ABSTRACT
CONTEXT: Arogyakiranam program, a state-run health entitlement scheme, caters to health care needs of 0 to 18-year-old children, in government hospitals of Kerala. Very few studies have been conducted in this regard. AIM: An interim analysis of the functioning of this program through stakeholder perspective facilitates understanding the mode in which the program is currently progressing, thereby paving way for bettering it further. METHODS AND MATERIAL: A qualitative study in three purposively selected districts of Kerala consisting of in-depth interviews was conducted across different levels of stakeholders including officials from different health care levels and beneficiary caretakers who bring their wards to these centers. RESULTS: The functioning of the scheme with regard to implementation, fund flow, monitoring, documenting, reporting etc., was found to be following a fine structure. The scheme provides financial risk protection to the beneficiaries' families. Perceived challenges were lesser public awareness of the scheme, the requirement of an updated guideline, funds, the need for the availability of specialists and other amenities. Complete electronic hospital proceedings, a separate account for the scheme, staff reorientation/training, more reviews, and appraisals were emphasized. The overall functioning of the scheme is found to be streamlined and highly fruitful in terms of catering to the child population in the state. CONCLUSION: Arogyakiranam program has proven to be a boon to its beneficiaries with nil out-of-pocket expenditure, providing an array of health care amenities, ensuring equity thereby relentlessly working towards universal health coverage.
ABSTRACT
CONTEXT: Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs. AIMS: To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry. SETTINGS AND DESIGN: A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry. METHODS AND MATERIAL: Data on sociodemographic details, selected risk factors of NCDs-alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using "Fagerstrom Addiction Scale" and "Alcohol Use Disorder Identification Test" scales, respectively. STATISTICAL ANALYSIS USED: Data were single entered using EpiData and analyzed using EpiData Analysis. RESULTS: Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence. CONCLUSION: Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.
