Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five

Understanding Policy and Programming on Sex-Selection in Tamil Nadu: Ethnographic and Sociological Reflections

The family-planning programme of Tamil Nadu, largely a female sterilisation campaign, has been applauded as one of the successful public health interventions in India, which had arguably led to the drastic fertility decline in the state. To the state's dismay, however, the fertility decline in Tamil Nadu was also attended by the increasing reports of female infanticide and sex-selective abortion. In its subsequent response, the state in Tamil Nadu introduced specific policy and interventionary measures to curb the practice. In this paper, I critically examine these responses in their local ethnographic contexts to highlight the manner in which family-planning goals get intertwined with the political intervention on the issue of sex-selection. This leads to women's diminishing access to unmet needs for family planning and reproductive health services thereby contributing to further marginalisation of Tamil women

Blockage of Angiotensin II type 2 receptor prevents thyroxine-mediated cardiac hypertrophy by blocking Akt activation

Although most of effects of Angiotensin II (Ang II) related to cardiac remodelling can be attributed to type 1 Ang II receptor (AT(1)R), the type 2 receptor (AT(2)R) has been shown to be involved in the development of some cardiac hypertrophy models. In the present study, we investigated whether the thyroid hormone (TH) action leading to cardiac hypertrophy is also mediated by increased Ang II levels or by change on AT(1)R and AT(2)R expression, which could contribute to this effect. In addition, we also evaluated the possible contribution of AT(2)R in the activation of Akt and in the development of TH-induced cardiac hypertrophy. To address these questions, Wistar rats were treated with thyroxine (T(4), 0.1 mg/kg BW/day, i.p.), with or without AT(2)R blocker (PD123319), for 14 days. Cardiac hypertrophy was identified based on heart/body weight ratio and confirmed by analysis of atrial natriuretic factor mRNA expression. Cardiomyocyte cultures were used to exclude the influence of TH-related hemodynamic effects. Our results demonstrate that the cardiac Ang II levels were significantly increased (80%, P < 0.001) as well as the AT(2)R expression (50%, P < 0.05) in TH-induced cardiac hypertrophy. The critical involvement of AT(2)R to the development of this cardiac hypertrophy in vivo was evidenced after administration of AT(2) blocker, which was able to prevent in 40% (P < 0.01) the cardiac mass gain and the Akt activation induced by TH. The role of AT(2)R to the TH-induced cardiomyocyte hypertrophy was also confirmed after using PD123319 in the in vitro studies. These findings improve understanding of the cardiac hypertrophy observed in hyperthyroidism and provide new insights into the generation of future therapeutic strategies.FAPESP Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[01/11678-8]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[03/04638-8]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CNPq Conselho Nacional de Desenvolvimento Cientifico e TecnologicoConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Quantitative assessment of renal arterial occlusion in a porcine model using spatial frequency domain imaging

We present the results of a feasibility study with spatial frequency domain imaging (SFDI) to produce quantitative measurements of optical property and chromophore concentration maps of three porcine kidneys utilizing a renal occlusion model at the near-infrared wavelengths of 658, 730, and 850 nm. Using SFDI, we examined the dynamics of absolute oxygen saturation (StO(2)). The mean StO(2) for the kidneys varied from approximately 60% before occlusion, to 20% during occlusion, to 55% after reperfusion. We also present, for the first time to the best of our knowledge, reduced scattering coefficient ([Formula: see text]) maps of the kidney during occlusion. We observed a substantial decrease in the wavelength dependence of scattering (i.e., scattering power) in the three kidneys, with a mean decrease of 18% ± 2.6%, which is indicative of an increase in scatterer size, and is likely due to tissue changes such as edema that follow from occlusion and inflammation

Income dynamics in Tamil Nadu, India from 1971 to 2003: changing roles of land and human capital

This article examines the changing role of physical and human capital in income dynamics in Tamil Nadu, India, using detailed daily records of farming households from 1971 to 2003. We find that income growth until the early 1990s is attributed to the rice Green Revolution and the associated development of nonrice farm sector. Further growth after the 1990s became possible due to the rapid nonfarm sector development that has been stimulated by the liberalization of Indian economy since 1991. In accordance with this change in income structure, the importance of physical and human capital has changed. Human capital was important in the early 1970s to take advantage of the rice Green Revolution technology. Once the new technology became standard among farmers, human capital became an insignificant factor. The importance of human capital has revived in a different manner in recent years firstly because it has increased farmers' access to nonfarm job opportunities, and secondly because farm management has become more knowledge intensive in the face of increasing scarcity of labor and water. The contribution of physical capital increased during the Green Revolution period, while it started declining after that. The changing mechanism is characterized as the shifting importance from physical to human capital in accordance with the changing engines of income growth from the Green Revolution to the development of nonfarm sector. Copyright 2006 International Association of Agricultural Economists.