These are written by CEHAT staff and are published in various journals
and magazines or presented at various National and International
Conferences. In addition the collection also includes Papers/Articles
written by CEHAT staff on various health issues.
Jesani, Amar; Iyer, Aditi
Published Year: 1993
Women and their right to determine their sexuality, fertility and reproduction are considerations that have seldom, if ever, been taken into account in the formation of policies related to abortion.
Gupte, Manisha; Bandewar, Sunita; Pisal, Hemalata
Published Year: 1996
Gupte, Manisha; Bandewar, Sunita; Pisal, Hemalata
Published Year: 1997
The Indian Medical Termination Of Pregnancy Act Came Into Force In1972, In Response To The Highmortality And Morbidity Associated With Illegal Abortion. However, 25 Years On, Both Restrictions In The Law And The Way It Is Implemnted Through Service Delivery Have Failed To Meet The Abortion Needs Of Large Number Of Women. Using Data From A Larger Qualitative Study In Rural Maharashtra, This Paper Explores Women's Perceptions Of Their Rights And Needs In Relation To Abortion. The Women Were Ambivalent About Abortion, Based On Their Roles And Identity As Mothers, But They Saw The Necessity For Barotion Andsupported Each Otherto Have Abortions. They Had Conflicting Feelings With Regards To Abortion On Grounds Of Fetal Sex, And Problematic Issues Of Sexuality, Especially For Single Women In Relation To Abortion, Also Arose. Provided With The Details Ofindia's Abortion Legislation, Which They Knew Little About, The Women Had Suggestions For Making The Law More Women-sensitive. Their Experiences Make It Clear That Vast Improvements In Abortion Policy And Service Delivery Are Needed In India.
Bandewar, Sunita
Published Year: 1997
Bandewar, Sunita
Published Year: 1998
The present paper explores the applicability of menstrual regulation (MR) as an abortion method in the Indian context. While doing so, MR method is evaluated socio-medically and legally. Effort has also been made to evaluate its feasibility in terms of resources and acceptability to providers and users in India. Evaluation is based on a review of literature on various aspects of MR of the last 25 years. This exercise of socio-medical, legal and feasibility evaluation of MR builds a strong case for its promotion to bring down abortion related morbidity and mortality, to enhance the opportunities for potential users to avail of contraceptive services, to reduce the psychological burden of guilt borne by the women for undergoing an abortion, to reduce the intensity of emotional trauma that they experience for having had an abortion. Finally, the paper also discusses the constraints in promoting MR in India and strategies to overcome them. Against this backdrop, the paper emphasises the critical role of the Information-Education-Communication (IEC) component and the need to incorporate it officially in the MR promotion policy.
Bandewar, Sunita
Published Year: 1999
Saha, Shelley
Published Year: 2000
Saha, Shelley
Published Year: 2000
Bandewar, Sunita; Pisal, Hemalata; Lele, Mugdha
Published Year: 1998
Bandewar, Sunita
Published Year: 2000
Women in India are fortunate in having access to legal abortion services, made possible through the Medical Termination of Pregnancy (MTP) Act, 1971. The act passed by the Indian Parliament is considered revolutionary for it allows women to both avail abortion care due to failure of contraception and have access to abortion without the husband's consent.
Bandewar, Sunita
Published Year: 2001
Balaji, Rajeswari
Published Year: 2002
Saha, Shelley; Manasee, Mishra
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Duggal, Ravi; Ramachandran, Vimala
Published Year: 2004
While the Medical Termination of Pregnancy Act (MTP Act) has existed for 33 years, certified and legal abortion facilities account for only a quarter of all such private facilities in the country. Neither the public nor private abortion services have fully measured up to the needs of the abortion seekers
Duggal, Ravi; Ramachandran, Vimala
Published Year: 2004
The Abortion Assessment Project–India, begun in August 2000, is one of the largest studies on abortion ever undertaken in India. This article synthesises the findings of the six facility surveys, two community-based surveys, eight qualitative studies, policy review and commissioned working papers that were produced as part of the project by researchers from across India. Public investment in abortion services nationally was found to be grossly inadequate. 75% of facilities were found in the private sector in the six states and were overwhelmingly perceived to give better services. Although some important changes were made in the 1971 Medical Termination of Pregnancy Act related to clinic certification and medical abortion, further changes during the second phase of the government's Reproductive and Child Health Programme are recommended, based on this research and state and national-level consultations organised by the project. These include integrating abortion services into primary and community health centres, increased investment in public facilities, promoting use of vacuum aspiration and medical abortion, convincing providers to stop using curettage, broadening the base of abortion providers by training paramedics to do first trimester abortions, and reskilling traditional providers to play alternative roles that support women's access to safe abortion services.
Duggal, Ravi
Published Year: 2004
Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman’s marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount – first trimester abortion averages Rs.500–1000 and second trimester abortion Rs.2000–3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe bortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.
Sana Contractor
Published Year: 2011
Jesani, Amar
Published Year: 2014
Bandewar, Sunita; Pisal, Hemalata; Lele, Mugdha
Published Year: 1998
Chaudhari, Leni
Published Year: 2005
Chaudhari, Leni
Published Year: 2005
Madhiwalla, Neha
Published Year: 1999
Jesani, Amar
Published Year: 1998
Khot, Anagha; Menon, Sumita; Deosthali, Padma
Published Year: 2000
Deosthali, Padma
Published Year: 2001
Rege, Sangeeta
Published Year: 2003
Padma Deosthali; Seema Malik
Published Year: 2003
Padma Deosthali; Burte, Aruna
Published Year: 2003
Saha, Shelley
Published Year: 2004
Padma Deosthali
Published Year: 2004
Deosthali, Padma; Maghanani, Poornima
Published Year: 2005
Padma Deosthali
Published Year: 2006
Padma Deosthali
Published Year: 2006
Padma Deosthali
Published Year: 2007
Padma Deosthali; Seema Malik
Published Year: 2009
Rege, Sangeeta; Padma Deosthali
Published Year: 2009
Padma Deosthali
Published Year: 2009
Sangeeta Rege; Rupali Gupta
Published Year: 2010
Domestic Violence (DV), well recognised as a public health concern worldwide, is still missing, as a concern, from the Indian public health system. In public hospitals, which are the only viable health care option for a majority of the socio-economically marginalised population, the issue of DV is still on the distant horizon of public health reforms. Hence, CEHAT felt the urgent need to bring it on to the radar of the public health system. Dilaasa, the first public-hospital based crisis counselling centre in India, was established in collaboration with the Municipal Corporation of Greater Mumbai in two public hospitals in Mumbai. Since 2001, Dilaasa has been engaged in providing counseling and psycho-social support services to women facing violence, and a training cell was set up to sensitise the hospital staff on DV. CEHAT was involved in demonstrating the crisis intervention model for DV response, merging the centre with the hospital’s medical services, and later in monitoring its services after handing over charge of both the centres to the hospital management in 2006. CEHAT implemented different mechanisms for monitoring of the centre, but ensuring the quality of services provided by the centre has always been a challenge. The hospital management provided infrastructure and resources for DV counselling and training, but issues such as transfers of deputed staff, a lack of reporting mechanisms or clear cut policies for referrals, and a lack of efforts to institutionalise the training cell, among others have been surfacing as on-going challenges. The Dilaasa experience highlights governance issues in institutionalising the issue of DV within a public health institution.
Padma Deosthali; Sangeeta Rege
Published Year: 2010
Padma Deosthali; Sangeeta Rege
Published Year: 2010
Bhate-Deosthali; T. K. Sundari, Ravindran; Vindhya, U.
Published Year: 2012
Women experiencing violence most often decide to seek legal action only after the violence has escalated and that too without having any documentary evidence. The Dilaasa crisis centres at two public hospitals in Mumbai since 2001 have been established out of the recognition that the public health system is an important site for the implementation of anti-domestic violence intervention programmes. The crisis centres therefore straddle both discourses of public health and gender. The paper offers critical insights into the model and its impact in terms of its ability to reach out to women who are undergoing abuse and offer them multiple services in one setting. Read More
Bhate-Deosthali, Padma; Lingam, Lakshmi
Published Year: 2016
There are an estimated 7 million burn injuries in India annually, of which 700,000 require hospital admission and 140,000 are fatal. 91,000 of these deaths are women; a figure higher than that for maternal mortality. Women of child bearing age are on average three times more likely than men to die of burn injuries. This paper reviews the existing literature on burn injuries in India and raises pertinent issues about prevalence, causes and gaps in recognising the gendered factors leading to a high number of women dying due to burns. The work of various women’s groups and health researchers with burns victims raises several questions about the categorisation of burn deaths as accident, suicide and homicide and the failure of the health system to recognise underlying violence. Despite compelling evidence, the health system has not recognised this as a priority. Considering the substantial cost of burns care, prevention is the key which requires health systems to recognise the linkages between burn injuries and domestic violence. Health systems need to integrate awareness programmes about domestic violence and train health professionals to identify signs and symptoms of violence. This would contribute to early identification of abuse so that survivors are able to access support services at an early stage.
CEHAT
Published Year: 2017
As there is lack of reliable data on prevalence of domestic violence , the evidence on women facing domestic violence can be drawn from Dilaasa established by CEHAT. This helps this helps to explain the peculiar public health problem as there is a huge difference between those who are actually suffering and those who reported that they are suffering in India.
Pilgaokar, Anil
Published Year: 1994
Nandraj, Sunil
Published Year: 1998
D'Souza, Lalitha; Emmel, Nick; Nidhi, Amulya
Published Year: 1999
Duggal, Ravi
Published Year: 1992
Duggal, Ravi
Published Year: 1994
Duggal, Ravi
Published Year: 1999
The Department of Family Welfare, of the Central Govt. says, "The Family Welfare Program in India is being promoted on voluntary basis as a people's movement in keeping with the democratic traditions of the country. The program seeks to promote responsible parenthood, with a two-child norm - male, female or both - through independent choice of the family planning method best suited to the acceptor. For conveying message of small family norm to the masses, motivational, educational and persuasive efforts are made without any resort to any form of coercion" (Family Welfare Program in India - Year book 1989-90, Department of Family Welfare, GOI, New Delhi, pg. 48). This is how the government views its family planning program, which it never tires highlighting that it was the first official program of population control in the world! I have deliberately begun with the above quote because not only is it full of lies but it also drives in many home truths about the governments' perceptions.
Rege, Sangeeta; Shrivastava, Surabhi
Published Year: 2021
Jesani, Amar; Pilgaokar, Anil
Published Year: 1993
Jesani, Amar
Published Year: 1993
Duggal, Ravi
Published Year: 1993
Jesani, Amar; Pilgaokar, Anil
Published Year: 1995
The medical fraternity must be made accountable for their actions. And patients, as consumers of medical treatment, must have the right to health education. Dr. Amar Jesani and Dr. Anil Pilgaokar talk about the need for asserting patient’s rights
Jesani, Amar; Iyer, Aditi
Published Year: 1995
Through history, women have practised forms of birth control and abortion. These practices have generated intense moral, ethical, political and legal debates since abortion is not merely a technomedical issue but "the fulcrum of a much broader ideological struggle in which the very meanings of the family, the state, motherhood and young women's sexuality are contested" (Petchesky R.P, 1986: vii). Women have overtly or covertly resorted to abortion, but their access to services has been countered by the imposition of social and legal restrictions, many of which have origin in morality and religion. The norms governing the ethics of abortion have been constantly remoulded to suit the times and the social contexts in which they are set. Despite the dissimilarities in their construct, intent and orientation, these norms have invariably been directed to the fulfilment of social needs that do not recognise women's right to determine their sexuality, fertility and reproduction. This paper reviews the abortion scenario with particular reference to India. A brief historical account of the role of the medical profession in criminalising and decriminalising abortion services is followed by a discussion on the politics of abortion in India. An analytic review of the abortion situation in India provides the reader with information about legal and illegal abortions and the paper concludes by placing the issue of abortion in the context of social (rather than individual) needs and rights.
Jesani, Amar
Published Year: 1996
The mainstream social sciences in India have largely ignored the fact that India is a very violent society. Although the investigation and documentation of political violence was started in a systematic manner by many small voluntary groups and the media much earlier (the 19 months of State of Internal Emergency in the mid 1970s provided impetus to it), the mainstream social sciences had not taken sufficient interest in the phenomenon. The other forms of social and political violence, viz. gender, caste, communal etc. were also analysed inadequately. However, the decade of 1980s has heralded some change. For example, three edited volumes by Prof. A.R. Desai (1986, 1990, 1991) and in his recent study of Gujarat (with D’Costa, 1994) have brought together collection of documents and writings on the political violence and violation of democratic rights which would have otherwise found less recognition in the social science discourse. Similarly, social scientists have also started paying attention to the communal violence and violence against women. For example, the works of Asgharali Engineer, Veena Das (1992), Flavia Agnes (1990, 1992), Chhaya Datar (1992), Vibhuti Patel and many others have done much needed conceptual and empirical work on the subject. Due to their work certain types of violence which suffered from social taboos, such as rape, wife beating, child abuse etc have now found a place in the social science discourse and in the campaigns of concerned organisations. In fact, these concerns have altered the political agendas of many social and political movements. At the same time this has brought in its wake more concern for the victims and survivors of violence.
Nandraj, Sunil
Published Year: 1997
Mistry, Mani
Published Year: 1998
Right to Health is intrisincally linked to Right to Life which is enshrined by the Constitution of India as Fundamental Right of every citizen. It thus logically becomes the duty of the state to ensure the Right to Health for all its citizens. The article 47 of the Constitution under the directive principles also reinforces the state's responsibility towards improving the public health. - " The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the state shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health". The article 47 of the constitution thus sees the states responsibility even beyond medical care, to responsibility towards good nutrition and living standards. Health related responsibilities are mentioned in the state as well as concurrent list; public health and sanitation, hospitals and dispensaries fall within the state list, while health care items like drugs and poisons, legal, medical and other professions, prevention of extension from one state to another of infections or contagious diseases or pests affecting men, animals or plants fall in the concurrent list.
Duggal, Ravi
Published Year: 1998
If all people, irrespective of their economic or social status are to have access to health care, then the state has to play a more decisive role in ensuring access to such care. This is possible only if health care is regarded as a right.
Jesani, Amar
Published Year: 1998
The paper begins with a historical evaluation of health care in India and the developed countries and then tries to analyse the existing health care services in our country. It highlights how health activism of the last three decades has raised people's consciousness and concerns for health issues. In the last few years activism has shifted from experimentation in provision to the demand for better provision and control over providers. The paper concludes with suggestions for encouraging the emergence of a health movement.
Shukla, Abhay
Published Year: 2000
Published Year: 1998
Shukla, Abhay
Published Year: 1999
Shukla, Abhay; Pitre, Amita
Published Year: 2001
Shukla, Abhay
Published Year: 2001
Shukla, Abhay
Published Year: 2001
Pitre, Amita
Published Year: 2001
Pitre, Amita
Published Year: 2001
Nidhi, Amulya
Published Year: 2001
Menon, Sumita; Contractor, Qudsiya
Published Year: 2001
Khot, Anagha; Menon, Sumita
Published Year: 2002
Shukla, Abhay
Published Year: 2003
Shukla, Abhay
Published Year: 2003
Phadke, Anant
Published Year: 2003
By way of commemorating the 25-year old Alma Ata Declaration on health for all, the health movement organised a three-day programme on the right to health. Included were public submissions on denial of health care that illustrate the deterioration in the public health system.
Phadke, Anant
Published Year: 2003
Mahabal, Kamayani Bali
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Mahabal, Kamayani Bali
Published Year: 2004
Mahabal, Kamayani Bali
Published Year: 2004
Mahabal, Kamayani Bali
Published Year: 2004
Mahabal, Kamayani Bali
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Contractor, Qudsiya
Published Year: 2005
Chatterjee, Chandrima
Published Year: 2005
Mahabal, Kamayani Bali
Published Year: 2006
Chaudhari, Leni
Published Year: 2007
Published Year: 2012
Mahabal, Kamayani Bali
Published Year: 2006
Sinha, Roopashri
Published Year: 1995
Duggal, Ravi
Published Year: 1991
Duggal, R. (1991 july - august). Private health expenditure. Medico Friend Circle Bulletin, (173-174), 14-16.
Duggal, Ravi
Published Year: 1991
Duggal, R. (1991 november - december). Ending the underfinancing of primary health care. Medico Friend Circle Bulletin, (177-178), 7-9.
Duggal, Ravi
Published Year: 1992
Duggal, Ravi
Published Year: 1992
Duggal, Ravi
Published Year: 1993
Nandraj, Sunil; Duggal, Ravi
Published Year: 1994
Duggal, Ravi
Published Year: 1994
Duggal, Ravi
Published Year: 1994
Nandraj, Sunil
Published Year: 1995
Nandraj, Sunil; Duggal, Ravi; Vadair, Asha
Published Year: 1995
Nandraj, Sunil; Duggal, Ravi; Vadair, Asha
Published Year: 1995
Duggal, Ravi
Published Year: 1995
Duggal, Ravi
Published Year: 1995
Duggal, Ravi
Published Year: 1995
Duggal, Ravi
Published Year: 1995
Duggal, Ravi
Published Year: 1995
Duggal, Ravi
Published Year: 1994
Nandraj, Sunil; Duggal, Ravi
Published Year: 1996
Duggal, Ravi
Published Year: 1996
Duggal, Ravi
Published Year: 1997
A meaningful analysis of recent health budgets can only be made in the context of the direct and indirect encouragement given by the state to the growth of the private sector in the health services. First, the slowing down of state investment in the hospital sector and the subsidies, soft loans and duty and tax exemptions offered; second the creation of a market for modern health care through the setting up of PHCs and cottage hospitals in the rural area, and third the consistent expansion in highly qualified medical personnel who could not be absorbed on the state sector.
Duggal, Ravi
Published Year: 1998
Duggal, Ravi
Published Year: 1998
Economic reforms towards liberalisation began in the early eighties. The classical 'Hindu' rate of growth in the eighties had doubled from 3% to 6%, without much inflation and with declining levels of poverty. Thus we were already liberalising our economy and speeding up growth without the World Bank running the show. Infact, the post (1991)-reform period slowed down growth, increased poverty and inflation, and reversed many trends of the eighties. Today health care has become fully commodified and the private sector is the dominant provider of health care globally, as well as in India. New medical technology has aided such a development and the character of health care as a service is being eroded rapidly. This process of commodification has created a unique characteristic of the health sector making health care a supply-induced demand market. Provision of routine medical care for a wide range of diseases and symptoms in India is mostly in the private sector. As regards the public sector the large investment in health care is being wasted due to improper planning, financing and organisation of the health care delivery system. While public health services are inadequate to meet peoples health care needs the private health sector whatever be its quality and / or effectiveness has filled the gap. Private medical practice flourishes almost everywhere. Medical practice in India is a multi-system discipline and in addition is also burdened with a large number of unqualified practitioners. Private general practice is the most commonly used health care service by patients in both rural and urban areas. This translates into a whopping Rs.400 to 600 billion private health care market in the country at today's market prices. This large private health care market has grown with direct and indirect state support. The government provides concessions and subsidies to private medical professionals and hospitals to set up private practice and hospitals. The government has pioneered the introduction of modern health care services in remote areas by setting up PHCs. While the latter introduces the local population to modern health care it also provides the private sector an entry point to set themselves up. Construction of public hospitals and health centres are generally contracted out to the private sector. In recent years the government health services have introduced selectively fee-for-services at its health facilities. The government has allowed the private health sector to proliferate uncontrolled. The above are a few illustrations of how the state has helped strengthen the private health sector in India. In today’s liberalised scenario, and with World Bank’s advice of limiting state's role to selective health care for a selective population, the private health sector is ready for another leap in its growth. And this will mean further appropriation of people's health and a worsening health care scenario for the majority population. 2 Finally a very clear impact one sees is declining state investments in the health sector. New medical technologies have helped complete the commodification of health care and this has attracted increased interest of the corporate sector that has jumped into the health care business in a very big way. This has led to the further consolidation of the private health sector in India.
Nadkarni, Avadhut
Published Year: 2000
In this overview, we examine the effects of globalisation and liberalisation on the Indian economy. These macroeconomic and sectional effects form the background to the study of the effects of globalisation on women's work, environment and health in the subsequent parts of this report.
Madhiwalla, Neha
Published Year: 2000
Duggal, Ravi
Published Year: 2000
We are into year 2000 but where is “Health For All” as vowed by WHO member nations at Alma Ata in 1978? Year 2000 was selected to be that magical year by when all people of this world were projected to have access to primary health care. Since then the situation has barely changed. The countries that could not provide basic health care to its people then, continue to be unable to do so even today. It is not as if there is a lack of resources – more drugs are produced, the private health sector has grown geometrically, people are spending much more out of pocket, newer technologies are available etc – but those not having access to primary health care have increased in numbers.
Duggal, Ravi
Published Year: 2000
Duggal, Ravi
Published Year: 2000
Duggal, Ravi
Published Year: 2000
Duggal, Ravi
Published Year: 2002
Duggal, Ravi
Published Year: 2002
Phadke, Anant; Shukla, Abhay
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 2003
In India, as elsewhere, those who have the capacity to buy health care from the market most often get it without having to pay (or it directly, and those who lh·c a hand-to-mouth existence are forced to make direct payments,often with a heavy burden of debt, to access health care ji-om the market.
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 2003
This analysis of the trends in public health expenditure in Maharashtra shows that the State has to become more proactive in raising resources being allocated to the health sector. The level of public health spending is very low in the state, both as a ratio within the state budget and as a proportion to the SDP. Read More
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Raymus, Prashant
Published Year: 2005
Duggal, Ravi
Published Year: 2004
Primary healthcare in rural India is provided on the basis of a system of entitlements – a sub-centre with two health workers for 2500-5000 population, a 4-10 bedded primary health center with one doctor and various paramedic staff for 10,000-30,000 population, and a 30 bedded Community Health Centre with six doctors including basic specialists for every 5 PHCs. Apart from this there are sub-district and district hospitals for secondary level referral. While this is the stated norm not all states have as yet achieved these levels. These are reasonable levels (though not adequate or optimal) of provision provided all expected facilities in terms of staff, medicines, diagnostics, maintenance, transportation etc are adequately provided for. That is adequate resources are made available for these services to function optimally. In reality this does not happen even in a developed state like Maharashtra. This paper addresses issues related to resource mobilization and resource use in rural health services and develops a framework that can be used to improve allocative efficiency of existing resources as well as tapping additional resources. The paper begins with a review of rural health services, utilization and expenditure patterns, both in the public and private sector. It highlights the various dichotomies existing in the healthcare system vis-à-vis rural health services. It next looks at how resources are presently being used in the public health system and provides a critical and analytic assessment using data from Finance Accounts of various state governments, and uses an illustration from Maharashtra to highlight resource related concerns, constraints and opportunities within the state. After presenting the above analysis the paper goes on to develop a framework for a universal access healthcare system based on equity. It not only discusses the possibilities within the public system but goes beyond to present a comprehensive framework of a public-private mix which works on the principle of universal access and equity, debunking the iniquitous system of usercharges. The paper concludes with how the framework can be made workable, including a profile of financial requirements for the reorganized healthcare system.
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Raymus, Prashant
Published Year: 2007
Dantas, Anandi
Published Year: 2010
Dantas, Anandi
Published Year: 2011
Dantas, Anandi
Published Year: 2011
Published Year: 2013
David, S.
Published Year: 2013
Barai - Jaitly, Tejal; Ghosh, Soumitra
Published Year: 2018
Nandraj, Sunil; Duggal, Ravi
Published Year: 1991
Nandraj, S., & Duggal, R. (1991 july - august). Regulating the private health sector. Medico Friend Circle Bulletin, (173-174), 5-7.
Kurian, Oommen C
Published Year: 2012
In Maharashtra, the Association of Hospitals and its member charitable hospitals are attempting to back out of providing free and subsidised beds to poor patients under the Bombay Public Trust Act Scheme which is a legally mandated service in return for subsidies. They are deliberately confusing this scheme with another health scheme of the Maharashtra government which is a business opportunity at competitive rates. Should the government fall for the obfuscation by these hospitals, it will end up paying the private “charitable” hospitals at market rates for what the latter are supposed to provide free in return for heavy subsidies. Read More
Shah, Nehal
Published Year: 2017
Duggal, Ravi
Published Year: 1994
Duggal, Ravi
Published Year: 1998
A policy document is essentially the expression of ideas of those governing to establish what they perceive is the will of the people. A health policy is thus the expression of what the health care system should be so that it can meet the health care needs of the people. Until 1983 there was no formal health policy, the latter being reflected in the discussions of the National Development Council and the Central Council of Health and Family Welfare, and the Five Year Plan documents and/or occasional committee reports. As a consequence of the global debate on alternative strategies during the seventies, the signing of the Alma Ata Declaration on primary health care, and the recommendations of the ICMR-ICSSR Joint Panel, the government decided that the above fora may have served the needs in the past, but a new approach was now required. The health policy of 1983 was the first effort at an official policy statement. There are three questions that need addressing. Firstly, have the tasks enlisted in the 1983 NHP been fulfilled as desired? Secondly, were these tasks and the actions that ensued adequate enough to meet the basic goal of the 1983 NHP of providing "universal, comprehensive primary health care services, relevant to actual needs and priorities of the community"? And thirdly, did the 1983 NHP sufficiently reflect the ground realities in health care provision? The conclusion is that the present paradigm of health care development has in fact raised inequities, and in the current scenario of structural adjustment the state of health care is only getting worse. Hence, the need for a new policy framework to bring about health sector reforms which would make primary health care accessible to all without any social, geographical or financial inequities. The paper begins with a review and critique of the 1983 health policy, develops a rationale for a new health policy, defines a framework for health sector reforms, argues for structural changes within the context of a universal health care approach and evolves the framework of a model. Further, the paper projects resource requirements of the reformed structure and how it could be financed. And finally it raises policy issues that will need to be addressed in order to make such a system work.
Duggal, Ravi
Published Year: 2001
Duggal, Ravi
Published Year: 2001
Duggal, Ravi
Published Year: 2002
Duggal, Ravi
Published Year: 2005
Jesani, Amar
Published Year: 1991
Jesani, A. (1991 5 october). Repression of health professionals. Economic and Political Weekly, 26(40), 2291-2292.
Jesani, Amar
Published Year: 1998
Every time health workers go on strike, a battle is waged not only between strikers and their managements, but also between the right to strike and the ethics of not doing so(1,2,3,4). The latter battle appears to be important, for it raises some controversial issues. A strike is an extreme action, which threatens the livelihood of many strikers if it fails or is crushed. Therefore, at such times fence sitters and doubters are as disliked by strikers as by their opponents. Debates at the time of a strike are often motivated by strikers immediate need for survival and the state's resolve to crush the struggle. The former normally uses the language of rights while the latter of morality. Abstract morality usually projects strikers as 'oppressors' of unattended patients, and supports the real oppressor.
Madhiwalla, Neha
Published Year: 1999
Khot, Anagha; Menon, Sumita; Deosthali, Padma
Published Year: 1999
The article attempts to explore the various dimensions of intrafamilial violence in a community set-up and the factors influencing it in this environment. It also highlights the key role of the health professionals in responding to violence and the role of the community in preventing violence and caring for the victims of violence.
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Jesani, Amar
Published Year: 1997
Mistry, Mani
Published Year: 1998
Jesani, Amar
Published Year: 1998
Duggal, Ravi
Published Year: 1998
Phadke, Anant; Shukla, Abhay
Published Year: 1999
Duggal, Ravi
Published Year: 2001
Saha, Shelley; T. K. Sundari, Ravindran
Published Year: 2002
Nidhi, Amulya
Published Year: 2002
Duggal, Ravi; Dilip, T. R.
Published Year: 2002
Dilip, T. R.
Published Year: 2002
Duggal, Ravi
Published Year: 2003
Duggal, Ravi; Dilip, T. R.
Published Year: 2004
Chaudhari, Leni
Published Year: 2005
Barai - Jaitly, Tejal
Published Year: 2018
Duggal, Ravi
Published Year: 2003
Bandewar, Sunita
Published Year: 2005
Nandraj, Sunil
Published Year: 1994
Nandraj, Sunil; Khot, Anagha; Menon, Sumita
Published Year: 1997
Khot, Anagha; Menon, Sumita
Published Year: 1999
Nandraj, Sunil
Published Year: 2000
Nandraj, Sunil
Published Year: 1999
Khot, Anagha; Menon, Sumita
Published Year: 1999
Nandraj, Sunil; Khot, Anagha; Menon, Sumita; Brugha, Ruairi
Published Year: 2001
Accreditation has been recommended as a mechanism for assuring the quality of private sector health services in low-income countries, especially where regulatory systems are weak. A survey was conducted in Mumbai, India, in 1997-98 to elicit the views of the principal stakeholders on the introduction of accreditation and. what form it should take. There was a high level of support for the classical features: voluntary participation, a standards-based approach to assessing hospital performance, periodic external assessment. by health professionals, and the introduction of quality assurance measures to assist hospitals in meeting these standards. Hospital owners, professional bodies and government officials all saw potential -though different -advantages in accreditation: for owners and professionals it could give them a competitive edge in a crowded market, while government officials reckoned it could increase their influence over an unregulated private market. Areas of disagreement emerged; for example, hospital owners were opposed to government or third party payment bodies having a dominant role in running an accreditation system. The growing strength of a health service user representative lobby in Mumbai is an additional reason why this would be a suitable place for piloting such a system. The biggest obstacle to introducing accreditation in poorly resourced settings, such as India, is in how to finance it. The provisional support of the principal stakeholders for such a development, demonstrated in this study, will require a commitment from government and policymakers if the potential benefits of accreditation to the health of the population are to be realised.
Chatterjee, Chandrima
Published Year: 2005
Mahabal, Kamayani Bali
Published Year: 2004
Duggal, Ravi
Published Year: 1996
Kale, Ashok; Phadke, Anant
Published Year: 1998
Our argument in brief - The annual cost of hepatitis B immunization of all the newborns alone in India would be Rs. 250 crores, whereas the budget for TB control in India this year is only Rs. 105 crores. Given such a high cost, all options to reduce the cost of Hepatitis -B immunization need to be seriously considered in detail. This cost can be reduced to one-fifth if intradermal route is used. Majority of the published studies show that i.d. route is as effective as i.m./s.c. route and that acceptability by the people is not a problem.
Kale, Ashok; Phadke, Anant
Published Year: 1999
Phadke, Anant
Published Year: 2002
In attempting to ensure that the pharmaceutical industry is able to function profitably, and perhaps, efficiently, policy-makers have completely ignored the health concerns that are integrally linked to the contours of the drug policy.
Phadke, Anant
Published Year: 2002
Dam oustees in Satara district of Maharashtra recently scored a signal victory, when their ‘sit-in struggle’ resulted in the acceptance of their demands by the state government, including those on water allowance and equitable distribution of water. The agitators in Satara have thus managed to continue their tradition of struggle in the quest for development.
Phadke, Anant
Published Year: 2002
Phadke, Anant
Published Year: 2002
Phadke, Anant
Published Year: 2002
Kale, Ashok; Phadke, Anant
Published Year: 2002
This paper compares the cost–efficiency of Selective and Universal hepatitis-B vaccination of newborns in India. Part-I critically examines this comparison made by Aggarwal and Naik (the only such comparison in India). It argues that firstly Aggarwal-Naik have measured cost-efficacy in terms reduction in HBsAg-pool and not in terms of reduction in the highly infectious and highly pathogenic HBeAg pool. Secondly in their cost-calculations, they have made biased, unrealistic assumptions about cost of the Selective Vaccination programme, which renders their exercise invalid. Thirdly, the data they have used, itself shows that Selective Vaccination of newborns of HBsAg positive mothers would reduce the HBeAg pool by 40% by immunizing just about 4 % of the newborns; epidemiologically a very attractive option. Part-II compares the cost efficacy of Selective versus Universal hepatitis-B vaccination strategies in India. The Selective vaccination strategy that we propose consists of in year I, identifying all the HBsAg positive mothers through antenatal screening and vaccinating their newborns within 24 hours of birth. This would protect about 40% of the newborns from the risk of HBeAg positivity by vaccinating only the 3% of the newborns, and the programme would cost one fourth of the programme of Universal Vaccination of all the newborns. Logistically also it would be a far better strategy. From year II onwards, only the HBsAg positive primis would be detected and their newborns will be vaccinated, along with vaccinating subsequent newborns of the cohort of HBsAg positive mothers, identified in year I. This subsequent annual screening of only the primis would, without reducing its efficacy, reduce the annual cost of the Selective Vaccination Programme from year II onwards, to only 8% of the annual cost of Universal Vaccination. In our epidemiological and socioeconomic situation, eradication of hepatitis–B is neither warranted nor possible in the next 50 years even with Universal Vaccination. This fact strengthens the case for this highly Selective Vaccination strategy .
Phadke, Anant
Published Year: 2003
Phadke, Anant
Published Year: 2003
Phadke, Anant
Published Year: 2003
Introducing the hepatitis B vaccine in the national immunisation programme would not only cost the government more than all the other six vaccines on the programme, but would yield little by way of public health protection. Read More
Phadke, Anant
Published Year: 2003
Independent analysis shows that introducing the Hepatitis-B vaccine in the national immunisation programme will yield small gains at high cost.
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2004
Phadke, Anant
Published Year: 2005
Phadke, Anant; Shukla, Abhay; Nidhi, Amulya; Kunte, Prasanth
Published Year: 2000
Bavadekar, Amruta; Rege, Sangeeta; Deosthali, Padma
Published Year: 2017
Rege, Sangeeta; Bhate-Deosthali, Padma
Published Year: 2018
Rege, Sangeeta
Published Year: 2018
Jesani, Amar; Duggal, Ravi
Published Year: 1992
Jesani, Amar
Published Year: 1992
Jesani, Amar
Published Year: 1994
Jesani, Amar
Published Year: 1994
Is it the Doctor’s duty to force-feed hunger strikers? Or is he only required to explain the pros and cons of their decision to them?
Pilgaokar, Anil
Published Year: 1995
Jesani, Amar; Vadair, Asha
Published Year: 1995
Jesani, Amar
Published Year: 1995
Jesani, Amar
Published Year: 1995
Iyer, Aditi
Published Year: 1996
Jesani, Amar
Published Year: 1996
In last one decade the health care professionals have been severely criticised both for being indifferent to their social responsibility and for not regulating themselves. As patients become more aware of their rights and the market in health care continues to operate without restraints exercised as a part of the self regulation, it is not difficult to foresee the emergence of new demands for imposing regulations on health care by the state. There is increasing evidence to suggest that, harassed by the rising cost of health care, the middle classes and the poor would welcome regulations. However, experience of the historical developed countries show that if such regulations are not accompanied by holistic planning to make health universally accessible to people, they invariably become self-defeating by encouraging the monster of private health insurance and the finance capital. The US is a classical example of having highest number of regulations over the health care market and yet, such regulations have neither brought down the cost of health care nor made consumers as well as providers happy. In fact, the increasing dominance of private insurance companies and corporations have encroached upon the professional independence of providers and done nothing to achieve the social goal of making health care universally accessible. Thus, the health care providers in our country will soon be required to make a choice between external regulations and the genuine self-regulations in tune with their social responsibility and the goal of achieving health care ethics.
Mahabal, Kamayani Bali
Published Year: 2003
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 1992
Duggal, Ravi
Published Year: 1993
Jesani, Amar
Published Year: 1996
Social activists have been demanding reforms in health care services for a very long time. The new economic policy (NEP) and the structural adjustment programmes (SAP), officially stated by the government since 1991, have only made the need to take action in the field of health care very urgent. The international experiences of SAP have conclusively shown that health care is one of the important components of the social sector which is getting adversely affected by the governments attempt to reduce its expenditure. In our country there are several reasons why such an adverse impact on health care is going to be very severe. Such an impact is as much due to the kind of health service system that exists as the high level of existing poverty. We shall not fo into the latter, namely how the NEP and SAP could accentuate poverty and the problems of the poor. We shall explain briefly what it could do and is doing to make health care accessible to the people. That will be followed by our suggestions on the strategy that the social activists could employ.
Jesani, Amar
Published Year: 1999
Jesani, Amar; Iyer, Aditi
Published Year: 1999
Duggal, Ravi
Published Year: 1999
Nidhi, Amulya; Saha, Shelley
Published Year: 2000
Shukla, Abhay
Published Year: 2001
Duggal, Ravi; Kamath, Rajashree; Dilip, T. R.
Published Year: 2001
Duggal, Ravi; Dilip, T. R.
Published Year: 2001
Dilip, T. R.
Published Year: 2001
A., Asharaf
Published Year: 2001
Shukla, Abhay
Published Year: 2002
Dilip, T. R.
Published Year: 2002
Dilip, T. R.
Published Year: 2000
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Duggal, Ravi
Published Year: 2003
Historically India has always had a very large private health sector, especially for ambulatory healthcare services. These include providers of modern medicine as well as traditional practitioners. Hospital services until the mid-seventies were predominantly in the public domain. Medical education was almost a public monopoly until late eighties after which private sector grew rapidly but even today 75 per cent of outturn of medical graduates is from public medical schools. Post mid-seventies the State provided various incentives like concessional land and tax breaks for setting up of private hospitals and duty exemptions for imports. The private pharmaceutical industry also received substantial State patronage for its growth through process patent laws, subsidised bulk drugs from public sector companies and protection from MNCs.
Duggal, Ravi
Published Year: 2003
Dilip, T. R.
Published Year: 2003
Saha, Shelley
Published Year: 2004
Phadke, Anant
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2004
Duggal, Ravi
Published Year: 2005
Duggal, Ravi
Published Year: 2005
Chaudhari, Leni
Published Year: 2005
Rege, Sangeeta; Sana Contractor
Published Year: 2009
This study provides an insight into our experiences of implementing the Sexual Assault Forensic Evidence collection Kit (SAFE Kit), a comprehensive protocol for evidence collection developed by Centre for Enquiry into Health and Allied Themes (CEHAT), for one year in two public hospitals in Mumbai, India. A protocol was implemented for evidence collection for cases of sexual assault accompanied by sensitization and capacity building of health professionals on the issue of sexual violence. Support services were also provided to the victims. The handling of victims of sexual assault in these hospitals was documented and several gaps in relation to obtaining consent, recording of history, preserving confidentiality of victims and provision of care were noticed even after comprehensive protocol had been implemented. The introduction of protocols ensured meticulous collection of medico-legal evidence and health care providers were enthusiastic about implementing them. However, the response was far from adequate when it came to providing the victim with holistic care, despite the fact that sensitization training had taken place along with implementation . of the protocol. The forensic role of health care providers took precedence in cases of sexual assault; therefore the aspect of care took a back seat. Solely an introduction of protocols will not substantially change the manner in which victims of Gender-based Violence (GBV) are treated by the health system. One time capacity building is also not 355 sufficient to change attitudes and undo biases. This requires a more fundamental change in the way medical education treats sexual assault. The preoccupation with medico-legal requirement of handling cases of sexual ass<;!ult must be replaced by an emphasis on providing holistic care to victims. Moreover, fear of the legal system and administrative rigmarole thwart the efforts of even sensitive providers. Demystifying legal obligation and modifying administrative procedures related to handling of victims and provision of holistic care will aid this process and make it easier for providers to respond sensitively.
Rege, Sangeeta; Reddy, Jagadeesh Narayana; Bhate-Deosthali, Padma
Published Year: 2017
Rege, Sangeeta; Reddy, Jagadeesh Narayana; Bhate-Deosthali, Padma
Published Year: 2017
Chandrasekhar, Aarthi
Published Year: 2018
Mahabal, Kamayani Bali
Published Year: 2004
Pitre, Amita
Published Year: 2005
Pitre, Amita
Published Year: 2006
Guidelines in India for the examination and treatment of survivors of sexual assault are inadequate. The guidelines that exist for some aspects may not serve the best interests of survivors or of legal procedures. This paper draws on formal and informal consultations to discuss some of the problems that arise due to the absence of standard guidelines in this context. Caring for survivors of sexual offences can involve several departments in a hospital, including casualty, gynaecology, paediatrics, radiology and forensics. Law enforcement agencies are also involved because medical evidence forms an important link in any investigation. Any lacunae on the part of any of these departments may result in a disservice to the survivor. However, a paucity of standard guidelines and reference material in India makes it difficult for health professionals to decide on how best to proceed in such cases.
Rege, Sangeeta; Deosthali, Padma; Amin, Avni; Meyer, Sarah R.; García-Moreno, Claudia; Avalaskar, Prachi
Published Year: 2020
Rege, Sangeeta; Deosthali, Padma; Ayarkar, Sujata; Pradhan, Anagha; Singh, Anupriya
Published Year: 2020
Gupte, Manisha
Published Year: 1993
Madhiwalla, Neha
Published Year: 1997
Madhiwalla, Neha
Published Year: 1998
Iyer, Aditi
Published Year: 1998
Padmadas; Dilip, T. R.
Published Year: 1999
Madhiwalla, Neha
Published Year: 2001
Barai - Jaitly, Tejal; Contractor, Sana
Published Year: 2018
Rege, Sangeeta; Bhate-Deosthali, Padma; Shingare, Pravin; Gadappa, Srinivas; Deshpande, Sonali; Gaikwad, Nandkishore ; Vaidya, Shailesh
Published Year: 2019
Khanday, Zamrooda
Published Year: 2017
Rege, Sangeeta; Bhate-Deosthali, Padma; Arora, Sanjida
Published Year: 2019
To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence.
Pre experimental study with pretest/posttest design.
Two public hospitals in Mumbai, India.
In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post intervention analyses were carried out with 142 women at 6 weeks post delivery; 13 women were not contactable.
The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre and post intervention data.
Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health.
Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60–65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (Pvalue 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status postintervention.
Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health.
Rege, Sangeeta; Bhate-Deosthali, Padma
Published Year: 2019
Health and Human Rights Journal, Vol.21, No.2, 2019, pp. 189 - 198
Access to abortion is desperately needed when pregnancy is the result of rape, both within and outside marriage, and especially when a girl has been raped. The availability of services remains highly restricted because of the way abortion providers interpret the law. This paper presents the experiences of 40 rape survivors, including two children, denied an abortion following rape. The cases were recorded by CEHAT (Centre for Enquiry into Health and Allied Themes) in the course of building capacities of public hospitals to respond to violence against women in Mumbai, India, since 2000. We found that enormous damage is inflicted on women and girls by misinterpretation of the laws on abortion and rape, combined with a lack of understanding of the serious damage rape does, particularly repeated rape, and alongside other forms of assault and abuse. Domestic laws in India place a clear legal responsibility on health professionals to offer immediate care and treatment to rape survivors, including timely access to abortion. It is past due time for both the government and the courts to begin to hold themselves and health professionals accountable for ensuring this care is provided.
Rege, Sangeeta; Vernekar, Durga
Published Year: 2020
Mahabal, Kamayani Bali
Published Year: 2004