Delhi Government Research Articles

Access to antibiotics in New Delhi, India: implications for antibiotic policy.

ObjectiveThe present survey was conducted to investigate the price and availability of a basket of 24 essential antibiotics and eight high-end antibiotics at various levels of health care in public and private sector in National Capital Territory of Delhi, India using standardized WHO/HAI methodology.MethodsData on procurement price and availability was collected from three public healthcare providers in the state: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Overall a total of 83 public facilities, 68 primary care, 10 secondary cares and 5 tertiary care facilities were surveyed. Data was also collected from private retail (n = 40) and chain pharmacies (n = 40) of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR).ResultsPublic sector: Delhi state government has its essential medicine list (Delhi state EML) and was using Delhi state EML 2007 for procurement; the other two agencies had their own procurement list. All the antibiotics procured including second and third generation antibiotics except for injections were available at primary care facilities. Antibiotic available were on the basis of supply rather than rationality or the Delhi state EML and none was 100% available. There was sub-optimal availability of some essential antibiotics while other non-essential ones were freely available. Availability of antibiotics at tertiary care facilities was also sub-optimal. Private sector: Availability of antibiotics was good. For most of the antibiotics the most expensive and popular trade names were often available. High-end antibiotics, meropenam, gemifloxacin, and moxifloxacin were commonly available. In retail pharmacies some newer generation non-essential antibiotics like gemifloxacin were priced lower than the highest-priced generic of amoxicillin + clavulanic acid, azithromycin, and cefuroxime aexitl.ConclusionsInappropriate availability and pricing of newer generation antibiotics, which may currently be bought without prescription, is likely to lead to their over-use and increased resistance. All providers should follow the EML of whichever of the three concerned Delhi public sector agencies that it is under and these EMLs should follow the essential medicine concept. The Indian regulatory authorities need to consider urgently, drug schedules and pricing policies that will curtail inappropriate access to new generation antibiotics.

Where are we now: assessing the price, availability and affordability of essential medicines in Delhi as India plans free medicine for all.

BackgroundInequitable access to medicines is a major weakness in the Indian health care system. Baseline data needed to develop effective public health policy and provide equitable access to essential medicines. The present survey was conducted to investigate the price, availability, and affordability of fifty essential medicines in the public and private sector in Delhi, India using standardized WHO/HAI methodology.MethodsData on procurement price and availability was collected (July-October 2011) from three public healthcare providers: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Data on price and availability of medicines was collected from private retail and chain pharmacies of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR).ResultsThe procurement price of surveyed medicines was 0.53-0.82 times the international reference price-IRP. However, the overall mean availability of surveyed medicines in facilities under state government and MCD was 41.3% and 23.2%, respectively. The overall mean availability of medicines in three tertiary care facilities operated by the federal government was 49.3%. Availability of generic medicines was much higher in the private sector. Off-patented medicines, like diazepam, diclofenac, and doxycycline had the highest MPRs. The price ratio between procurement and retail was as high as 28 (range 11–28) for certain medicines. Seven-day treatment with a popular brand of amoxicillin+clavulanic acid or one inhaler each of budesonide and salbutamol cost 2.3 and 1.4 days’ wages for the lowest paid government worker. A majority of India’s population cannot afford these prices.ConclusionsThis study revealed that procurement prices of surveyed medicines were reasonable in comparison to IRP. However, variation in procurement prices of certain medicines by different public procurement agencies was noted. Availability of medicines was very poor in public sector facilities, which are the primary source of free medicines for a majority of India’s low-income population. Availability of medicines is better in private retail pharmacies but affordability remains a big challenge for a majority of the population. These data have significant policy implications that could help in amending policies to increase the access to essential medicines for India’s population.

Homeopathic drug therapy Homeopathy in Chikungunya Fever and Post-Chikungunya Chronic Arthritis: an observational study

To observe the effect of homeopathic therapy in Chikungunya Fever (CF) and in Post-Chikungunya Chronic Arthritis (PCCA) in a primary health care setting. A prospective observational study was conducted at Delhi Government Homeopathic Dispensary, Aali Village, New Delhi, India, for a period of 6 months, from 1st October 2010 to 31st March 2011. 126 patients (75 CF, 51 PCCA) were enrolled based on predefined inclusion criteria. A single homeopathic medicine was prescribed for each patient after case taking with the help of Materia Medica and/or Repertory. Results were evaluated on the basis of visual analogue scale and symptom scores. Complete recovery was seen in 84.5% CF cases in a mean time of 6.8 days. 90%cases of PCCA recovered completely in a mean time of 32.5 days. Homeopathic therapy may be effective in CF and PCCA. A randomized controlled trial should be considered.

Orphan and vulnerable children infected or affected by HIV/AIDS in Delhi – situational analysis and state government's initiative of household economic strengthening

HIV epidemic brought a terrible toll on children and families worldwide. There are 25 million orphans in India from all causes, of which approximately two million may be attributed to HIV/AIDS. National AIDS Control Organization (NACO), Government of India, recently started focusing on orphan and vulnerable children (OVC) through Children Affected by AIDS (CABA) Pilot Scheme in 10 districts of the country including one district of Delhi. This study was conducted to describe the situation of OVC infected or affected by HIV/AIDS in Delhi and the process followed by Delhi State AIDS Control Society (DSACS) to enable grant of financial assistance to OVC infected or affected by HIV/AIDS from Government of Delhi and its implementation thereafter with overall objective of household economic strengthening of people living with HIV/AIDS (PLHIV). The data during April 2010–March 2012 from nine antiretroviral treatment (ART) centers, CABA pilot scheme, and two institutions providing residential care to CABA in Delhi were analyzed. Total number of OVC in Delhi is estimated to be 1908 of which 766 are infected with HIV and 1142 are affected by HIV/AIDS. Through CABA Pilot Scheme, few OVC could be linked to existing Government Welfare Schemes due to lack of essential documents. Hence, DSACS planned a special financial assistance scheme for PLHIV to retain CABA in home-based care. In the first six months, 6.8% PLHIV, 11.7% children living with HIV/AIDS, 9% double orphan children infected with HIV/AIDS, 9% double orphan children affected by HIV/AIDS, and 68% destitute children infected with HIV/AIDS received benefit of the scheme. To maximize impact, efforts are being made to develop linkages of cash transfer households with other social service providers. Strength, Weakness, Opportunity & Threat (SWOT) analysis has been done with aim to improve the scheme. A national policy to address the cause of OVC infected or affected by HIV/AIDS is need of the hour.

A Signature Cable-Stayed Bridge in India—The Yamuna Bridge at Wazirabad in New Delhi

The Government of Delhi has commissioned a new cable-stayed bridge across the River Yamuna at Wazirabad, New Delhi, designed to make a symbolic statement of the emerging India. It will be the core element of a new recreation area being planned north-east of the city centre of the Indian capital. The most interesting feature of this unsymmetric cable-stayed bridge with a composite deck is an inclined bow-shaped steel pylon with a large glass-covered top. The pylon holds two cable planes towards the main span and a single cable plane for the backstays. This paper describes the conceptual and structural design as well as fabrication and erection issues of this new type of long-span cable-stayed bridge presently under construction and scheduled to be opened to traffic late 2013.

Health impacts of particulate pollution in a megacity—Delhi, India

In Delhi and its satellite cities, vehicle exhaust, industries, waste burning, and construction activities account for the bulk of the particulate (PM) pollution, which between 2008 and 2011, averaged 123±87μg/m3 for PM2.5 and 208±137μg/m3 for PM10, both exceeding the national annual ambient standards of 40μg/m3 and 60μg/m3, respectively.Amulti-sectoral emissions inventory for 2010 was modeled using the ATMoS dispersion model and local meteorology to estimate health impacts in terms of premature mortality and morbidity effects. For the observed PM levels in the city, the health impacts analysis estimates 7,350–16,200 premature deaths and 6.0 million asthma attacks per year. For six residential and industrial zones, we also modeled the sector contributions to ambient PM2.5 ranging 16–34% for vehicle exhaust, 20–27% for diffused sources, 14–21% for industries, 3–16% diesel generator sets, and 4–17% brick kilns. Finally, we present some thoughts on technological, institutional, and behavioral interventions that might help the Government of Delhi to develop an action plan encompassing multiple sources and include interventions to reduce health impacts in the future years.

Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study

BackgroundIn developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.MethodsDesign: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES).ResultsSignificantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs.10th graders (72.3% vs. 67.0%; p<0.05). A dose–response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated.ConclusionDaily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.

A Changing India's Search for Leadership

A Changing India's Search for Leadership Harsh V. Pant (bio) In more ways than one, India stands at a crossroads today in its sixth decade since independence. Politically, democracy in India is thriving as new alliances emerge virtually every election cycle and governments, at both the regional and national levels, are thrown out at regular intervals by a populace that demands better governance from the ruling elites. Economically, the country continues to perform well, despite the inefficiencies of the government, primarily due to the dynamism of its private sector. And increasingly India is not shy to assert itself on the global stage as a power that can shape and possibly transform the emerging global balance of power. But beyond the hype of a "new" India, there is another story. Despite all the claims that India is a rising power, the country is passing through a serious crisis. The government in New Delhi is facing a credibility test as the nation has been besieged by a plethora of corruption scandals in recent months. From the Commonwealth Games to telecommunications, there have been scandals galore, and the government has found it difficult to operate amid demands by the opposition and the civil society for greater accountability. The Indian government is paralyzed to the point of looking like a lame duck, given that there is no political will to make tough decisions and follow them through. Dark clouds are gathering on the economic horizon, with many questioning the ability of the Indian government to initiate the much-needed second generation of economic reforms. India has always been a land of myriad contradictions, but these contradictions have been accentuated over the last three fateful decades. In India Since 1980, Sumit Ganguly and Rahul Mukherji, two of the most prolific and perceptive observers of contemporary India, tell this fascinating story of the momentous changes underway in the country by using the conceptual frame of what they term the "four revolutions": the deepening of Indian democracy, secularism, economic reforms, and changing Indian foreign policy. These are huge themes to cover in a single volume, and the authors should be commended for presenting a succinct and rigorous analysis in an eminently readable form. [End Page 114] Given my research interest in Indian foreign policy, this discussion will largely focus on those parts of the book that delve into changing Indian foreign policy priorities in recent decades. The authors rightly highlight the crucial role that structural changes and key individuals at critical junctures have played in allowing New Delhi to make some significant changes in its foreign policy priorities. The impact of the end of the Cold War has been evident in almost all spheres of Indian foreign policy, with the authors focusing particularly on India's outreach to Israel, the transformation of U.S.-India relations, India's emergence as an overt nuclear power in 1998, the ushering in of a cautious change in Sino-Indian relations, the maintenance of an important defense relationship with Russia, and the extension of relations with Southeast Asia. A broad overview of these changes succeeds in bringing out the choices that India has been making over the last three decades. It is in the last section of the chapter on foreign policy that the authors present some of their most important and interesting insights. They exhort Indian elites "to begin a discussion of the principles that might undergird Indian foreign policy" (p. 55). I have also commented along similar lines in my own work. It is not that there are no debates in India on the foreign policy choices facing the nation, but rather that these debates are happening in an intellectual vacuum with the result that micro issues dominate the foreign policy discourse in the absence of an overarching framework. A major power's foreign policy cannot be effective in the absence of a guiding framework of underlying principles that is a function of both the nation's geopolitical requirements and its values. In India, that big debate is still awaited, though a few recent attempts to articulate broad intellectual principles to guide foreign policy priorities suggest that the idea of nonalignment continues to enjoy wide support among members...

The ‘missing middle’: class and urban governance in Delhi’s unauthorised colonies

This research critically engages with existing theories of class and urban governance, and is empirically located in Delhi, India. The paper argues that existing theories of urban participatory governance in the global South, which polarise urban citizens and their mobilisation strategies into the elite, typically understood as guilty of ‘capturing’ participatory structures; and the poor, conceptualised as excluded from formal governance mechanisms but active in more politicised forms of mobilisation, are incomplete. This research identifies urban citizens who fit neither the ‘elite’ nor ‘poor’ conceptual binary, and explores how such ‘ordinary’ citizens engage in participatory urban governance. Empirically, research addresses Delhi’s unauthorised colonies (UCs), residential areas that have evolved mostly on private land that is not classified ‘residential’ in the Delhi Master Plan. Housing roughly a quarter to one‐third of Delhi’s population and comprising a mix of classes, UCs are technically illegal locations for residential development, are consequently excluded from Delhi’s network of basic urban services (water, roads, electricity) and face potential demolition. UCs are conceptualised as representing India’s ‘missing middle’ both empirically, highlighting the multiplicity of the middle class, and conceptually, revealing the failure of binary concepts to accurately describe participatory urban governance for those in ‘the middle’. In addition, analysis highlights how UCs’ invisibility (linked to their heterogeneity – i.e. their empirical and conceptual ‘middle‐ness’) functions as both an asset and a limitation in terms of participation in urban governance. The paper calls for greater recognition in academic and policy debates regarding the nuances in everyday life that are overlooked by neat binaries. As the Delhi case shows, a large proportion of urban populations are neither ‘poor’ nor ‘elite’, and arguably a similar trend is likely to exist in cities throughout the world where segments of populations demographically in ‘the middle’ are ‘missing’ from academic and policy debates.

Citizen–Government partnership: Bhagidari in Delhi

Bhagidari is a unique experiment of participatory governance in Delhi, the national capital of India. By involving the stakeholders in day-to-day governance, this is also an innovative design of urban governance. Contrary to the Weberian notion of pyramidic administration, Bhagidari provides a bottom-up model of administration in which citizens remain instigators of change and not merely recipients. This has its flip side as well since it is the brainchild of the incumbent chief minister of Delhi. This distinctive experiment has not got many takers in the city of Delhi which is an impediment towards the fulfillment of its goal. Nonetheless, Bhagidari is an innovative theoretical design to re-conceptualize urban administration in perhaps one of the most populous parts of the globe.

A Diachronic Study of the Political Economy of Ranikhera Village in Delhi

This article highlights the changes that have taken place in the political economy of Ranikhera village between 1953 and 2008. Urbanisation is the key factor in transforming the village life. Agriculture has lost its traditional importance as a major source of livelihood. The social relations of production between the landowning Jajmans and landless servicing castes have been affected by opening up of new employment opportunities in the metropolitan city of Delhi. Many Dalits have ‘emancipated’ themselves from their earlier dependence on their Jajmans. The growth of unauthorised colonies adjacent to the village has led to the emergence of new economic and political relations between the migrant population and the villagers. Recent acquisition of agriculture land by the Delhi government has further affected the village life.

Closing the Gap between ‘Expert’ and ‘Lay’ Knowledge in the Governance of Wastewater: Lessons and Reflections from New Delhi

The wastewater crisis in megacities of the Global South is increasingly recognised. However, sector‐driven approaches (of river pollution, sewerage, or city‐wide drainage) have had limited success in tackling this multifaceted problem. This article seeks to dynamise debates by positioning the current crisis in relation to contests of knowledge. Focusing on wastewater governance in Delhi, the article explores the question which different knowledges about wastewater exist in scientific communities, governments, and amongst citizens. What is frequently understood as ‘expert’ knowledge of the Central Pollution Control Board, is juxtaposed with the ‘lay’ experiences of citizens residing in one unauthorised colony in East Delhi. Exploring both, the article provides insights on the mechanisms through which community experiences are excluded from policy deliberations, leading to major wastewater‐related problems being overlooked. The article then calls for enhanced attention to knowledge integration, thus strengthening the participation of citizens in formulation and implementation of wastewater programmes.

Knowledge and Attitude of Nursing Personnel regarding Patient Safety and Rights in Hospitals of Delhi

Nursing ethics apart, the increased awareness towards the treatment procedures being adopted and the standards of hygiene in the hospital setting necessitates proper knowledge and attitude of the personnel attending the patients. The present study, conducted in government and private hospitals of Delhi covered 200 samples (100 each from government and private), using Structured Knowledge Questionnaire. It was revealed that majority of nursing staff working in private hospitals had greater knowledge about patient safety and rights; they also had better patient-friendly attitude. It is suggested that nurses should practice with relevant guidelines in mind.

Urban governance and health care provision in Delhi

This paper considers how changes in urban governance in Delhi over the last two decades have influenced the provision of health care services. It begins by describing the introduction of, or return to, elected governments for the National Capital Territory of Delhi and for the Municipal Corporation of Delhi. It then discusses public health care, which in effect serves low-income groups as most higher-income groups now use private services, and how this has changed, drawing on interviews and direct observations of elected representatives and officials at state and municipal levels, political cadres, NGOs, members of residential welfare associations and public health care users. The research focused on four municipal wards that included a middle-class area, a mixed-income area, a ward where many slum communities had been relocated and an “urban village”. The research also included an analysis of the priority given to health care issues (and what those issues are) in the Legislative Assembly and in the Municipal Health Department and Municipal Health Committee. The paper suggests that the opening by state government of new invited spaces for resident welfare associations meant that the elected members of the Legislative Assembly and of the municipal government were by-passed. It increased the influence of resident welfare associations, but these are a feature of middle-class areas whose inhabitants use private health care. It avoided contestation, as the state could decide who was invited. The role of NGOs as advocates for the urban poor also diminished, as many were drawn into becoming implementers of government programmes. In effect, this increase in participation can be seen as a new form of centralization, strengthening the position of senior bureaucrats and by-passing the elected politicians.

Assessment of Good Governance Initiatives of Government Agencies of State of Delhi

Government of Delhi is constantly working towards the development of the city and striving to facilitate better living for its citizens. Government is aware of the fact that citizens have to interact or deal with different government agencies for their different day to day requirements and many a times have to face difficulties. The delivery of services has improved over the years but volume of work is also increasing in greater proportions. Increasing and shifting population, coupled with nuclear family along with decreasing social interactions has enhanced the complexity of the delivery of services to the satisfaction of the public. There are certain actions, which are taken by particular department or agency to improve its efficacy. But some initiatives have been taken up centrally to improve the working of the officials, which is essential to keep pace with the changes taking place in society. These are in consonance with the technological advances taking place globally. Government of National Capital Territory of Delhi has initiated many programs for offsetting the polarization of resources and achieving economic growth. To enhance the efficiency and effectiveness of such measures government has even moved beyond the standard exercise of measuring the performance through budget utilization, financial expenditure and physical target assessments. Delhi has a unique position and developmental demands, due to it being a city-state with fast expanding population and lots of expectations of its citizens.

The urban water reform project: a critical discourse analysis of the water policy making process in Delhi, India

Making sense of policy processes in India requires an understanding of how particular ways of thinking about water have gained ascendancy in national and state discourses, and how they have determined the frame through which water is perceived, defined and handled. The way in which the concept of water is framed has important implications for the ways in which water reform policies come to be shaped. Shifting narratives of the causes and solutions to water issues in a neoliberal India both drive and produce policy processes, making available or constraining policy choices in which different forms of water knowledge can be available and mobilized. Using methods of critical discourse analysis, this paper uses the Delhi Water Reform Project as a basis for understanding how power and knowledge define spaces of engagement among a range of positioned actors like the World Bank, the Government of Delhi, and civil society. It argues that their strategies are constructed in a way that permits intervention in a manner so as to promote a particular kind of technical and managerial approach that lends persuasiveness to policy instruments.

Of giants and jewelers: The monumental and the miniature in India’s historic landscapes

The major part of India’s architectural heritage is to be found in its towns. This paper will, after an historical survey, look at the various agencies that over the last two decades have been concerned with urban heritage, to examine their agenda, and the pressures they face. ‘Heritage cities’ is a term which appears not only in documents of the Archaeological Survey of India and of the Indian National Trust but also, more recently, in statements made by the Ministry of Urban Development, the Government of Delhi in the context of the Commonwealth Games, and the Ministry of Tourism. The paper will discuss ‘preservation’ of facades/interiors of individual buildings, or of precincts, the use/reuse of historic areas/buildings, and the references to history, through commemoration, naming/renaming, erasing. It argues that conservation should be part of a holistic and humane town-planning policy.

Navigating ‘New’ Delhi: Moving Between Difference and Belonging in a Globalising City

Delhi's government is remodelling the built environment into an imagined ‘global city’, to attract transnational capital, human resources and an international sports spectacle (the Commonwealth Games 2010). As the city's population is diverted and moved on to make way for new infrastructure, residents are, in the process, traversing new spaces, reappropriating space in new ways and engaging in new interactions. This paper explores the possibilities and challenges of these interactions in a qualitative study of the everyday mobility of 23 diverse young people living in Delhi. The study found that interactions were defined by existing perceptions of ‘order’ and ‘proper’ behaviour by known and unknown others. The navigation of both familiar and uncomfortable territories was carried out through the deployment of competencies such as translation and avoidance skills. While the findings indicate that the city contains spaces of interaction that can generate unintended meanings and contest established power relations, these interactions were not always harmonious, reinforcing the idea that social relations that constitute urban space are divergent and unequal. The paper concludes by arguing that while Delhi was divided into spaces of belonging and familiarity, working against the possibilities of interactions with ‘others’, these spaces can be necessary to manage positions of difference and inequality.

Practising Social Work in Schools: Reflections from Delhi

School social work enters its second century as a profession still conflicted about its central mission, roles and tasks. As a progressive and corrective institution of society, there are greater expectations from the school system in the contemporary era to provide a facilitative environment for children to imbibe values and ethics for overall personal development. The irony, however, lies in the role of school social workers who are expected to provide holistic services to the school system and find themselves caught in a web of ambiguity and role confusion amidst the bureaucratic and hierarchical school environment. Are school social work practitioners meant to be the ‘in-house’ clinicians providing services to children in need or are they supposed to become involved in the larger programme development to enhance the social and emotional learning of all students in a school? Attempting to mirror the complexities of school social work in the contemporary scenario, the present paper is based on findings from recent research conducted in government and private schools in Delhi, India. It unveils the roles and tasks taken up by school social workers, explores the opinions of teachers and students about social work intervention in schools and also seeks to critique the scope of school social work in the present context.

Climate Change and Water Governance in Delhi: Legends, Tales and Plans

Urban agglomerations like Delhi are witnessing a notable demographic changes that is only projected to grow further. Climate variability coupled with resource stress could further exacerbate the pressure on water resources. In this context, the paper examines the climate science-society-policy linkages in New Delhi while discussing issues related to provisioning of water. The lacunae in The Delhi Climate Change Agenda (2009-2012) is critically examined. Further an attempt is made to analyse well crafted climate change action plans of cities namely Mexico City and New York City.