Trends in rural fiscal decentralisation in India’s Karnataka state: a focus on public health

For decades, decentralisation reforms have been seen as a powerful instrument by health policy advocates to improve health sector performance in developing countries. In India, the 73rd Constitutional Amendment introduced in 1992 called for strengthening the fiscal autonomy and service delivery capacity of rural local governments. This paper explores how decentralised governance influences public health sector resource allocation, equity and efficiency in rural Karnataka. For this, the authors analysed administrative data published by the Karnataka state government to create tailored standardised performance measures that capture the degree of local governments’ fiscal discretion in implementing public health programmes from 2011–18 at the district level. The findings highlight sector-specific differences in fiscal autonomy, ranging from high local discretion over funds in the nutrition sector to very limited discretion in the medical and public health sector. They also show that decentralised public health funding is not well-targeted to areas of greatest need in Karnatak

Report from a symposium on catalyzing primary and secondary prevention of cancer in India

PurposeOral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. MethodsIndian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages.ResultsInnovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences.ConclusionsSymposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival

Trends in Andhra Pradesh with a focus on poverty

As background to the Young Lives study, this paper looks at demographic, socio-economic,and poverty trends for the state of Andhra Pradesh during the 1990s. Substantive changes in the demographic structure, composition of economic activity, and trends in poverty are noted. Additionally, it reviews the literature on poverty measurement issues for generic populations as well as for children. A major unresolved issue is a standard and widely accepted definition of childhood poverty although a number of indicators are commonly presented when discussing quality of life for children. Following this, this paper also presents trends in immunisation coverage, nutrition, and various educational indicators for children in Andhra Pradesh over the 1990s

Brothers in Arms? Covid-19 and Hindu-Muslim conflict in India

Recurrent episodes of Hindu-Muslim violence have plagued India for many years. The Covid-19 pandemic poses new challenges against this backdrop of religious conflict. We explore the performance of various Indian districts in terms of their Covid-19 cases alongside their historical proclivities towards Hindu-Muslim violence. The link between inter-faith cooperation in an area and its subsequent performance in terms of Covid-19 cases is theoretically ambiguous. It may be that areas characterised by low(er) religious antagonism are better able to harness trust within and across communities to jointly battle the spread of the pandemic. Equally, the continual presence of religious violence may induce cooperation within each community and thus check the spread of the virus in riot-prone areas. Combining several district-level datasets, we uncover a robust correlation between various Covid-related outcomes and past conflict measures. Specifically, we find that higher levels of prior Hindu-Muslim conflict is associated with a lower number of Covid-19 infections, deaths and active cases. This pattern is consistent and holds across a wide range of specifications. Our empirical analysis therefore finds strong support for the latter channel

To R or Not: Mainstreaming Informal Providers

On a hot summer afternoon, there is a huge commotion around the Jawnpore District Hospital. There is passionate sloganeering by the ruling party supporters competing with protests by the opposition party activists against the alleged lack of personnel and infrastructure in the district hospital. Not far away from this hullabaloo, Grameen Arogya, a non-governmental organization, stages a satyagraha to silently protest against the official silence on dysentery deaths in the region. A motorcade of government cars enters the hospital grounds. The local leaders of the ruling party and the District Hospital Superintendent are waiting to welcome and garland Shri Jagatprakash Goel, Union Health Minister, visiting the hospital. Goel ji joins the doctors in their regular ward rounds and inspects the hospital. Then he addresses the public and the medical community including a few office bearers of the medical association (the association of registered doctors). The moment Goel ji concludes the address, Mr Das from Grameen Arogya, rushes to the podium and hands a memorandum to Goel ji. He grabs the microphone and makes an emotional account of the deplorable healthcare situation in Jawnpore. He discusses the difficulties arising due to a lack of registered doctors and rampant absenteeism in the public hospital, particularly when there is no private provider of healthcare. He proposes that the only practical way to alleviate these difficulties in providing rural healthcare is to ‘mainstream the quacks’ and cites a 2006 multi-national survey-based research study ( Chaudhury et al., 2006 ). He appeals to Shri Jagatprakash Goel, the minister, to make provision for special training of informal providers (Ips), to fill the need for medical practitioners in rural areas. Supporters of the ruling party and members of the medical community run to the dais to stop Mr Das from speaking further. But the minister asks the crowd to calm down and handles the situation. He assures Grameen Arogya that he will investigate the issue

Inventory trends in emerging market supply chains: Evidence from the Indian automotive industry

In the current paper, using a sample data of 58 firms consisting of automakers and auto component suppliers across a 14-year period, we study the factors contributing to efficient inventory management in the Indian automotive Industry. We use fixed effects regression models to document trends in inventory holdings over time and how this varies across inventory types and across tiers in the supply chain. Our results show that inventory holdings have declined differentially across tiers and across different types of inventories. We find tier-1 suppliers reduced all components of their inventories with the help of TQM and lean efforts

In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer?

Summary: India's woes with an underprioritized and hence underfunded and understaffed public health system continue to plague public healthcare delivery. Though the need for appropriately qualified public health cadre to lead public health programmes is well established, a well-meaning conducive approach to implementing this is lacking. As the COVID-19 pandemic brought back the focus on India's fragmented health system and primary healthcare deficiencies, we discuss the primary healthcare conundrum in India in search of a quintessential fix. We argue for instituting a well-thought and inclusive public health cadre to lead preventive and promotive public health programmes and manage public health delivery. With the aim being to increase community confidence in primary health care, along with the need to augment primary healthcare infrastructure, we argue for a need to augment primary healthcare with physicians trained in family medicine. Provisioning medical officers and general practitioners trained in family medicine can salvage community's confidence in primary care, increase primary healthcare utilization, stymie over-specialization of care, channelize and prioritize referrals, and guarantee competence in healthcare quality for rural communities