Healthcare Scenario: Health for All to Sustainable Development Goals

Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. There is a huge cross section of the population that continues to struggle to gain access to affordable good quality healthcare. Although the rich can access healthcare by paying large sums of money, the poor are under major threat of financial duress. In Primary health care level public share is more with affordable cost but with compromised quality while in tertiary level private share is more with quality but at high cost and is focused in urban areas. Government has started spending at tertiary care level (newer AIIMS) to broaden the care spectrum but without much improvement at primary health care level. Accountable health care remains challenge for middle and low income countries. Accountability refers to “the principle that individuals, organizations and the community are responsible for their actions and may be required to explain them to others” (1). Low levels of public health financing, supply side gaps, an acute shortage of human resources and the rising cost of healthcare continue to severely affect access, affordability and quality of health services across the country. These issues make difficult for the public sector to remain accountable. The government has been attempting to address two main challenges: to ensure that all citizens can access healthcare equitably and to ensure that healthcare is made available at an affordable cost and without compromising on quality. So three important pillars for effective HCDS are cost, Access & Quality.

Modified BG Prasad Socio-economic Classification, Update - 2019

Modified BG Prasad socioeconomic scale has been in use for determining the socio-economic status of study subjects in community-based health studies in India since 1961.It is an income-based scale and, therefore, constant update is required to take inflation and depreciation of rupee into account. For industrial workers (IW), the consumer price index (CPI) is used to calculate updated income categories at any given point of time, viz Jan 2019.

Modified BG Prasads Socio-economic Classification-2018: The need of an update in the present scenario

Modified BG Prasad socioeconomic scale has been in use for determining the socio-economic status of study subjects in community-based health studies in India since 1961.It is an income-based scale and, therefore, constant update is required to take inflation and depreciation of rupee into account. For industrial workers (IW), the consumer price index (CPI) is used to calculate updated income categories at any given point of time, viz Jan 2018. These details of the calculations involved will help many researchers to calculate specific income categories for their ongoing and prospective research work in current calendar year. On the Department of Labour website (www.labourbureaunew.gov.in), state-specific CPI values are also available and should be used to determine more accurate income categories. The current exercise is a step towards increasing the validity of use of classification with relevance to the current price levels and enabling a real time update for a considerable time in the near future. The health behavior of an individual or a community is interdependent on their socio-economic status. The concept of socio-economic status is widely used in medical sociology. The social standing of an individual or a family in the society can be measured by it. Therefore, is an important factor affecting the health condition of an individual or a family. (1) Socio-economic status has been defined as “The position that an individual or family occupies with reference to the prevailing average standards of cultural and material possessions, income and participation in group activity of the community”. The social status may be inherited, but in modern society it is achieved on the basis of occupation, income, type of housing and neighborhood, membership of the certain associations and organizations, material, possessions, etc. (2) In India, several methods or scales have been developed for classifying different populations based on their socio-economic status, viz. Parikh scale 1964, Shirpurkar scale 1967, Jalota scale 1970, Kulsherestha scale 1972, Srivastava scale 1978, Bharadwaj scale 2001. (3-8) Modified BG Prasad’s classification that is used for both urban and rural areas. Modified Kuppuswamy classification is used in urban and peri urban areas which considers the education of the head of family, occupation of head of the family and per capita monthly income.(9,10) Another classification for rural areas is Uday Pareekh classification which takes into account following characteristics namely caste

articleIndicators of maternal ‘near miss’ morbidity at different levels of health care in North India: A pilot study.

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Life Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.

An evaluation of oxidative stress in diabetes mellitus during uncontrolled and controlled state and after vitamin E supplementation.

OBJECTIVE: The study was conducted on 50 patients (10 insulin dependent diabetes mellitus (IDDM) and 40 non-insulin dependent diabetes mellitus (NIDDM) of recently diagnosed diabetes mellitus. The main objectives of the study were: 1. To evaluate oxidative stress at uncontrolled stage. 2. To evaluate the effect of optimal control on oxidative stress irrespective of type of drug therapy used. 3. To further evaluate the effect of vitamin E supplementation on oxidative stress after achieving optimal control. This was done in order to explore anti-oxidant effect of vitamin E. METHODS: Fifty patients of uncontrolled diabetes of less than 1 year duration and without any overt complications were studied. The parameters of oxidative stress included malonyl-di-aldehyde (MDA), reduced glutathione and vitamin E levels in the blood. They were done at three stages i.e. (a) In uncontrolled stage, (b) At controlled stage and (c) After 4 weeks of vitamin E supplementation in dosage of 400 mg daily. The parameters of control included fasting blood sugar < or = 140 mg%, post prandial < or = 200 mg and HbA1c < or = 7% (analysed by prepared kit). RESULTS: The significantly raised levels of MDA and decreased levels of reduced glutathione and vitamin E during uncontrolled stage of diabetes indicated free radical stress inducing lipid peroxidation. The significant fall of MDA and rise in reduced glutathione and vitamin E levels in blood after optimal control revealed its beneficial effect on oxidative stress. The levels were not normalised but still stayed higher than controls. After 4 weeks of vitamin E supplementation, further fall in MDA and rise in reduced glutathione suggested beneficial effect of vitamin E over and above the optimal control. Vitamin E estimation in blood at this stage did not constitute parameter of oxidative stress as it was provided from outside but was done to know the compliance of patients. Normalisation or near normalisation was not achieved with vitamin E therapy indicating persistence of oxidative stress. CONCLUSION: There was an evidence of oxidative stress in diabetes which decreased with optimal control and further declined after vitamin E supplementation indicating anti-oxidant effect of vitamin E alone. Normalisation of oxidative stress was not achieved. A further study is desired to study the effect of vitamin E for longer period at least 3-6 months before a definite conclusion is drawn.

Neurological manifestations of leukemia--clinical and pathological findings.

Out of 70 cases of leukemia studied, 19 had neurological manifestations. All cases were autopsied. Leukemic infiltrates and intracranial hemorrhages produced various neurological manifestations. In autopsied cases 37.2% showed infiltrative changes. Intracranial hemorrhages contributed to 20%, the cause of which were due to thrombocytopenia and leukostasis. Leukemic nodules, demyelination and astrocytosis, gliosis were also seen on histopathology.