Vijay Kumar Tiwari

Cost of treatment for cancer: experiences of patients in public hospitals in India.

BACKGROUND To assess the treatment pattern and expenditure incurred by cancer patients undergoing treatment at government tertiary hospitals in India. MATERIALS AND METHODS A cross-sectional study of 508 cancer patients randomly selected from tertiary cancer hospitals funded by central/state governments located in major cities of five states in India, namely Kerala, Maharashtra, Rajasthan, West Bengal and Mizoram, during March - May 2011 was conducted. Information related to direct costs, indirect costs and opportunity costs incurred on investigations and treatment, major source of payment and difficulties faced by patients during the course of treatment was collected. RESULTS About 45% of the patients used private health facilities as the first point of contact for cancer related diseases as against 32% in public hospitals. About 47% sought private health facilities for cancer investigations, 21% at district/sub-district hospitals, and about 4% contacted primary health care facilities. A majority of the patients (76%) faced financial problems while undergoing treatment. CONCLUSIONS The results highlight the importance of involving the primary health care system in the cancer prevention activities.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka

Meeting the needs of HIV-positive pregnant women and their offspring is critical to India′s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent-to-child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT-RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Standards, Frameworks and Practices in Health Management Information and Evaluation Systems (HMIES) in Australia and India Lessons for Future Transition in India?

India has a long history of the Health Management Information and Evaluation System (HMIES). Though it has well served its purpose of administrative reporting, however, it has failed to provide relevant and sufficient information to users of health services, planners and policy makers as available information is fragmented, incomplete and sometimes inconsistent. The National Health Policies of 1983 and 2002 and the National Statistical Commission of India 2005 have laid down clear benchmarks for HMIES. In spite of several efforts in the past, the national HMIES does not fully conform to ‘International Data Quality Frameworks, Systems and Standard Practices’. In this article, efforts are made to compare information collection and governance system, its standardization and extent of utilization for decision-making in Australia and India and give recommendations to transform our national HMIES to be compatible with international standards, frameworks and practices.

Management and Implementation of Mukhyamantri Nishulk Dava Yojna in a District Hospital, Rajasthan: Perspectives, Issues and Challenges

The Mukhyamantri Nishulk Dava Yojna (MNDY) was started across the state since 02 October 2011 in order to distribute most commonly used drugs free of cost to all patients visiting the government hospital. To run the scheme, an advanced inventory management by the name of e-Aushadhi has been developed and implemented across all public health facilities (PHFs). Trained human resources and computers with printers and internet connectivity are provided. In this study, 183 patients and staff responsible for the implementation of the scheme and specialists were interviewed. The study revealed that patients and doctors were highly satisfied with the functioning of the scheme and they are getting the majority of the medicines prescribed by the doctor. The scheme has been able to reduce out-of-pocket (OOP) expenditure on medicines and increased hospital attendance manifold.

Predictors of Risky Sex Behavior among Adolescents in a Traditional Indian Society: Implications for Program Intervention Strategies

Objective: The purpose of the study was to assess the risk behavior and its effect on involvement in sex among school-going adolescents as a part of assessing implementation of Adolescent Reproductive and Sexual Health Scheme (ARSH) in a state of India. Methods: The sample covered 3069 randomly selected adolescents (students) from 9 th to 12 th standard in various government, private and missionary-run schools from two districts, namely, Aizawl and Champhai in the state of Mizoram. Results: It was found that more than one-third of adolescents (37%) accepted taking alcohol and 72% of adolescents accepted seeing pornographic movies. Nearly 23% respondents were aware about premarital pregnancy among friends and 7.5% were aware about complication due to unsafe abortion among them. About 10% accepted involvement in premarital sex and majority of them (70%) had premarital sex between age group 15 and 19 years and 54% never used condom. Influence of peer group who were taking alcohol, tobacco and drug and exposure to erotic materials was found to be the major risk factors for indulgence in unsafe sex practices among adolescents. Conclusion: Better awareness and counseling against tobacco, alcohol and drug abuse, and pornographic literature among adolescents is needed through school health education.