Awareness to Action through Multi-Channel Advocacy for Effective Tobacco Control” in Karnataka. This project is funded through Bloomberg Initiative for tobacco control project of HRIDAY (Health Related Information and Dissemination Among Youth) and is simultaneously done in other four Indian states by different agencies.
In Karnataka, IPH is working in collaboration with Gramin Shikshan Charity Foundation to implement the project in five intervention and two control districts. Project aims to advocate for and build capacity of district level law enforcement officers and NGOs for effective tobacco control.
Various activities including state and district level need assessment (of govt officers and NGOs) and pre-compliance monitoring exercises have been undertaken. There will be district level training workshops and various advocacy activities before we do post-compliance monitoring exercises.
HESVIC is a three-year research project (2009-12) being implemented under the European Community Seventh Framework Programme (FP7).
The project aims to investigate stewardship and regulation as it relates to governance of health systems in policy and practice through a comparative study of three Asian countries – Vietnam, India and China. The project uses maternal health care services as a case study of stewardship and regulation. The goal is to support policy decisions in the application and extension of principles of accessibility, affordability, equity and quality coverage of health care in the three countries.
HESVIC partner organisations
Nuffield Centre for International Health and Development (NCIHD), Leeds Institute of Health Sciences, University of Leeds, UK
Hanoi School of Public Health (HSPH), Vietnam
Fudan School of Public Health (FU), Fudan University, China
Institute of Public Health (IPH), Bangalore, India
Department of Public Health, Prince Leopold Institute of Tropical Medicine (ITM), Belgium
Social Development and Gender Equity, Royal Tropical Institute (KIT), Netherlands
As a part of Health Inc’s Work Package 1 ‘Capacity building and research network’ led by ITM, the newsletter offers a step-by-step package of support throughout the lifespan of the project (2011-2014). Each Newsletter discusses a specific (sub)topic related to research on social exclusion/inclusion and provides key references for further reading.
Second in a series of three Health Inc Newsletters on focus groups. After having discussed the history of focus group discussions (FGDs) and their particularities in social research (Newsletter 5), the present Newsletter 6 goes for the answer on a practical question: how to get the most out of FGDs?
The fifth newsletter of the Health Inc Capacity Building & Research Network is out. With this edition, the newsletter moves towards discussing qualitative methods esp. focus group discussions and their role in exploring the ‘how’ and ‘why’ of social exclusion.
The fourth newsletter contains two interesting articles on conducting research among the socially excluded. Both articles talk about why and how should excluded people be involved in planning and implementing the study. This is important if one is to conduct ethical research that makes exclusionary processes visible and affects policy.
Discussing social inclusion, the twinned concept of social exclusion, with illustrations from Senegal, Ghana and India. Peru’s president is given the last word (actually his first); the turtle keeps quiet.
An overview of the term social exclusion traveling South, and concrete examples from the Health Inc study countries: India, Ghana and Senegal. Food for thought from BR Ambedkar to conclude, and the turtle’s name revealed.
An introduction to the Health Inc research consortium, to the Health Inc newsletter, and a very first introduction to the concept of social exclusion. A quote of Bertrand Russell to complete, and an unidentified turtle on top.
The Rashtriya Swasthya Bima Yojna (RSBY), along with the National Rural Health Mission (NRHM), is a flagship programme introduced by the central government in April 2008, to increase the breadth, depth and height of coverage so that ultimately universal coverage can be achieved.
Key features of this scheme are a systematic focus on the poor with an aim to try and cover all BPL families within a period of five years, covering more than 700 hospitalisation packages, thereby protecting the poor from major health shocks, and finally a cashless mechanism through the “smart card”. The RSBY is an excellent attempt at providing social protection in health for the vulnerable and poor in India.The scale of RSBY, its clear social purpose, as well as its original design also make the scheme a tremendous learning opportunity for social policy-makers in India and all over the world.
Hence, there is a need to study the RSBY in more detail and identify what works and what does not work, and also understand why. This is also an excellent opportunity to provide feedback to policy makers and managers of this scheme, so that the scheme can be further strengthened.
To study the impact of the RSBY scheme in Patan district of Gujarat state in terms of enrolment rates, access to quality hospital care and financial protection
To list and understand the issues with governance, enrolment, utilisation and monitoring of the scheme
Two dimensions are being studied and hence, two distinct methodologies are used:
To look at what is happening, a household survey will be conducted using a structured, closed ended questionnaire.
To understand why certain events are happening, qualitative methods like key informant interviews and focus group discussions will be conducted.
This study will assess the performance of the RSBY vis-a-vis enrolment, access to quality hospital care and financial protection. .All the three dimensions of universal coverage – the coverage of the BPL families, the depth of the RSBY package and the out-of-pocket payments will be considered during analysis and interpretation of results. The study results are expected to provide an explanation to policy makers and managers to enable them to make necessary corrective actions to improve the effectiveness and efficiency of the RSBY. The results will hence, be disseminated to stakeholders from district to national levels through a workshop and also to academicians, activists and policy makers via publications in peer reviewed journals.
Title – Socially inclusive health care financing in West Africa and India
Short title – Financing health care for inclusion
Project Acronym – Health Inc
Duration – 36 months
In most low- and middle- income countries (LMIC), out-of-pocket payments make up a large proportion of total health expenditure (on average 75% in Asia and 50% in Africa). At the international level, there is now a consensus that out-of-pocket payments for health care increase inequity and as a result, increased risk pooling is necessary. There has been a recent proliferation of health financing reforms in LMIC which aim to introduce prepayment at affordable prices for low socio-economic groups and targeted subsidies for indigents and other vulnerable groups. However, while such reforms have led to increased utilization of health care, it is often the case that the poor and informal sector continue to be excluded from coverage.
The research project Health Inc. (Financing health care for inclusion) puts forward the hypothesis that social exclusion is an important cause of the limited success of recent health financing reforms.
In four countries/states (Ghana, Karnataka, Maharashtra and Senegal), Health Inc. will employ mixed methods to analyse whether different types of financing arrangements not only overcome social exclusion to successfully cover poorer population groups but, crucially, also increase social inclusion by empowering socially marginalised groups. A multi-sectoral stakeholder analysis will additionally explore whether vulnerable population groups participate in policy making and whether their needs are represented and understood. Health Inc. will also identify and test policy recommendations.
This will be done through a process of comparing and contrasting policies across contexts in order to elicit lessons. Following this, local policy makers and population groups will be consulted in a feasibility analysis.
Using a wide range of media, Health Inc. will disseminate those lessons learnt among different target populations: local, national and international public health authorities, researchers and health and development cooperation actors in general. Health Inc. will also consolidate and expand international research networks and build the capacity of the partners in the consortium.
This blog is about what I observed and experienced as being one of the many, but the only male, attendants at a labor ward of the tertiary maternity hospital in Bangalore. This is in context of a minor (girl) with risk pregnancy who was admitted to and looked after by urban health project team after she was found to be in labor for 24 hours by our community health assistants at her in-law’s home. There was no support from family.
Roopa, my senior colleague, managed to assist in admission and investigations, following which the expecting mother was in what is called ‘clean’ labor ward (yes that’s how it is officially called). I took over duty as patient’s attendant from Roopa to be over night at hospital along with my other colleague, Amrutha (who joined me little later in night) so that I can do run around that may be needed in case of emergency.
For me, it was a first experience of being at labor ward. It was a very busy scene there due to sheer number of cases to be handled by a few (post graduate medical student, an intern, a couple of Aayas) staff available. We witnessed some 15 deliveries that night. No attendant was allowed to accompany women in labor ward so we all were crowding near its entrance in the lobby where we were frequently shouted at by Aaya requesting us to be away. So only thing we can do is to sit in the lobby, hear screams of women from labor ward and wait till name of the woman who delivered is announced. It must be scary for women inside as they were lined up inside the ward and I suspect they were able to see other woman delivering.
Among all these, suddenly just past the midnight, a spiritual leader from the near by Mosque started praying in a loud tone just at the entrance of labor room for a new born baby just delivered by a muslin woman. To my surprise, staff did not interfere and did not pay much attention. But it took many women waiting outside the ward with surprise. Later, from long conversation with this gentleman who taught me meanings of prayers that I used to hear a lot in KG halli, I understood that this was a normal happening and he used to visit the ward often. Things were just back to normal and a doctor (all of whom happened to be women) came walking from another end of the ward with a blood covered new born in her hands. This stunned every one of us waiting in that corridor, with our eyes fixed to the baby and I heard many asking each other, “is that a live or dead baby?”
Few hours passed by and I realized that this was not the place for a man to be. Every half an hour, a security guy or Aaya will walk the corridor and drive out attendants especially men (as only one female attendant is expected to be there). I had to repeatedly explain that I needed to be there, being the only attendant. To qualify as sole attendant, I sat apart from Amrutha as if we did not know each other. Also I came to know to my surprise that there is no toilet for men in this hospital. I got familial with all the corners of the hospital in search of this sought after place and was finally directed by security guy to go out in the dark.
By 12.45 am, o
ur young mother delivered a male baby through normal delivery. What a happy news! Then came a challenge of keeping the baby with me till morning. Attendant has to sign the form taking responsibility of the baby as baby kidnapping incidents have been reported in past. This is where completely unrelated women in the corridor showered empathy and help. They helped me wrap baby with available cloths and taught me to handle the baby well, while explaining what they were doing in Tamil/Kannada – though they knew I do not know these languages. Most women who passed by asked one question “yenu magu”, and I soon learned to answer “gandu magu (male child)”. Some one asked “nimda?” (yours?). In fact some imagined me as driver of Amrutha’s car!
Finally by around 4.30 am when mother was shifted out from the labor ward, some strange guy with camera appeared from the dark end of the corridor asking to unwrap the baby and adjusting mother in a specific pose! I later understood he takes photos so that by the time of discharge, a computerized birth certificate can be handed over with photo and other details.
It was a night that made me wiser. I leant about maternity services; how to handle a newborn; few things about Islam; challenges of huge work load that few health staff somehow manages; and humanity of a common man. By early morning, I located a Sulabh Shouchalaya (public toilet) in the campus of the nearby hospital only to find me in a queue waiting for a manager to complete ‘Aggarbattis and routine chores’ before he can open the facility for us.