Surinder M. Bhardwaj

Access to Health Care A Conceptual Framework and its Relevance to Health Care Planning

Despite some serious past efforts to clarify its multiple dimensions and meanings, access to health care has remained a rather elusive concept, hampering the work of health care policymakers and professionals as they endeavor to effect meaningful health care reform. This article provides perhaps the most detailed clarification of the access concept, especially the crucial linkages among the various access dimensions, and presents a comprehensive conceptual framework for evaluation and planning activities as they relate to peoples access to health care services. The proposed conceptual model recognizes access as the outcome of a process involving the interplay between the characteristics of the health care service system and of potential users in a specified area, and moderated by health care related public policy and planning efforts. An elaborate typology of access, incorporating four pairs of access dimensions, is also derived. This atomization of the concept allows us to focus on specific aspects of the access to health care problem, and to develop precise outcome indicators of health system performance for evaluative purposes. Further, it enables the access concept and its pertinent dimensions to be put into proper perspective when assessing the health care access situation in a specific national or regional context. The relevance of the proposed access model and the typology to health care planning in general, and to spatial planning of health care service systems in particular; is also discussed.

Non-Hajj Pilgrimage in Islam: A Neglected Dimension of Religious Circulation

Emphasis by geographers on the study of the hajj to Mecca has resulted in the neglect of ziarat, or non-hajj pilgrimages to other Islamic holy places. Associated with saints, many of the Sufi order, and martyrs, these holy places attract a vast number of pilgrims. Non-hajj pilgrimages may also be considered symbolic of the regional cultural expressions of Islam, especially in the non-Arab countries. This preliminary study situates ziarat within a typology of Islamic religious circulation. It shows that ziarat is part of the dynamic tradition of religious circulation in Islam in various regions: North Africa, Shia areas of Southwestern Asia, Central Asia, and South Asia.

Attitude toward different systems of medicine: A survey of four villages in the Punjab—India

Abstract This study reports the type of medical practitioners and the system of medicine preferred by one hundred and four rural heads-of-households in four selected villages in Ropar District of Punjab (India). There are three main systems of medicine prevalent in the rural areas of Punjab; allopathy (modern or angrezi ), ayurveda (indigenous Indian) and unani (Ionian). The latter two are popularly called desi medicine. The practitioners of allopathy, ayurveda and unani are respectively called doctors, vaidyas and hakims . The four villages were selected such that one had a “broad range” of medical and health facilities, the second one had only a vaidya , the third one only a hakim and finally, the fourth had no physician at all. The results of the survey indicated, contrary to the views of many social scientists, that angrezi medicine and allopathic physicians were generally preferred over the desi (indigenous) medicine and its practitioners. The survey data were then classified to reflect the major caste groupings in the study area; the untouchables (scheduled castes), the landowning caste ( Jats ), and others. All groups showed a substantial preference for the angrezi system of medicine. Less than 4% of the sampled heads-of-households showed a clear preference for desi medicine. In none of the four villages was the indigenous physician preferred solely on the basis of either his ayurvedic or unani system of treatment. About a third of the sampled heads-of-households indicated that their preference for either angrezi or desi medicine would depend upon the particular malady. This suggests that the expectancy of cure is more consequential than a traditional commitment to a system of medicine. It is suggested that a culturally relevant classification of acute and chronic diseases, be developed to better appreciate the preferences of rural people for a specific system of medicine. The question of preference for the indigenous physicians also cannot be divorced from their social role in the rural milieu .

The Temple as a Symbol of Hindu Identity in America

For overseas Hindu communities, the temple became an important symbol of ethnic regrouping. From the indentured expatriates of sugar colonies of the colonial era through the recent, highly educated, Asian Indian immigrants to America, the Hindu temple has served as a place of worship and, even more importantly, as a symbol of heightened cultural identity. Although the role of the temple in the Hindu regrouping in the diaspora has been previously examined, this paper reexamines this process in America in light of new data. Preliminary results indicate that the Hindu temple is not only an important religious focus for American Hindus, but also has generated links between Indian and expatriate Hindus in new ways. In fact, vigorous temple building activity among all Hindu diasporic communities could lead to a renaissance in temple building and possibly in Hinduism itself. We examine the Hindu temple as a component of the Hindu regrouping process in the postindustrial American context.

Regional development and seasonality of communicable diseases in rural Andhra Pradesh, India

This paper explores the seasonality of morbidity due to communicable diseases in Guntur district in Andhra Pradesh, India. The district has been divided into development regions using cluster analysis. Seasonality of selected communicable diseases is then compared with the levels of development. It is shown that seasonality is most pronounced in the least developed region of the district. In the most developed region, seasonality of morbidity is low. The paper supports the general hypothesis that there is a decreased seasonality of illness as development takes place.

The Concept of Sacred Cities in Asia with Special Reference to India

Sacred places range all the way from small towns with a single religious focus to cities that symbolize in their microcosm the entire sacred cosmos of a particular religion. Small settlements with goddess temples, that attract thousands, sometimes hundreds of thousands of pilgrims at specific occasions, but are virtually deserted after the yatra (pilgrimage), share some common elements with cities which have large “sacred complexes” (to use Vidyarthi’ s term) or those that are known for their massive Kumbha fairs attended by millions of people.