Management of Blood Transfusion Services in India: An Illustrative Study of Maharashtra and Gujarat States

Blood is a vital healthcare resource routinely used in a broad range of hospital procedures. It is also a potential vector for harmful, and sometimes fatal, infectious diseases such as HIV, HBV, and HCV. Morbidity and mortality resulting from the transfusion of infected blood have far-reaching consequences. The economic cost of a failure to control the transmission of infection is visible in countries with a high prevalence of HIV. Shortfalls in blood supply have a particular impact on women with pregnancy complications, trauma victims and children with severe life-threatening anaemia. Ensuring a safe, source and ethical supply of blood and blood products and rational clinical use of blood are important public health responsibilities of every national government. Blood transfusion services in India rely on very fragmented mix of competing independent and hospital based blood banks of different levels of sophistication, serving different types of hospitals and patients. Voluntary and non-remunerated blood is in short supply. The SACS ensure only the availability of safe blood in blood banks. Clinical use of blood is not monitored, and the use of blood components is very low. Managing blood transfusion services involves donor management, blood collection, testing, processing, storing, issue of safe blood and blood products when clinically needed, and staff training. Maharashtra Government, by setting up its State Blood Transfusion Council as an independent unit under the Department of Health, has set up an excellent example to address the above managerial issues in meeting the transfusion requirements than any fragmented system. We strongly recommend the Maharashtra model to all other states and union territories in India.

Study of Blood-transfusion Services in Maharashtra and Gujarat States, India

Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor

Study of Blood-transfusion Services in Maharashtra and Gujarat States, India

Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor

Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India

Background: Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period. Methods: Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE. Results: The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE. Conclusions: Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/ other test and treating complicated cases in public health centres need to be strengthened

Concordance in spousal reports of current contraceptive use in India

AbstractCouple-level reports of contraceptive use are important as wives and husbands may report their use differently. Using matched couple data (N = 63,060) from India’s NFHS-4 (2015–16), this study examined concordance in spousal reports of current contraceptive use and its differentials. Reporting of contraceptive use was higher among wives (59.0%) than husbands (25.2%). Concordance was low; 16.5% of couples reported the current use of the same method, while 20.4% reported the current use of any method. Many husbands did not report female sterilization as a means of contraception being used by their wives. Reconstruction of contraceptive use among men, based on the ‘ever-use of sterilization’ question asked to men, increased concordance by 10%. Multivariate analyses showed that concordance was low in urban and southern India, among younger women and among women with a lower wealth index. Men’s control over household decision-making and negative attitudes towards contraception were associated with lower concordance. The findings highlight the importance of using couple-level data to estimate contraceptive prevalence, and the role of education programmes to inculcate positive attitudes towards contraception, fostering gender equality and involving men in family planning efforts. The results also raise the issue of data quality as the survey questions were asked differently to men and women, which might have contributed to the wide observed discordance.</jats:p

MORBIDITY PATTERN OF HOSPITALIZATION AND ASSOCIATED OUT OF POCKET EXPENDITURE: EVIDENCE FROM NSSO (2017-2018)

In 2018, according to the National Sample Survey Report, the number of cases of hospitalization per 1000 persons in 365 days was 29 in India (26 per 1000 in rural and 34 per 1000 in urban areas). Between 2004 and 2014, for example, the average medical expenditure per hospitalization for urban patients increased by about 176%, and for rural patients, it jumped by a little over 160%.  Most of these hospitalizations are for infections, but a significant number also for treatment for cancer and blood-related diseases.  The increase in access to healthcare has also brought with it a massive spike in costs. India is rapidly undergoing an epidemiological transition with a sudden change in the disease profile of its population. This study aimed to analyze hospitalization due to different factors like age and morbidity and its effect on health care utilization from nationally representative data from 2018 among the total population of India.  75th round of National Sample Survey Organisation (NSSO) conducted in July 2017- June 2018 has been used to examine what are the determinant factors that affect the hospitalization and mean monthly disease-specific expenditure in the different age group populations in India. We have used cross-tabulation to understand the association between morbidity patterns and healthcare utilization with other socio-demographic variables.  A set of logistic regression analyses was carried out to understand the role of age patterns on hospitalization. A log-linear regression model was used to understand the significant predictors of out-of-pocket expenditure (OOPE).</jats:p

Hysterectomy in India: Spatial and multilevel analysis

Objective: Using the unit-level data of women aged 15–49 years from National Family Health Survey-IV (2015–2016), the article maps the prevalence of hysterectomy across districts in India and examines its determinants. Methods: Descriptive statistics, multivariate techniques, Moran’s Index and Local indicators of Spatial Association were used to understand the objectives. The data were analysed in STATA 14.2, Geo-Da and Arc-GIS. Results: In India, the prevalence of hysterectomy operation was 3.2%, the highest in Andhra Pradesh (8.9%) and the lowest in Assam (0.9%). Rural India had higher a prevalence than urban India. The majority of women underwent the operation in private hospitals. Hysterectomy prevalence ranged between 3% and 5% in 126 districts, 5% and 7% in 47 districts and more than 7% in 26 districts. Moran’s Index (0.58) indicated the positive autocorrelation for the prevalence of hysterectomy among districts; a total of 202 districts had significant neighbourhood association. Variation in the prevalence of hysterectomy was attributed to the factors at the primary sampling unit, district and state level. Age, parity, wealth and insurance were positively associated with the prevalence of hysterectomy, whereas education and sterilization was negatively associated. Conclusion: Hysterectomy operation in India presented the geographical, socio-economic, demographic and medical phenomenon. The high prevalence of hysterectomy in many parts of the country suggested conducting in-depth studies, considering the life cycle approach and providing counselling and education to women about their reproductive rights and informed choice. Surveillance and medical audits and promoting the judicial use of health insurance can be of great help. </jats:sec