Crying baby gets the milk? The governmentality of grievance redressal for patient rights violations in Karnataka, India.

BACKGROUND: Patient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations. METHODS: We used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the 'governmentality' of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals. RESULTS: Collective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure that the State accepted a complaint against a medical professional. Each institution, and especially the medical professional council, exercised its power by problematising the grievance in its own way which was distinct from the problematisation of the grievance by the collective. The State bureaucracy enacted its power by creating a maze of organisational units and by fragmenting the grievance redressal across various bureaucratic units. CONCLUSION: There is a need for measures guaranteeing accountability, transparency, promptness, fairness, credibility and trustworthiness in the patient grievance redressal system. Governmentality as a framework enabled to study how subjects (care-seeking individuals) are rendered governable and resist dominant forces in the grievance redressal system for patient rights violations.

Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets.

Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of malnutrition and their district-level distribution shows clustering in different geographies and regions. Methods: The last round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more nuanced understanding of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of cereal cultivation with the prevalence of child malnutrition. We studied the current science on growth-related nutrient-sensing pathways to explain this pattern.  Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed early prevalence of 40% at six months of age. Wasting was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets. Low maternal BMI in districts with higher wasting could be linked to the consumption of millets as staple. We conceptualised a hypothetical schematic pathway linking early origin of wasting in children with millet-based diet, driven by inhibition of critical intra-cellular pathways controlling growth covering pre-natal, post-natal and early childhood. The analysis was limited by lack of fine-scale data on prevalence of low birth-weight and type of cereal consumed. Conclusions: Multi-site observational studies of long-term effects of type of cereals consumed could help explain the ecogeographic distribution of malnutrition in India. Cereals, particularly millets constitute the bulk of protein intake among the poor, especially in rural areas in India where wasting persists. Policies and programs targeting malnutrition need to address type of cereal consumed in order to impact childhood malnutrition in parts of India where subsistence cultivation of millets for staple consumption is prevalent.