By ‘default or design’? The expansion of the private health care sector in Madhya Pradesh, India

Costa, Ayesha De; Johannson, Eva

doi:10.1016/j.healthpol.2011.06.005

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…The high maternal mortality ratio (437/100 000) and perinatal mortality rate (39.3/1000) observed in the study cohort suggest that the risk factors for adverse birth outcomes in this community are multifactorial, including a weak health system. Health systems challenges in Jharkhand also include insufficient access to care and potential treatment effects might be diluted by the high background rates of care seeking and treatment from the private sector 22 23…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India

et al. 2019

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BackgroundThe control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP.MethodsA cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18–28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine–pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia.ResultsBetween April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints.ConclusionISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India

et al. 2019

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“…Wherever there is higher economic growth, the private sector -usually restricted to urban areas - also spread to rural areas [ 41 ] such as Gujarat. One of the reason for this growth in the private sector is the underfunding and underperformance of the public sector [ 42 ]. Gujarat has more than 2,000 obstetricians registered in the Gujarat section of the Federation of Obstetricians and Gynaecological Societies of India.…”

Section: Discussionmentioning

confidence: 99%

The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach

Sharma

Giri²,

Christensson

et al. 2013

BMC Int Health Hum Rights

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BackgroundUnder the National Rural Health Mission, the current emphasis is on achieving universal institutional births through incentive schemes as part of reforms related to childbirth in India. There has been rapid progress in achieving this goal. To understand the choices made as well as practices and perceptions related to childbirth amongst tribal women in Gujarat and how these have been influenced by modernity in general and modernity brought in through maternal health policies.MethodA model depicting the transition in childbirth practices amongst tribal women was constructed using the grounded theory approach with; 8 focus groups of women, 5 in depth interviews with traditional birth attendants, women, and service providers and field notes on informal discussions and observations.ResultsA transition in childbirth practices across generations was noted, i.e. a shift from home births attended by Traditional Birth Attendants (TBAs) to hospital births. The women and their families both adapted to and shaped this transition through a constant ’trade-off between desirable and essential’- the desirable being a traditional homebirth in secure surroundings and the essential being the survival of mother and baby by going to hospital. This transition was shaped by complex multiple factors: 1) Overall economic growth and access to modern medical care influencing women’s choices, 2) External context in terms of the international maternal health discourses and national policies, especially incentive schemes for promoting institutional deliveries, 3) Socialisation into medical childbirth practices, through exposure to many years of free outreach services for maternal and child health, 4) Loss of self reliance in the community as a consequence of role redefinition and deskilling of the TBAs and 5) Cultural belief that intervention is necessary during childbirth aiding easy acceptance of medical interventions.ConclusionIn resource poor settings where choices are limited and mortality is high, hospital births are perceived as increasing the choices for women, saving lives of mothers and babies, though there is a need for region specific strategies. Modern obstetric technology is utilised and given meanings based on socio-cultural conceptualisations of birth, which need to be considered while designing policies for maternal health.

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“…Evidence on the adequacy of health insurance in financing health care and health care access showed mixed results. 14,15,16,17 Examining the effectiveness of the pro-poor public-funded insurance schemes especially RSBY, studies show that these insurance schemes failed in providing financial protection to the poor. 5,18,19,20 However, these studies were limited only to RSBY.…”

Section: Introductionmentioning

confidence: 99%

How effective health insurance schemes are in tackling economic burden of healthcare in India

Mahapatro¹,

Singh

2018

Clinical Epidemiology and Global Health

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By ‘default or design’? The expansion of the private health care sector in Madhya Pradesh, India

Cited by 15 publications

References 26 publications

Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India

Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India

The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach

How effective health insurance schemes are in tackling economic burden of healthcare in India

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