Multiskills training of medical doctors in India: Experience from Rajasthan.

Background. The Government of India has been conducting multiskills training programmes to address the shortage of specialized human resources in gynaecology and anaesthesia for maternal and child healthcare. There has been little evaluation of the operation of these programmes, though several years have passed since their introduction. Methods. We did a cross-sectional study to assess some aspects of the multiskills training programmes in gynaecology and anaesthesia, and the utilization of human resources trained under this scheme in Rajasthan. The analysis was primarily based on a review of records of postings of doctors obtained from the Department of Health and Family Welfare, Government of Rajasthan. Information was also obtained through qualitative interviews with 122 doctors from 14 districts of the state, irrespective of their training status. Results. In 2012, a total of 302 anaesthetists and 480 gynaecologists were posted in various public health facilities in Rajasthan. Of these, 128 (42%) anaesthetists and 69 (14.4%) gynaecologists had received multiskills training. However, only 57% of trained doctors were posted at health facilities for which they were trained. The acceptance of multiskills training among doctors was found to be low. Conclusion. Posting and deployment of personnel who had received multiskills training was often inappropriate, leading to suboptimal utilization of the skills acquired during such training and suboptimal delivery of public health services. Accreditation of the multiskills training programmes by regulatory bodies such as the Medical Council of India may improve the acceptance of such training among MBBS doctors and their colleagues. There is a need to review multiskills training programmes.

Positioning of Fortified Products for Behavior Change: Research Insights from India.

Objectives: Food Fortification program is being implemented in Rajasthan, India by fortifying milk, flour and oil with essential micronutrients. The challenge is to make food fortification commonplace so that it can address the devastating effects of vitamin and mineral deficiencies, particularly among the vulnerable populations. The objective of the study was to develop appropriate positioning strategy for fortified foods. Methods: A cross sectional descriptive research design was used to assess the buying behavior and perceived costs and benefits of the consumers towards fortified products. A total of 1011 respondents were interviewed across four cities of Rajasthan. Using Kuppuswamy’s socio economic scale (2012), the analysis was done as per socio-economic class. Using Rothschild’s framework (1999) which helps in describing the relationship between various activities in terms of individual decision-making and perceived costs and benefits, positioning strategies were identified to create continuous demand for the fortified products from the consumers’ side. Results: It was found that about 63.6% were consuming wheat grains. Of this, 62% and 51.9 % reported trust and purity as the reason behind using grains. Of those who were buying flour, majority (46.5%) attributed the reason to less time consumption and about 34% were made aware of the current brand by the retailer. Conclusions: Positioning fortified flour as a hallmark of purity and also which consumes less time could result in its acceptance. Retailers are required to be used as ambassadors for influencing the decision of the people. Selling and resistance points for fortified foods have been used for positioning.

Social Marketing Framework for Food Fortification: A Case from India.

Objectives: To design a strategic social marketing and communication framework for fortified foods which is acceptable to people from all socio-economic strata. Methods: Household level data was collected from 80 retailers (big, middle and small grocery store/shops) and 250 households from each of four cities of India using a cross sectional descriptive research design. Level of awareness and factors which influence buying of fortified food and the communication preference as per consumers and retailers was assessed to design suitable communication mix responsible for behaviour change. Results: Based on the findings of the study, a strategic framework of social marketing and communication strategies was proposed with reference to 4Ps i.e. fortified food products, their price, place and promotion. Of the total respondents, majority considered softness of chapatti (wheat bread) as the most important attribute and 57.9% bought it from retail outlet. A total of 50.9% have changed the brand and for 37.7%, irregular supply was the first reason for changing the brand. After being explained about fortified food, a huge 83.3 % of the respondents expressed their willingness to spend a little more for fortified food. For promotion, about 36.5%, 20.1% and 20.5% preferred TV, personal interaction and newspaper respectively. Conclusions: Only about 5 % of all respondents were aware of fortified food. The collected information was used to develop a strategic framework of social marketing and communication strategies with reference to (4Ps) i.e. fortified food products, their price, place and promotion using communication mix.

Dignity of women patients in health clinics.

This essay draws attention to violations of privacy and confidentiality in healthcare. It argues that such violations are experienced not only by rural women and beneficiaries of government health services but also by better-off women in private clinics in urban areas. It is possible that the occasional reports of such violations represent a fraction of the actual number of such incidents. There is an urgent need to recognise the problem and take corrective measures.