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BACKGROUND: Recognizing the potential of the country's large youth population and the importance of protecting and supporting its health and well-being, the Government of India committed to strengthening its programmes and systems for adolescents, initially through the Adolescent Reproductive and Sexual Health Strategy (ARSH) launched in 2005 and, subsequently, through the National Adolescent Health Programme (Rashtriya Kishore Swaasthya Karyakram or RKSK) launched in 2014. In 2016, in response to a request from the Government of India, the World Health Organisation undertook a rapid programme review of ARSH and RKSK at the national level and in four states (Haryana, Madhya Pradesh, Maharashtra and Uttarakhand) to identify and document lessons learnt in relation to four domains of the programmes (governance, implementation, monitoring and linkages) that could be used to enhance current and future adolescent health programming in India. METHODOLOGY AND FINDINGS: A rapid programme review methodology was utilised to gain an overview of the successes and challenges of the two adolescent health programmes. A desk review of policy statements, Program Implementation Plans (PIPs) (Program Implementation Plan (PIP) is an annual process of planning, approval and allocation of budgets of various programmes under the National Health Mission (NHM). It is also used for monitoring of physical and financial progress made against the approved activities and budget. ), reports and data provided by the four State governments was conducted alongside 70 semi-structured interviews with health, education and NGO officials at national, state, district and block levels. Data showed that the ARSH Strategy put adolescent health on the agenda for the first time in India, though insufficient human and financial resources were mobilised to ensure maximum impact. Further, the Strategy's focus on clinical service provision in a limited number of health facilities with a complementary focus on promoting community support and adolescent demand ...

In spite of a high rate of growth and ample government initiatives to maintain equality in case of gender , the gap between genders still exist in India. In India, based on their sex, gender variation is usually prescribed as the injustice or discrimination against women. Gender inequality limits women's participation in various fields and it also hampers the life of the future generation also. Women are confronted with many hurdles in everywhere. Female foeticide is one of the worst types of discrimination against females where a female is refused her most essential and fundamental right, i.e. the right to live life. In India, female foeticide means outside of valid law, the abortion of a female foetus. In India, the recurrence of female foeticide is expanding day by day. In present day, it seems that the sex determination test leading to the practice of female foeticide overlooked and uncomplicated than before. Since ancient days, killing of female foetus is an extraordinary feature under the rule of patriarchy in Indian society. According to census report, the child sex ratio has decreased from 945 girls (0-6 years) per 1000 boys (0-6 years) in 1991 it is 927 girls per 1000 boys in 2001 to 919 girls per 1000 boys in 2011. The picture of female foeticide in North-East India is quite good as compared to the other states of India. As per the census 2011, Arunachal Pradesh has the highest child ratio among the Indian states i.e. 972 while Haryana has the lowest child sex ratio i.e. 834 per thousand males. According to decennial Indian census, the sex ratio in the 0 to 6 age group in India has risen from 102.4 males per 100 females in 1961, to 104.2 in 1980, to 107.5 in 2001, to 108.9 in 2011. On this background, here, an attempt has been made to examine the issue of female foeticide as an indicator of gender inequality in India. This paper is mostly descriptive in nature entirely based on secondary data.

BACKGROUND: Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education. METHODS: Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as 'good', 'fair' and 'poor' if it scored > 7, 5–7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP's) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases. RESULTS: Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p = 0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p = 0.001) and good referral letters (0.7 vs 18%; p = 0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p = 0.001]. CONCLUSION: Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage ...

A single hospital admission can deplete household resources so considerably as to induce impoverishment, especially in the Indian context of low government healthcare expenditure. Rashtriya Swasthya Bima Yojana (RSBY) was a national health insurance scheme for below-poverty-line Indian families, to provide improved access to hospitalization and greater financial protection via a public-private-partnership employing private sector implementation capacity. Study objectives were to understand governance (including regulatory) environment and contract arrangements; evaluate expansion of services to beneficiaries; and assess compliance of providers and user satisfaction. A case study approach in two districts met the need for in-depth information on scheme functioning, and RSBY implementation was examined between 2011 and 13 in Patiala (Punjab) and Yamunanagar (Haryana). Methods included 20 key stakeholder interviews, analysis of secondary datasets on beneficiaries and claims, primary data collection in 31 public and private hospitals and in greater depth in 12 hospitals, and an exit survey of 751 patients. Enrolled and non-enrolled hospitals were mapped in each district and service availability of enrolled hospitals assessed; enrollee characteristics were analysed; for the 12 hospitals, information was obtained on structural quality and process of care, and patient satisfaction and out-of-pocket payments. The Indian states and the government of India did not specify formal regulatory and implementation procedures in detail and states largely contracted out their functions to private insurance firms. Findings show regulatory weaknesses, and contractual breaches. Enrolment rates were low in both districts and more so for Patiala and there was limited access to services. There was little difference in process of care between public and private hospitals, though the structural capacity of private hospitals was better than public hospitals. RSBY helped improve accessibility and gave some degree of financial protection to patients. It also actively engaged with existing resources in the Indian health care and insurance markets.

INTRODUCTION: Globally, one in two people needing insulin lack access. High prices and poor availability are thought to be key contributors to poor insulin access. However, few studies have assessed the availability, price and affordability of different insulin types in low-income and middle-income countries in a systematic way. METHODS: In 2016, 15 insulin price and availability surveys were undertaken (using an adaptation of the WHO/Health Action International medicine price and availability measurement methodology) in Brazil, China (Hubei and Shaanxi Provinces), Ethiopia, Ghana, India (Haryana and Madhya Pradesh States), Indonesia, Jordan, Kenya, Kyrgyzstan, Mali, Pakistan, Russia (Kazan Province) and Uganda. Data were collected in three sectors (public, private pharmacies and private hospitals/clinics) in three regions per survey. Insulin prices were standardised to 10 mL 100 IU/mL in US dollars ($). Data were also collected for four comparator medicines. RESULTS: Mean availability was higher for human (55%–80%) versus analogue insulins (55%–63%), but only short-acting human insulin reached 80% availability (public sector). Median government procurement prices were $5 (human insulins) and $33 (long-acting analogues). In all three sectors, median patient prices were $9 for human insulins. Median patient prices for analogues varied between the public sector ($34) and the two private sectors ($44). Vials were cheaper than pens and cartridges. Biosimilars, when available, were mostly cheaper than originators. A low-income person had to work 4 and 7 days to buy 10 mL human and analogue insulin, respectively. For isophane human insulin, only three countries meet the WHO target of 80% availability of affordable essential medicines for non-communicable diseases in any sector. CONCLUSION: Improving insulin availability and affordability needs to be addressed through national and global actions, including prioritising the supply of more affordable human insulin, increasing competition through the use of lower priced ...

In the present study, the researcher tried to trace out the impact of socio-economic variables, for example, area of residence, type of family, parent employment status, caste system and the annual household disposable income of the family on teenagers' influence in family buying of selected products. The present study is focused on to get an insight into role of teenagers in buying decision-making process of families in Haryana. A total of 234 households were visited, and responses of teenagers were taken from four villages, and two cities, Hisar and Kaithal. The data were collected between March and July 2013. The study is confined to three decision stages during buying decision-making process of television and cell phone. ANOVA and t test have been used to achieve the objectives of the study. Study reveals that 98 per cent of respondents have television set at their home in which 30 per cent families are having TV of LG brand followed by Samsung and Videocon. Every family (100 per cent) is having a cell phone and 36.6 per cent of teenagers have personal cell phone. Nokia is the most possessed brand among families (54 per cent) followed by Samsung, Tata Indicom and Spice. While analyzing the influence of teenagers in family buying decision-making process across decision stages, majority of them participated in it. Caste and income have significant impact on teenagers influence in cell phone-buying decision stages but not in the case of TV. This might be because TV is common and a family product and cell phone is a more personalized product. Rural teenagers of scheduled caste and general caste were significantly more influential in buying decision-making process of cell phone than did those in urban backward caste. It was found that with an increase in annual disposable income of the family, they were significantly more influential than teenagers from lower-income families.

In India women are among the most vulnerable and marginalized group in the world of work. Almost two fifth of its population lives below poverty line. In India, when a man is working 391 minutes woman is working 457 minutes a day. According to 2001 census the average age of the entire female worker was 33.6 as compared with the male average of36.5 and the participation of women in the labour force has always been lower than that of man in the rural as well as urban areas. Still they are considered as an uncontributory towards the national growth because they are unskilled, unorganized and financially dependent upon male. As a result they are unable to convert their dreams into reality although they have entrepreneurial potential. Realizing their backwardness the Government of India has launched number of schemes such as: Swarna jayanti Gram Swarozgar Yojana, (SGSY), Development of Women and Children in Rural areas (DWCRA), Integrated Rural Development Programme {IRDPJ, Supply of Improved tool kits to Rural Artisan (SITRA) etc. The SGSY has been introduced with a clear objective to establish large number of micro enterprises in rural areas and to uplift the socio economic standard of the poor through Self-Help Groups (SH Gs). In some of the states these groups are doing well in SH Gs activities whereas many states are not performing due to many reasons. The present paper is an attempt to find out the performance of SH Gs in Fatehbad district of Haryana. It has been found that SHGs are not performing as per expectations only few SH Gs are actively involved in SH Gs activities, some has just got first installment whereas majority of the groups has not taken even a single penny to start their activities, and some are availing the subsidy and not taking keen interest to generate employment and revenue.

The reform process in India has so far mainly concentrated at the central level. India has yet to free up its state governments sufficiently so that they can add much greater dynamism to the reforms. Greater decentralization of decision making from the center to the states will lead to greater competition among the states and therefore to higher efficiency and productivity in these regions. Policy making at the sub-national level is essential in order for the state governments to be able to follow development strategies suitable to their socio-economic, cultural, and geographic characteristics. Coastal states, for example, can follow a more focused export-led growth strategy, or states with a large pool of trained manpower, such as IT professionals in Tamil Nadu or Karnataka can lay more emphasis on IT and service sector. A few of the Indian States have been more reform-oriented, such as Andhra Pradesh, Gujarat, Karnataka, Maharashtra, and Tamil Nadu, but states, such as Haryana, Kerala, Orissa, Madhya Pradesh, Punjab, Rajasthan and West Bengal have a lot to catch-up with. Of course, Bihar and Uttar Pradesh are even further behind. We analyze the state-level situation in fifteen major states based on the progress of state-level policy reform. Accordingly, we have divided these states into three categories of reformers. These are the reform-oriented states, intermediate reformers and the lagging reformers. We then examine the performance of these states in terms of SDP growth, foreign direct investment, industrial investment proposals, and software exports among other variables. Real annual average growth rates of per capita gross state domestic product bear testimony to the fact that our group of reform-oriented states are the fastest growing states in India in the post-reform period. Also, these states have performed better in attracting both domestic and foreign investment, software exports, and in the areas of primary health and education.

AbstractGroundwater is considered as an imperative component of the accessible water assets across the world. Due to urbanization, industrialization and intensive farming practices, the groundwater resources have been exposed to large-scale depletion and quality degradation. The prime objective of this study was to evaluate the groundwater quality for drinking purposes in Mewat district of Haryana, India. For this purpose, twenty-five groundwater samples were collected from hand pumps and tube wells spread over the entire district. Samples were analyzed for pH, electrical conductivity (EC), total dissolved solids (TDS), total hardness (TH), turbidity, total alkalinity (TA), cations and anions in the laboratory using the standard methods. Two different water quality indices (weighted arithmetic water quality index and entropy weighted water quality index) were computed to characterize the groundwater quality of the study area. Ordinary Kriging technique was applied to generate spatial distribution map of the WQIs. Four semivariogram models, i.e. circular, spherical, exponential and Gaussian were used and found to be the best fit for analyzing the spatial variability in terms of weighted arithmetic index (GWQI) and entropy weighted water quality index (EWQI). Hierarchical cluster analysis (HCA), principal component analysis (PCA) and discriminant analysis (DA) were applied to provide additional scientific insights into the information content of the groundwater quality data available for this study. The interpretation of WQI analysis based on GWQI and EWQI reveals that 64% of the samples belong to the "poor" to "very poor" bracket. The result for the semivariogram modeling also shows that Gaussian model obtains the best fit for both EWQI and GWQI dataset. HCA classified 25 sampling locations into three main clusters of similar groundwater characteristics. DA validated these clusters and identified a total of three significant variables (pH, EC and Cl) by adopting stepwise method. The application of PCA resulted in three factors explaining 69.81% of the total variance. These factors reveal how processes like rock water interaction, urban waste discharge and mineral dissolution affect the groundwater quality.

Being a developing country with a large population with high density, India was on high alert for the COVID-19 pandemic. India overcame much difficulty from the first wave, but was soon after smacked by the second wave of the COVID-19 pandemic. Due to its contiguous nature, people were advised to stay in their home, but some people have to continue their work to maintain public health, law and order and provide necessary services. Sanitary workers are one of them; they maintain cleanliness and sanitise public places, communities, towns and cities to control the COVID-19 spread. It is essential to know and understand their situation in such a problematic condition of the COVID-19 pandemic. This paper will elaborate on their social, occupational, and living conditions and possible relation with COVID-19. The author collected quantitative data through a cross-sectional study in four towns (Ladwa, Indri, Thanesar and Radaur) of Haryana in 2017. Quantitative and qualitative data had collected from sanitary workers through structured interview and observation. During fieldwork, the researcher lived with the community and observed closely. Results show that their working conditions are risky, working timings and duration also risky, alcohol and tobacco use is high, protective gears are not available to them, job status primarily contractual, no or low educational standard, health conditions are down and the standard of living is low & living situation are congested. The results indicate that they are at high risk of COVID-19 infection, to develop severe acute illness from COVID-19 and community spread. While their sanitary workers come into contact with different kinds of waste and surfaces, so their chance of infection is high because COVID-19 can survive on any surface. Their occupational, educational, social, health, living standards and living conditions make them vulnerable to developing a severe acute illness, leading to a high death rate and community spread. Therefore we need to take some essential steps in this regard.

COVID-19 caused by novel coronavirus (nCoV-19) declared by WHO as a pandemic has the potential to spread very fast thereby affecting a huge population. The first COVID-19 case in India was reported on 30th January, 2020, and in next three months, the number has soared to 33,050 despite a nationwide lockdown imposed on 25th March, 2020. Various states (provinces) of the country have been affected to varying extent. In this paper, an attempt has been made to delineate the potential risk zones of COVID-19 across entire country using Analytic Hierarchy Process (AHP) and Geographical Information System (GIS) on the basis of data released by government agencies. The resultant thematic map was classified into 6 risk zones viz. very high, high, moderate, slightly moderate, low and very low. Overall, one-third population of the country shall come under high risk zone followed by 26% in high risk zone, 10% in moderate risk zone, 29% in slightly moderate risk zone and 1% each in low and very low risk zones. Most populous/densely populated states are likely to be affected moderately or severely. The study reveals a pattern that the Central India shall witness a higher rate of COVID-19 cases whereas the Southern, extreme Northern and Northeastern states excluding Assam comparatively lower rate. The study found that three states, Bihar, Madhya Pradesh and Uttar Pradesh are likely to be very high risk zone owing to larger pressure of population over health facilities. Arunachal Pradesh, Goa, Mizoram, Sikkim and some other union territories are low risk zone whereas Himachal Pradesh and Andaman & Nicobar Islands fall under very low risk zone. Other states like Haryana, NCT of Delhi, Rajasthan and UT of Dadra & Nagar Haveli are likely to witness moderate risk of COVID-19 whereas Andhra Pradesh, Jammu and Kashmir (undivided), Karnataka, Kerala, Manipur, Meghalaya, Nagaland, Punjab, Tamil Nadu, Telangana, Tripura, Uttarakhand, West Bengal and UT of Lakshadweep will fall under slightly moderate risk zone. (PDF) Analytic ...

INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours post-delivery. Hence, this time period is very crucial for the survival of newborns and mothers both. As per maternal and child health program guidelines in India, it is clearly mentioned that all the government health facilities should discharge the mother and baby only after 48 hours of delivery in case of normal delivery and after 7 days in case of delivery conducted by cesarean sections. AIM: The aim of the study was to find the various factors responsible for early maternity discharge (<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities. MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study were included after taking proper informed consent. A questionnaire was developed by the investigators to interview the women. The questionnaire consists of 26 items which included the socio-demographic details and questions on various factors affecting postnatal stay at the health facility. RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them, 12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines. It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries were significantly associated with early discharge. Among those who had NVD and stayed beyond 48 h, most of them mentioned that the round-the-clock availability of doctors/nurses was the main reason for their staying at the health facility. CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There is a need for essential counseling to be imparted to the ...

Introduction The present study was undertaken to develop a valid and reliable scale for measuring a feeling of alienation in students with visual impairments (that is, those who are blind or have low vision). Methods In this study, a pool of 60 items was generated to develop an Alienation Scale for Visually Impaired Students (AL-VI) based on a review of the literature and discussions with colleagues and experts in the field. The items were organized into six dimensions of alienation, namely powerlessness, meaninglessness, normlessness, social isolation, self-estrangement, and cultural estrangement, and were rated on the five-point Likert scale. The standardization of the scale was completed with 118 students with visual impairments in the age group of 10 to 25 years, selected randomly from specialized and inclusive schools in the state of Haryana, India. Results The item analysis was done by calculating t- and r-values; seven items were deleted, and a final 45 items were retained. The calculated value of Cronbach's alpha and split-half correlation came out to be 0.87 and 0.86, respectively. The construct validity was determined by computing the coefficient of correlation between scores of this scale and the scores obtained by using the Student Alienation scale (SAS) of R. R. Sharma (Sharma, 2012). The percentile norm for the scale was determined after verifying normality of the scores by using a Q-Q plot. Discussion The findings of the present study suggest that the AL-VI may serve as a useful tool in future research to assess alienation in persons with visual impairments in India. The findings further demonstrate that the AL-VI produced scores that are reliable and valid. The AL-VI can be used outside India after determining its reliability and validity in context-specific conditions. Implications for practitioners The AL-VI scale is applicable to students with visual impairments, teachers of students with visual impairments, principals, social workers, psychologists, and rehabilitation professionals. Practitioners could use this tool for assessing and understanding the level of alienation among students with visual impairments, thereby helping them in planning and executing strategies for remediating alienation.

Decentralized district-based health planning is essential in India because of large inter-district variations. Presently, there are 640 districts in India with an average population of two million per district. There is a need for studying the performance of family planning programs at district level. Current paper aims to explore the district-level differences in the use of modern family planning methods (mCPR) in rural areas, changes in contraceptive usage over time, and the association between changes and macro-level socio-demographic characteristics. Current paper uses data from the third round of District Level Household Survey conducted in 2007–08 (DLHS-3) and the latest round of National Family Health Survey conducted in 2015–16 (NFHS-4). The sample size for representing a district varies from 1000 to 1500 households in DLHS-3 and 836 to 1800 households in NFHS-4. Out of the total 640 districts as per Census 2011, the 506 districts which have common geographical boundary in DLHS-3 and NFHS-4 have been considered for analysis. Results show a wide variation in mCPR at district level in India. Only 91out of 506 districts have more than 64% mCPR, majority being from Andhra Pradesh, Haryana, Maharashtra, and Punjab. Six out of 10 districts have CPR below 50% and majority of them being from central, north-eastern, and eastern regions of India. Since 2007–08, there has been significant decline in them CPR among half of the districts (256/506), majority decline being in the southern and western regions of India. Only in 69 districts mCPR increased by more than 10 percentage points from 2007–08 to 2015–16. At the same time, it declined by more than 5 percentage points in onethird of the districts. Findings reveal that marginal changes in female literacy, child marriage, unmet need for spacing family planning methods, antenatal care and institutional delivery have no impact on mCPR over time, but significant changes in these contextual factors of more than 10 percentage points increase/decrease have greater impact ...