An Online Inclusive Examination Framework for India

Intellectual disability (ID) presents a significant public health challenge in rural India, characterized by disparities in access to healthcare, stigma, and socio-economic barriers. This comprehensive review examines recent advances and persistent challenges in understanding, diagnosing, and supporting individuals with ID in rural communities in India. Advancements in diagnosing and intervening in intellectual disability in rural India have been achieved through various approaches, including community-based screening programs, culturally tailored assessment tools, telemedicine, and mobile health solutions. These initiatives prioritize widening access to healthcare services and early intervention, with the overarching goal of enhancing outcomes for individuals with intellectual disabilities. However, formidable challenges persist. Limited access to specialized services, pervasive stigma, socio-economic disparities, and inadequate awareness hinder progress in addressing the needs of individuals with ID in rural India. These challenges necessitate a multi-faceted approach involving policymakers, healthcare providers, educators, and community leaders. Addressing these challenges requires prioritizing the needs of individuals with ID, promoting awareness and advocacy, investing in capacity building, and implementing policy reforms. Collaborative efforts are essential to overcome barriers and ensure that individuals with ID in rural India receive the support and opportunities they deserve. Moving forward, it's essential to prioritize on-going research, expand service provision, and nurture a culture of acceptance and inclusion. These endeavors are critical for shaping a future where individuals with intellectual disabilities in rural India can not only thrive but also actively contribute to their communities. While strides have been made, significant challenges persist in addressing intellectual disability in these areas. Acknowledging these hurdles and collectively working to overcome them is vital for building a more inclusive and equitable society that values the unique contributions of all individuals, regardless of their abilities. In conclusion, the author concluded that while progress has been made, significant challenges remain in addressing intellectual disability in rural India. By acknowledging these challenges and working together to overcome them, we can build a more inclusive and equitable society for all individuals, regardless of their abilities.

The need for access to basic amenities - drinking water, sanitation, electricity and drainage - to ensure a decent quality of life has been internationally recognised and acted upon in the form MDGs and various policies and programmes in India. Deprivation and disparities in access to basic amenities in rural areas have been highlighted in this paper using data from Census of India, 2001 and 2011, and National Sample Survey's Housing Conditions Rounds unit records data, 1993 and 2008/2009. Determinants of households having access to basic amenities in the house have been estimated using an econometric exercise on household level information, NSS unit record data 2008/09. Despite improvement many households in rural India still face severe access deprivations and hence low standards of living. Households belonging to the weaker sections of society have been most deprived of access to basic amenities, and the corresponding disparities in access among various socio-economic groups have increased over last decades. This paper suggests the need for immediate attention towards providing adequate basic amenities with inclusive and group-specific provisions (also socio-spatial situatedeness focus) in rural India so as to raise the overall quality of life.

Educational inequality remains a significant challenge in rural India, with disparities in access to infrastructure, teacher quality, and technology hindering equitable learning opportunities. This study examines these inequalities in two rural regions: Barwani, Madhya Pradesh, and Kalahandi, Odisha. Using a mixed-methods approach, the research combines qualitative interviews with students, teachers, and policymakers, alongside quantitative data on enrollment, infrastructure, and learning outcomes. Findings reveal that 72% of schools in Barwani lack science laboratories, while 65% of schools in Kalahandi lack digital tools, reflecting severe infrastructural gaps. High student-to-teacher ratios of 70:1 in Barwani and 60:1 in Kalahandi further strain educational quality, exacerbated by a lack of trained teachers. Poor access to technology and unreliable internet connectivity limit digital literacy, perpetuating the digital divide. The study also evaluates government interventions such as the Sarva Shiksha Abhiyan and digital education initiatives, finding implementation inconsistencies in remote areas. The findings highlight how educational inequality restricts social mobility and economic opportunities, particularly in underdeveloped regions. Future research should focus on the effectiveness of targeted policies and explore innovative, technology-driven solutions to bridge these disparities, fostering equitable educational development and sustainable growth in rural India.

BackgroundThe COVID-19 pandemic is causing widespread morbidity and mortality. It has led to a myriad of mental health problems, particularly in health care providers (HCPs). To strengthen the fight against COVID-19, it is essential to investigate the mental health challenges being faced by the HCPs, their emotional responses, and coping strategies.ObjectivesWe aimed to explore the lived experiences of frontline HCPs in rural India during the peak of the second wave of the COVID-19 pandemic.MethodsThrough purposive heterogenous snowball sampling, five HCPs in rural Dhanbad were recruited and one-on-one double-blind unstructured interviews were conducted. The interviews were transcribed and master themes and subthemes were extracted by interpretative phenomenological analysis.ResultsSix master themes and 23 subthemes were identified. Our findings demonstrate that the participants were under mental duress due to heavy workloads, fear of getting infected and transmitting the infection, urban–rural disparities in access to medical supplies and peer support, and negative social perception of HCPs during the pandemic. Most HCPs have not yet processed the psychological effects of being at the frontlines of the COVID-19 pandemic in a resource-poor setting; however, spirituality seems to be an important coping mechanism that helps them get through the day.ConclusionsThis study is unique in the sense that not many studies have been conducted to evaluate the psychological issues of Indian HCPs during this pandemic. Much less is known about the mental health of HCPs in rural settings. Moreover, novel findings such as negative social perception of HCPs during the pandemic and HCPs resorting to spirituality as a coping strategy against stress, open a plethora of research opportunities wherein the results of this qualitative study, along with the existing literature and findings of future quantitative studies, can establish better understanding of the impact of the pandemic on HCPs.

The COVID-19 pandemic is causing widespread morbidity and mortality. It has led to a myriad of mental health problems, particularly in health care providers (HCPs). To strengthen the fight against COVID-19, it is essential to investigate the mental health challenges being faced by the HCPs, their emotional responses, and coping strategies. We aimed to explore the lived experiences of frontline HCPs in rural India during the peak of the second wave of the COVID-19 pandemic. Through purposive heterogenous snowball sampling, five HCPs in rural Dhanbad were recruited and one-on-one double-blind unstructured interviews were conducted. The interviews were transcribed and master themes and subthemes were extracted by interpretative phenomenological analysis. Six master themes and 23 subthemes were identified. Our findings demonstrate that the participants were under mental duress due to heavy workloads, fear of getting infected and transmitting the infection, urban-rural disparities in access to medical supplies and peer support, and negative social perception of HCPs during the pandemic. Most HCPs have not yet processed the psychological effects of being at the frontlines of the COVID-19 pandemic in a resource-poor setting; however, spirituality seems to be an important coping mechanism that helps them get through the day. This study is unique in the sense that not many studies have been conducted to evaluate the psychological issues of Indian HCPs during this pandemic. Much less is known about the mental health of HCPs in rural settings. Moreover, novel findings such as negative social perception of HCPs during the pandemic and HCPs resorting to spirituality as a coping strategy against stress, open a plethora of research opportunities wherein the results of this qualitative study, along with the existing literature and findings of future quantitative studies, can establish better understanding of the impact of the pandemic on HCPs.

One main advantage of having developed credit markets is that there are better opportunities of dealing with risk. This paper measures access to credit in rural India and the role of credit institutions as insurance mechanisms. I am able to do this by comparing data for 720 rural households that I collected from two Indian states, Kerala and Uttar Pradesh. To measure a household's access to credit, I develop an equilibrium model of sorting based on a random utility approach. The initial results indicate that there are large disparities in access to credit, particularly from formal sources. The predominant sources of credit, however, are cooperative societies and informal ties between households. The main results indicate that access to credit serves as an insurance against idiosyncratic income shocks. This, however, crucially depends on the exact source of credit. While access to banks does not provide insurance against an income shock, access to cooperative societies and informal ties offer the best insurance against such shocks. Households that primarily rely on moneylenders for credit are the worst hit during an income shock. The results show that a 1 percent increase in access to cooperative, lowers the probability of reducing consumption expenditure against an income shock by 18 percent.

Equitable access to institutional credit is crucial for enhancing the productivity and livelihoods of rural households, particularly in agrarian economies like India. Despite multiple financial inclusion programs, disparities persist across caste groups. This study examines caste-based exclusion in institutional credit among agricultural households using unit-level data from the 77th round of the National Sample Survey (2019). Employing probit regression, we identify key determinants of credit access, while the Blinder–Oaxaca decomposition quantifies the explained (structural) and unexplained (discriminatory) components of disparities. Results show that Scheduled Castes (SCs) and Scheduled Tribes (STs) are significantly less likely to access institutional credit compared to Upper Castes (UCs), with the unexplained discriminatory component accounting for 42% of the gap for SCs, 60% for STs, and 8% for Other Backward Classes (OBCs). Limited landholdings, lower monthly per capita expenditure (MPCE), and reduced education levels contribute to structural disadvantages, while systemic bias further restricts access. The findings highlight that, despite targeted programs such as the Kisan Credit Card (KCC) and Pradhan Mantri Jan Dhan Yojana (PMJDY), implementation gaps and social exclusion hinder equitable credit distribution. Addressing such disparities is critical not only for social justice but also for achieving Sustainable Development Goals (SDGs) related to poverty reduction, reduced inequalities, and decent work. The study calls for caste-sensitive lending policies, improved awareness and outreach in marginalized communities, and monitoring mechanisms to ensure fair credit allocation. By quantifying both structural and discriminatory barriers, this research contributes actionable insights for policymakers to promote inclusive rural development.

This study investigates the factors that influence the adoption of digital technology in rural areas of India, with a focus on the Digital India Program (DIP). By analyzing the age distribution, education levels, technology adoption rates, and utilization patterns among rural populations, this research provides insights into the effectiveness of the DIP in targeting specific demographics and promoting digital inclusion. Quantitative data were collected from 400 respondents in Kalahandi District in the Odisha state of India. The data collected were analyzed using SPSS. The findings reveal a predominantly young population in rural India, indicating a workforce with significant economic potential and a higher likelihood of embracing digital technologies. Moreover, the study highlights the high levels of education among respondents, indicating a population well-equipped to understand and benefit from digital initiatives. Unexpectedly, the research shows a higher rate of digital technology adoption among female respondents, challenging the perception of gender disparities in technology access. This finding suggests that the DIP has played a vital role in bridging the gender gap and empowering women in rural areas. Additionally, the study uncovers a trend towards mobile-based services over computer-based services, signaling a shift in technology utilization patterns. This emphasizes the need to prioritize mobile technology and improve connectivity in rural areas to ensure wider access to digital platforms.

India's rural and tribal communities face persistent disparities in healthcare access and outcomes. While the biomedical model dominates the public health landscape, there is a growing recognition of the need for culturally responsive, preventive, and holistic approaches to health. This article proposes a synergistic integration of the Ottawa Charter for Health Promotion with Naturopathy, a core discipline under India's AYUSH framework. Drawing upon both global frameworks and Indigenous wisdom of healing with plants and herbs for medicinal and nutritional purposes, the article argues for an integrated community health promotion strategy that leverages the cultural legitimacy, ecological appropriateness, and preventive strengths of Naturopathy to fulfil the Ottawa Charter's vision. Evidence from public health interventions and AYUSH initiatives in India underscores the feasibility and relevance of this approach, particularly in tribal and rural regions.

India's rapid development and expanding population have intensified the need for sustainable energy solutions. This is particularly significant in addressing the growing disparity in energy access between urban and rural communities. As the country shifts from traditional fossil-fuel-based power generation to cleaner technologies, nuclear energy is poised to play an increasingly vital role. Small Modular Reactors (SMRs) represent a promising option to meet these energy demands in a decentralized and environmentally friendly manner, especially in rural regions. In this perspective article, we explore the technological, economic, social, and environmental advantages of deploying SMRs in rural India. SMRs offer the potential for faster and cheaper build, as well as stable and reliable power, which is essential for driving economic growth in underdeveloped areas. However, several challenges need to be addressed, including regulatory and legislative hurdles that could impede the integration of SMRs into the existing energy mix. This article also suggests solutions such as leveraging India’s existing reactor technology expertise, utilizing the mature supply chain framework, co-locating SMRs with renewable energy sources, and advocating for necessary regulatory and legislative reforms. These would help SMRs serve as a crucial bridge in facilitating a smoother transition from fossil fuel plants to clean energy technologies, particularly in underserved rural communities.

Background: Agriculture remains the principal source of livelihood in rural India, with over half of the population dependent on it. Among tribal communities, who traditionally practiced hunting and food gathering, there has been a historical transition to shifting cultivation and eventually to settled agriculture. Today, agriculture constitutes the primary livelihood for most tribal groups. In Telangana, where diverse tribal communities such as the Lambadi, Gond, Koya, Kolam and Chenchu reside, agriculture continues to be central to their sustenance. However, these communities experience unequal access to agricultural resources, leading to disparities in livelihood outcomes. Methods: This study investigates the nature and extent of disparities in agricultural practices among tribal communities in Telangana, as well as the underlying causes and socio-economic consequences of these disparities. The research is based on primary data collected from five tribal communities through a mixed-methods approach. Data was gathered from 400 surveyed households, 10 focus group discussions (FGDs) and several key informant interviews conducted across selected tribal regions. Result: The study reveals substantial inter-community disparities in agricultural access, practices and outcomes. These disparities are driven by factors such as landholding patterns, irrigation access, government scheme implementation and socio-political marginalization. The consequences include rising indebtedness, distress-driven land sales and an increasing shift toward alternative and migratory livelihoods. The findings underscore the need for targeted policy interventions to address structural inequalities and enhance agricultural sustainability for tribal populations.

Disparities in Access to Basic Amenities Across Caste, Ethnicity and Classes in Rural and Urban India

Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.

Evidence of Geospatial and Socioeconomic Disparities in Access to Online Grocery Shopping for Fresh and Frozen Produce in North Carolina

Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons may be defined under the umbrella term sexual and gender minorities (SGM). SGM often experience disparities in access to care negatively impacting their health outcomes. Aim of the study was to assess knowledge, attitude and practical experience of neurologists associated with European Academy of Neurology (EAN) in caring for SGM patients. The study has been conducted amongst EAN neurologists using a 29 Likert-type questions survey (from "strongly disagree" to "strongly agree") exploring the knowledge, attitudes and practices towards SGM patients. The survey was distributed via mail to all 3410 EAN members, from June to October 2024. Overall, 171 respondents gave the consent to participate, with almost 73% responding to each question. 133 out of 171 respondents declared their sex assigned at birth (76 women, 57.1%; mean age 43.2 ± 13.0 years). Considering knowledge, almost 75% felt comfortable explaining differences between sexual orientation and gender identity. A low percentage (2.9% and 6.4%, respectively), was aware that LGBTQ individuals could experience disproportionate levels of physical and mental health problems compared to heterosexual and cisgender individuals. A large majority of participants reported insufficient training to work with LGBTQ and almost 70% declared interest in receiving further training on providing appropriate care to SGM persons. Most of the European neurologists were aware of the limits in providing healthcare to SGM recognizing the importance of training and education in approach and treat SGM patients in order to provide high-quality neurological care.