Pre-existing Community Research Articles

Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors.

Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay Early intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.

A qualitative needs assessment of human trafficking in Ethiopia: recommendations for a comprehensive, coordinated response

BackgroundHuman trafficking is a global human rights violation that has profound health, economic, and social impacts. There has been little investigation of service needs and response options for human trafficking survivors in Ethiopia. The purpose of this study was to understand the potential service needs and response options for human trafficking in Ethiopia from multiple stakeholder perspectives.MethodsWe conducted a qualitative needs assessment and used content analysis to analyze individual interviews with key stakeholder groups including service providers, academics, lawyers, and non-government organization (NGO) workers between the summer of 2015 – spring of 2016.ResultsIn total, 17 individuals participated and content analysis elicited four overarching themes related to post-trafficking needs, including mental health considerations, barriers and facilitators to providing survivor services, survivor service needs, and comprehensive care models.ConclusionsThis qualitative needs assessment suggests that trafficking survivors may require professional and community services throughout their trafficking experiences, including medical care, economic and job opportunities, legal advocacy, and mental health services. Interventions should harness preexisting community strengths such as Ethiopia’s “social healing system,” health extension workers, and mobile technology. Future studies should explore tailored interventions and comprehensive models of care implemented within the pre-existing healthcare, social service, and community structures.

Suicide risk during the COVID-19 pandemic

Although it is still too early and uncertain to accurately predict the outcomes of the COVID-19 pandemic on suicide rates, the main principles guiding suicide prevention during the pandemic are that 1) suicide is preventable, 2) the time for action for mental health is now, and 3) the worldwide concerted efforts ensure a better outcome. Although a unique universal effect of pandemic on suicide is unlikely, the current data suggest that the impact will vary over time and can depend on individual socioeconomic context, ethnicity and mental health, country economic power, and global collaborations to actively promote resilience and effective response, such as the International COVID-19 Suicide Prevention Research Collaboration.We need to address both emerging risk factors, and the potential increase of pre-pandemic risk factors for suicide. Moreover, the effective tackling of the issue requires a better understanding of the preexisting trends in suicide rates, more effective and comprehensive assessment tools, effective adjustment of previous evidence-based prevention strategies to the pandemic context, and the effective inclusion of social risk factors generating inequities in access to resources and care. Most universal strategies for suicide prevention are government-based, while selective and indicated strategies dwell on appropriate government funding of mental and social health care services; hence, the key role of policies driven by global collaborative research and spearheaded by governments in the effective tackling of suicide prevention during the pandemic. In Romania, the pandemic increased the impact of preexisting societal and community risk factors, along with barriers to appropriate family, community and professional help. Therefore, TelVerde Antisuicide emerges as an important means for suicide prevention. This resource provided by the Romanian Alliance for Suicide Prevention (a non-governmental organization) significantly improves suicide prevention on all levels, thus contributing to filling the gap created by the lack of a national, government-driven suicide prevention strategy.

“Even if it’s my story it can have your touch”: using dialogic processes as an entry point to a culturally responsive writing pedagogy

ABSTRACTWe argue that opening a space for dialogic, imaginative writing in the classroom can create entry points for a culturally responsive writing pedagogy (CRWP). We explore how collaborative writing for a pre-existing community digital platform (FundZa) and audience aids the implementation of CRWP in a creative writing course for South African education students.Data from a focus group evaluation show that the course generated a number of new literacy lenses which challenged students to rethink static, monolingual views of language and narrative as well as the kinds of literacies necessary for the creation of a good story. One of the most significant findings entailed a new appreciation of the role of multiple perspectives in the collaborative writing process and moves from a monologic view of writing towards a dialogic view. Many students were encouraged to take imaginative leaps towards unfamiliar cultural contexts and audiences, through peer collaboration, discussion and drafting.

Anthropogenic stressors affect fungal more than bacterial communities in decaying leaf litter: A stream mesocosm experiment.

Despite the progress made in environmental microbiology techniques and knowledge, the succession and functional changes of the microbial community under multiple stressors are still poorly understood. This is a substantial knowledge gap as microbial communities regulate the biogeochemistry of stream ecosystems. Our study assessed the structural and temporal changes in stream fungal and bacterial communities associated with decomposing leaf litter under a multiple-stressor scenario. We conducted a fully crossed 4-factor experiment in 64 flow-through mesocosms fed by a pristine montane stream (21 days of colonisation, 21 days of manipulations) and investigated the effects of nutrient enrichment, flow velocity reduction and sedimentation after 2 and 3 weeks of stressor exposure. We used high-throughput sequencing and metabarcoding techniques (16S and 18S rRNA genes) to identify changes in microbial community composition. Our results indicate that (1) shifts in relative abundances of the pre-existing terrestrial microbial community, rather than changes in community identity, drove the observed responses to stressors; (2) changes in relative abundances within the microbial community paralleled decomposition rate patterns with time; (3) both fungal and bacterial communities had a certain resistance to stressors, as indicated by relatively minor changes in alpha diversity or multivariate community structure; (4) overall, stressor interactions were more common than stressor main effects when affecting microbial diversity metrics or abundant individual genera; and (5) stressor effects on microbes often changed from 2 weeks to 3 weeks of stressor exposure, with several response patterns being reversed. Our study suggests that future research should focus more on understanding the temporal dynamics of fungal and bacterial communities and how they relate to ecosystem processes to advance our understanding of the mechanisms associated with multiple-stressor interactions.

Assessing the national capacity for disaster research response (DR2) within the NIEHS Environmental Health Sciences Core Centers

IntroductionDisaster research response (DR2) is necessary to answer scientific questions about the environmental health impacts of disasters and the effectiveness of response and recovery strategies. This research explores the preparedness and capacity of National Institute of Environmental Health Sciences (NIEHS) P30 Core Centers (CCs) to conduct DR2 and engage with communities in the context of disasters.MethodsIn early 2018, we conducted an online survey of CC Directors (n = 16, 69.5% response rate) to identify their DR2 relevant scientific assets, capabilities, and activities. Summary statistics were calculated. We also conducted in-depth, semi-structured interviews with 16 (69.5%) CC Community Engagement Core directors to identify facilitators and barriers of DR2 community engagement. Interview notes were coded and thematically analyzed.ResultsSurvey: While 56% of responding CCs reported prior participation in DR2 and preparedness to repurpose funding to support DR2, less than one third reported development of a disaster-specific data collection protocol, deployment plan, or concept of operations plan, participation in an exercise to test DR2 capacity, development of academic partnerships to conduct DR2, development of a process for fast-tracking institutional review board approvals for DR2, or maintenance of formal agreements with state, local, or community-based partner(s). A number of CCs reported developing or considering developing capacity in these areas. Barriers to, and tools and resources to enhance, CC engagement in DR2 were identified. Interviews: Four key components for community engaged DR2 were identified: pre-existing community relationships, responsive research that benefits communities, coordination among researchers, and coordination with community response partners. Several roles for, benefits of, and barriers to Community Engagement Rapid Response Teams (CERRT) were described.ConclusionsCCs have significant scientific assets and community partnerships that can be leveraged for DR2; however, additional planning is necessary to ensure that these scientific assets and community partnerships are leveraged when disasters strike.

Leadership and Factors Enabled the “Group Allocation” which Preserved Pre-existing Local Social Ties in Prefabricated Temporary Housing After Great East Japan Earthquake (GEJE)

Introduction:Social isolation and death alone in the prefabricated temporary housing after a disaster has been a social concern. The importance of social ties among the community has been suggested and several reports pointed out the positive effect of “group allocation” which preserves pre-existing local social ties compared to the “lottery allocation”.Japan Red Cross Society recommended “group allocation” as a better option than “lottery allocation” on their guidelines. However, many municipalities carried out “lottery allocation” for temporary housing arrangement after the Great East Japan Earthquake (GEJE).Aim:To collect the information about the accelerating factors and bottlenecks when practicing the “group allocation”.Method:In-depth interview was conducted between August and November 2013. Interviewees were the professionals of disaster management, individuals who were involved in arranging the prefabricated housing and the residents. This research was supported by the Ministry of Education, Culture, Sports, Science, and Technology in Japan.Results:This study found the municipality which carried out “group allocation” had characteristics such as: (1.) the staff in charge of housing arrangement had the information about the positive effect of “group allocation”, and (2.) pre-existing community leaders were able to gather residents’ opinions, and citizens were involved in the decision making to some content.Discussion:Although this study is based on the experience of a limited number of key persons, it would be useful to give the insight about the possible bottleneck for the practitioners who will be in charge of housing arrangement under the disaster setting in future. Also, the relevancy and evidence about “group allocation” should be carefully examined in the context of preventing social isolation as well as various long-term effects. It would be essential that the knowledge and experience will be accumulated and shared between municipalities in a usable and comparable format.

School Travel Planning with the Kahnawake Schools Diabetes Prevention Project: Partnership Perspectives

Despite several studies examining the impact of school active transportation programming, there is limited understanding about undertaking the process of planning and evaluation from the perspective of community stakeholders. Most importantly, programming is rarely undertaken within an Indigenous context, which requires understanding of unique characteristics, culture, and needs. This study combined community-based participatory research with methods of ethnography within the Kahnawake Schools Diabetes Prevention Project in the Indigenous community of Kahnawake, Canada. This study fully engaged community members, built on pre-existing community and researcher strengths and increased the knowledge and understanding of active transportation to support schools in programming and implementation. In particular, this study, which may be relevant to other Indigenous and non-Indigenous communities, shed light on stakeholder perspectives of undertaking school active transportation program planning, which can inform the practice and provide support to others currently or planning to undertake similar projects.

Tracking Replicate Divergence in Microbial Community Composition and Function in Experimental Microcosms.

The study of microbial community functions necessitates replicating microbial communities. Variation in community development over time renders this an imperfect process. Thus, anticipating the likely degree of variation among replicate communities may aid in experimental design. We examined divergence in replicate community composition and function among 128 naturally assembled starting communities obtained from soils, each replicated three times, following a 30-day microcosm incubation period. Bacterial and fungal communities diverged in both composition and function among replicates, but remained much more similar to each other than to communities from different starting inocula. Variation in bacterial community composition among replicates was, however, correlated with variation in dissolved organic carbon production. A smaller-scale experiment testing nine starting communities showed that divergence was similar whether replicates were incubated on sterile or non-sterile pine litter, suggesting the impact of a pre-existing community on replicate divergence is minor. However, replicates in this experiment which were incubated for 114days diverged more than those incubated for 30days, suggesting experiments that run over long time periods will likely see greater variation among replicate community composition. These results suggest that while replicates diverge at a community level, such divergence is unlikely to severely impede the study of community function.

Tabula non-rasa: go-along interviews and memory mapping in a post-mining landscape designated for urban expansion

ABSTRACTPeri-urban areas have long and diverse histories but when targeted for large-scale housing expansion, they are at risk of becoming a blank slate for development, a potential loss to both existing inhabitants and potential newcomers. In this paper, we develop a method to recover and narrate the sense of place of members of the pre-existing local community and map those memories onto specific locations and views within the landscape. Situated in a post-mining landscape on the edge of the city of Edinburgh, designated for urban expansion, our case study reveals the rich and diverse memories associated with seemingly ordinary landscape features; a stark contrast with the generic selling slogans and housing typologies presented by the developers. Deployment of methods like ours can help planners of urban redevelopment and expansion to better appreciate the sense of place of long-term residents and stimulate the process of place-making on new housing estates.

The Mobilizing Effects of Economic Threats and Resources on the Formation of Local Occupy Wall Street Protest Groups in 2011

This paper examines how threatening economic conditions and preexisting community resources facilitated the spread of Occupy Wall Street protest groups to more than 600 counties in the continental United States in 2011. Using a generalized linear mixed model, we find that economic threats and accessible resources are complementary facilitators of movement mobilization. But contrary to the expectations based on earlier media and scholarly accounts, the “disruptive threats” caused by the Great Recession failed to predict the formation of Occupy groups. Instead, groups were more likely to mobilize in counties that had the “positional threats” of relatively higher income inequality and relatively lower median incomes in comparison to state norms. However, the effect of positional economic threats was nuanced as counties with lower than average unemployment more likely had groups mobilized. In addition, resources continue to demonstrate empirical importance in explanations of social movement mobilization, as Occupy groups were more likely to form in counties with greater access to social-organizational and human resources. Combined, these findings suggest that scholars can strengthen their analyses by considering threats and resources as complementary facilitators of local protest mobilization and by focusing greater attention on how differing types of threats may influence the mobilization of social movements.

A Tale of 2 Constituencies: Exploring Patient and Clinician Perspectives in the Age of Big Data.

Background:Patient and clinician stakeholders are inadequately engaged in key aspects of research, particularly regarding use of Big Data to study and improve patient-centered outcomes. Little is known about the attitudes, interests, and concerns of stakeholders regarding such data.Research Design:The New York City Clinical Data Research Network (NYC-CDRN), a collaboration of research, clinical, and community leaders built a deidentified dataset containing electronic health records from millions of New Yorkers. Guided by a patient-clinician advisory board, we developed a question guide to explore patient and clinician experiences and ideas about research using large datasets. Trained facilitators led discussions during preexisting patient, community, and clinician group meetings. The research team coded meeting notes and identified themes.Results:Fully 272 individuals participated in 19 listening sessions (139 patients/advocates, 133 clinicians) at 6 medical centers with diverse NYC communities: 76% were female and 63% were nonwhite. Clinicians and patients agreed on all major themes including the central role of clinicians in introducing patients to research and the need for public campaigns to inform stakeholders about Big Data. Stakeholders were interested in using granular data to compare the care and clinical outcomes of their neighborhoods with others across NYC, but were also concerned that data could not truly be deidentified.Conclusions:Clinicians and patients agree on potential benefits of stakeholder-engaged Big Data research and provided suggestions for further research and building stakeholder research capacity. This evaluation demonstrated the potential of brief meetings with existing patient and clinical groups to explore barriers and facilitators to patient and clinician engagement.

Questioning the mental health effects of community-based interventions: evaluation of a women empowerment programme

This study conducted an empirical evaluation of a pre-existing women empowerment community programme purporting to address negative consequences of traumatic experiences and gender-based violence while facilitating posttraumatic growth. It was conducted in Tembisa, a South African township, with 103 women aged 18–56 ( M = 27.77, SD = 8.29). The women were assessed before the start of the programme. A 3-month follow-up assessed 70 women: 39 in the intervention group, 31 in the control group. Factors assessed included demographic information, traumatic experiences, depressive symptoms (Patient Health Questionnaire–9), and symptoms of posttraumatic stress disorder (PTSD Symptoms Scale–Interview for DSM-5). Results on the mental health measures indicated the general need for a programme supporting the women in coping with their challenges due to poverty, unemployment, and inequality in the community. Results suggested that the programme had little or even negative influence on the women’s functionality and mental health symptoms. The strong focus on traumatic experiences of the women empowerment programme seems to be inadequate for the specific needs of this target group. This article argues against the implementation of interventions without tailoring them to the specific needs of the target populations. A collaboration between researchers and practitioners is recommended to adequately pursue the goals of such programmes.

High-Performing Local Health Departments Relate Their Experiences at Community Engagement in Emergency Preparedness.

Local health departments (LHDs) are implementing a national mandate to engage community partners, including individuals, businesses, and community- and faith-based organizations in the larger public health emergency preparedness (PHEP) enterprise. Investigate how LHDs of varying size and resource levels successfully engage the community in PHEP to help uncover "best practices" that aspiring agencies can replicate, particularly in low-resource environments. In-depth, semistructured qualitative interviews with practitioners from 9 highly performing LHDs. Participating agencies comprised equal amounts of small (serving <50 000 residents), medium (serving 50 000-500 000 residents), and large (serving >500 000 residents) LHDs and were diverse in terms of geographic region, rural-urban environment, and governance structure. A cross section of LHD staff (n = 34) including agency leaders, preparedness coordinators, public information officers, and health educators/promoters. Local health department performance at community engagement as determined by top scores in 2 national LHD surveys (2012, 2015) regarding community engagement in PHEP. Based on key informant accounts, high-performing LHDs show a holistic, organization-wide commitment to, rather than discrete focus on, community engagement. Best practices clustered around 5 domains: administration (eg, top executive who models collaborative behavior), organizational culture (eg, solicitous rather than prescriptive posture regarding community needs), social capital (eg, mining preexisting community connections held by other LHD programs), workforce skills (eg, cultural competence), and methods/tactics (eg, visibility in community events unrelated to PHEP). For LHDs that wish to enhance their performance at community engagement in PHEP, change will entail adoption of evidence-based interventions (the technical "what") as well as evidence-based administrative approaches (the managerial "how"). Smaller, rural LHDs should be encouraged that, in the case of PHEP community engagement, they have unique social assets that may help offset advantages that larger, more materially resourced metropolitan health departments may have.

High Gut Microbiota Diversity Provides Lower Resistance against Infection by an Intestinal Parasite in Bumblebees.

The microbiome, especially the gut flora, is known to affect the interaction between parasites and their hosts. In this context, a parasitic infection can be viewed as an invasion into the preexisting microbial ecological community. Hence, in addition to the intrinsic defense mechanisms of the host itself, infection success depends on the colonization resistance of the microbiota. In the bumblebee Bombus terrestris, the microbiota provides resistance to the intestinal parasite Crithidia bombi, yet which properties actually provide protection remains largely unknown. Here, we show that the community structure of the gut microbiota-in terms of bacterial operational taxonomic units (OTUs) of 16S ribosomal RNA gene sequences-before parasite exposure can be informative of the eventual infection outcome. Specifically, higher microbiota OTU diversity is associated with less resistance. However, the microbial community structure does not differ between infected and noninfected individuals or between infected individuals of varying susceptibility. This suggests that parasite infection success depends on the microbiota composition but that subsequent changes occur, although the exact alteration that occurs remains elusive. In fact, the bumblebee microbiota is surprisingly unaffected by parasite exposure and infection. Rather, the microbiota-host interaction before parasite exposure seems to be a key mechanism regulating resistance to infection.

Evaluating community participation: A comparison of participatory approaches in the planning and implementation of new primary health-care services in northern Australia.

Community participation is increasingly seen as a prerequisite for more acceptable and sustainable health services. It is difficult to evaluate the extent of participation in health planning and implementation of services, and there are limited tools available to assist in evaluating such processes. Our paper reports on community participation as part of the implementation of 2 primary health programs in regional north Queensland, Australia. We define community participation as collective involvement of people, including consultation, from a community of place or interest in aspects of health service development. We pragmatically evaluate and compare the extent of participation by using a framework developed by Rifkin and colleagues in 1988 and subsequently refined. Data collected from the implementation of each program were analyzed and ranked on a spidergram against 5 process indicators: needs assessment, leadership, resource mobilization, management, and organization. Community participation was found to vary across the programs but was most extensive in both programs in identifying need and potential solutions. Both programs demonstrated high levels of integration of the implementation of health programs with preexisting community structures. Involving local communities in genuine opportunities in managing the programs and mobilizing resources was more challenging. Key differences emerged in the people involved in the programs, the settings and frameworks used to facilitate implementation. We conclude that Rifkin's process indicators are a useful starting point for assessing community participation, particularly for health planners who are required to include participatory approaches when planning and implementing services. We suggest areas that require further consideration.

'We All Work Together to Vaccinate the Child': A Formative Evaluation of a Community-Engagement Strategy Aimed at Closing the Immunization Gap in North-West Ethiopia.

The role of community engagement (CE) in improving demand for immunization merits investigation. The International Rescue Committee developed a CE strategy to implement a vaccine defaulter-tracing tool and a color-coded health calendar aimed at increasing uptake of immunization services in north-west Ethiopia (‘The Fifth Child Project’). We report findings from a formative evaluation of this project. In May/June 2016 we conducted 18 participant observations of project activities, 46 semi-structured interviews and 6 focus groups with caregivers, health workers, community members/leaders. Audio-recordings and fieldnotes were transcribed, anonymized, translated and analyzed thematically using inductive and deductive coding. Additional data was collected in November 2016 to verify findings. The project was suitably integrated within the health extension program and established a practical system for defaulter-tracing. The calendar facilitated personalized interactions between health workers and caregivers and was a catalyst for health discussions within homes. At the community level, a regulation exercise of sanctions was observed, which served as a deterrent against vaccine default. Pre-existing community accountability mechanisms supported the CE, although varying levels of engagement between leaders and health workers were observed. The benefits of shared responsibility for immunization were evident; however, more transparency was required about community self-regulatory measures to ensure health-related discussions remain positive.

From "celluloid comrades" to "digital video activism”: queer filmmaking in postsocialist China

Although homosexuality was decriminalised in 1997 and partially depathologised in 2001, LGBTQ issues are still strictly censored in Chinese media. With the rapid growth of China’s LGBTQ community, an increasing number of independent films featuring LGBTQ issues have emerged in the past two decades. In this article, I trace a brief history of queer cinema in the People’s Republic of China in the postsocialist era (1978 to present). In particular, I chart the significant turn from ‘celluloid comrades’, i.e. queer people being represented by heterosexual identified filmmakers in an ambiguous way, to what leading Chinese queer filmmaker Cui Zi’en calls ‘digital video activism’, in which LGBTQ individuals and groups have picked up cameras and made films about their own lives. In doing so, I unravel the politics of representation, the dynamics of mediated queer politics and the political potential of queer filmmaking in China. I suggest that in a country where public expressions of sexualities and demands for sexual rights are not possible, queer filmmaking has become an important form of queer activism that constantly negotiates with government censorship and the market force of commercialisation. Rather than representing a pre-existing identity and community, queer films and filmmaking practices have brought Chinese gay identities and communities into existence.

Quarante ans de suivi dans la steppe du Sud-Oranais (Algérie) : changements de diversité et de composition floristiques

Forty years monitoring in an Algeria alfa steppe in southern Oran Region (Algeria) : plant diversity and composition changes. The loss of plant diversity as a degradation feature in arid steppic rangelands is one of the crucial concerns in the southern Mediterranean countries. These rangelands are facing two interacting driving forces : the arid climate with recurring and more or less lasting droughts on the one hand, and overgrazing on the other. Long-term monitoring of change in diversity and composition of plant communities is considered to be the best way to understand the history and mechanisms of ecosystem degradation and desertification. Starting from a pre-existing community in which alfa (Stipa tenacissima L.) was the dominant and the keystone species regarding ecosystem structure and functioning, forty years monitoring allowed analysing changes in floristic richness, diversity and community composition prior attaining its current state of degraded and impoverished steppe.

Prevention of Grievances through AB-NHPM Policy Document Amendments (AB-NHPM: Ayushman Bharat-National Health Protection Mission)

Background: The NHPM is a central initiative targeting approximately 50 Cr deprived population of the country. When beneficiaries seek service from the providers, there is a chance for the raise of grievances. Whenever, a beneficiary faces any difficulty, it needs to be redressed through a dedicated system which is specially placed for this function, but efficient system will never wait for the grievances to arise but prevents it either at the stage of policy designing or implementation phase. Due to this reason, there is a need to study each clause of the policy document, and to know how it works during utilization by the policyholders. Objective: To identify the clauses in the ‘Model Tender Document.volume.2 for Selection of Implementation Support Agency for providing support services for the implementation of AB-NHPM’ which could be of concern to the stakeholders of the scheme? Methods: Secondary data analysis of newspapers, previous studies, and IRDAI’s regulatory documents for literature review. Results were obtained through review of ‘Model Tender Document.volume.2 for Selection of Implementation Support Agency for providing support services for the implementation of AB-NHPM’. Observations: The clauses related to pre-existing conditions, exclusions, emergency conditions and Community Health Centre (CHC) hospitals could be of concern to the stakeholders in the scheme and affect overall quality of the scheme. Conclusion: Firstly, although pre-existing diseases are covered, mostly people with chronic diseases require Out Patient Department (OPD) consultation, but OPD is excluded under this Scheme. Secondly, the clauses related to exclusions require clarification whether diseases related to alcohol, drugs and tobacco will be entertained or not because insurance companies are reluctant to cover. Thirdly, a few conditions related to emergency should be relaxed to the private hospitals in order to improve accessibility. Lastly, the CHCs hospitals will face difficulty in maintenance of MIS, resultant there could be problems with medical audit under the scheme.