International Journal of Health Systems and Implementation Research

Importance of GHG Accounting: A Public Health Imperative in Climate Action

Jaya Tiwari — 2024-06-30

‘Green House Gas (GHG) Accounting’, utilizing greenhouse gas protocols, is crucial in addressing the current pressing issue of climate change and its cascading impact on public health. This current editorial highlights the critical role of precise GHG accounting in identifying major sources of emission and how implementing targeted interventions and reduction in GHG emission can lead to significant public health benefits, including significant decrease in respiratory and cardiovascular diseases, demonstrating the importance of integrating data of GHG emissions and public health policies.

Vaccination Coverage and Inequalities in India (2011-2024)

Saritha Ala — 2024-06-30

Vaccination coverage in India has improved over the years, but significant inequalities persist across socioeconomic groups and geographic regions. According to the latest National Family Health Survey (NFHS-5) data from 2019-2021, the full immunization coverage among children aged 12-23 months was 76% at the national level, an increase from 62% in NFHS-4 (2015-16). However, there are stark disparities across states, with some states like Assam (59%) and Uttar Pradesh (63%) lagging far behind others like Andhra Pradesh (90%) and Lakshadweep (97%). Socioeconomic factors such as household wealth, mother's education, and rural/urban residence play a significant role in determining vaccination coverage. Children from the poorest households (65%) and those whose mothers have no schooling (65%) have much lower full immunization rates compared to the richest households (84%) and those with mothers having 12 or more years of schooling (88%). Studies have consistently shown a disproportionate concentration of unvaccinated or partially vaccinated children among lower socioeconomic strata, with factors like poverty, illiteracy, and lack of access to healthcare contributing to these inequalities. Addressing these inequalities requires targeted interventions focusing on improving healthcare access and educational opportunities for disadvantaged populations.

India's Public Policy Guidelines and Programs for the Welfare of its Senior Citizens: What more needs to be done?

Rakesh Kumar Sahoo — 2024-06-30

India is the most populous country in the world, and has nearly 138 million elderly persons (aged 60 years or above). According to the Report of the Technical Group on Population Projections for India and States 2011-2036, there are more elderly females (71 million) than males (67 million), mostly living in rural areas (73 million) and with an old age dependency ratio of 15.7 in 2021. Both the share and size of the elderly population are increasing over time. Objective: To review the public policy and the schemes available for the senior citizens in India, and identify areas that need focused attention. Methods: Multiple global, regional, and national databases were searched using pre-identified search terms. Results: There exists a huge gap in both supply and demand side despite a National Policy on Older Persons, 1999 (under revision), a National Council of Senior Citizens, an Integrated Program for Older People (maintenance of old age homes and respite care homes; multi-service centers, mobile Medicare unit, dementia daycare center, a multi-facility care center for older widows, physiotherapy clinics, help lines and counseling, program for Sensitization, awareness projects for, formation of senior citizen associations/ self-help groups) and various financial, social, and health care schemes for the elderly run by various Ministries. Interstate variations in performance, poor public perception of aging, their rights, and benefits are adversely affecting the schemes. Conclusion: The Public Sector needs to focus more on strong and intensified political will, a humanitarian approach, innovative schemes, evidence to influence policy, more attention to social, psychological, and health care needs, adequate health financing, governance, monitoring, and impact of the schemes.

Conflict Management in Healthcare Setting – An Essential Public Health Skill

Anjusha Ranjith — 2024-06-30

Health system is one of the most human resource intensive organizations. The scope, dimensions of work in any health system and the interdependence of each compartment of health system makes it even more complex. The complexity of health system coupled with the inadequacy, unequal distribution and incompetency of human resources make it vulnerable to conflicts at workplace which further plagues the performance. Addition of new cadres of human resources to increase the efficiency also creates opportunity for new conflicts at workplace. We enumerate conflict management skills which are essential skills to be practiced by public health practitioners to identify conflicts early and resolve them using appropriate methods.

An Epidemiological Investigation of Acute Diarrhoeal Disease Outbreak in Saloni Village of Balodabazar District, Chhattisgarh

Shweta Sharma — 2024-06-30

Background: Every year in India, acute diarrheal disease (ADD) causes 12 million infections and 1216 fatalities. On May 6, 2024, an Acute Diarrhoeal Disease(ADD) outbreak was reported from Saloni village in Balodabazar district, Chhattisgarh. Objective: to investigate the outbreak, determine the source of infection, and implement immediate control and preventive measures. Methods: A case was deﬁned as a person experiencing at least three or more loose watery stools in 24 hours in Saloni village between May 6, 2024, and May 19, 2024. We collected stool samples for bacterial culture and tested water from multiple water sources for faecal coniform. Results: A total of 26 cases were identiﬁed, with 80% female, and 10 hospitalizations (38%). The median age was 35 years (range 1 month to above 60 years). Cases started on May2, 2024. District authorities started chlorination of water sources on May 6, 2024, and cases declined soon after. Two stool samples were taken for culture, which were found to be negative. Two, out of the ﬁve water samples collected from pipelines and hand pumps were positive for Escherichia coli. Conclusions: This ADD outbreak was likely associated with the consumption of contaminated drinking water from the leaked water pipeline supply. We recommend the government to supply chlorinated drinking water and to promote good hygienic practices among the people.

Stakeholders' Perception of Digital Payment in a Public Hospital in India

Anu Maiyammai — 2024-06-30

Background & Objectives: An important aspect of digital technology is the advent of new payment methods. Digital transformations can impact poverty alleviation, ﬁnancial inclusion, and resource utilization. India is predominantly a cash-based economy. The government of India has taken several steps to facilitate digital payments, yet most of the ﬁnancial transactions are cash-based. Methods: We have carried out a study in tertiary care hospitals to understand the factors behind the utilization of digital payment or lack of it. It is a cross- sectional and questionnaire-based study aimed to explore the knowledge, attitudes, and practices of patients as well as fee collectors. Results: We found variable knowledge about different modes of online payment but many patients are aware of one or the other modality. People tend to use cash more frequently for transactions less than INR 1000. Conclusion: Even though there is awareness regarding digital payment there is a hesitancy in using the digital payment methods and certain factors have been highlighted. There are challenges in the adoption of digital payment in our country. We must take steps to overcome these if we want to reap the purported beneﬁts of digitalization fully.

The Needs Assessment of Trolleys for Optimized Patient Flow in the Outpatient Department of a Tertiary Care Hospital

Vijay Tadia — 2024-06-30

Background: Stretcher trolleys are very important support structures for patients, especially for outpatient department care. Often patients and attendants are found struggling to get the trolleys. Although hospitals keep on purchasing new ones, this equipment gets damaged very fast. Therefore, to assess the current situation a student project was assigned. Objective: To do an exploratory study and gauze the requirement for trolleys in the Outpatient Department at a tertiary care hospital in North India. Methodology: A descriptive exploratory research design was used to conduct the study at the OPD Complex at a tertiary care hospital over seven weeks from July 4, 2022, to August 20, 2022. Data was collected through direct observation using non- participant observation and a structured questionnaire. The video recording by CCTV Cameras at the entrance and exit was also reviewed to observe the movement and use of trolleys. Key Informant Interviews were conducted regarding the requirements of the trolleys in the New OPD Complex. Findings: 76% of the participants faced some sort of difﬁculty in getting the trolleys. Only 7% got from the waiting areas. Others got either from the road near the OPD (23%), from parking areas (16%), from different ﬂoors/levels of the OPD Complex(6%), from the nearby Centre (9%),or the emergency area (8%). A large number (31%) of patients received trolleys from other patients after their usage. Around 80 trolleys were available in the morning per day and the demand was about 103 trolleys. So, 23 more trolleys were required to ﬁll the gap between the demand and supply of patient trolleys for a better patient experience. CCTV footage was able to ﬁnd the location of the trolleys. Recommendation: Hospitals need to put in place better tracking mechanisms with the use of CCTV and artiﬁcial intelligence so that the availability of existing trolleys can be tracked. The system of maintenance can be strengthened to undertake repairs. Alternate trolley storage spaces and distribution mechanisms may be explored.

Prevalence and Correlates of Gastroesophageal Reﬂux Disease (GERD) amongst undergraduate Students in a city of North India

Nikhilesh Challa — 2024-06-30

Gastroesophageal Reﬂux Disease (GERD) is a chronic gastrointestinal situation with the indications of heartburn and regurgitation. This study aimed to assess the prevalence and its correlates among undergraduate students from a medical college, an engineering college, and a college teaching nonprofessional courses in Chandigarh, a northern city in India. The study was cross-sectional in design and the data was collected using a GerdQ questionnaire. The sample size was 705 students studying in medical, engineering, and non-professional streams in different colleges of the city. The study duration comprised two months. The prevalence of GERD was found to be 11.02% in medical students, 20.09% in engineering students, and 15.74% in students studying non-professional courses. Important risk factors were stress, midnight snacks, tobacco use, and ordering food from restaurants. The prevalence of GERD in all streams was found similar to the prevalence in the Indian population. Lifestyle modiﬁcations are recommended in the form of removal of risk factors among students to maintain healthy patterns and balance between study & life.