Background: The recent Ebola outbreak notified in West Africa recorded 6,553 cases and 3,083 deaths till 30th September 2014. This is the longest reported outbreak, suggesting poor preparedness and inadequate public health response. Learning from these experiences can help taking future disease-control measures in West Africa and elsewhere. Materials and Methods: This scoping study was done to summarize a range of evidences available on the current “Ebola Viral Disease” (EVD) outbreak. All articles in English language related to the epidemiology of Ebola in humans, published between 1st March and 30th September 2014, were considered for review. Search engines, such as PubMed and Google Scholar, were used to search for the following keywords: “Ebola,” “Ebola Virus,” “Ebola Viral Disease,” and “Ebola Hemorrhagic Fever.” Snowballing using cross-references was done to find related literature on EVD. Related websites, blogs, and published news articles were reviewed. Studies of varying designs were considered without any quality assessment. Results: This is the first ever Ebola outbreak affecting large urban communities. Factors that worsened the outbreak were as follows: Weak health systems, unfavorable cultural practices, poverty, illiteracy, mistrust for the government, extensive cross-border movement, slow response from international agencies, and lack of tested treatment and prevention strategies. Simple measures of universal precaution, isolation and tracking of contacts, supportive treatment, and appropriate burial practices were difficult to implement. Conclusions: The outbreak in West Africa illustrates serious weaknesses in the ability of the international communities to respond to these outbreaks. Cost of setting up an infrastructure for early effective response is insignificant compared to the huge social and economic cost of the outbreak. Strong health system, improved preparedness, and effective community participation are imperative for control.
Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries.Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.
In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment. In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi. Factors associated with longer paths included reason for going to first health facility (nearness and known provider), availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks. Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.
In their paper about progress towards universal health coverage in Brazil, the Russian Federation, India, China, South Africa (BRICS), 1 Rao et al. report that in India in 2011, of total government expenditure, about 8% was expended on health.This estimate was from the World Health Organization's (WHO's) global health observatory data respository, 2 which is based on national health accounts.For India, data on the national health accounts were last collected in 2004-2005.More recent data are usually based on estimates obtained through national technical contacts or from publiclyavailable documents, which are then harmonized with the national health accounts framework.Missing values are estimated using various accounting techniques depending on the national data available. 3wever, according to the Indian Government's budget and expenditure data for the fiscal year 2012-2013 (Table 1), [4][5][6][7] the government spent about 1 104 543 million rupees on health (central and states combined).This is about 3.68% of the total government expenditure of 30 037 588 million rupees and not 8% as quoted in the article.
Public health goes beyond the domain of curative medicine. It has always taken a backseat with no immediate tangible outcome. Moreover, it generally falls in the ambit of government services, inadequate due to lack of resources. This paper proposes to revitalize some aspects of preventive and curative health service delivery, based on the felt need of the society. Changing demographics and disease pattern warrants modification in health service delivery. Economic growth of the country has made larger section of population capable to pay for quality health services at reasonable costs. Business in these identified domains will benefit population at large simultaneously satiating the interests of present-day entrepreneurs.
Since the launch of Global Polio Eradication Initiative in 1988, disease burden has been reduced by more than 99% globally. Lately, India has witnessed a year without a case of poliomyelitis. It no longer stands endemic and is being regarded as a model for polio eradication efforts in other low income endemic countries: Pakistan, Nigeria and Afghanistan. The near elimination of wild polio virus in India has set forth new challenges of vaccine derived polio virus and need for newer strategies in oral poliomyelitis vaccine cessation preparatory phase. Stricter surveillance measures are needed to check for importations, any spread of virus in migratory populations and rapid containment of newly found virus. No stone should be left unturned in this last ditch effort for extermination of polio virus form environmental circulation. India's battle against polio will be cited as the biggest public health achievement or the most expensive public health failure.
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