Relevance of the world health organization in a multipolar world in solving global health challenges.

There have been many criticisms about the World Health Organization (WHO) in the last decade. In a multipolar world, there are rivalries between nations and geopolitical regions. However, health issues remain outside the murky world of politics due to their far-reaching consequences on human society. The power conferred on the WHO is very significant in protecting the health and well-being of the global population. As a neutral organization, the WHO is supposed to uphold people's rights to health, especially in controlling diseases of international importance. The paper highlighted the significant roles of the WHO in leadership issues, research and development, solving disputes among countries, providing resources for low-performing regions, regulating international health laws, responding to a humanitarian crisis, and communicating during the crisis. Further, evidence from global literature critically analyzed the enforcement role of WHO on international health regulations (IHRs).

Assessment of Workplace Hygiene among Contractual Workers in the Steel and Power Industry of Odisha, India.

Background: Workplace hygiene is vital in controlling infectious diseases in industries. The factors like unhealthy environment, unhygienic workplace, and contact between healthy and disease-affected employees cause industrial hazards in workplaces. Objectives: This study assessed various components of workplace hygiene among industrial workers. Materials and Methods: A quantitative survey has been conducted in a steel, and power industry limited in Odisha. The study surveyed 425 male contractual workers for primary data on workplace hygiene. Probability proportion to sample technique adopted for justification of the sample. The univariate and bivariate analysis models have been done according to the study's objective. Results: Nearly 92% of respondents reported proper use of washing facilities, and 97% used toilet and urinal appropriately. One-fourth of respondents use personal disinfected clothing, and 92.2% have access to safe drinking water. The factors such as education, technical education, and occupation are significantly associated with respondents' use of washing facilities, dining hall, personal protective clothing, safe drinking water, proper cleaning, and sanitation at the workplace. Conclusion: Workplace hygiene strengthens the safety measures at the workplace and reduces the incidences of occupational hazards.

Household sanitation and menstrual hygiene management among women: Evidence from household survey under Swachh Bharat (Clean India) Mission in rural Odisha, India.

Introduction: Discussion on women empowerment without addressing their basic needs would be meaningless. As such, the needs of women and girls have been prioritized in global sanitation efforts including menstrual hygiene. However, there is little research on existing approaches on menstrual management. India's most ambitious sanitation campaign named Swachh Bharat Mission or "Clean India Mission" aimed to achieve universal sanitation coverage in every single household, targeted to end open defecation by October 02, 2019. This study aimed to assess the women's perception of household sanitation facilities and menstrual hygiene management experience in Odisha under Swachh Bharat Mission. Methods: The study is a community-based survey having cross-sectional in nature conducted among 700 rural women and girls aged 15-45 years in the Balesore district of Odisha state in India from January to April 2021. A multi-stage sampling method was adopted to select the study participants. Data was collected using a pretested questionnaire based on the Performance Monitoring and Accountability 2020 survey questionnaire and analyzed by SPSS version 25. Descriptive statistics was used to assess the household sanitation and menstrual hygiene management experience among women. Results: More than two-thirds (68.4%) of rural households use improved sanitation facilities. Around 30% of families have inadequate sanitation infrastructure, which means at least one household member defecates in the open space. Nearly 64.6% disposed of their menstrual absorbents in the bush or field, while 29.1% disposed in the river and 24.1% in the waste bin. Still, 40.6% of women were using clothes as menstrual absorbents, and 54.9% of the respondents reported washing their menstrual materials for re-use. Of those who washed and re-used, 99.2% said their re-use material was completely dry before re-use. About 69.7% of the respondents mentioned that they change their menstrual absorbents in sleeping areas at home. About 91% of the respondents reported that the place where they changed their menstrual absorbents was safe, clean, and private. Only 22.5% of women responded to having water and soap at their menstruation management area. Conclusion: The effort for improvements in sanitary techniques during menstruation is partly effective in creating healthy behavior. The current strategy for developing programs to adopt menstrual hygiene measures needs a bottom-up approach with women at the center. Components associated with menstrual hygiene management, such as women's cleanliness, water supply, and the availability and accessibility of disposable sanitary napkins, should be given specific attention. It is essential to acknowledge the issues like toilet construction and behavior change communication to consolidate the gains in an era of "Clean India Mission."

Behavioral interventions towards knowledge and awareness of reproductive cancer care: A study on select Indians using an online survey.

BACKGROUND: The behavioral aspects of human beings influence the incidences of cancer cases directly and indirectly. The factors like positive thinking and motivation were found to change the behavior toward knowledge and awareness of cancer. The main objective of the study is to assess the knowledge and awareness of select Indians about reproductive cancer. MATERIALS AND METHODS: The online survey method assessed various components of knowledge and awareness about reproductive cancer. A Google Form has been distributed through social media platforms such as e-mail, Instagram, Facebook, and WhatsApp. The coded data has been computed in SPSS (version 25) by IBM (USA) for the analysis. Univariate and bivariate data analysis has been drawn to justify the objective. RESULTS: Nearly 68 percent of the respondents were aware of reproductive cancer. Among them, 17 percent know about cervical cancer, and 12.5 percent have awareness about breast cancer. Electronic and print media (41.2 percent) were major sources of information about reproductive cancer. Nearly 48 percent of respondents reported that multiple sexual partners and poor sexual hygiene were risk factors for reproductive cancer. Around 57 percent of respondents reported reproductive cancer is preventable, 59 percent knew about cancer screening, and 63.5 percent knew the treatment process. The gender of the respondents was associated (p-value = 0.002) with awareness of reproductive cancer. It has been found that there is a significant association between knowledge of screening tests and the treatment process of reproductive cancer. The marital status of respondents is strongly associated (p-value = 0.000) with the awareness of reproductive cancer. CONCLUSION: The factors like knowledge of reproductive cancer and awareness proceed as an important role in cancer prevention. A gender-neutral cancer awareness program is needed to increase cancer awareness irrespective of marital status.

Assessment of health management information system for monitoring of maternal health in Jaleswar Block of Balasore District, Odisha, India.

BACKGROUND: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. OBJECTIVE: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013-2014. METHODS: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. RESULTS: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. CONCLUSION: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.

Utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India: a systematic review.

Background Albeit Indian system of medicine has been practised since long however it has got recent prominence after some policy decisions made to make it more accessible to the people of India. Methods A two fold search strategy was adopted to obtain the literature; search through PUBMED and hand search through cross references. Of the 58 articles obtained through both the search approaches 13 articles were finally included in the review. Results The studies reviewed assessed the utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India. Utilization was observed in a particular geographical area (states) and by a specific group of people such as tribal and general population, medical practitioners and religious groups. Perception about AYUSH system was mixed with different segments of the society. Preference among the general population revolved around distrust or frustration with allopathic medicine, cost effectiveness, accessibility, non-availability of other options and less side effects of AYUSH medicines. Moreover people primarily adopted AYUSH systems of medicine based on their personal experiences and recommended the same to other people as well. Conclusions A mixed response was observed through this systematic review with regard to utilization, preference, perception and characteristics of people adopting traditional and AYUSH systems of medicine in India. A higher level of awareness and governmental patronization is required to make it available to the common man at the last corner of the society for the benefit of the former and the system as well.

Can the AYUSH system be instrumental in achieving universal health coverage in India?

Universal health coverage (UHC) in the Indian context is understood as easily accessible and affordable health services for all citizens. The Planning Commission of India constituted a High Level Expert Group (HLEG) in October 2010 for the purpose of drafting the guidelines of UHC. While the primary focus of UHC is to provide financial protection to all citizens, its delivery requires an adequate health infrastructure, skilled health human resources, and access to affordable drugs and technologies so that all people receive the level and quality of care they are entitled to. This paper attempts to link the ayurveda, yoga and naturopathy, unani, siddha and homoeopathy (AYUSH) systems of medicine with UHC. Here, the AYUSH system refers to the AYUSH workforce, therapeutics and principles, and their individual role in delivering UHC to the citizens of India. In outlining the role of AYUSH, the paper lays stress on the 10 guiding principles of UHC, as proposed by the HLEG. However, as the AYUSH system is not the principal health service provider in India, the dominant system being that of allopathic medicine, a few components of UHC may not fit neatly into the AYUSH system. This paper has adopted the definition of UHC quoted by the HLEG.

The Need and Importance of Incorporating Academic Research Results in to the Curricula of Ayurveda in India.

Every year a noticeable number of MD and PhD students pass out from various Ayurveda colleges across the country. Each of these Post Graduate (PG) and doctoral students do submit a research thesis as a part of fulfillment of their respective degrees. As on 01/04/2015 there were 98 PG Ayurveda colleges in India with an admission capacity of 2441 seats each year. Moreover many of the post graduate institutes provide doctoral level (PhD) education which is primarily involved with research thesis. Such meticulous research carried out under the supervision of an academic expert should not go in vein and hence the research findings need to be slotted in to the respective areas and disciplines of Ayurveda syllabus. This will help in bringing in the latest scientific trends of Ayurveda to graduate students. Distressingly such practices are not in vogue in Ayurveda education system and most of the colleges follow the same stereotypic pedagogy using the classical texts of Ayurveda or their respective commentaries written decades back. Use of classical treatises and their respective commentaries offers very limited access to the recent scientific developments of Ayurveda as these commentaries are mostly one time efforts and do not undergo repeated revisions thus limiting the inclusion of present day innovations. In this commentary an effort has been made to understand the source, output, need and importance of such academic research finding with reference to their incorporation in to curricula of Ayurveda.

Salient Features of a Proposed Adolescent Health Policy Draft for India.

India is one of the most populous countries in the world. The adolescent population in India constitutes about one fifth of the total Indian population. Adolescent phase is a transitional phase in life and the adolescents are neither child nor adult at this stage and are full of energy, have significant drive and new ideas. The relatively lower death rate and relatively good health status of the adolescents has always been a misleading measure to adolescent health and thus given lesser priorities. In order to respond effectively to the needs of adolescent health and development, it is important to place adolescence in a life-span perspective within dynamic sociological, cultural and economic realities. For this, government of India has started a national programme known as "Rashtriya Kishor Swathya Karyakram" in 2014. However, India as a country does not have an adolescent health policy till date and hence the country requires a national adolescent health policy. The key priorities should include sexual and reproductive health, nutritional problems (both under and over nutrition), substance abuse, mental health, road traffic accidents, intentional violence and non-communicable diseases. In addition to key priorities, the policy draft should include pertinent components such as a preamble, guiding principles, coordinating agencies, monitoring and evaluation, research and documentation components.

Impact of a Structured Tuberculosis Awareness Strategy on the Knowledge and Behaviour of the Families in a Slum Area in Chhattisgarh, India.

INTRODUCTION: Of different methods of disease prevention, health education and awareness programmes can empower people regarding several aspects of disease management and thereby enabling them in accessing the right treatment, in right time, at right place. AIM: The aim of this study was to assess the impact of a structured Tuberculosis (TB) awareness strategy on the knowledge and behaviour of slum dwellers of Durg, Chhattisgarh, India. MATERIALS AND METHODS: A TB awareness intervention was implemented in terms of informing the houses of marginalized and vulnerable communities about TB, its symptoms, diagnosis, treatment and Revised National TB Control Program (RNTCP) services and the impact of the same was assessed through a survey questionnaire before and after the implementation of the intervention. RESULTS: Of the knowledge components the improvement was incurred above 90% among the study participants in all components except in two components such as; modes of TB transmission and availability of free treatment facilities. In the behavioural segment, after the implementation of the awareness strategy, 53% and 92% of the respondents reported to visit government health facility for seeking help for their general and TB related problems respectively. Similarly the responses regarding not approaching the government health facility for TB care were changed after the implementation of the awareness strategy and 36% of the respondents said they would prefer to visit government health facility for TB care. CONCLUSION: Health education activities should be directed to improve the knowledge of slum dwellers regarding the modes of TB transmission and availability of free treatment at public health facilities.

"Exit exams" for medical graduates: a guarantee of quality?

Despite a great deal of opposition from many segments of the medical community, the Medical Council of India (MCI) has proposed to the Ministry of Health and Family Welfare, Government of India that a pan-India exit examination be introduced for graduating MBBS doctors. Whether the proposal should be put forward was considered twice, once in 2010 and again in 2013, and finally the plan was ready to be taken forward seriously in 2015. The proposal has elicited appreciation and criticism from different segments of the medical community. It aims to improve the quality of medical professionals and create an all-India chapter of doctors. People are ready to welcome the move if it is integrated with the final year MBBS examination and licentiate examination and serves as an entrance examination for medical graduates. Further, the Supreme Court's order that the National Eligibility and Entrance Test (NEET) be made compulsory aims to create a fair, transparent and non-exploitative system. This move has the potential to reduce corruption and foster a merit-based system of medical education. However, making NEET compulsory would have an impact on the proposed exit examination. Given this background, we analyse the pros and cons of the new initiative on the basis of articles published in newspapers and journals, with a special focus on its impact on improving the standards of quality in the medical profession.

Maternal Health Situation in Bihar and Madhya Pradesh: A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-3 and 4.

INTRODUCTION: Maternal health constitutes the health of women during pregnancy, childbirth and the postpartum period. Bihar and Madhya Pradesh (MP) constitute the Empowered Action Group (EAG) states under National Rural Health Mission (NRHM) and are consistently having poor maternal health indicators. AIM: The main objective of this study was to assess the maternal health situation of Bihar and MP based on National Family Health Survey (NFHS-3) and 4 fact sheets. MATERIALS AND METHODS: The study adopted a narrative description in which the NFHS fact sheets (NFHS-3 & 4) of both these states were obtained from appropriate sources and compared for various maternal health indicators. RESULTS AND DISCUSSION: Albeit progress has been observed from NFHS-3 to NFHS-4 however, the progress is very dismal compared with the progress of other similar Indian states. Relatively MP has shown better progress compared to Bihar. Poor performance is being observed in all the three levels of maternal health; pregnancy {Ante-Natal Care (ANC), Tetanus toxoid (TT) and Iron and Folic Acid (IFA)}, child birth (Institutional delivery by Skilled Birth Attendant (SBA), Caesarean Section (CS) and post partum care (hospital stay and Janani Suraksha Yojna (JSY). The poor performance of both these states in all these indicators requires multipronged approach strong political will, health system strengthening, community mobilization and awareness. CONCLUSION: Given the status of maternal health in India and more especially in states BIMARU (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh) and EAG states (Empowered action group), improvement in the performance of maternal health related activities is highly necessary.

Health System Competency for Maternal Health Services in Balasore District and Jaleswar Block, Balasore, Odisha, India: An Assessment.

INTRODUCTION: A competent health system is of paramount importance in delivering the desired health services in a particular community. AIM: The broad objective of this study was to assess the health system competency for the maternal health services in Balasore District and Jaleswar block of Balasore district, Odisha, India. MATERIALS AND METHODS: A mixed method approach was adopted in order to understand the health system competency for maternal health services in the study area. RESULTS: There was poor accessibility through road, poor electricity connection and piped water for the health care centers in the district. Even, existing Primary Health Centres (PHCs) lack ECG and X-Ray machines for proper diagnostic services which jeopardize the catering of health services. Community Health Centres (CHC) lack basic diagnostic and ambulance services making the tribal pockets inaccessible. The tribal dominated Jaleswar block shows poor performance in terms of total registered Antenatal Checkups (ANC) (only 77%). A gradual decrease in the rate of ANC, from first to fourthcheckup, was observed in the district. CONCLUSION: Lack of public health infrastructure in general and non-compliance to Indian Public Health Standards (IPHS) in particular, affect the health of tribal women resulting in lack of interest in availing the institutional delivery services and other pertinent maternal health services.

Perspectives and Challenges of HMIS Officials in the Implementation of Health Management Information System (HMIS) with Reference to Maternal Health Services in Assam.

INTRODUCTION: Health Management Information System (HMIS) is one of the important components of National Rural Health Mission (NRHM). The web portal of HMIS was launched by the Ministry of Health and Family Welfare (MOHFW), Govt. of India (GOI) in 21(st) Oct. 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. AIM: The aim of the study was to assess the quality perspectives and challenges among HMIS officials in implementing HMIS at their respective levels, i.e. district and block level. MATERIALS AND METHODS: We conducted a pilot qualitative study in two districts of Assam. HMIS officials working at district and block level were interviewed in-depth with the help of a semi-structured interview schedule which lasted from May to July 2014. RESULTS: Both HMIS and MCTS (Mother and Child Tracking System) formats were considered useful, by the HMIS officials, for data collection, planning at various levels, tracking maternal and neonatal deaths, institutional deliveries. HMIS officials reported that MCTS is useful for monitoring individual health status especially the status of the mother and child and HMIS being helpful as a health facility monitoring tool. CONCLUSION: The study used a small sample size, hence similar type of studies are required with large sample size to understand the perspectives and challenges of HMIS officials in the implementation of HMIS.

An Evaluation on Medical Education, Research and Development of AYUSH Systems of Medicine through Five Year Plans of India.

INTRODUCTION: Indian system of medicine has its origin in India. The system is currently renamed as AYUSH, an acronym for Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy. These are the six Indian systems of medicine prevalent and practiced in India and in few neighboring Asian countries. OBJECTIVE: The primary objective of this review was to gain insight in to the prior and existing initiatives which would enable reflection and assist in the identification of future change. MATERIALS AND METHODS: A review was carried out based on the five year plan documents, obtained from the planning commission web portal of Govt. of India, on medical education, research and development of AYUSH systems of medicine. RESULTS: Post independence, the process of five year planning took its birth with the initiation of long term planning in India. The planning process embraced all the social and technology sectors in it. Since the beginning of five year planning, health and family welfare planning became imperative as a social sector planning. Planning regarding Indian Systems of Medicine became a part of health and family welfare planning since then. During the entire planning process a progressive path of development could be observed as per this evaluation. A relatively sluggish process of development was observed up to seventh plan however post eighth plan the growth took its pace. Eighth plan onwards several innovative development processes could be noticed. Despite the relative developments and growth of Indian systems of medicine these systems have to face lot of criticism and appraisal owing to their various characteristic features. In the beginning the system thrived with great degree of uncertainty, as described in 1(st) five year plan, however progressed ahead with a vision to be a globally accepted system, as envisaged in 11(th) five year plan. CONCLUSION: A very strong optimistic approach in spreading India's own medical heritage is the need of the hour. The efforts are neither completely insufficient nor sufficient enough; hence a continuous endeavor for the revival and dissemination of India's own medical inheritance for the welfare of the society at large is highly desirable.

Dissociated reality vis-a-vis integrative planning of AYUSH in Maternal Health Program: A situational analysis in Jaleswar block of Balasore district of Odisha, India.

Mainstreaming of AYUSH and revitalization of local health traditions is one of the innovative components of the National Rural Health Mission (NRHM) in the state of Odisha, India. In this study, an attempt was made to assess the potential of collocating AYUSH to improve maternal health services in tribal dominated Jaleswar block of the Balasore district. In addition, the study aimed at unearthing the underlying challenges and constraints in mainstreaming AYUSH and linking it with the Maternal Health Program. Review of the policy documents and guidelines, both central and state government, was made to assess the implementation of AYUSH in Odisha. Primary data were collected through interviews with AYUSH doctors, district and block level health administrators, and tribal women. The study revealed the inadequacy of basic amenities, infrastructure, drugs, and consumables in the health centers for integrating AYUSH in the delivery of maternal health services. Analysis of the job chart and work pattern of AYUSH doctors showed underutilization of their specialized knowledge to treat patients. Lack of continued medical education, standard operating procedures for treatment and spatial marginalization made suboptimal utilization of AYUSH services. This is unfortunate given the fact that such regions are economically underdeveloped and already have a distinct orientation toward indigenous health systems. AYUSH, on account of its holistic approach and proven cost-effectiveness, could be a viable option for improving maternal health in the region. The study concluded that although there is huge scope for integrating AYUSH in Maternal Health Program under the ongoing NRHM, the full potential is yet to be exploited.

Family Planning Practices, Programmes and Policies in India Including Implants and Injectables with a Special Focus on Jharkhand, India: A Brief Review.

The National Family Health Survey (NFHS)-3 clearly delineates that the usage of contraceptive practices has increased considerably but is more inclined toward terminal methods of contraception especially the female sterilization. The fact is also evident from various studies carried out from time to time in different Indian states. Given the context we carried out a short review to understand the family planning practices, programs and policies in India including implants and injectable contraceptives with a special focus on the state of Jharkhand. We found that among the reversible methods IUCD (intra uterine contraceptive devices), OC (oral contraceptive) pills and condoms are the most commonly used methods. In this review, in addition to national picture, we specially focused on the state of Jharkhand owing to its very gloomy picture of family planning practices as per NFHS -3 reports. The current usage of any methods of contraception in Jharkhand is only 35.7% out of which terminal methods especially female sterilization accounts to 23.4% and male sterilization being only 0.4%. Similar picture is also reflected in the conventional methods such as; IUCD-0.6%, oral pill -3.8% and condom-2.7%. Compared to the national figure the unmet need for family planning in Jharkhand is also relatively high for the conventional reversible methods than that of terminal methods which is 11.9 and 11.3 respectively. Injectable contraceptives are available only through private or social marketing channels, because of which their use is limited. The studies carried out in different Indian states show improvement in contraceptive prevalence but the same needs further improvement.