Factors affecting the choice of health care utilisation between private and public services among the elderly population in India.

India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

Assessment of health management information system for monitoring of maternal health in Jaleswar Block of Balasore District, Odisha, India.

BACKGROUND: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. OBJECTIVE: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013-2014. METHODS: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. RESULTS: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. CONCLUSION: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.

Assessment of Private Homes as Spaces for the Dying Elderly.

AIM: This study makes an assessment of end-of-life care of the elderly in private homes in Kolkata, West Bengal, India. PARTICIPANTS AND METHODS: Primary data were collected from private homes which supported elder care through observation and semi-structured interviews with primary family caregivers of the elderly. RESULTS: The study finds that the major factors preventing private homes from providing adequate care to the elderly were architecturally inadequate housing conditions, paucity of financial support, and scarcity of skilled caregivers. Besides, considerable neglect and domestic abuse of the elderly was also found in some private homes. In addition, the peripheral location of private homes within public health framework and inadequate state palliative policy, including stringent narcotic regulations, accentuated the problems of home care. CONCLUSION: The study concludes by questioning the rhetoric of private homes as spaces for the dying elderly in Kolkata and suggests remedial measures to improve their capacity to deliver care.

Dying in intensive care units of India: Commentaries on policies and position papers on palliative and end-of-life care.

PURPOSE: This study critically examines the available policy guidelines on integration of palliative and end-of-life care in Indian intensive care units to appraise their congruence with Indian reality. MATERIALS AND METHODS: Six position statements and guidelines issued by the Indian Society for Critical Care Medicine and the Indian Association of Palliative Care from 2005 till 2015 were examined. The present study reflects upon the recommendations suggested by these texts. RESULT: Although the policy documents conform to the universally set norms of introducing palliative and end-of-life care in intensive care units, they hardly suit Indian reality. The study illustrates local complexities that are not addressed by the policy documents. This include difficulties faced by intensivists and physicians in arriving at a consensus decision, challenges in death prognostication, hurdles in providing compassionate care, providing "culture-specific" religious and spiritual care, barriers in effective communication, limitations of documenting end-of-life decisions, and ambiguities in defining modalities of palliative care. Moreover, the policy documents largely dismiss special needs of elderly patients. CONCLUSION: The article suggests the need to reexamine policies in terms of their attainability and congruence with Indian reality.

End-of-life Characteristics of the Elderly: An Assessment of Home-based Palliative Services in Two Panchayats of Kerala.

BACKGROUND: Home-based palliative services form the cornerstone of Kerala's palliative program. However, two issues need research: (a) whether family-homes can be considered as the locus of ageing and dying for marginal populations who experience deprivation and poverty and (b) whether the present delivery structure meets the needs of elderly population. These issues are examined in the context of two rural areas. The study explores end-of-life characteristics of the elderly - their sociodemographic status and living patterns, morbidity profile, and functional status. It also looks into the accessibility and utilization of palliative services and respondents' satisfaction with different components of the services. MATERIALS AND METHODS: A descriptive cross-sectional survey design is used. Data were collected based on the interviews of sixty service users sampled randomly from a roster of palliative care services. Semi-structured interviews were substantiated by personal field observations. RESULTS: The study has found people living under extreme financial distress with inadequate shelter and poor social security provisions. The health profile is characterized by high level of functional dependence. Many dependent widowed women were living alone without appropriate care and shelter. The palliative program as perceived by the respondents is characterized by few doctor visitations and poor frequency. CONCLUSION: The study concludes that home-based palliation in its present form does not promote good end-of-life care. It lacks an integrated approach with good service-mix. It raises serious questions on family-home as the locus of ageing and dying for marginal populations, and suggests need for restructuring of the palliative program.

Dissociated reality vis-a-vis integrative planning of AYUSH in Maternal Health Program: A situational analysis in Jaleswar block of Balasore district of Odisha, India.

Mainstreaming of AYUSH and revitalization of local health traditions is one of the innovative components of the National Rural Health Mission (NRHM) in the state of Odisha, India. In this study, an attempt was made to assess the potential of collocating AYUSH to improve maternal health services in tribal dominated Jaleswar block of the Balasore district. In addition, the study aimed at unearthing the underlying challenges and constraints in mainstreaming AYUSH and linking it with the Maternal Health Program. Review of the policy documents and guidelines, both central and state government, was made to assess the implementation of AYUSH in Odisha. Primary data were collected through interviews with AYUSH doctors, district and block level health administrators, and tribal women. The study revealed the inadequacy of basic amenities, infrastructure, drugs, and consumables in the health centers for integrating AYUSH in the delivery of maternal health services. Analysis of the job chart and work pattern of AYUSH doctors showed underutilization of their specialized knowledge to treat patients. Lack of continued medical education, standard operating procedures for treatment and spatial marginalization made suboptimal utilization of AYUSH services. This is unfortunate given the fact that such regions are economically underdeveloped and already have a distinct orientation toward indigenous health systems. AYUSH, on account of its holistic approach and proven cost-effectiveness, could be a viable option for improving maternal health in the region. The study concluded that although there is huge scope for integrating AYUSH in Maternal Health Program under the ongoing NRHM, the full potential is yet to be exploited.

The experiences of adolescents with thalassemia in West Bengal, India.

In disadvantaged settings, where medical and socioeconomic support structures are inadequately developed, adolescent thalassemic patient respondents (ATPRs) live a dismal existence. In this article, the authors explore the experiences of ATPRs in West Bengal, India, with a view to addressing the question of whether thalassemia can be considered a disability, using a qualitative research design involving a purposive sampling method. The authors conducted in-depth interviews with 36 patients. The findings show that culture and education play a major role in illness experiences. The consequence of thalassemia is extremely stressful, and patients face a variety of physical, psychological, and social problems. Considering these experiences, the study concludes that thalassemia might be officially considered as a disability in India, requiring a multiple theoretical as well as a multipronged intervention method to tackle it adequately.