I am a Lecturer at Makerere University College of Health Sciences, School of Public Health, Uganda. I am involved in training and supervising Master of Public Health Distance Education (MPH-‐DE) students at the College. Supervision of Distance Education students requires skills to enable the student benefit from the interaction with supervisor and for the supervisor to be able to deliver to the students’ expectations. As a Disaster Resilience Research Fellow, I have just completed a Distance /E-‐learning certificate course in Disaster Resilience Leadership (DRL).
Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” ICD-10,WHO, 1994.
It has been said that being pregnant and giving birth to a child is a joyous moment in a woman’s life. However where I come from, the prospect of dying during childbirth is an imminent threat that looms over every pregnant woman’s mind. It does not help that in India, even today, a large number of women deliver at home, with much higher figures in rural and remote areas.
When a woman dies during childbirth, she leaves behind more than a motherless child. The family is at risk of disintegration as a ripple effect. “Studies in developing countries indicate that the risk of death for children under five years doubles or even triples if their mother dies. Motherless children are likely to get less healthcare and education as they grow up. Girls, in particular, suffer because they are forced to drop out of school to look after their younger siblings. Maternal death is thus, almost inevitably, a double tragedy.”
For many maternal mortality is a particularly sensitive indicator of inequality. It is considered as a litmus test of the status of women, their access to healthcare, and the adequacy of the health care system in responding to their needs.
Jharkhand is one of the most underperforming states of the country. The maternal mortality ratio (MMR) in the state is much higher than the national average. In recent years there has been a drop in the MMR of the state of about 44%.
However there is still a long way to go. According to the third National Health and Family Survey in Jharkhand one could clearly see a gap in the health seeking behaviour among the women in different social groups during the antenatal care period. [5] More than a third of the marginalized groups do not have a single antenatal check-up during their pregnancy. Although more than half of women from the urban areas visit some type of healthcare facility (public, private, or trust) for delivery, in rural areas the percentage is only about 10 percent. This gap is also visible during the post natal care period. In rural areas in more than 80% of cases no pregnant women receives postnatal care services. This signifies that a major portion of the women do not undergo any type of postnatal check up, a period when the mortality rates are high.
When compared to other states in India, Jharkhand is amongst the ten worst performing states. Comparison with states which have a better MMR shows that a large number of deliveries in the better states are conducted by skilled birth attendants. This is not the case in Jharkhand. In addition to poor medical care, before, during, and after pregnancy, several factors play an important role in this situation. Low importance is given to women including reproductive care, and unfair customary practices which deprive pregnant women, lactating mothers, and infants of nutrition and food are prevalent in many areas of Jharkhand.
The definition above for maternal death is universally accepted and used for statistical enumeration. However more often than not the faces behind these numbers are forgotten. The agony women face during labour gets lost behind a big pile of paperwork. States like Jharkhand still suffer from problems that are not only due to medical methods.
Although at a national level we are improving in terms of the MMR and other maternal health indicators there are still states that are severely lagging behind. There are key equity issues such as social, economical, and geographical backgrounds that play important roles in maternal deaths. To nationally bring a change with respect to maternal deaths, the need of the hour is to help these low performing states improve and perform on par with other developed states.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
According to the 2011 census, approximately 400m of India’s 1.21bn population are “internal migrants.” These migrant communities in Indian cities constitute a large proportion of people living in urban slums.
Some of them have migrated from rural to urban settings as an entire family, others as parents, and some as individuals (the head of the household, for example). Some have become urban residents working in the construction industry, and they migrate back to their origin (homes) seasonally for agricultural work. Some migrate to escape civil conflict or domestic violence.
All face tremendous pressure to earn higher wages, as income opportunities in rural areas are very limited. Consequently, rapid urbanization in India has resulted in a high concentration of migrants in city slums.
Migrants are one of the most vulnerable groups in society, living in extreme poverty with low living standards; a lack of suitable housing, electricity, drinking water, sanitation, and cooking fuel; and without access to nutritious food, education, and healthcare.
Many migrant families will either have no identity documents, or government identity documents that are registered just to their place of origin. This means that without permanent residence in their current place of living, they’re not entitled to the services offered by state welfare schemes.
Because their families are living a nomadic life, children will often not have completed full immunisation or received health check-ups, increasing the risk of child mortality.
Two pregnant women I spoke to while visiting a slum in Bangalore say they didn’t receive regular antenatal and postnatal care. Indeed, many migrant women have home births (often because of a belief in following family tradition), which can adversely affect health outcomes for both mothers and babies, even if the local health centre is within walking distance.
If India is serious about achieving universal health coverage, it has to reach out to different parts of its population, including those on the move. The urban migrant community and their ability to access healthcare needs particular focus here.
Healthcare programmes should prioritise gathering data on these communities, which will result in the inclusion of many such migrant families and their children in government services. We need targeted health interventions and outreach efforts, which take into account the vulnerability of migrant women and children.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
It was estimated that nearly one million new cases of cancers will have been diagnosed in India by 2015, of which 0.67 million people are expected to die of conditions related to cancer. Cancer of the mouth and lungs in men, and cervix and breast cancer in women account for more than half of all cancer deaths in India.
Various health system weaknesses contribute to this state of cancer morbidity and mortality in India. In most cases the disease is diagnosed at a late stage when the effectiveness of known treatment options is low. Even if cancer is identified at an early stage, 50% of patients stop visiting hospitals after two or three cycles of chemotherapy due to the high cost of treatment. People still lack faith in cancer treatment options possibly due to very few early diagnoses and prevention stories making the news in India, especially in rural areas. There is a strong notion that even after spending huge amounts of money on treatment, the chances of survival are low. For example, consider a patient who is supposed to take Aromycin tablets every day. The cost of each tablet is approximately INR 800 (This is the equivalent of USD $12. In a largely poor country like India, daily wages are often less than half of this amount). So the monthly expenditure for a single medication alone (leaving aside other medications and fees for visiting a doctor) could be as high as INR 24000 (nearly USD $400) per month. In general cancer patients sometimes require three to 12 or more chemotherapy sessions, which can be a huge economic burden to an average Indian family.
Chemotherapy to treat cancer is out of reach for many Indians. It is not always covered under insurance which is a question of deep concern to many. As the new government at the centre in India is reassessing our country’s health policy, I feel we should evolve better strategies for improving coverage of cancer in insurance policies. Even better would be if the government itself would provide better financing arrangements for those who cannot afford the prohibitive treatment costs. The government ought to engage pro-actively with pharmaceutical companies, software companies, corporate hospitals, and universities to ensure that they contribute more to improving public health. This can happen through better governance, appropriate regulation, and partnerships with all sectors. In a country such as India, where cancer care is available, it is a pity if we cannot make it affordable and accessible to a large part of our population.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
The swine flu epidemic caused by a new strain of the influenza A (H1N1) virus became a public health problem in India in 2014 for the second time in the last decade. In 2009, it was categorised as a pandemic by the Indian government and all public health centres were advised to take strict measures to control it and prevent its recurrence in the future. However, in 2014 when it recurred, our public health system was unprepared.
India was one of many countries in the world that was affected by the pandemic in 2009.With 1178 deaths and more than 12,000 positive cases, the Indian health system struggled to cope with the impact. In comparison to 2009, in 2014 the total number of laboratory confirmed cases crossed the 33,000 mark and more than 2000 people died. Following 2009, the government had suggested compulsory preventive measures, which included vaccination. On enquiry, however, both the government and private hospitals did not have the vaccines in stock during the second epidemic. All the hospitals were out of stock due to the sudden increase in demand.
We conducted a study of 400 doctors, 120 nurses, and 400 people from the general population who were interviewed in the states of Delhi, Gujarat, Rajasthan, and Maharashtra, which were the areas worst affected by the epidemic. The interview questions covered topics aimed at assessing people’s knowledge of the symptoms of swine flu, the mode of infection, high risk groups, prevention, and immunization including the correct use of masks and tests.
80% of those interviewed had not even heard about the disease. When asked we got a broad range of answers on what the word “swine flu” means, ranging from the common cold to HIV/AIDS, which showed the sheer lack of knowledge about the condition. The data collected from doctors revealed that only 77.2% of doctors and only 71.4% of the nurses had knowledge about how to identify swine flu suspects.
Even simple questions such as asking about the correct way of wearing protective masks, which was advised by the government as a preventive measure revealed that close to 75% doctors, 74% nurses, and 89.25% of the general population were not able to answer it correctly.
As a nascent public health researcher, it was an eye opener. It helped me to understand the level of the seriousness of both the government and the private health sector when it comes to public health issues.
During this study, we observed that doctors do not always keep sufficiently up to date about new medicines and vaccinations available in the market, with 34.8% doctors unaware about high-risk groups while only 4% knew about the prevalence rate about this disease.
In my opinion this is just a manifestation of a deeper issue. On one hand high population density, especially in cities make us extremely susceptible to outbreaks and the spread of infectious diseases. On the other hand, severe unpreparedness makes it extremely difficult to curb the spread once such an event occurs. With a large and unregulated private sector where more than 70% of the population access healthcare, public health problems remain neglected. There is an overall lack of knowledge of the importance of being prepared for an event such as this. Even in public health systems, a lack of adequate infrastructure, insufficient resource supply, and inadequate monitoring leave us easily prone to such attacks.
The only way to address these issues is to spread awareness from the primary level and to make public health a part of general education. In addition to this, understanding the needs of the population, being prepared for such outbreaks with an effective public health system, and having regular audits to ensure preparedness, including following international guidelines, is essential to ensure that history doesn’t repeat itself when it comes to infections like swine flu.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
Live interaction of Student-teacher are very essential for engagement of students, especially, in an e-learning environment. Online learning is most effective when courses are led by a live teacher and students can interact with that teacher in real-time. The mere presence and active involvement of an instructor motivates students and helps them navigate challenging content, inspiring them to improve their performance. During such interactions, instructors bring in knowledge beyond the curriculum. Keeping this in mind, we organized a live hangout session with Prashanth, our subject matter expert and students of ePHM 2015. The students and Prashanth discussed on various topics like systems thinking, national health programmes, private sector regulation, etc. Here is a video of their interaction.
It was estimated that nearly one million new cases of cancers
The swine flu epidemic caused by a new strain of the influenza A (H1N1) virus became a public health problem in India in 2014 for the second time in the last decade. In 2009, it was categorised as a pandemic by the Indian government and all public health centres were advised to take strict measures to control it and prevent its recurrence in the future. However, in 2014 when it recurred, our public health system was unprepared.
