Indian Healthcare System Research Articles

Integrative medicine: A path to holistic healthcare

The COVID-19 pandemic has changed our entire viewpoint on the health-care systems in India. The concept of well-being has now taken the spotlight. Preventive techniques from different systems of medicine were adopted by the people which proved to be highly efficacious in beating the symptoms. This pandemic has taught us various lessons, of which embracing our traditional health systems is an important one. This crisis has given us an opportunity to understand that as much as how modern healthcare is doing wonders, the traditional health systems also have gems of wisdom which need to be explored and made accessible to all. Hence, integration of modern medicine with our traditional medicine would help us to treat an individual as a whole in a holistic manner.

Omicron Variant of SARS-CoV-2: An Indian Perspective of Vaccination and Management.

Omicron variants have highly influenced the entire globe. It has a high rate of transmissibility, which makes its management tedious. There are various subtypes of omicron, namely BA.1, BA.2, BA.3, BA.4, and BA.5. Currently, one omicron subvariant BF.7 is also immersed in some parts of India. Further studies are required for a better understanding of the new immersing SARS-CoV-2 subvariant of the omicron. They differ in the mutation of the spike proteins, which alters their attachment to the host receptor and hence modifies their virulence and adaptability. Delta variants have a great disastrous influence on the entire world, especially in India. While overcoming it, another mutant catches the pace. The Indian population is highly affected by omicron variants. It alters the entire management and diagnosis system against COVID-19. It demanded forcemeat in the health care system, both qualitatively and quantitively, to cope with the omicron wave. The alteration in spike protein, which is the major target of vaccines, leads to varied immunization against the subvariants. The efficacy of vaccines against the new variant was questioned. Every vaccine had a different shielding effect on the new variant. The hesitancy of vaccination was a prevalent factor in India that might have contributed to its outbreak. The prevalence of omicron, monkeypox, and tomato flu shared some similarities and distinct features when compared to their influence on the Indian population. This review emphasizes the changes omicron brings with it and how the Indian health care system outrage this dangerous variant.

Making primary healthcare delivery robust for low resource settings: Learning from Mohalla Clinics

The present healthcare scenario is still in its compromised state, whether it is the lack of infrastructure, medicines and human resources, especially in rural India. Moreover, the condition worsens in rural areas due to several reasons like lack of awareness, proper roads to access, and lack of proper delivery of healthcare model. The state government of Delhi, India, set up the “Mohalla” Clinics to provide essential healthcare to residents of Delhi and the surrounding areas, focusing on the urban poor. Essential health services, such as vaccinations, family planning, and counselling, are available at the Mohalla Clinics, where a doctor, a nurse, a pharmacist, and a lab technician are staffed. Despite a strong start and low operating costs, the Mohalla Clinic initiative still struggles to cover all Delhi state as envisioned. This study analyses the operational challenges of Delhi’s “Mohalla” Clinics and proposes lessons to be implemented for other primary healthcare infrastructure services for remote areas. The analysis is based on the systems (infrastructure, facilities, and services) strengths and limitations from a literature review and qualitative interview conducted among 55 respondents, including doctors, nurses, and patients among 11 Mohalla Clinics using the SUTD-MIT (Singapore University of Technology and Design—Massachusetts Institute of Technology Industrial Design Centre) interview template for Product Service System (PSS). The results show that there are lessons to learn from the model of Delhi Mohalla Clinics for other states to implement in their primary healthcare sectors. To achieve Universal Health Coverage (UHC), the Delhi Mohalla Clinic falls short due to several limitations. Thus, to achieve UHC, the Indian healthcare system needs a new healthcare delivery model. Hence, we ought to propose a new healthcare delivery model based on the gained insights from the study. One such delivery model proposed is a mobile Primary Health Center (mPHC). This collapsible system can be taken to far-flung regions, deployed for some hours, run the Out-Patient Department (OPD), collapsed, and returned to base.

Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection.

The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management:1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management.2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community.3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key.4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

Public Perceptions Regarding the Preparedness of Government to Combat the Third Wave of COVID-19 (SARS-CoV-2) Infection Across Various States of India.

India has already passed through 2 waves of the coronavirus disease (COVID-19) pandemic losing many lives. The reason for losing lives may be due to the unpreparedness of the health care system of India for this unprecedented pandemic. To assess the government's preparedness, an institutional-based cross-sectional prospective survey was conducted among the adult population of selected states in India. A self-administered 30-item questionnaire divided into 5 sections (demography of the participants, steps to create awareness, prevent spread of infection, handle the emergency, and prognosis) was distributed online through Google Forms. The responses were collected in an Excel file. SPSS software was used to perform the descriptive statistics and analysis of variance (ANOVA). Nearly a quarter of the participants "strongly disagree"/"disagree" about the government's preparedness for the third wave. Considering their perception, it cannot be assured that the government is well prepared to handle the emergency. So, the government must maintain emergency funding and develop a health infrastructure. The government should take steps to reduce social stigma, prevent spreading of unscientific propagation, and make people aware of the World Health Organization (WHO) as the reliable source of information for health emergencies to avoid a human crisis in the future.

“One Nation, One Health System”

Change is inevitable with time. When change happens, the needs, attitude, behavior, habits, etc., will also change. The same is the case with medical practices also. The public is well aware of the strengths and limitations of each medical system and is willing to accept multisystem or integrated systems of approach for their health needs. It is our duty to identify the strengths and limitations of each medical system and to complement the weakness of one system with the strengths of the other system. We aim to provide a holistic approach to alleviate suffering. It can be said that an ailing person is ready to seek advice irrespective of “pathy” or qualification and accepts medical pluralism, including advice from folk practitioners or tribal practitioners. In this method, where the patients seek pluralistic medical advice, there is a waste of time and money in consulting different systems. Also, there are chances of overdosage or synergetic or antagonistic actions of medicines. Unified medical practices that provide all types of medical services at one contact point ensure the utilization of the strengths of all medical systems at the same place, which would ultimately benefit patients. The unification or integration of medical practice needs to be done at a multilevel, and the medical systems should also be available as parallel services. The broad avenues of integration are at the practice level, medical education, and research. Integration is the key to having a patient-centric approach. The integration of medical systems has difficulties but is not impossible. Coordinated, collaborative, and accessible health care is inevitable in a patient-centered approach. Medical professionals from different systems must align their vision and values to benefit patients by crossing pathy barriers with openness. With unified medical systems in the “Indian Health Care System,” India can advance to be a global leader in the healthcare sector.

Strategic Planning for Clinical Services in Indian Health Care System

Strategic Planning for Clinical Services in Indian Health Care System

Traditional Medicine as a part of Indian healthcare system: Challenges and Recommendations

Traditional Medicine (TM) is a system of medicine which is a combination of medicine theories of various cultures, which can help in health maintenance, diseases prevention and diagnostics. But this system of medicine has not been globally recognized and accepted, due to numerous reasons including, lack of research, technology, funding etc, the present review focuses on discussing the gaps and limitations at both academic and administrative level in acceptance of TM as a part of Indian Healthcare system. Certain in vivo and in vitro studies have been discussed in the present review which have shown the beneficial effects of TM of various heath conditions. Based on the discussed studies and limitations, the authors have further proposed certain recommendations which includes documentation, national policies and academics that can be helpful in implementation of TM as a part of Indian healthcare system. Through the present study the authors have proposed that TM is an important healthcare system, and this can be combined with the conventional medicine to reduce the burden on healthcare system in India.

A New Strategy for Rejuvenating Primary Healthcare: The Government-Society Partnership Model.

Primary healthcare systems worldwide are under stress as increased demands during pandemic surges have exposed deficiencies in the system. Primary healthcare centers have significant responsibilities but are often underfunded and understaffed. Recent events, including the COVID-19 pandemic, have highlighted the importance of a strong primary health center network to promote community health and save lives. Most governments have multiple competing financial needs for scarce resources, ultimately limiting the advancement of government primary healthcare systems. Hence, various models involving collaboration and outsourcing have been evaluated and employed to improve primary health services. We propose and describe a sustainable and scalable government-society partnership model to bridge the gulf and rejuvenate primary healthcare with a focus on the Indian healthcare system. The involvement of key stakeholders, including society, non-government organizations, and corporate sponsors, is essential to rebuild the network.

Talking about death and dying: A delicate balance between the physician, patient, and their family caregivers

We thank the authors, Shah and Tiwari, for their evocative paper on passive euthanasia within the Indian healthcare setup.[1] The paper contributes to the larger discourse on the ethical dilemma of the right to die with human dignity. It highlights the need to initiate a dialogue within the Indian healthcare system regarding the introduction of communication skills for physicians and the practice of seeking healthy (and legal) consent when providing a diagnosis to the patient and their caregivers. This grants them the agency to actively participate in determining the quality of both their life and death. To ease the dilemma, the Indian Council of Medical Research Expert Group on “Do Not Attempt Resuscitation” (DNAR or passive euthanasia) highlighted the importance of open communication between the physicians and the patient/family caregivers to enhance the decision-making process.[2] In order to encourage open communication among the triad (patients, family caregivers, and their physicians) involved in illness communication in the Indian medical setting, it is necessary to recognize two unique aspects. First, India being a collectivist society, the agency and responsibility of the patient, especially in the case of terminal illness, are primarily vested with the family caregivers. This often overshadows the patients’ agency and role in the decision-making about their own bodies.[3] The vulnerable state of the patients renders them dependent on their family caregivers, who act as consent providers in treatment and medical decisions.[4] Despite their need for information regarding their illness and treatment, the patients play a passive role in illness communication and decision-making. Acknowledging the narratives of the authors of the current paper, research suggests that to provide consent for medical decisions, family caregivers have to engage in pragmatic questioning.[1,4] Often the family caregivers are forced to make a choice between the patient’s quality of life or continuing medical care. This dilemma results in feelings of guilt among the family caregivers. It is therefore crucial to recognize and involve the family caregivers in end-of-life decision-making and interventions. Second, patients and their caregivers in India prefer that their physicians initiate illness and treatment discussions.[4] Therefore, it is essential for physicians to lead discussions on DNAR/end-of-life. However, medical education in India does not offer training for communication skills as part of the curriculum.[5] The ramifications of not offering such training programs are also hinted at in the current paper, wherein physicians expressed fear and hesitancy to initiate conversations about DNAR with patients and caregivers.[1] It is imperative that a communication skills training program be included for physicians to focus on breaking bad news and open dialogue to having end-of-life conversations.[6] Further, cultural sensitivity needs to be incorporated while developing end-of-life interventions for patients.[7,8] To this end, we believe that achieving dignity in death is a process that begins with initiating sensitive conversations from the physician’s end. Furthermore, open and collaborative communication between the patient, physician, and family caregivers is required to ensure an ongoing dialogue on end-of-life care. This may help normalize conversations on death with dignity, bearing in mind the unique challenges of the Indian medical setting. Financial support and sponsorship The third author, Matsungshila Pongener, is funded by the Ministry of Education, Government of India. Conflicts of interest There are no conflicts of interest.

Impact of COVID-19 Pandemic on Retinopathy of Prematurity Services in the Indian Public Healthcare System.

To analyze the impact of the COVID-19 pandemic on the retinopathy of prematurity (ROP) services at Special Newborn Care Units (SNCUs), which provide care for sick neonates in the Indian public healthcare system. A retrospective chart analysis of 508 babies screened for ROP at two SNCUs in West Bengal (India). We compared the data from the lockdown period (April, 2020-June, 2020; study arm) with the same period of the preceding year, 2019 (control arm). Out of the 508 babies, 187 were screened during the lockdown and 328 during 2019. The odds of developing ROP were 2.08 times (95% CI:1.25-3.48; P=0.002) higher during the lockdown period (35/187 babies; 18.72%) as compared to the previous year (34/328 babies; 10.37%). Also, the risk of sight-threatening ROP (ST-ROP) increased significantly during the lockdown (12/35 ROP babies; 34.29%) compared to the previous year (4/34 ROP babies; 11.76%) (odds ratio: 3.9; 95% CI:1.1-13.7; P=0.015). Notably, all babies with ROP during the lockdown presented more than 30 days after birth, compared to none in the previous year. All babies requiring laser therapy recovered completely in both groups. An increased odds of developing ROP, including ST-ROP, was observed during the COVID-19 pandemic. Delayed ROP screening, which was noted in all study eyes, can have a detrimental effect on long-term visual prognosis. The findings of our research call for modifying the present healthy policy framework to make it more adaptable to disruptions in healthcare services, given the cyclical nature of the worldwide COVID-19 pandemic.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Colorectal Cancer Screening: Ratios from Hemogram to the Rescue

Colorectal Cancers (CRC) are one of the top ten cancers to increase the burden on the health care system in India. Often patients experience symptoms after carcinoma has significantly progressed. Timely and accurate screening in the target population remains a challenge for clinicians.

Spatial and Structural Design of Anganwadi Center using ETABS and Sketch Up

Anganwadi is a type of rural mother and child care centre in India. It was started by the Indian government in 1985 as part of the integrated child development services program to combat child hunger and malnutrition. Anganwadi means "courtyard shelter" in Indian Languages. A typical Anganwadi centre provides basic health care. It is a part of the Indian public health care system. Basic health care activities include contraceptive counseling and supply, nutrition education and supplementation, as well as pre-school activities. Primary school is a school in which children receive primary or elementary education from the age of about five to twelve, coming after pre-school and before secondary school.Six services like Supplementary Nutrition, Immunization, Health check-up, Referral Services, Nutrition and Health Education and Pre-school Education are provided to children in age group of 06 Months to 06 years, pregnant women and lactating mothers.Despite decades of impressive growth, India has an acute shortage of doctors. The doctor population ratio in 2013 was 1:1800; the recommended level is 1:1000. Through the Anganwadi system, the country is trying to meet its goal of providing affordable and accessible healthcare to local populations. Anganwadi workers have the advantage over the physicians living in the same rural area, which gives them insight into the state of health in the locality and assists in identifying the cause of problems and in countering them. They also have better social skills and can therefore more easily interact with the local people. As locals, they know and are comfortable with the local language and ways, are acquainted with the people, and are trusted.

Safe radiological spinal intervention: A multicenter snapshot survey of musculoskeletal radiologists in the UK and India

Objectives: Research, knowledge, and technological advances have promoted minimally invasive image-guided diagnostic and therapeutic intervention. Such interventions are increasingly performed for musculoskeletal diseases by radiologists within outpatient settings. The objective of this study was to ascertain levels of safe practice among musculoskeletal radiologists in the United Kingdom and the Indian public health-care system, as defined by access to spinal surgeons and anesthetists during radiological spinal procedures. Material and Methods: An online cross-sectional survey of eight questions (multiple choice and free text) was circulated among musculoskeletal radiologists in the UK and India, to evaluate: (i) Image-guided practice among musculoskeletal radiologists. (ii) Types of interventions undertaken. (iii) Practice setting. (iv) Availability of supportive, backup access to spinal surgery services. Results: A total of 53 replies were received of which 43 (81.1%) were from musculoskeletal radiologists who perform spinal interventional procedures. Spinal biopsies and injections were the most common procedures performed by the 43 eligible radiologists (79.1% and 74.4%, respectively), with vertebroplasty and sacroplasty performed by only 16.3% and 11.6%, respectively. Less than half (46.5%) of musculoskeletal radiologists performing interventional procedures did so within a hospital setting with both a spinal surgeon and an anesthetist on site, 20.9% had an anesthetist on site but no spinal surgeon and 16.3% had neither on-site. Conclusion: Minimally invasive image-guided diagnostic and therapeutic intervention is a niche sub-specialty practiced by a few musculoskeletal radiologists. Enhanced resource allocation, skills training, and multidisciplinary service provision will ultimately minimize existing deficiencies, improving patient-related clinical outcomes, and quality of care.

Out-of-Pocket Health Expenditure Among Migrant Workers in India: A Narrative Review.

Migrant workers make significant contributions to host regions and economies in many nations, frequently working in vulnerable situations in crucial sectors like agricultural and food processing, transportation, health care, and construction sectors. India has one of the world's highest out-of-pocket spending rates, with a cost making up about 62.6% of total health expenses. Migrant workers face healthcare financing burdens due to medical expenses resulting in large out-of-pocket payments. This narrative review aims to gain insight into why migrant workers face out-of-pocket expenditures on health and explore the inclusion of migrant workers in the existing healthcare system in India. For the literature search, databases like PubMed and Google Scholar were used to find relevant articles. This review will be helpful from the public health perspective in illustrating the need for studies and research on the health rights of migrant workers, their healthcare finances, and the social protection of such vulnerable populations who are poor and marginalized. Due to various health disparities, migrant workers may incur unforeseen out-of-pocket costs for the household healthcare system. Health insurance enhances the likelihood of accessing healthcare and minimizes out-of-pocket expenses on inpatient services. Patients' visits to primary healthcare facilities are not increased by health insurance; hospitals remain the primary healthcare provider. Most interstate migrant workers remain unprotected and burdened by the cost of healthcare due to OOP payments in case of medical emergencies. The legal status is a crucial predictor of migrants' access to affordable and adequate health care in a country.

Impact of COVID 19 on the Healthcare Sector in India: An Economic Overview

Covid-19, one of the major catastrophes of this century, also known as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2,) struck the world and created havoc with its rapid spread. Started as a mere local transmission from the city of Wuhan, China in 2019 and spread throughout the world. The present study is solely based on secondary data and is conceptual in nature. This paper aims to understand various aspects of the economic challenges facing the Indian healthcare system and possible measures undertaken to overcome the impact of the Covid-19 pandemic in India. The purpose of this paper is to analyze the short-term and potential long-term effects of this pandemic on the Indian healthcare sector. The whole India was surprised and countries did not have time to carefully prepare to fight this pandemic. This study provided a comprehensive analysis of the outbreak of Covid-19 in India and its impact on the healthcare sector the epicenter of the challenge.

Ethical dilemmas of a freshly graduated rural clinician in Kerala, India: a personal reflection

Freshly graduated doctors are the lesser-known workhorses of the rural healthcare system in India. These rural clinicians confront numerous ethical dilemmas in their day-to-day life, which are quite different from the ethical issues they may have encountered during their medical training and internship at a tertiary care hospital. These include taking end of life decisions, breaking bad news, conflicts in the doctor-patient relationship, declaration of death, and counselling of patients or family attendants of terminally ill patients. Yet, the decisions they make during such challenging situations are often influenced by their undergraduate training and limited clinical exposure. This is a personal reflection on the ethical dilemmas that I faced as a young medical graduate, appointed as the resident medical officer of a rural hospital in Kerala, and how they influenced me in my early stages of clinical practice.

Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India.

To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults. We analyzed baseline data from adults (≥ 50years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change wasformally tested with the log-likelihood ratio test. Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.

A Comparative Review of ICMR, WHO, and EMA Guidelines for Good Clinical Laboratory Practices.

With the advancement of clinical research and the increased burden on laboratory services, there is an unmet need for guidelines regarding proper laboratory functioning and reliable data generation. Several organizations from all over the world have published guidelines for these clinical and research laboratories. Good Clinical Laboratory Practices (GCLP) are stepwise procedures aimed at strengthening the quality of test results produced by all clinical laboratories engaged in human sample analysis. In this article, we attempt a comparison of the GCLP guidelines recently issued by the Indian Council of Medical Research with the guidelines released by the World Health Organization and the European Medicines Agency. Also, we have included and discussed several suggestions that, if included, will lead to the strengthening of the laboratory practices used for both research and patient care for overall improvement in the Indian healthcare system.