Delivery In India Research Articles

Alphanumeric vs. Numeric Token Systems and the Healthcare Experience: Field Evidence from Healthcare Delivery in India

Long wait times for patients are an important health policy issue in many countries, especially developing countries in which there is generally poorer health infrastructure, appointments are not very common, and the opportunity cost of competing life priorities is high. In this research, we examine via field experiments in health clinics in India whether providing numeric versus alphanumeric wait tokens can affect pain perceptions of patients and whether the type of tokens can also affect their wait-time perception and visit satisfaction. Our research provides initial evidence that alphanumeric tokens, in most cases, lead to lower pain perception, lower wait-time perception, and higher satisfaction levels with the healthcare system compared with numeric tokens. However, this is not always true; we also demonstrate boundary conditions when numeric tokens perform better and when the differences between tokens are attenuated. We conducted field experiments in three separate clinics and vary the type of tokens (numeric versus alphanumeric) used to test multiple token operationalizations in varied healthcare contexts. We explain our findings using the cognitive strategy of wait-time perception and discuss why this strategy is helpful for a developing country. This paper was accepted by Matthew Shum, marketing. Supplemental Material: The web appendices are available at https://doi.org/10.1287/mnsc.2022.4389 .

Quality of Public Services in the Era of Guaranteed Public Service Delivery

The provision of public services is one of the important functions performed by a government as it ensures the growth of a nation and promotes welfare and justice in society. Public services are characterised by timeliness, quality and grievance redressal in the course of service delivery. Quality is an important component of public service delivery and determines citizens’ satisfaction and trust in the government. The debates on governance during the 1990s were focused on service delivery as the most important component in the governance process. Public services were seen as a medium for interaction between the citizens and the government through street-level agents of the state to promote the welfare and wellbeing of the people. Developments like the Citizen’s Charter formulation and implementation, social audit, e-Governance programme, Public Service Guarantee Act, and so on have shaped the governance discourse in India. This essay highlights the significance of quality in public service delivery in India, its need the quality-satisfaction-trust triad, barriers to quality in public service delivery, tools to ensure the quality of public services in India and international best practices.

Strategic Initiatives to Improve Tobacco Cessation Delivery in India.

Globally, India is recognized for providing comprehensive coverage of tobacco cessation through the infrastructure and resources over the last two decades. Nevertheless, its current tobacco burden is worrying due to an increase in ~2 million initiators and 5.87% tobacco related deaths annually. It was to identify and describe challenges and barriers in tobacco cessation delivery that exist at various levels of health care as well as at the level of tobacco users, their care givers and communities in which they live. Besides authors' first-hand collective experience in the tobacco control for over 80 years and ~35 years in tobacco cessation and reviewed references, the stakeholders communications during various events along with telephonic or in-person with some of them were assimilated to comprehend an overall understanding of the issue. The challenges and barriers are primarily due to low priority assigned by the relevant functionaries, the inadequacy of resources, poor engagement of health-and insurance-sectors and healthcare workers, a low intent to quit by its users, suboptimal and discontinuous enforcement of the Cigarette and Other Tobacco Products Act of 2003 (COTPA), and indifference of the non-users. The countrywide strategic initiatives required "as a package" should include political and bureaucratic commitment, mass communication on benefits of quitting, licensed current users quitting through a timeline, use of systems approach in tobacco cessation delivery, implementation, and enforcement of vendor licensing and the proposed amendments in COTPA. Their perceived benefits will become a win-win situation for all stakeholders engaged in tobacco cessation delivery.

The effect of COVID-19 on orthodontic treatment demand and its delivery in India.

The ongoing pandemic has transformed the entire structural and functional framework of the world including the medical and dental healthcare services. The current study intends to examine the pattern of dynamically changing working conditions and orthodontic treatment delivery during the various phases of pandemic. An online survey was conducted using Google form for orthodontic specialists practicing in India. Information regarding the impact of the pandemic on various aspects like patient turnover, treatment demand, clinical management, and new challenges faced were analysed through a self-designed close-ended questionnaire for two phases. Phase I (March 2020 to September 2020) corresponded to the onset of COVID 19 pandemic and lockdown, whereas the Phase II (October 2020 to March 2021) coincided with the time of Unlock and resumption of activities thereafter. The parameters showing similar trend in Phases I and II included the willingness of ongoing orthodontic patients to report for appointments, choice of treatment modality, number and type of emergencies, cost of materials, guidelines for work, and duration of non-delivery of orthodontic procedures. The new patients reporting, complex orthodontic therapy, tele-consultation, and financial wellbeing showed an improvement while the usage of personal protective equipment kit, fear amongst orthodontists reduced in Phase II. Challenging situations warrant prudent measures to combat and continue the essential services, especially those related to the healthcare. A detailed analysis of the various phases of the ongoing pandemic will enable us to devise suitable measures to ensure uninterrupted orthodontic treatment even in such critical times.

Burns in India: a call for health policy action

Burns in India: a call for health policy action

Changing scenario of C-section delivery in India: Understanding the maternal health concern and its associated predictors.

Background:Caesarean section (C-section) delivery is a serious maternal health concern in the long run. Notedly, there is a lack of studies dealing with understanding the ways and reasons of C-section deliveries becoming a public health issue in today’s time in India and the measures to reduce the unnecessary caesarean sections. We have conducted this study to study the changes in the state-wise prevalence of C-section deliveries in India and understand C-section delivery’s socioeconomic and biomedical predictors.Materials and Methods:The study uses data from the fourth and fifth rounds of the National Family Health Surveys (NFHS). The per cent differences in the C-section deliveries from NFHS-4 to NFHS-5 across the states were measured through relative changes. The association between the C-section delivery and socioeconomic and biomedical factors were assessed using multiple logistic regression.Results:This study revealed that the C-section deliveries are higher in the southern states than in the other parts of India. Literacy plays a vital role in C-section deliveries. The probabilities of C-section deliveries are more in 30–40 and 40 + years. The women belonging to the median wealth index category were more likely (OR–CI, 1.62 [1.55–1.66]) to undergo the C-section followed by the women from wealthy households (OR–CI, 1.46 [1.41–1.52]).Conclusion:The Government’s health policymakers should take the initiative to reduce the C-section section delivery by means of building maternal health literacy and awareness among women and the community so that its future implications can be minimised. It is crucial to formulate a mandate and implement it in the states where C-sections are too high through community health workers and primary care providers.

Faculty Development Programs in Dentistry

Oral health-care delivery in India is rapidly evolving given the increasing awareness about oral health among the public, advances in dental science and technology, and the demand for high-quality care. The dental workforce needs to be trained to develop the required skills and attitudes for delivering quality dental care. Modifications are required in the dental curriculum to accommodate the changing needs of the society. There is an urgent need to incorporate advances in educational methods and technology in dental teaching/learning to prepare future dental practitioners for real-world challenges. The conventional training of dental faculty in India does not involve any training in educational methods and techniques. Faculty development programs organized on a regular basis in the institutions can be very helpful in training the teachers in the latest and evidence-based teaching/learning methods. This article highlights the current status of faculty development initiatives for improving dental education and also makes suggestions to improve faculty training in Indian dental institutions for future.

Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu

BackgroundCaesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively.MethodsThis study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data.ResultsOf participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31).ConclusionFindings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

Use of artificial intelligence in healthcare delivery in India

Use of artificial intelligence in healthcare delivery in India

Geographic variation in caesarean delivery in India.

BackgroundThe rate of caesarean delivery has increased markedly both globally and within India. However, there is considerable variation within countries. No previous studies have examined the relative importance of multiple geographic levels in shaping the distribution of caesarean delivery and to what extent they can be explained by individual‐level risk factors.ObjectivesTo describe geographic variation in caesarean delivery and quantify the contribution of individual‐level risk factors to the variation in India.MethodsWe conducted four‐level logistic regression analysis to partition total variation in caesarean delivery to three geographic levels (states, districts and communities) and quantify the extent to which variance at each level was explained by a set of 20 sociodemographic, medical and institutional risk factors. Stratified analyses were conducted by the type of delivery facility (public/private).ResultsOverall prevalence of caesarean delivery was 19.3% in India in 2016. Most geographic variation was attributable to states (44%), followed by communities (32%), and lastly districts (24%). Adjustment for all risk factors explained 44%, 52% and 46% of variance for states, districts and communities, respectively. The proportion explained by individual risk factors was larger in public facilities than in private facilities at all three levels. A substantial proportion of between‐population variation still existed even after clustering of individual risk factors was comprehensively adjusted for.ConclusionsDiverse contextual factors driving high or low rate of caesarean delivery at each geographic level should be explored in future studies so that tailored intervention can be implemented to reduce the overall variation in caesarean delivery.

Telemedicine Health Care Delivery in India: A Boon During COVID-19 Pandemic

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A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

It is estimated that the cost of road accidents in India is around 3% of the Gross Domestic Product of the country. On average, 400 persons die daily in road accidents in India, and cities, such as New Delhi and the national capital region are on the top of the list of road accident causalities. Based on the Basilica agreement, the Indian government has initiated various policy changes and infrastructure development along the national highways which include the redesign of blindspots on the roads and the infliction of heavy penalties for the violation of traffic rules and compliances. On the academic front, the Indo-US Emergency Medicine forum has inaugurated an academic college for emergency medicine in India that cooperates with various government and private healthcare providers and policymakers for the improvement of emergency/trauma care delivery. Lately, few business schools and healthcare educational institutes have focused on interdisciplinary training and research centers in the area of emergency care delivery. Policymakers are also proactively working with various organizations to implement new rules and compliance mechanisms. This prospective study entails a detailed review of the literature using keywords in the PubMed journals, news articles, and media reports. Authors encountered studies in the area of trauma care delivery in India and other countries in their comprehensive field research. Almost 100% of the cases were medico-legal and only one case out of 100 was an insured patient. Furthermore, 87% of the cases were new and only 13% were review cases. Based on the conducted analysis, the number of accidents reduced across the country after the implementation of the New Motor Vehicle Act in the year 2019. It is worth mentioning that, the government launched awareness programs for the public as well. Some of the major challenges identified included lack of coordination and institutional mechanisms for an integrated emergency care delivery, poor referral processes, inadequate ambulance services, lack of third-party coordination, and poor in-hospital resources, particularly in public healthcare organizations. Apart from these, there was an acute shortage of trained emergency medicine experts at all levels. Trauma care delivery is a complex issue and its accomplishment requires good coordination and collaboration among stakeholders. The study identified various challenges and opportunities for the improvement of trauma care delivery in India. There is an immense need and opportunity for the modification of the emergency care delivery system through the introduction of appropriate changes in the transportation policy, emergency care delivery models, institutional mechanisms, such as referral process, and appropriate resource allocation at different levels of care delivery system.

A new interventional home care model for COVID management: Virtual Covid IP

AimAmidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. MethodsThe Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. ResultsAmong the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. ConclusionsWith similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.

A System Theory Approach in Management of Community Health Centers (Mid-Level Health Organizations) in India

Health-care delivery in India has been developed at three levels specifically, primary, secondary, and tertiary. The secondary level of health-care basically includes Community Health Centers (CHCs), constituting the First Referral Units. The health-care system is that the organization (e.g. hospital, clinic, and nursing home) that has infrastructure and completely different complementary resources to support the work and development of care teams and microsystems. In open system theory, each system and its subsystems adapt to internal and external demands and feedback. Demands external to the health-care organization cover environmental factors (e.g., labor market, legislation, and population characteristics). Health-care organizations try to use a system that is functioning in response to feedback and informational signals to counteract lacuna. The application of system theory at mid-level will enhance the further managerial promptness at this level. In this paper, we described system theory as the process of identifying the systems of health-care delivery at the CHC level and subsystems with in CHCs and its interactions with environment and other systems.

Differential access to facilities for medical termination of pregnancy and delivery in India: A secondary analysis

IntroductionEmerging evidence suggests a difference in access to facilities for medical termination of pregnancy (MTP) and delivery among women in different regions of the country. However, we lack assessments at a large scale across all geographies. Our study aims to describe the percent contribution of private and public sectors in institutional deliveries and MTP in India. MethodsA secondary data analysis using the Health Management Information System statistics was performed. We obtained selective data regarding the total number of MTP and deliveries conducted at public and private institutions. The standard reports of the period between April 2018 and March 2019 were analyzed. The states (n = 29) and union territories (n = 7) were dichotomized into regions, namely north, south, east, west, north-east, and central. ResultsA large part of women underwent deliveries and abortions in the private sector in the southern and western states of India like Kerala, Tamil Nadu, Andhra Pradesh, Goa, and Maharashtra. Women in most of the northern states opted for public facilities for deliveries as well as abortions, except Punjab and Haryana. On the contrary, states like Bihar, Nagaland, and Union territories like Delhi and Dadra and Nager Haveli had a high percentage of abortions in the private sector and deliveries in public health facilities. ConclusionThis differential access highlights the need to assess the underlying factors for immediate actions by the policy-makers. Ensuring safe and good quality delivery and abortion services is the means to assure the sexual and reproductive health rights of women by the government.

Catastrophic expenditure rates and barriers for treatment adherence in patients with colorectal cancer in India: The CROCODILE study protocol.

Little is known about the delivery of colorectal cancer treatment in India and its associated costs. The aim of this study is to identify financial and nonfinancial barriers to adherence to colorectal cancer treatment in India. CROCODILE is a mixed-methods study with a quantitative and a qualitative workstream. The quantitative workstream will be a prospective cohort study to assess treatment adherence and catastrophic expenditure rates among patients with colorectal cancer in India. Consecutive newly diagnosed patients with histopathologically proven colorectal cancer from five tertiary hospitals in India will be included. Catastrophic expenditure will be defined as a treatment cost higher than 40% of nonsubsistence annual household income. Treatment costs will include medical, nonmedical and indirect expenses. Income assessment will be compared between three methods: patient-reported income, the International Wealth Index and the Gapminder tool. The qualitative workstream will explore the views and experiences of colorectal cancer patients and professionals about barriers to and facilitators for treatment adherence. Individual semistructured interviews with three to five patients and cancer care professionals in each centre will be performed. An analytical framework will be developed to perform the analysis, through a combined approach (deductive and inductive). The results will be triangulated with the quantitative workstream for mutual knowledge enrichment. The CROCODILE study will identify barriers to and facilitators for colorectal cancer delivery in India, influencing research and policy decisions. It will explore the feasibility of collecting data on patient-level costs and income to inform future economic evaluations in cancer and surgical care.

COVID-19 and the Prospects for Telemedicine in India

Restrictions in movements of all nonessential services have been curtailed in India and worldwide owing to the current COVID-19 situation. This potentiates the use of telemedicine to provide healthcare services during the COVID-19 pandemic and lockdown. Telemedicine which was initially primitive and not very well explored is now emerging to be a safe option for healthcare delivery in the interim. Recently, the Ministry of Health and Family Welfare in India has come up with a set of guidelines that eases both the doctors and patients. The clarity in regulations provides a boost to the existing private startups that were operating under a grey area until now and would also attract investors to provide the required push to establish these services in India at a national level. Hence, if accepted as a standard model of healthcare delivery in India, telemedicine will help address the COVID-19 situation as well as provide healthcare access in remote areas. Furthermore, with millions of people already using the “Aarogya Setu” mobile app, it serves as a potential platform to integrate a national telemedicine service.

Association between the type of provider and Cesarean section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016.

BackgroundPrevalence of Cesarean section (C-section) is unequally distributed. Since both extremely low and high levels of C-section can not only cause adverse birth outcomes but also impose a double burden of inefficiency within maternal health care, it is important to monitor the dynamics of key factors associated with the use of C-section.ObjectivesTo examine the association between type of provider and C-section in India in three-time points: 1999, 2006, and 2016, and also to assess whether this association differed across maternal education and wealth level.MethodsData were from three waves of cross-sectional and nationally representative Indian National Health Family Survey: Wave II (1999), III (2006), and IV (2016). Target population is women aged 15 and 49 who had an institutional delivery for the most recent live birth during the three or five years preceding the survey (depending on the survey round). Multivariate logistic regression models adjusting for state cluster effect were performed to determine the association between the type of providers and C-section. Differential association between the type of providers and C-section by maternal education and wealth level was examined by stratified analyses.ResultsThe prevalence of C-section among institutional delivery increased from 20.5% in 1999 to 24.8% in 2006 while it declined to 19.4% in 2016. The positive association between private providers and C-section became stronger over the study period (Odds Ratio (OR) = 1.39, 95% Confidence Interval (CI) 1.18–1.64 in 1999, OR = 3.71 95% CI 2.93–4.70 in 2016). The association was consistently significant across all states in 2016. The gap in C-section between public and private providers was greater among less-educated and poorer women. The ORs gradually increased from the poorest to the richest quintiles, and also from the least educated group (no formal education) to the most educated group (college graduate or above)ConclusionsOur results suggest that disparity in C-section between private and public providers has increased over the last 15 years and was higher in lower SES women. The behavior of providers needs to be closely monitored to ensure that C-section is performed only when medically justified.

Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic.

Background: Corona virus disease (COVID-19) was declared a pandemic by the World Health Organization in March 2020. This has affected service delivery among all medical disciplines in India including neurorehabilitation services.Aims and Objectives: The aims and objectives of the study were to assess the effect of COVID-19 pandemic on neurorehabilitation services across India.Methodology: A prospective nationwide survey study was undertaken by the Indian Federation of Neurorehabilitation during the pandemic. A questionnaire was prepared using Google forms software consisting of four sections: demography, neurorehabilitation practice before COVID-19 pandemic, neurorehabilitation practice during COVID-19 pandemic, and continuing medical education during COVID-19 pandemic.Results: Responses (872) were received from neurorehabilitation professionals across the country out of which 2.2% professionals did not give consent for participating in the survey. Participants (36.6%) were practicing traditional or independent referral basis rehabilitation, while 63.4% participants were practicing multidisciplinary rehabilitation. On an average, respective units were conducting 500–750 therapy sessions per month. Majority of the rehabilitation units in India lacked a physiatrist, rehabilitation nurse, music therapist, cognitive therapist, and urologist. Approximately 80% of the rehabilitation units have the basic rehabilitation modalities and advance technology was present in only 20% of the rehabilitation units. During COVID-19 pandemic, 19.5% centers were providing elective services, 50.3% emergency services, 15.6% new outpatient services, and 22.7% were providing follow-up outpatient services. Centers (51.5%) were providing telerehabilitation services for neurological conditions during the times of COVID-19 pandemic. Professionals (61.1%) providing telerehabilitation were working from home. Among the patients who needed neurorehabilitation, 28% were doing their exercises independently, 31% were supervised by caregivers, 17% were supervised by therapists, and 24% were not receiving any therapy. Participants (95.5%) wanted to receive more training in the field of neurorehabilitation. The participants utilized webinars (71%), online courses (22%), case discussion forums (19%), panel discussions (13%), and literature search (8%) during COVID-19 pandemic to continue education.Conclusion: The study reflects the situation of neurorehabilitation service delivery in India during the pandemic as the respondents were from all parts of the country and included most components of the neurorehabilitation team. Neurorehabilitation services were severely affected across India during the COVID-19 pandemic. Tele-neurorehabilitation has emerged as a new service delivery model during the pandemic. Online means of education has emerged as the primary source of continuing medical education during the pandemic.

Dental pain, parental SARS-CoV-2 fear and distress on quality of life of 2 to 6 year-old children during COVID-19.

BackgroundCoronavirus disease (COVID‐19) has crippled life, families and oral healthcare delivery in India due to nationwide lockdown.AimThrough cross‐sectional design, we investigated the impact of child's dental pain, caregiver's fear of SARS‐CoV‐2 and parental distress on oral health–related quality of life (OHRQOL) of preschoolers during the nationwide COVID‐19 pandemic lockdown.DesignPreschool children self‐reported their pain using Pieces of Hurt scale; caregiver SARS‐CoV‐2 fear was assessed using Fear of COVID‐19 scale and parental distress evaluated using 4‐item scale. Child's oral health was assessed using the dmft index and OHRQOL evaluated using early childhood oral health impact scale. Bivariate, multivariate regression analysis was conducted to identify predictors; statistical significance was set at 5%.ResultsSample mean age was 4.58 years, and about 69% were boys. Children reporting higher pain scores (OR = 1.9) due to decayed teeth and having dmft > 5 (OR = 4.25), followed by greater parental distress (OR = 4.13) and fear of SARS‐CoV‐2 (OR = 3.84), were significantly associated with poor OHRQOL during the COVID‐19 pandemic.ConclusionsGreater parental distress and fear of COVID‐19 among caregivers, higher self‐perceived dental pain among children and caries experience are associated with poor OHRQOL of preschool children during the COVID‐19 pandemic.