediate between modern allopathic medicine and traditional indigenous forms of healing, [17] such as by tailoring allopathic health recommendations to include and legitimize traditional beliefs. [19] Community health workers closely cooperate with each other and with other types of health workers (such as auxiliary nurse midwives) to encourage care utilization and deliver health services. [19] Currently, India's largest community health worker program, started in 2005 and now subsumed in the National Health Mission, consists of nearly one million Accredited Social Health Activist, a ratio of one for every 1000 people in rural villages and marginalized urban communities. [20]

Community health workers and participatory groups have been shown to change health behaviors [20] and impact health outcomes such as neonatal mortality. [21] Factors for these positive changes include active inclusion and recruitment of a large portion of women in the community, engagement and participation during skill development, and involvement of the community beyond group participation. [21] Community health workers may also serve as community leaders and change-makers by empowering women and demanding policy action to address health inequities. [22] Addressing these social determinants of health has a direct impact on healthcare utilization. [22] For example, empowered women are less likely to face health problems because they are more likely to be aware of problems with their health and therefore more likely to seek care to address these problems. [23] [24]

This grassroots intervention strategy often involves partnerships with local hospitals or government-organized non-governmental organizations (GONGOs), [24] who train female volunteers from the community and help organize participatory groups. [20] Though demonstrated to be effective, community health worker programs can be hampered by a lack of monitoring and accountability as a result of governmental decentralization. [25] Community health workers are not government employees but rather volunteers that state governments are responsible for training and financially incentivizing. [20] Health workers may also lack a sufficient understanding of the public health measure they are trying to promote due to inadequate training and resources. [17]

Drawbacks

Drawbacks to India's healthcare system today include low quality care, corruption, unhappiness with the system, a lack of accountability, unethical care, overcrowding of clinics, poor cooperation between public and private spheres, barriers of access to services and medicines, lack of public health knowledge, and low cost factor. [8] [26] These drawbacks push wealthier Indians to use the private healthcare system, which is less accessible to low-income families, creating unequal medical treatment between classes.doctors are reluctant to practice in rural areas.[ citation needed ]

Low quality care

Low quality care is prevalent due to misdiagnosis, under trained health professionals, and the prescription of incorrect medicines. A study discovered a doctor in a PHC in Delhi who prescribed the wrong treatment method 50% of the time. [26] Indians in rural areas where this problem is rampant are prevented from improving their health situation. [7] Enforcement and revision of the regulations set by the Union Ministry of Health and Family Welfare IPHS is also not strict. The 12th Five-Year Plan (India) dictates a need to improve enforcement and institutionalize treatment methods across all clinics in the nation in order to increase the quality of care. [8] There is also a lack of accountability across both private and public clinics in India, although public doctors feel less responsibility to treat their patients effectively than do doctors in private clinics. Impolite interactions from the clinic staff may lead to less effective procedures. [26]

Corruption

Healthcare professionals take more time off from work than the amount they are allotted with the majority of absences being for no official reason. [26] India's public healthcare system pays salaries during absences, leading to excessive personal days being paid for by the government. This phenomenon is especially heightened in Sub Centres and PHCs and results in expenditure that isn't correlated to better work performance. [26]

Overcrowding of clinics

Clinics are overcrowded and understaffed without enough beds to support their patients. Statistics show that the number of health professionals in India is less than the average number for other developing nations. [10] In rural Bihar the number of doctors is 0.3 for every 10,000 individuals. Urban hospitals have twice the number of beds than rural hospitals do but the number is still insufficient to provide for the large number of patients that visit. [7] Sometimes patients are referred from rural areas to larger hospitals, increasing the overcrowding in urban cities. [27]

Overcrowding also increases the likelihood of diseases spreading, particularly in urban, crowded areas of cities. Improper sanitation and waste disposal, even within clinics, can lead to an increased incidence of infectious diseases. [28]

Poor cooperation between public and private spheres

5% of visits to health practitioners are in private clinics or hospitals, many of which are paid for out of pocket. Money is spent on improving private services instead of on funding the public sector. [26] Governmental failure to initiate and foster effective partnerships between the public and private healthcare spheres results in financial contracts that aren't negotiated to help the common man. These contracts would allow the private sector to finance projects to improve knowledge and facilities in the public sphere. [8]

Barriers of access

Both social and financial inequality results in barriers of access to healthcare services in India. Services aren't accessible for the disabled, mentally challenged, and elderly populations. [8] Mothers are disadvantaged and in many rural areas there is a lack of abortion services and contraception methods. Public clinics often have a shortage of the appropriate medicines or may supply them at excessively high prices, resulting in large out of pocket costs (even for those with insurance coverage). [8] Large distances prevent Indians from getting care, and if families travel far distance there is low assurance that they will receive proper medical attention at that particular time.[ citation needed ]

Hospital fires

Many government hospitals do not follow the fire safety norms set in the National Building Code of India owing to cost saving measures and the preference for the lowest bidder in construction projects. [29] Due to this there have been frequent news reports of major hospital fires across India. [30] [31] [32] According to a Scroll.in report, the main reason for this vulnerability to electrical short circuits is the lack of dedicated electrical engineers in most hospitals and shortage of government electrical engineers in the various state public works departments. The same report found that between August 2020 to March 2022 there were 122 deaths due to 29 incidents of hospital fires during that period. [29]

Related Research Articles

<span class="mw-page-title-main">Clinic</span> Outpatient health care facility

A clinic is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs of populations in local communities, in contrast to larger hospitals which offer more specialized treatments and admit inpatients for overnight stays.

<span class="mw-page-title-main">All India Institute of Medical Sciences, New Delhi</span> Public medical research university and hospital in New Delhi, India

All India Institute of Medical Sciences, New Delhi, also known as AIIMS Delhi, is a public medical research university and hospital in New Delhi, India. The institute is governed by the AIIMS Act, 1956 and operates autonomously under the Ministry of Health and Family Welfare.

<span class="mw-page-title-main">Primary health care</span> "Essential" health care key to securing universality by emphasizing community and equity

Primary health care (PHC) is "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making. Services are provided at a cost that the community and the country can afford at every stage of their development in the spirit of self-reliance and self-determination. In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems. The World Health Organization, or WHO, elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services[1]." Based on these definitions, PHC cannot only help an individual after being diagnosed with a disease or disorder, but can actively contribute to preventing such issues by understanding the individual as a whole.

The primary health center or primary healthcare center (PHC) is the basic structural and functional unit of the public health services in developing countries. PHCs were established to provide accessible, affordable and available primary health care to people, in accordance with the Alma Ata Declaration of 1978 by the member nations of the World Health Organization WHO.

A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.

The Bhore Committee was set up by the Government of India in 1943. Also known as the health survey and development committee. It was a health survey taken by a development committee to assess health condition of India. The development committee worked under Joseph William Bhore, who acted as the chairman of committee. The committee consisted of pioneers in the healthcare field who met frequently for two years and submitted their report in 1946.

<span class="mw-page-title-main">Rural health</span> Interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

<span class="mw-page-title-main">Hospital</span> Health care facility with specialized staff and equipment

A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care.

<span class="mw-page-title-main">Healthcare in Senegal</span> Overview of the health care system in Senegal

Healthcare in Senegal is a center topic of discourse in understanding the well-being and vitality of the Senegalese people. As of 2008, there was a need to improve Senegal's infrastructure to promote a healthy, decent living environment for the Senegalese.

<span class="mw-page-title-main">Healthcare in Ghana</span>

Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.

<span class="mw-page-title-main">Community health worker</span> Type of informal health care provider

A community health worker (CHW) is a member of a community who provides basic health and medical care within their community, and is capable of providing preventive, promotional and rehabilitation care to that community, typically without formal education equal to that of a doctor or nurse. A community health extension worker (CHEW) is a specially trained professional who provides similar preventive, curative and rehabilitative health care and services to people where they live and work, often with some college-level training. Other terms for this type of health care provider include lay health worker, village health worker, community health aide, community health promoter, and health advisor.

The community health center (CHC) in the United States is the dominant model for providing integrated primary care and public health services for the low-income and uninsured, and represents one use of federal grant funding as part of the country's health care safety net. The health care safety net can be defined as a group of health centers, hospitals, and providers willing to provide services to the nation's uninsured and underserved population, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. According to the U.S. Census Bureau, 29 million people in the country were uninsured in 2015. Many more Americans lack adequate coverage or access to health care. These groups are sometimes called "underinsured". CHCs represent one method of accessing or receiving health and medical care for both underinsured and uninsured communities.

<span class="mw-page-title-main">Community health center</span>

A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. Typical services covered are family practice and dental care, but some clinics have expanded greatly and can include internal medicine, pediatric, women’s care, family planning, pharmacy, optometry, laboratory testing, and more. In countries with universal healthcare, most people use the healthcare centers. In countries without universal healthcare, the clients include the uninsured, underinsured, low-income or those living in areas where little access to primary health care is available. In the Central and East Europe, bigger health centers are commonly called policlinics.

<span class="mw-page-title-main">National Health Mission</span> Public health initiative in India

The National Health Mission (NHM) was launched by the government of India in 2005 subsuming the National Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue until March 2020. It is headed by Mission Director and monitored by National Level Monitors appointed by the Government of India.Rural Health Mission (NRHM) and the recently launched National Urban Health Mission (NUHM). Main program components include Health System Strengthening (RMNCH+A) in rural and urban areas- Reproductive-Maternal- Neonatal-Child and Adolescent Health, and Communicable and Non-Communicable Diseases. NHM envisages achievement of universal access to equitable, affordable and quality health care services that are accountable and responsive to the needs of the people.

<span class="mw-page-title-main">Primary Health Centre (India)</span> Type of public health care facility in India

Primary Health Centre (PHCs), sometimes referred to as public health centres, are state-owned rural and urban health care facilities in India. They are essentially single-physician clinics usually with facilities for minor surgeries. They are part of the government-funded public health system in India and are the most basic units of this system. As on 31 March 2019 there are 30,045 PHCs in India in which 24,855 are located on rural areas and 5,190 are on urban areas. The idea of creating PHCs in India was set forward by Bhore committee in 1946.

Healthcare in Malawi and its limited resources are inadequate to fully address factors plaguing the population, including infant mortality and the very high burden of diseases, especially HIV/AIDS, malaria and tuberculosis.

<span class="mw-page-title-main">Health care access among Dalits in India</span>

Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. The Government has since launched several programs and policies to realize ‘Health for All’ in the nation. These measures are in line with the sustainable development goals set by the United Nations. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals. The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like - manual scavenging, skinning animal hide, and sanitation. The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits and Adivasis have the lowest healthcare utilization and outcome percentage. Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.

<span class="mw-page-title-main">Healthcare in India</span> Overview of the health care system in India

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services.

<span class="mw-page-title-main">Academy of Family Physicians of India</span>

The Academy of Family Physicians of India (AFPI) is a professional academic society, registered as a non-profit organization in India. AFPI has been founded with the aim of promoting family medicine and primary healthcare. Family medicine is the practicing speciality and academic discipline of majority Indian doctors. Although there were GP associations such as IMA CGP and FFPAI have been existing for several decades, there was no forum for spearheading development of academic family medicine in India. AFPI is an equivalent organization to American Academy of Family Physicians, College of Family Physicians of Canada, Royal College of General Practitioners, Royal Australian College of General Practice for India.

References

  1. 1 2 3 4 5 6 7 8 9 10 Chokshi, M; Patil, B; Khanna, R; Neogi, S; Sharma, J; Paul, V; Zodpey, S (December 2016). "Health systems in India". Journal of Perinatology. 36 (Suppl 3): S9–S12. doi:10.1038/jp.2016.184. PMC   5144115 . PMID   27924110.
  2. 1 2 3 4 5 Gupta, Monica (December 2005). "Public Health in India: Dangerous Neglect". Economic and Political Weekly. 40 (49): 5159–5165. JSTOR   4417485.
  3. ↑ "Number of maternal deaths | Data".
  4. ↑ "Number of infant deaths | Data".
  5. ↑ "Child Mortality".
  6. ↑ "| NITI Aayog".
  7. 1 2 3 Balarajan, Yarlini; Selvaraj, S; Subramanian, S (11 January 2011). "Health care and equity in India". Lancet. 377 (9764): 505–515. doi:10.1016/S0140-6736(10)61894-6. PMC   3093249 . PMID   21227492.
  8. 1 2 3 4 5 6 7 "20" (PDF). Twelfth Five Year Plan (2012-17) (Vol-III ed.). Planning Commission, Government of India, New Delhi.
  9. ↑ George, Mathew (11 September 2014). "Commentary: Viewpoint: Re-instating a 'public health' system under universal health care in India". Journal of Public Health Policy. 36 (1): 15–23. doi:10.1057/jphp.2014.37. ISSN   0197-5897. PMID   25209538. S2CID   42303783.
  10. 1 2 Peters, David (1 January 2002). "2" . Better Health Systems for India's Poor: Findings, Analysis, and Options. World Bank Publications.
  11. ↑ http://nhsrcindia.org/sites/default/files/NHA%20Estimates%20Report%20-%20November%202018.pdf [ bare URL PDF ]
  12. ↑ "National Health Accounts - Estimates for India -Financial Year 2015-16" (PDF). nhsrcindia.org.
  13. 1 2 "Guidelines for District Hospitals" (PDF). Indian Public Health Standards. Ministry of Health and Family Welfare, Government of India. 2012. Retrieved 9 March 2018.
  14. ↑ AIIMS Bhopal.
  15. ↑ "About PM-JAY - National Health Authority | GOI". nha.gov.in. Retrieved 20 March 2024.
  16. 1 2 Reddy, K; Sivaramakrishnan, Kavita (16 September 2016). "Unmet National Health Needs: Visions of Public Health Foundation of India". Economic and Political Weekly. 41 (37): 3927–3933. JSTOR   4418695.
  17. 1 2 3 Leslie, Charlie (October 1989). "India's Community Health Worker Scheme: A Sociological Analysis". Ancient Science of Life. 2: 40–53.
  18. ↑ Osrin, David; Vaidya, Leena; Porel, Maya; Patil, Sarita; More, Neena Shah; Alcock, Glyn A. (1 December 2009). "Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai's urban slums". Health Education Research. 24 (6): 957–966. doi:10.1093/her/cyp038. ISSN   0268-1153. PMC   2777946 . PMID   19651641.
  19. 1 2 Mishra, Arima (2014). "'Trust and teamwork matter': Community health workers' experiences in integrated service delivery in India". Global Public Health. 9 (8): 960–974. doi:10.1080/17441692.2014.934877. PMC   4166967 . PMID   25025872.
  20. 1 2 3 4 Ved, R.; Scott, K.; Gupta, G.; Ummer, O.; Singh, S.; Srivastava, A.; George, A. S. (8 January 2019). "How are gender inequalities facing India's one million ASHAs being addressed? Policy origins and adaptations for the world's largest all-female community health worker programme". Human Resources for Health. 17 (1): 3. doi: 10.1186/s12960-018-0338-0 . ISSN   1478-4491. PMC   6323796 . PMID   30616656.
  21. 1 2 Rath, Suchitra; Nair, Nirmala; Tripathy, Prasanta K.; Barnett, Sarah; Rath, Shibanand; Mahapatra, Rajendra; Gope, Rajkumar; Bajpai, Aparna; Sinha, Rajesh (22 October 2010). "Explaining the impact of a women's group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation". BMC International Health and Human Rights. 10 (1): 25. doi: 10.1186/1472-698X-10-25 . ISSN   1472-698X. PMC   2987759 . PMID   20969787.
  22. 1 2 Schneider, Helen; Nandi, Sulakshana (1 September 2014). "Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India". Health Policy and Planning. 29 (suppl_2): ii71–ii81. doi:10.1093/heapol/czu074. ISSN   0268-1080. PMC   4202921 . PMID   25274643.
  23. ↑ Davis, Lwendo Moonzwe; Schensul, Stephen L.; Schensul, Jean J.; Verma, Ravi; Nastasi, Bonnie K.; Singh, Rajendra (2014). "Women's empowerment and its differential impact on health in low income communities in Mumbai, India". Global Public Health. 9 (5): 481–494. doi:10.1080/17441692.2014.904919. ISSN   1744-1692. PMC   4624628 . PMID   24766149.
  24. 1 2 Sharma, Aradhana (1 January 2006). "Crossbreeding Institutions, Breeding Struggle: Women's Employment, Neoliberal Governmentality, and State (Re)Formation in India". Cultural Anthropology. 21 (1). doi:10.1525/can.2006.21.1.60.
  25. ↑ Singh, Nirvikar (2008). "Decentralization and Public Delivery of Health Care Services in India" (PDF). Health Affairs. 27 (4): 991–1001. doi:10.1377/hlthaff.27.4.991. PMID   18607032.
  26. 1 2 3 4 5 6 Hammer, Jeffrey; Aiyar, Yamini; Samji, Salimah (6 October 2017). "Understanding Government Failure in Public Health Services". Economic and Political Weekly. 42 (40): 4049–4057. JSTOR   40276648.
  27. ↑ Bajpai, Vikas (13 July 2014). "The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions". Advances in Public Health. 2014: 27. doi: 10.1155/2014/898502 .
  28. ↑ Ezeh, Alex (16 October 2016). "Improving the health and welfare of people who live in slums" (PDF). The Lancet. 389 (10068): 559–570. doi:10.1016/S0140-6736(16)31848-7. PMID   27760702. S2CID   3511402.
  29. 1 2 Barnagarwala, Tabassum (13 April 2022). "Why Indian hospitals turn into raging infernos". Scroll.in. Retrieved 2 August 2022.
  30. ↑ "14 Covid Patients In ICU Killed In Maharashtra Hospital Fire". NDTV.com. Retrieved 2 August 2022.
  31. ↑ "Madhya Pradesh: Eight dead, 5 injured in Jabalpur hospital fire". The Indian Express. 1 August 2022. Retrieved 2 August 2022.
  32. ↑ "Dozens die in India hospital fire". BBC News. Retrieved 2 August 2022.


This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.