‘The money is important but all women anyway go to hospital for childbirth nowadays’ - a qualitative exploration of why women participate in a conditional cash transfer program to promote institutional deliveries in Madhya Pradesh, India

Background In 2005–06, only 39 % of Indian women delivered in a health facility. Given that deliveries at home increase the risk of maternal mortality, it was in this context in 2005, that the Indian Government implemented the Janani Suraksha Yojana program that incentivizes poor women to give birth in a health facility by providing them with a cash transfer upon discharge. JSY helped raise institutional delivery to 74 % in the eight years since its implementation. Despite the success of the JSY in raising institutional delivery proportions, the large number of beneficiaries (105 million), and the cost of the program, there have been few qualitative studies exploring why women participate (or not) in the program. The objective of this paper was to explore this. Methods In March 2013, we conducted 24 individual in-depth interviews with women who delivered within the previous 12 months in two districts of Madhya Pradesh, India. Qualitative framework analysis was used to analyze the data. Results Our findings suggest that women’s increased participation in the program reflect a shift in the social norm. Drivers of the shift include social pressure from the Accredited Social Health Activist (ASHA) to deliver in a health facility, and a growing individual perception of the importance for ‘safe’ and ‘easy’ delivery which was most likely an expression of the new social norm. While the incentive was an important influence on many women’s choices, others did not perceive it as an important consideration in their decision to deliver in a health facility. Many women reported procedural difficulties to receive the benefit. Retaining the cash incentive was also an issue due to out-of-pocket expenditures incurred at the facility. Non-participation was often unintentional and caused by personal circumstances, poor geographic access or driven by a perception of poor quality of care provided in program facilities. Conclusions In summary, while the cash incentive was important for some women in facilitating an institutional birth, the shift in social norm (possibly in part facilitated by the program) and therefore their own perceptions has played a major role in them giving birth in facilities

Participation in the state led '<i>Janani Sahayogi Yojana'</i> public private partnership program to promote facility births in Madhya Pradesh, India: views from private obstetrician partners

BackgroundIn Madhya Pradesh, India, the government invited private obstetric hospitals for partnership to provide intrapartum care to poor women, paid for by the state. This statewide program, the Janani Sahayogi Yojana (JShY or maternal support scheme), ran from 2006 to 2012. The partnership was an uneasy one with many private obstetricians choosing to leave the partnership. This paper explores the motives of private obstetricians in the state for participating in the JShY, their experiences within the partnership, their interactions with the state and motives for withdrawal among those who withdrew from the scheme. This study sheds light on the dynamics of a public-private partnership for obstetric care from the perspective of private sector obstetricians.MethodFifteen in-depth interviews were conducted with private obstetricians and hospital administrators from eight districts of Madhya Pradesh who had participated in the JShY. A Framework approach was used to analyze the data.ResultsPrivate obstetricians reported entering the JShY partnership for altruistic reasons but also as way of expanding their practices and reputations. They perceived that although their facilities provided better quality of care than state facilities, participation was risky because beneficiaries were often unbooked and seen as 'high risk' cases. The need to arrange for blood transfusions for these high risk women was perceived as particularly difficult. Cumbersome paper work and delays in receiving payments from the state also dissuaded participation. Some participants felt that there was inadequate engagement by the state, and better monitoring and supervision would have helped. The state changed the financial reimbursement arrangements due to a high proportion of Cesarean births in the early years of the partnership, as these were perversely incentivized. This change resulted in a large exodus of private obstetricians from the partnership.ConclusionThis study highlights the contribution of cumbersome processes, trust deficits and a lack of dialogue between public and private partners. Input from both public and private sectors into the design of a carefully thought through financial reimbursement package for private partners was highlighted as a necessary component for future success of such schemes

Feasibility assessment of crowdsourcing slogans for promoting household waste segregation in India: a cross-sectional study

IntroductionCrowdsourcing is an emerging technique to engage or access a wider set of experts and multiple stakeholders through online platforms, which might effectively be employed in waste management. Therefore, we assessed the feasibility of the crowdsourcing method to provide an alternative approach that can improve household waste segregation using an “online-slogan-contest”.MethodsThe contest was promoted via targeted emails to various governmental and non-governmental organizations and through social media platforms for around 4 weeks (25 days). The entries were received through a Google form. The slogans were assessed by the experts and analyzed using content analysis methods.ResultsTotal 969 entries were received from different geographic regions in India. Of that, 456 were in English and 513 in Hindi. Five themes of waste segregation emerged from the received slogans: (1) Community awareness, responsibility, and support, (2) Significance of household waste segregation, (3) Use of separate dustbins, (4) Health and well-being, and (5) Environment and sustainability.DiscussionCrowdsourcing approaches can be used by local authorities for improving waste management approaches and are recommended as these involve a wider audience within a short time frame. Moreover, this approach is flexible and integrating crowdsourcing approaches strengthens our understanding of existing waste management activities

Perceptions and Experiences of Caregivers on Child Injuries : A Qualitative Study from Central India

To explore caregivers' perceptions of childhood injuries in the rural and urban areas of India, with a focus on causes, consequences, prevention, and treatment. We conducted eight focus group discussions with fifty female caregivers in rural and urban areas of Ujjain in Central India and used thematic content analysis. The caregivers identified how children injured themselves through falls, road traffic injuries, metallic nails and tool injuries, ingestions of foreign objects and poisons, burns, drowning, and suffocation. The reported consequences of injuries ranged from pain, infections, scar formation, phobia, stigma, and emotional stress to complications like physical disability, loss of eyesight, head injury, paralysis, and even death. Many caregivers blamed children and their mischievousness for the injuries and failed to realise/acknowledge the role of better supervision and environmental modifications in injury prevention. Caregivers used several first aid methods to respond to injuries. These included applying pressure to stop bleeding during fall and road traffic injuries, inducing vomiting by giving the poison victims saltwater to drink, and tobacco leaves to chew. In addition, some caregivers resorted to using coconut oil and toothpaste on burnt skin and giving back blows for choking. Caregivers in communities had experiences of different types of child injuries. Further education on need for better supervision, relevant environmental modification and appropriate first aid treatment of various injuries is required.publishedVersionPeer reviewe

The CKD.QLD data linkage framework: chronic kidney disease and health services utilisation in Queensland, Australia

Chronic kidney disease (CKD) is one of the most common chronic diseases in the western world. In Australia, around 1.7 million Australians aged 18 years and over (about one in ten) have indicators of CKD, and 1.8 million hospitalisations were associated with CKD in 2017–18. There is currently very little understanding of the impact of CKD on health service utilisation and costs. Understanding the disease pathways of CKD and its effects on service utilisation and patient outcomes is essential to predicting the course of the disease in the future, its effects on health services utilisation and capacity to better manage the burden of premature deaths or the need for dialysis that results from CKD. We describe the establishment of a data linkage framework to study hospital admissions of CKD patients in the public renal services in the Australian state of Queensland, and its potential to advance understanding of their course and outcomes. Seven years of retrospective data (2011–2018) on hospital-based health services utilisation were provided by Queensland Health for all 7,341 patients who enrolled in the CKD.QLD Registry up to Jan 2019. The data were supplied from three datasets: the Queensland Hospital Admitted Patient Data Collection, the Queensland Registrar General deaths, and the Activity Based Funding Model Output data. In addition, data were supplied from two cohorts of de-identified patients admitted to hospital in the same interval (22,023 patients each), who were not in the CKD.QLD Registry, the first with CKD and the second without CKD as indicated by International Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification. The comprehensive and multifaceted data via the data linkage will enable us to identify opportunities for efficiencies in management of patients with CKD and for interventions that improve their outcomes

Решение обратной задачи кинематики шестизвенного робота

Материалы XX Междунар. науч.-техн. конф. студентов, аспирантов и молодых ученых, Гомель, 23–24 апр. 2020 г

Наука и гуманизм

ЦИВИЛИЗАЦИЯНАУКАЕСТЕСТВЕННЫЕ НАУКИГУМАНИЗМЭТИКАКУЛЬТУР