Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad

Governments in many developing countries acknowledge they are facing difficulties in their attempt to meet the basic health needs of their populations. They rely on contracting out to private (for-profit and not-for-profit) organizations as a strategy to meet the needs of underserved populations. For the most part, the public sector chooses to contract out primary healthcare services to the private sector to expand access, increase the availability of medicines and medical supplies, and improve the quality of care. In both urban and rural settings, private for-profit and non-profit health service providers serve both the rich and the poor. Communities often recognize private sector healthcare providers to be more responsive to their healthcare needs and preferences in terms of services available, suitable timings and geographical access etc. Private sector has always played a significant role in the delivery of health services in developing countries. Public-private-partnership (PPP) is an approach under which services are delivered by the private sector, while the responsibility for providing the resources rests with the government. Establishing a PPP requires a legal framework acceptable to all the partners, clarity on the commitment of resources, roles and responsibilities of each partner, as well as accountability to provide a given set of services at a desired level of quality and affordable user charges. Formalizing such an arrangement between partners requires conceptualising a framework for Public Private Partnership (PPP) to manage the delivery of health services. In this paper, we describe the design, development and implementation of a PPP for managing urban health services in Ahmedabad city, Gujarat. Our model has succeeded in bringing together compatible public and private partners to plan and deliver quality healthcare services to meet the community needs of Vasna ward, in Ahmedabad. The new Vasna Urban Health centre was inaugurated on July 23, by the Chief Minister of Guajarat. This new centre now serves about 120 outpatients everyday as against an average of 10 outpatients daily earlier.

In vitro evaluation of marketed antimalarial chloroquine phosphate tablets

Background & objectives: The aim of the present study is to investigate the physicochemicalequivalence of seven brands of tablets containing chloroquine phosphate, an antimalarial purchasedfrom different retail pharmacy outlets.Methods: The quality and physicochemical equivalence of seven different brands of chloroquinephosphate tablets were assessed. The assessment included the evaluation of uniformity of weight,friability, crushing strength, disintegration and dissolution tests as well as chemical assay of thetablets.Results: All the seven brands of the tablets passed the British Pharmacopoeia (BP) standards foruniformity of weight, disintegration and crushing strength. One of seven brands failed the friabilitytest. One of the brands did not comply with the standard assay of content of active ingredients.Dissolution test passes the pharmacopoeial standards for chloroquine phosphate tablets. There wereno significant differences in the amounts of chloroquine phosphate released from the different brands.Interpretation & conclusion: Out of the seven brands of anti-malarial chloroquine phosphate tabletsonly one brand fails to meet BP quality specifications which shows constant market monitoring ofnew products to ascertain their equivalency to pharmacopoeial standards

Building the Infrastructure to Reach and Care for the Poor: Trends, Obstacles and Strategies to overcome them

Infrastructure forms a critical part of health service delivery in any country. Availability, Accessibility, Affordability, Equity, Efficiency and Quality of MNH services highly depend on the distribution, functionality and quality of infrastructure. Most developing countries have invested substantially in developing health infrastructure in rural areas which provides a base for extending MNH services to the poor. Still, there is clear evidence that in many countries there are gaps and inadequacies in health infrastructure. The functionality and utilization of health infrastructure has been sub-optimal or poor due to a variety of reasons. This paper reviews available literature and assesses the coverage and gaps in infrastructure for MNH. It also identifies critical issues in management of infrastructure and analysis their causes and impact on services delivery to the poor. The paper also reviews impacts of reforms on infrastructure and provides some recommendations for improvement of infrastructure management so as to ensure better services to the poor.

A study of effect of intra umbilical oxytocin in active management of third stage of labour

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality. PPH is the loss of more than 500 ml blood following vaginal delivery or 1000 ml blood following caesarean section. India has a maternal mortality ratio of 167 per 1 lakh live births. The most common cause of maternal mortality is haemorrhage which accounts for 25-30% of maternal mortality of which PPH is a significant cause. Methods: 200 patients were included in this prospective observational study and divided into two groups, group A, underwent only active management of third stage of labour and group B received intra umbilical oxytocin administration in addition to AMTSL. The maternal and neonatal outcome was observed between the two and the difference was noted. Results: Mean duration of third stage of labour of group A patients was 3.89±0.89 minutes and Mean blood loss was 386±85.30 ml and that of group B patients was 1.96±0.68 minutes and 235±72.99 ml respectively. These were found to be statistically significant among all the other parameters. Conclusions: The duration of third stage of labour and the amount of postpartum blood loss was significantly less when intra umbilical injection of oxytocin was used in addition to AMTSL. So, to conclude intra umbilical vein oxytocin injection should be used routinely in addition to AMTSL in order to prevent PPH

A Public Private Partnership Model for Managing Urban Health: A Study of Ahmedabad City

Urbanization is an important demographic shift worldwide. India’s urban population of 300 million represents 30 % of its total population; with the slum population in urban cities registering a 5 % growth in the last few years. Responding to the healthcare needs of urban poor is therefore very essential. Government of India focus has been mainly on rural health till the late 90s. Recognizing the urgency to manage urban health for the vulnerable sections of our population, the 9th and 10th Five Year Plans of the Government of India have laid special emphasis on developing a well structured network of urban primary care institutions. Ahmedabad city (also known as Ahmedabad Municipal Corporation, AMC) is the sixth largest city in India with a population of 3.5 million spread over 192 square kilometers, across 43 wards. AMC has nearly 2500 slums and chawls housing approximately 1.5 million people. Out of 43 wards in AMC, 9 wards which house more than 20 % of AMC population, have no government health facility at all. With more than 3500 private health facilities in AMC, it is therefore worthwhile to explore Public Private Participation (PPP) to improve the delivery of healthcare services. In this working paper, we outline our approach to developing a PPP model for a decentralized and integrated primary healthcare center for each ward of AMC. Our model is built on a clear understanding of the socio-economic profile, status of public health, and the healthcare seeking habits of Ahmedabad population. Our GIS (Geographic Information System) methodology guides the AMC authorities to identify good locations for urban health center (UHC) so as to ensure availability, affordability, accessibility, and equity to primary healthcare facilities to the slum populations. We illustrate our methodology for Vasna and Naroda wards in AMC.

Informant-based screening tools for dementia: an overview of systematic reviews

Background: Informant-based questionnaires may have utility for cognitive impairment or dementia screening. Reviews describing the accuracy of respective questionnaires are available, but their focus on individual questionnaires precludes comparisons across tools. We conducted an overview of systematic reviews to assess the comparative accuracy of informant questionnaires and identify areas where evidence is lacking. Methods: We searched six databases to identify systematic reviews describing diagnostic test accuracy of informant questionnaires for cognitive impairment or dementia. We pooled sensitivity and specificity data for each questionnaire and used network approaches to compare accuracy estimates across the differing tests. We used grading of recommendations, assessment, development and evaluation (GRADE) to evaluate the overall certainty of evidence. Finally, we created an evidence ‘heat-map’, describing the availability of accurate data for individual tests in different populations and settings. Results: We identified 25 reviews, consisting of 93 studies and 13 informant questionnaires. Pooled analysis (37 studies; 11 052 participants) ranked the eight-item interview to ascertain dementia (AD8) highest for sensitivity [90%; 95% credible intervals (CrI) = 82–95; ‘best-test’ probability = 36]; while the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was most specific (81%; 95% CrI = 66–90; ‘best-test’ probability = 29%). GRADE-based evaluation of evidence suggested certainty was ‘low’ overall. Our heat-map indicated that only AD8 and IQCODE have been extensively evaluated and most studies have been in the secondary care settings. Conclusions: AD8 and IQCODE appear to be valid questionnaires for cognitive impairment or dementia assessment. Other available informant-based cognitive screening questionnaires lack evidence to justify their use at present. Evidence on the accuracy of available tools in primary care settings and with specific populations is required

Cost Effectiveness Analysis Evaluating Real-Time Characterization of Diminutive Colorectal Polyp Histology using Narrow Band Imaging (NBI)

Background: Endoscopists and new computer-aided programs can achieve performance benchmarks for real-time diagnosis of colorectal polyps using Narrow-Band Imaging (NBI), though do not perform as well as endoscopists with expertise in advanced imaging. Previous cost-effectiveness studies on optical diagnosis have focused on expert performance, potentially over-estimating its benefits. Aim: Determine cost-effectiveness of an NBI ‘characterize, resect and discard (CRD)’ strategy using updated assumptions based on non-expert performance. Methods: Markov model was constructed to compare cost-effectiveness of the CRD strategy, where diminutive polyps characterized as non-adenomas with high confidence are not resected and adenomas are resected and discarded, versus standard of care (SOC) in which all polyps are resected with histologic analysis. Rates related to NBI performance, missed polyps, polyp progression, malignancy, and complications, as well as quality-adjusted life years (QALYs) were derived from the literature. Costs were age and insurer-specific. Mean QALYs and costs were calculated using first order Monte Carlo simulation. Deterministic and probabilistic sensitivity analyses were conducted. Results: The mean QALY estimates were similar for the CRD (8.563, 95% CI: 8.557-8.571) and SOC strategy (8.563, 8.557-8.571), but costs were reduced ($2,693.06 vs.$2,800.27, mean incremental cost savings: $107.21/person). Accounting for colonoscopy rates, the CRD strategy would save$708 million to $1.06 billion annually. The model was sensitive to the incidence of tubular adenomas; the results were otherwise robust in all other one-way and probabilistic analyses. Conclusions: An NBI CRD strategy is cost-effective when compared to the SOC, even when employed by non-experts. The appreciated benefit is primarily due to cost savings of the CRD strategy

BACTERIAL DISEASES OF LIVESTOCK ANIMALS AND THEIR IMPACT ON HUMAN HEALTH

Recently, whole world is facing the problem of infectious diseases related to animal diseases that pose significant threats to human health. In other words, humans may acquire zoonotic infections through various routes i.e. food, water etc. The transmission of certain bacterial diseases (through food and water) is one of the important cause of illness in both developing and developed countries. Most of the infectious pathogens that are normally reside in the intestinal tract of healthy animals and may transmit the disease through products (meat, milk or eggs) and faecal contamination of the environment. Normally, minute amount of intestinal contents are released and contaminate milk during milking; carcass at slaughter and egg during laying. Generally, risk associated with this type of contamination is somehow minimised where proper food hygiene is normally applied throughout the entire food chain from production, through processing to preparation at home. In this view, we provide some information about bacterial diseases of livestock animals and their effect or impact on human health.Â