Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM)

Background Continuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16. Methods We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. Results The study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother’s education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable. Conclusions Our study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and granting greater power to the states might lead to equitable distribution of CMHS.

AN ECONOMIC ANALYSIS OF AWARENESS ON RURAL HEALTH PROGARMMES IN MUDIKANDANALLUR VILLAGE, SRIMUSHNAM TALUK,CUDDALORE DISTRICT,TAMILNADU

World Health Organization (WHO) defines adolescence as the period of life between 10and 19 year of age. The adolescent experiences not only physical growth and change but also emotional, psychological, social, and mental change and growth. Physiological changes change lead to sexual maturity and usually occur during the first several year of this period. Adolescence represents a window of opportunity to prepare for a healthy adult life. The world’s adolescent population-1200 million persons, 10-19 year of age or about 19% of the total population-faces series of serious challenges not affecting their growth and development but also their livelihood as adults. Yet adolescents remain a largely neglected, difficult-to-measure, and hard-to-reach population, in which the needs of adolescent girls in particular are often ignored. Adolescence is period of increased risk taking and therefore susceptibility to behavioural problems at the time of puberty and new concerns about reproductive health. Majority of adolescents still do not have access to information and education on sexuality, reproduction, and sexual and reproductive health and rights, nor do they have access to preventive and preventive curative service. Commercial innovation to address health needs at the bottom of the pyramid for more than 800 million men, women and children across India living on USD 1-3 ADAY, the idea if accessible and affordable medicine is often as remote as their rural homes. Arogya Parivar (“health family’’ in Hindi) is a for-profit social initiative developed by Novartis to reach the undeserved million living at the bottom of the pyramid in rural India. After just years, Arogya Parivar is proving to be both a force for improving rural health programme in rural community and a sustainable business.

Pattern of road traffic injuries among individuals attending a rural health training center in Tamil Nadu

Background: Road traffic injuries (RTIs) are a leading public health problem. Approximately 1.3 million people die each year as a result of road traffic crashes as of June 2021. RTIs cause considerable economic losses to individuals, their families, and to nations as a whole. 93% of the world's fatalities on the roads occur in low-and middle-income countries. This study aimed to assess the pattern of RTIs among individuals attending a rural health training center in Tamil Nadu.Methods: The present study was a record based cross sectional study comprising of 113 patients who attended an outpatient department in rural health training center in Tamil Nadu from January 2021 to June 2021.We collected socio-demographic data (age and sex) and pattern of injuries from the database. We entered data in excel sheet and analyzed using SPSS version 21.0.Results: Mean (±SD) age of the patients was 34.2(±18.46) years. Most common pattern of injury was abrasion 98 (86.7%), followed by contusion 28 (24.8%) and laceration 14 (12.4%) respectively. Most RTIs required dressing 106 (93.8%) while 13 (11.5%) needed suturing.Conclusions: The present study showed that RTIs were more common in the younger male population. Abrasion was the most common type of injury reported.

Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States

Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this manuscript, we deconstruct the definitions and narratives of “rural” communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Online multidisciplinary integrated rural healthcare education programs during the COVID-19 pandemic for students from different universities: experiences and guidelines

PurposeThe COVID-19 pandemic has led to “forced innovation” in the health education industry. High-quality training of the future rural health workforce is crucial to ensure a pipeline of rural health practitioners to meet the needs of rural communities. This paper describes the implementation of an online multidisciplinary teaching program focusing on integrated care and the needs of rural communities.Design/methodology/approachA multidisciplinary teaching program was adapted to allow students from various disciplines and universities to learn together during the COVID-19 pandemic. Contemporary issues such as the National Aged Care Advocacy Program for Residential Aged Care COVID-19 Project were explored during the program.FindingsThis case study describes how the program was adopted, how learning needs were met, practical examples (e.g. the Hand Hygiene Advocacy within a Rural School Setting Project), the challenges faced and solutions developed to address these challenges. Guidelines are proposed for remote multidisciplinary learning among health professional students, including those in medical, nursing, pharmacy, dentistry, and allied health disciplines.Originality/valueThe originality of this program centers around students from multiple universities and disciplines and various year levels learning together in a rural area over an extended period of time. Collaboration among universities assists educators in rural areas to achieve critical mass to teach students. In addition it provides experiences and guidance for the work integrated learning sector, rural health workforce practitioners, rural clinical schools, universities, policy makers, and educators who wish to expand rural online multidisciplinary learning.