This document reports the proceedings of a research-to-policy workshop that was organized as part... more This document reports the proceedings of a research-to-policy workshop that was organized as part of a multi-country cross-disciplinary research project on the private health care sector in urban poor neighbourhoods in India, Indonesia and Thailand, entitled "Health System Reform and Ethics: Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand". The project consisted of a combination of medical anthropological research among private (for-profit) practitioners and among people living in poor urban neighbourhoods; a health economics study among poor urban households and a desk study that assessed existing regulations and ethical guidelines in the three countries. The project period was April 2004 to December 2007. A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means. It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia. The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study:
1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study 2) Health systems ethics among private practitioners: ethnographic sub-study 3) Family-level treatment and health-related decision-making: interview sub-study 4) Household survey: health economics sub-study The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07).
The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.
The final report of the Commission on Social Determinants of Health (SDH) has been the subject of... more The final report of the Commission on Social Determinants of Health (SDH) has been the subject of analysis and policy discussions since its release in August 2008. Keeping in mind some of the early reviews of this report, the time has come to evaluate the pathways, both academic and political, that need to be mobilized to address this report in its fullest measure. As the dissemination of the report enters a new phase, its interpretation and reception in diverse policy arenas gains in importance, and its prioritization by key state and non-state agencies will need to be critically mapped and advocated in the near future. To address this, we need to recapitulate the strengths and implications of the report, as well as its national pathways. 1 The report focuses on the importance of achieving health equity at a time when inequalities have increased within and across countries. Several western European countries, Canada and even the US have expressed concern over the rising inequalities in health. Among the developing countries, economic liberalization over the past 3 decades has impacted socioeconomic and health opportunities differentially across regions and social groups. While the upper middle classes have clearly benefited from the twin processes of globalization and liberalization, other sections of the middle class and the organized and unorganized working classes have not benefited to a similar degree. Given the variations in the levels of inequality within and across countries, this report reaffirms the need to acknowledge the relationship between society and health, and upholds the principles of social justice. It states that the ‘commission’s vision is a world in which all people have the freedom to lead lives they have reason to value. This is a matter of social justice. Health and its key determinants are an issue of human rights. Politically, it is vital, as the success of a society can be judged from the quality and fair distribution of its population’s health’. 2 As a first step towards achieving equity in health, the commission offers a conceptual framework drawn on the basis of a review of the theoretical frameworks that have informed this area of inquiry. In addition, it has commissioned papers on nine themes—early child development, globalization, employment conditions, social exclusion, health systems, priority public health conditions, measurement and evidence, women and gender equity, and the urban setting. These nine themes are called the knowledge networks and under each of them there is a position paper that reviews the existing literature and also offers suggestions. 3
This chapter analyses the role and social characteristics of market forces in the health service ... more This chapter analyses the role and social characteristics of market forces in the health service system in India. It argues that while there are studies that have individually focused on financing, provisioning, drugs and technology, there is a need to take a systemic view of it. It also examines the rise of corporate sector health care through the example of Apollo hospitals and illustrates the complex interaction between regional, national, and international capital and the support from the political class to facilitate the corporate sector in health care. The role of the diasporic networks and their access and influence on policymaking during the last three decades has been highlighted.
... RAMA V BARU, G SADHANA ... The fourth quadrant includes those districts, which represent diff... more ... RAMA V BARU, G SADHANA ... The fourth quadrant includes those districts, which represent differential levels of de-velopment with both middle ranking and well-developed districts, and the pattern observed in this quadrant is one of high incidence but low CFR. ...
The health workforce is hierarchical in structure in terms of skill mix and social composition. M... more The health workforce is hierarchical in structure in terms of skill mix and social composition. Most of the studies on the health workforce are focused on the number of personnel in the public sector. The private sector that has a large presence employs a significant percentage of the total health work force but there is little reliable data on the numbers involved. This is largely due to the lack of regulation of the private health services. Apart from the numbers involved in both the sectors, a few studies have shown the relationship between the work and social hierarchy in health services. While the public sector has a more diverse mix of social backgrounds due to affirmative policies, the private sector ownership is mostly dominated by an upper and middle caste-class combine. There is an under-representation of minorities and women as owners of private health services. The gendered nature of work is visible with the middle and lower rungs constituted by mostly women and men from...
This article identifies key processes that influence the size and characteristics of private prov... more This article identifies key processes that influence the size and characteristics of private provisioning in health care in India, Pakistan, Bangladesh and Sri Lanka, as well as the variations in the pattern of such private sector presence in these countries. Privatisation of health care in the highly iniquitous countries of south Asia jeopardises access to the large sections of the population that live in poverty.
Recent epidemics of gastro-enteritis in two of the poorest districts of Andhra Pradesh illustrate... more Recent epidemics of gastro-enteritis in two of the poorest districts of Andhra Pradesh illustrate well why there is a need for a comprehensive broad-based public health policy which emphasises preventive and promotive care.
This document reports the proceedings of a research-to-policy workshop that was organized as part... more This document reports the proceedings of a research-to-policy workshop that was organized as part of a multi-country cross-disciplinary research project on the private health care sector in urban poor neighbourhoods in India, Indonesia and Thailand, entitled "Health System Reform and Ethics: Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand". The project consisted of a combination of medical anthropological research among private (for-profit) practitioners and among people living in poor urban neighbourhoods; a health economics study among poor urban households and a desk study that assessed existing regulations and ethical guidelines in the three countries. The project period was April 2004 to December 2007. A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means. It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia. The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study:
1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study 2) Health systems ethics among private practitioners: ethnographic sub-study 3) Family-level treatment and health-related decision-making: interview sub-study 4) Household survey: health economics sub-study The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07).
The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.
The final report of the Commission on Social Determinants of Health (SDH) has been the subject of... more The final report of the Commission on Social Determinants of Health (SDH) has been the subject of analysis and policy discussions since its release in August 2008. Keeping in mind some of the early reviews of this report, the time has come to evaluate the pathways, both academic and political, that need to be mobilized to address this report in its fullest measure. As the dissemination of the report enters a new phase, its interpretation and reception in diverse policy arenas gains in importance, and its prioritization by key state and non-state agencies will need to be critically mapped and advocated in the near future. To address this, we need to recapitulate the strengths and implications of the report, as well as its national pathways. 1 The report focuses on the importance of achieving health equity at a time when inequalities have increased within and across countries. Several western European countries, Canada and even the US have expressed concern over the rising inequalities in health. Among the developing countries, economic liberalization over the past 3 decades has impacted socioeconomic and health opportunities differentially across regions and social groups. While the upper middle classes have clearly benefited from the twin processes of globalization and liberalization, other sections of the middle class and the organized and unorganized working classes have not benefited to a similar degree. Given the variations in the levels of inequality within and across countries, this report reaffirms the need to acknowledge the relationship between society and health, and upholds the principles of social justice. It states that the ‘commission’s vision is a world in which all people have the freedom to lead lives they have reason to value. This is a matter of social justice. Health and its key determinants are an issue of human rights. Politically, it is vital, as the success of a society can be judged from the quality and fair distribution of its population’s health’. 2 As a first step towards achieving equity in health, the commission offers a conceptual framework drawn on the basis of a review of the theoretical frameworks that have informed this area of inquiry. In addition, it has commissioned papers on nine themes—early child development, globalization, employment conditions, social exclusion, health systems, priority public health conditions, measurement and evidence, women and gender equity, and the urban setting. These nine themes are called the knowledge networks and under each of them there is a position paper that reviews the existing literature and also offers suggestions. 3
This chapter analyses the role and social characteristics of market forces in the health service ... more This chapter analyses the role and social characteristics of market forces in the health service system in India. It argues that while there are studies that have individually focused on financing, provisioning, drugs and technology, there is a need to take a systemic view of it. It also examines the rise of corporate sector health care through the example of Apollo hospitals and illustrates the complex interaction between regional, national, and international capital and the support from the political class to facilitate the corporate sector in health care. The role of the diasporic networks and their access and influence on policymaking during the last three decades has been highlighted.
... RAMA V BARU, G SADHANA ... The fourth quadrant includes those districts, which represent diff... more ... RAMA V BARU, G SADHANA ... The fourth quadrant includes those districts, which represent differential levels of de-velopment with both middle ranking and well-developed districts, and the pattern observed in this quadrant is one of high incidence but low CFR. ...
The health workforce is hierarchical in structure in terms of skill mix and social composition. M... more The health workforce is hierarchical in structure in terms of skill mix and social composition. Most of the studies on the health workforce are focused on the number of personnel in the public sector. The private sector that has a large presence employs a significant percentage of the total health work force but there is little reliable data on the numbers involved. This is largely due to the lack of regulation of the private health services. Apart from the numbers involved in both the sectors, a few studies have shown the relationship between the work and social hierarchy in health services. While the public sector has a more diverse mix of social backgrounds due to affirmative policies, the private sector ownership is mostly dominated by an upper and middle caste-class combine. There is an under-representation of minorities and women as owners of private health services. The gendered nature of work is visible with the middle and lower rungs constituted by mostly women and men from...
This article identifies key processes that influence the size and characteristics of private prov... more This article identifies key processes that influence the size and characteristics of private provisioning in health care in India, Pakistan, Bangladesh and Sri Lanka, as well as the variations in the pattern of such private sector presence in these countries. Privatisation of health care in the highly iniquitous countries of south Asia jeopardises access to the large sections of the population that live in poverty.
Recent epidemics of gastro-enteritis in two of the poorest districts of Andhra Pradesh illustrate... more Recent epidemics of gastro-enteritis in two of the poorest districts of Andhra Pradesh illustrate well why there is a need for a comprehensive broad-based public health policy which emphasises preventive and promotive care.
The idea of school health is re-imagined with an emphasis on the need for children’s health progr... more The idea of school health is re-imagined with an emphasis on the need for children’s health programmes to be rooted in an understanding of the social context. Such programmes must address health, nutrition and education in a comprehensive manner. The article details findings and insights emerging from a qualitative study conducted in municipal schools in Delhi, located in contexts of poverty. The study identifies areas requiring changes in teacher education and health programmes. A creative methodology was utilised to record children’s perceptions and teachers’ views on health, which found that an approach that privileges the voices of the child and the school in public health planning can be very meaningful.
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countries. The project period was April 2004 to December 2007.
A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been
a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means.
It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly
understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia.
The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study:
1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study
2) Health systems ethics among private practitioners: ethnographic sub-study
3) Family-level treatment and health-related decision-making: interview sub-study
4) Household survey: health economics sub-study
The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07).
The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.
countries. The project period was April 2004 to December 2007.
A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been
a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means.
It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly
understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia.
The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study:
1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study
2) Health systems ethics among private practitioners: ethnographic sub-study
3) Family-level treatment and health-related decision-making: interview sub-study
4) Household survey: health economics sub-study
The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07).
The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.