BackgroundParticipation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts.DesignA questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1.ResultsKnowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting.ConclusionsThe high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted.

Abstract:The Indian city of Pune witnessed rapid growth and deep transformation processes in the last three decades. This paper assesses past developments and recent structures and processes against the concept of urban sustainability. Following an overview of the historical development, the dimensions of sustainability are discussed separately, based on empirical findings. Urban growth puts enormous pressure on Pune's land and water resources, changing the ecology of the area. The increasing water demand of Pune's growing population competes with growing energy and water demands. An assessment of future climate change impacts indicates that the storage capacity of the reservoirs is more frequently not met during the rainy season. In addition, extreme dry years can aggravate the effects of land use change on water resources in the future. The city's growth and especially the large in-migration has also changed Pune's social fabric significantly. Wealth is distributed unevenly in the city and social disparities can be observed along two fault lines, namely along classes and caste groups. The population development and the increasing socioeconomic polarization are linked to the economic development of the city. Pune's formal economy has a robust base. However, as in many cities of the Global South, the informal economy is the most relevant source of income for large parts of the population. Pune's development is challenged by informality, poor infrastructure and inadequate planning and governance. Recently new approaches towards urban renewal and smart city development were launched. These new approaches aim at overcoming blockades in the traditional planning. A special challenge for urban planning is the transformation of urban fringe areas of the city, as this process is currently taking place in an unsustainable manner. The paper concludes that urban development has to become holistic, integrative and participative and should abandon the stereotype vision of the world class city in favor of a sustainable, locally adjusted pathway of development.

Urban sprawl and population increase are fundamentally transforming periurban areas in the Global South. These areas often suffer from inadequate environmental planning, resulting in water sources being overexploited, degraded, and redistributed. These processes affect water-based livelihoods due to disadvantages in water access and inadequate water governance. On the positive side, these transformation processes are leading to alternative water-based livelihoods. We systematically review and critically comment on the literature on water-based livelihoods in periurban areas of the Global South to provide the current scientific knowledge on this topic. Transformations of water-based livelihoods in periurban areas were also evaluated in terms of their sustainability. We conclude that rapid developments of periurban areas contain threats and potentials for water-based livelihoods and some emerging water-based livelihoods, whereas some emerging water-based livelihoods provide interim solutions for institutional supply gaps. Major lacunae in research are the (1) lack of holistic approaches, which address social dimensions of transformations, (2) the lack of studies applying a differentiated perspective on neighbouring areas within the urban fringe and (3) a lack of knowledge on emerging (water-based) livelihoods.

BackgroundPrivate practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities.MethodsLiterature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed.ResultsThe current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance.ConclusionThe issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2476-9) contains supplementary material, which is available to authorized users.

India’s urbanisation results in the physical and societal transformation of the areas surrounding cities. These periurban interfaces are spaces of flows, shaped by an exchange of matter, people and ideas between urban and rural spaces—and currently they are zones in transition. Periurbanisation processes result inter alia in changing water demands and changing relations between water and society. In this paper the concept of the hydrosocial cycle is applied to interpret the transformation of the waterscapes of six periurban villages in the fringe areas of Pune, Hyderabad and Kolkata. In doing so, three specific aspects will be investigated: (1) the institutions shaping the hydro-social cycle, (2) the interplay between water as a livelihood-base and the waterscape, (3) the interplay between the waterscape and water as a consumption good. This approach opens new views on periurban interfaces as emerging mosaic of unique waterscapes. The meaning of water, the rights to access water and the water related infrastructure are constantly renegotiated, as permanently new water demands emerge and new actors enter the scene. Especially this process-based understanding links the theoretical lens of the hydrosocial cycle with the object of investigation, the periurban space.