User:Anikakalra/sandbox

Selecting Possible Articles

Final

3/7/3018

Area: Homelessness in India

Sectors: Healthcare in India - plan to add a new section; maybe 'access' and/or initiatives for universal healthcare.

First look

1/30/2018

Area:

1. https://en.wikipedia.org/wiki/Obesity_in_India . Working on this article can help me prepare for my practice experience because one of my roles will be to educate the local communities about preventing obesity and bad heart health. Thus, this article would directly pertain to an issue I will be assisting with at the health clinic and researching this would greatly help me in my work there.

To improve on this surprisingly short article, I would expand on obesity by social class, describing more specifically which classes of society are inflected with obesity and why. Furthermore, I would improve on the diet, lifestyle, and social changes contributing to obesity. FInally, I would expand on the difference between different age groups and different states of India and obesity. The talk page only has one comment on it, thus highly indicating that this page needs a lot of work! (I compared this article to the American obesity page for reference and ideas).

2. https://en.wikipedia.org/wiki/Family_planning_in_India . Working on this article would assist me in becoming more knowledgeable about family planning in india. One of my roles in my PE would be assisting women in the clinic. Thus, learning about family planning in India important. To improve on this article, I would start by improving the section on the government’s involvement with and opinion of family planning (there are only two short paragraphs about one program). I would also discuss NGOs and non-profits invovlement in family planning and accessibility to family planning clinics. Finally, I would like to add statistics on how many clinics there are in India as that is surprisingly missing. The talk page doesn’t really discuss anything about adding information, it mostly discusses about editing sources.

Sectors

1. https://en.wikipedia.org/wiki/Homelessness_in_India . Working on this article will be extremely valuable in terms of preparing for my trip. My role will include educating local villagers and homeless people on healthy habits and lifestyles. Adding more to this page would help me learn more about the vast problem that homelessness is in India and give me more insight to help those who are homeless.

To start off, I would first add to the description of Homelessness in India at the top, the introduction. This very short paragraph surprisingly doesn’t include any statistics on the amount of homeless in India, nor does it describe the social classes or age groups or educational level of the homeless. It doesn’t discuss the government nor the history of homelessness. Finally, it doesn’t preview any causes. After adding to this first intro on homelessness in India, I would then expand on the topics that have not been mentioned in the article such as the history and government intervention/support. I would expand on every section that does exist as they all seem incomplete. The page also seems disorganized and in need of better sectioning and additional information. The talk page consists one comment about sources editing.

2. https://en.wikipedia.org/wiki/Standard_of_living_in_India . This article is valuable because it gives an overall image of what the standard of living actually is due to huge class stratification and as a result of poverty. Researching this would give me more of an idea as to why poverty exists and how class stratification and standards of living affect poverty.

To change this article, I would discuss the rising middle class, as posted in the talk page. Furthermore, I would expand on the concept of standard of living beyond just the poor to upper and middle classes. Finally, I would discuss the standard of living of the poor: including discussion on slums, low-income housing, and a mention of the homeless. This is surprisingly left out in the article (it gives facts and statistics about poverty but not about the living situations).

3. https://en.wikipedia.org/wiki/Below_Poverty_Line_(India) . This page is important because my clinic helps low to no income people of Jaipur. Thus, learning about what defines the poverty line will be helpful in understanding how little an income the patients may make. Furthermore, it gives me a broader view of the huge issue of poverty in India (the lower the poverty line, the less income and likely more poverty).

To fix this article, I would mostly add a discussion on the role of the government and non-profit organizations in helping raise the poverty line. I would discuss the implications of the poverty line more (i.e. what the $1.90 international poverty line can actually buy in India) as well as different ways to define the poverty line (more specific to the country of India, for example the talk page refers to specifying what India defines as poverty).

Evaluating Two Articles

Areas: Jaipur district Notes

• The introduction doesn't contain any broad statistics such as the population size and region size.
• The divisions section is hard to understand - are there 13 divisions in the governmental body of the state of Rajasthan or in all of India (for someone unfamiliar with India geography this is an especially pressing question)? What are 'Panchayat Samitis'?
• The Demographics section repeats the exact same statistic (Jaipur is 10/640 in population size rank of Indian cities) as written in the introduction.
• Demographics does not discuss the population sizes of different age groups. It doesn't discuss the different languages spoken there, the education levels, the income and wealth levels, and occupational status of the majority of the population. Furthermore, it fails to discuss birth rate and death rate. Finally, it doesn't have information on marital status, average age of marriage, and average family size.
• The organization of this page is incomplete. The culture section contains information about the weather. Weather and Climate should be its own section.
• The culture section should include things about common holidays celebrate there and common religious practices.
• There can be a section on the geography of Jaipur District including neighborhoods, school districts, etc.
• There can be a section on the Economy of Jaipur, how is the government of Jaipur District involved in the economy?
• Transportation should also be included. Is there a public transport network set up? Is it used by majority of peophle?
• History can also be included. How did the Jaipur District form? How did the government decide to split Rajasthan into 13 districts with Jaipur as one of them?
• The article does appear balanced and neutral with no personal viewpoints or opinions.
• The information about famous people from Jaipur in the Culture section seems out of place.

Personal question: I am unsure if all this information I listed above belongs in the Jaipur city wikipedia article or the Jaipur District.

Sectors: Homelessness in India Notes

• The Introduction has some grammar mishaps. This paragraph also doesn't include any statistics such as the amount of homelessness in India, nor does it describe the demographics of homelessness (social class, age groups, educational and occupational levels, income levels).
• There is a lack of information on the history and the causes of homelessness in India from its beginnings. I would also expand on the Problems section where it discusses a few causes to explore them more in depth and detail.
• There is a lack of discussion on the government's current initiatives to counter homelessness.
• Furthermore, there is less detail on the sections about the situation in slums today. What are the conditions there? How many people on average live in each slum?
• I would add a section on Problems Faced by Homeless People. What sorts of day to day issues do they face? What stigmas do they face?
• I would discuss the health situation of the homeless and sanitation of their nighttime sleeping areas.
• Violence can also be discussed against the homeless.
• NGOs and other non-profits initiatives should be added as well.
• Everything in the article does seem both relevant and neutral.
• Some things are less cited.
• The information seems to be in total about the history (but not the beginnings) and not about the current situation.
• Finally, one of the biggest issues is that the Talk page contains no comments about adding information.

Bibliography

Area: Homelessness in India

1. Urban homeless shelters in India: Miseries untold and promises unmet by Geetika Goel, Piyali Ghosh, Mohit Kumar Ojha and Akanksha Shukla. This article argues that homeless shelters created by the government of India are lacking in many ways and was written for the purpose of informing those involved in these initiatives of such issues. The article details the many acts of supreme court in instigating homeless shelters as well as the terrible conditions in them. They make their argument by using examples of shelters and comparing them to the regulations mandated by the court. I discusses urban homeless shelters that are in place in India. This plays a role in my wiki assignment as I can use the information from this article to discuss government initiatives in homeless shelters. Furthermore, this article is very pertinent to my area as Jaipur, India has many homeless peoples and the problem has persisted for years. ^[1]
2. Mental Health, mental illness, and human rights in India and elsewhere: What are we aiming for? by Brendan D. Kelly- scholarly peer reviewed article. This article was written to shed light on the rights deserved by all humans, intended for those with the power to enact them. It argues that the mentally ill should have have human rights in India. Kelly supports his argument by discussing specific principles of the UN. This article helps shed light on the rights every citizen deserves, including the homeless. Thus, the information I gather can help me discuss the causes of homelessness. Furthermore, this is very applicable to my PE as healthcare is a human right all citizens in India deserve, as well as mental healthcare. Learning about this from a UN perspective will give me new insight I can apply when I work with homeless peoples in Jaipur. ^[2]
3. The impact of drop-in centres on the health of street boys in New Delhi: An interpretive descriptive study by Ronita Nath, Wendy Sword, Kathy Georgiades, Parminder Raina and Harry Shannon- peer reviewed scholarly article. This article was written to inform about drop-in centers for children in India to those with the power to create more centers. This article argues that drop-in centers help children of the streets, as long as they become accustomed to having mentors and rules. It portrays its argument by using an example of a drop in center as well as quotes from mentors and children who stay there. This article relates to my wikipedia contributions because a section on street children exists in the wikipedia page. Thus, I can use this information to add and expand on this section. Furthermore, it relates to my practice experience because many outreach programs I will be working on is in relation to street children. ^[3]
4. Social determinants of health - Street children at crossroads by Anjali Gupta. This article is very important for my research. Gupta wrote this article to show the dismal conditions of street children for the those with the power to help. The article argues that street children are seen as criminals and are not provided with health services because of prejudice and judgement. Gupta discusses the living situations of children through statistics and then goes on to discuss their health. This is a great article to use because it gives me insights as to why street children don't have access to healthcare, which links both my area and my sector together. Additionally, it links greatly to my practice experience where I will be working with street children to improve their hygiene . ^[4]
5. Incidence, type and intensity of abuse in street children in India by Prachi Rathore. Rathore wrote this essay to describe the reasons children end up homeless in order to implore those with power to help these children. This article is arguing that children can end up homeless due to abusive and exploitative families and employers. Rathore shapes her argument by giving statistics on abuse and correlations to behavior of street children. Specifically, this article relates to my practice experience because It discusses abuse for homeless children in Jaipur, which is the area of my PE. Rathore surveyed street children in Japiur to collect and analyze data on different types of abuse. Furthermore, it pertains to my wiki contributions because it gives me valuable information to add to the street children section of my area. ^[5]
6. Street Children in India: A Non-Government Organization (NGO)- Based Intervention Model by Amit Sen. Sen wrote this piece for people that work with NGOs to help street children in order to give them an example of an NGO that has been working well in Delhi. This source argues that the Salam Baalak Trust helps street children well. It supports this argument by describing the many factors of SBT and their work with children. This is useful for my wiki contribution as initiatives to help street children are missing from this page. Additionally, it relates to my practice experience, because I will be working with an NGO that helps street children, just as the SBT. Learning about shelters where children can get health services will help provide me with context when I discuss hygiene with children at the clinic. ^[6]
7. National Report on "A World Fit for Children" by Uncief. This report was written with the purpose of describing the MDG goals of India for the audience of government and non-governmental workers who have the power to act on them. It argues that the government should have initiatives to meet the MDG goals of India. They make their argument by depicting current initiatives in place. This will be very helpful to my discussion of causes of homelessness as well as government and NGO initiatives for street children. Furthermore, it pertains to my practice experience because healthcare is part of the MDG goals of India.^[7]
8. Shelters for the Urban Homeless: A Handbook for Administrators and Policymakers by Commissioners of the Supreme Court. The section of the book I read was written to provide a history of homeless shelters for those looking to create new ones. It provides a lot of details on past shelters in order to argue for new shelters to follow and improve upon these models. The section supports the argument by depicting past homeless shelters such as Night shelters along with their failings. This will be useful for my discussion on government acts towards homeless shelters. Furthermore, this is related to my practice experience as I will be conversing with many individuals who may reside in homeless shelters in Jaipur.^[8]
9. Tenth report of the commissioners of the Supreme court. Permanent shelters for urban homeless populations: the national report on homelessness by Commissioners of the Supreme Court. This report was written to discus improvements on homeless shelters for those in charge of them. The report argues that the government should improve shelters. It uses evidence of the current state of homeless shelters to discuss potential changes. This is useful to my conversation of improvements that can be made to homeless shelters and pertains to my practice experience as I will be conversing with individuals that reside in shelters.^[9]

Sectors: Healthcare in India

1. Newborn healthcare in urban India by Sharma, J; Osrin, D; Patil, B; Neogi, S B; Chauhan, M; Khanna, R; Kumar, R; Paul, V K; Zodpey, S. This article was written to show the differences between urban and rural healthcare to medical professionals in India. It discusses how urban healthcare is deteriorating due to huge population shifts from rural areas as well as initiatives to improve health care in certain urban and rural areas. The authors support their argument by discussing government initiatives in urban areas as well as discussing statistics about both rural and urban India. This article has a lot of information that can fit into the rural and urban parts of the article. Furthermore, it relates to my practice experience because the org I am working with is located at the outskirts of urban Jaipur and so learning about healthcare inequalities in this area would help me better understand the purpose of my work.^[10]
2. Determinants of choice of healthcare services utilization: empirical evidence from India by Vishal Mishra, Dipanjan Kumar Dey. This article depicts the differences between public and private healthcare services to urge the government to acknowledge the inequalities between the sectors. The article argues that many citizens utilize public healthcare and so the government should focus on improving cheaper public hospitals. This argument is made through depiction of statistics on private and public health services as well as discussion of the goal of universal health care. This article is helpful for my discussion of access to healthcare as both sectors of healthcare are accessible by different populations. Furthermore, it is pertinent to my practice experience as the org I will work for acts as a third party outside from the public and private sphere to provide healthcare to those excluded by both. ^[11]
3. Health care and equity in India by Y Balarajan. This article was written in order to investigate issues in equity of healthcare to inform the public and government of India. Balarajan's article describes the many factors related to inequity in healthcare and access to care. He argues that in order to find and implement solutions, it is necessary to first throughly research the causes of inequity. He supports his argument by listing statistics related to factors that prevent access to care. This article is very pertinent to my discussion of barriers to healthcare access. Furthermore, it provides me with a lot of information that will be useful in my practice experience for why citizens are resorting to NGOs as opposed to private or public hospitals.^[12]
4. Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality by Shankar Prinja, Manmeet Kaur, and Rajesh Kumar. This article was written to persuade the Indian government to pay attention to health discrepancies in the country. The authors argue for the government to reform health insurance in India and expand its reach. The article supports its argument by discussing initiatives and possible solutions to universal healthcare in India. Additionally, it discusses government insurance plans that can help achieve this goal and thus increase access. The article is pertinent to my wiki assignment because it discusses the need for an increase in access as well as ways to do so. Furthermore, it relates to my practice experience because citizens that visit the NGO I will be working for have a lack of healthcare provided by the government.^[13]
5. Is Provision of Healthcare Sufficient to Ensure Better Access? An Exploration of the Scope for Public-Private Partnership in India by Sabitri Dutta and Kaushik Lahiri. The authors wrote this article to inform the public of initiatives that are in place to help access to healthcare and urge the government to create more. The article tries to find the relationship between provisions available and healthcare access in two states in India to argue for more health programs. To support the argument, the article describes the states' health attainment scores and details government initiatives in place that can fix the gap between access and deficiencies in care. This article will be very useful for the overall healthcare access section as well as the urban section in the article. It discusses a major problem to access which is financial ability and contains initiatives to solve the issue. Additionally, this is very pertinent to my practice experience as many citizens I will be working with lack financial ability for care.^[14]
6. Healthcare in India: Changing from Financing Strategy by Ravi Duggal. This article was written to inform the public of the unfair setup of their healthcare system: the government pays for a tiny proportion of services. The article argues for the government to take a larger stance in financing healthcare. It discusses schemes to improve funding of health services and talks about creating universal healthcare and private healthcare. This is pertinent to my analysis of healthcare as finance is a large part of access and universal healthcare is the ultimate goal. Furthermore, it is very pertinent to my practice experience as low financial ability stops many from receiving healthcare from a public or private hospital.^[15]
7. Issues of creating a new cadre of doctors for rural India by Jayakrishnan Thayyil and Mathummal Cherumanalil Jeeja. This article was written to inform the government of health discrepancies in rural areas. The article argues that a lack of access results from a deficiency of doctors in rural compared to urban areas. To support the argument, the article looks at the downfalls of rural health after the initiation of the National Rural Health Mission. This article is useful for my research because I currently have a lack of information on rural access. Furthermore, this information can help me in my practice experience as many citizens from rural areas will come to the clinic I will be working at.^[16]
8. Healthcare At the Bottom of the Pyramid An Assessment of Mass Health Insurance Schemes in India by Geeta Bhardwaj, Anuradha Monga, Ketan Shende, Sachin Kasat, and Sachin Rawat. The purpose of this article is to inform the public about how healthcare is financed. The article argues for the importance of government funding in health insurance. The authors support their argument by discussing many statistics about the funding of healthcare. This will be beneficial for my discussion of access and universal healthcare as both are very dependent on financial situation. Furthermore, this is pertinent to my practice experience as many citizens I will work with have low financial stability^[17]
9. Where are the healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh province, India by Ayesha De Costa. This article was written to inform urban doctors the reasons for a lack of rural doctors and urge them to help rural populations. De Costa argues that there is an unequal distribution of doctors due to diminishing infrastructure in rural areas. She analyzes the relationship between access and service to healthcare providers with caste or tribe in rural areas. This article is very pertinent to my discussion of access and why some populations have less access than others. Furthermore, I will be seeing many citizens of lower caste at the health clinic and so learning about the health inequalities they face specifically is very beneficial.^[18]
10. Capturing Benefits from the Public Policy Initiatives in India: Inter-Group Differences in Access to and Usage of the Rashtriya Swasthya Bima Yojana Health Insurance Cards by Vani Borooah, Vinod Mishra, Ajaya Naik, and Nidhi Sbharwal. This article was written to inform the public about the RSBY program as part of the Public-Private Partnerships Initiative. The article argues that RSBY has supported 33 million families, although eligibility for the program does not equate to participation in it. The argument is supported with evidence such as statistics about the reach of the program as well as closer looks at two states in India. I can use this information to add to my discussion of initiatives and improvements that can be made. This article is pertinent to my practice experience as I will be working for a healthcare NGO and RSBY works in the same sector. Thus, the information I learn about the faults of the RSBY can pertain to my NGO as well.^[19]
11. Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare by Anup Karan, Winnie Yip, and Ajay Mahal. This article discusses state wide health initiatives to inform the public of actions in place to improve healthcare access. The authors argue that state initiatives are necessary to decrease out-of-pocket expenses and non-medical spending. It does this by discussing numerous initaitaves as well as the RSBY. This is very useful for my discussion of the RSBY as an initiative to expand health services to the lower populations as well as other potential solutions that are in place. Furthermore, this pertains to my practice experience as initiatives such as RSBY involve healthcare and learning about them can help prepare me for working at my healthcare NGO.^[20]
12. National Urban Health Mission: An analysis of strategies and mechanisms for improving services for urban poor by Denny John, SJ Chander, Narayanan Devadasan. The purpose of this article is to discuss faults of the NRHM and strategies for improvement to inform those that work with NGOs. The authors support their argument by discussing the issues with the NRHM as well as three tiers to work on. This information adds to my discussion of initiatives in place for the impoverished to improve their health access in rural areas. This article applies to my PE as well as people from rural areas will be coming to the clinic I will work at.^[21]

Notes from Papers

Area Homelessness in India

Source 1: ^[1]

• can edit the first sentence of the article with this new information that its a family of 4 members that has an average of 5 generations as homeless.
• 1.77 million homeless according to the census in 2011
• india defines homeless as by the Census of India - people who don't live in census houses. Can live on pavements, roadsides, railway platforms, under stairs, in pipes, at temples, or on the streets. Make houses with cardboard, tin, wood, plastic. Can't afford slums.
• stereotypes: lazy, antisocial, in the way of city improvement, beggars, criminals.
• Makeup: single men, women,, women with children, elderly, disabled.
• Government: policies for affordable housing, shelters in urban areas in past decades.
  • shelter = contains the basic necessities of a home. Commissioners of the Supreme Court - just a covered space that homeless can feel safe and secure and is accessible by anyone who wants to visit it. has protection from the environment, place to keep their things, can drink water and take showers, has bathrooms and sanitation and security.
  • location - ideally would be in areas where there are lots of homeless
  • Supreme court mandated for cities with > 5 lakhs populations and part of the Jawaharlal Nehru national urban Renewal Mission, shelters must have sanitation and good water, toilets, baths, cooling, heating, ventilation, lights, emergency lights, fire safety, recreation spaces, TVs, first aid, shelter from mosquitos and rodents, beds, kitchen and utensils, counseling, childcare facilities, transport for emergencies that are medical.
  • Shelter is short term, housing would be permanent. shelters do not replace the right to housing, which all people have.
• History:
  • Night Shelters for Urban Shelterless - urban areas in 1988/89. Housing and Urban Development Corporation (Gov of India) executed it. 20,000 rupees per year with 50% payed by government and 50% pays by loans by HUDCO or sponsors.
  • renamed in 1992 to Shelter and Sanitation Facilities for Footpath Dwellers in Urban Areas by Ministry of Urban Development. stopped using pay toilets and made it more dorm - like for night and social place in day. stopped in 2005 because states could'n't get funds for it.
  • major intervention: Supreme court acted on the report below and ordered amount of homeless shelters that need to be there based on population (one to house 100 people). also has to be run 24/7 every day of the year and have beds, bathrooms, water, healthcare, first aid, services. 62 cities participated.
  • Finally, in 2013, government started the National Urban Livelihood Mission which had guidelines for states on how to create and use these shelters.
• conditions:
  • 2010 report by Commissioners of the Supreme Court showed horrible conditions in night time shelters, barely better than streets. furthermore, many people who were eligible for this shelter had to work during the nights so would need refuge in the day. need 24/7 ones.
• Data collected from analysis of homeless shelters:
  • 97% male 19-50 years surveyed. 22% 51-70.
  • four shelters had females.
  • male wage workers, taxi drivers, rickshaw drivers, tourists.
  • bedding is provided in all four cities
  • few have functional first aid, rodent control, and office/ activity space.
  • some have bad cooking equipment and tools, no shelters have gas available to cook with. there is space for cooking, may not be in working condition and no utensils.
  • bad lighting and ventilation and bad fire safety
  • drinking water is what is upheld the most but quality may not be good. hard to get water for washing clothes. sometimes shortage of drinkable water.
  • study identified state of UP as being unable to provide rights for the homeless as dictated by the Constitution of India.
  • no separate shelters for women and children
  • bare minimum of government demands are not being met.
  • 11 female surveys/ 426
  • either women don't find them helpful or there is no to low tendency for families to seek shelters.
  • bedding not enough or very dirty and unclean
  • some don't have bathrooms or are very dirty^[1]

Source 2:^[2]

• people with a mental illness have the right to live in a community according to the UNs pricnicples for Protection of Persons with Mental Illness and the Improvement of Mental Health Care in 1991.
• mentally ill have high rates of homelessness^[2]

Source 3:^[3]

• there are about 18 million street children in India, the largest amount in any country in the world.
• according to UNICEF, 4 categories: children at risk who live with families but work on the streets for income, children who primarily stay on the street but have some place of residence with some family, children of the street who spend most of life on street and don't live with families or contact, abandoned children who are on their own on the streets with no adults in their lives.
• street children have health issues compared to non-street children. both physical and mental.
• drop in centers did help street children
• children liked the services because they were allowed to act themselves, had a support system, and opportunities
• children did realize they would have to adapt to non-street way of life
• liked it because of non-judgmental staff and supervisors.
• children preferred center because they could play and learn. on the streets they claim to either do drugs or be working.
• free medical care and clothing and food.
• could let go of adult responsibilities and didn't have to sleep hungry or work on the streets. didn't get sick from the food.
• street children often don't get help from their parents/families. often they say they can only trust the staff for support because on streets they don't get any.
• see the staff as their families
• learn good morals and direction from staff
• reduced drug habits because of instruction from staff
• learned good health habits like washing hands and brushing teeth, shower, change clothes and wear clean clothes, stay clean.
• more opportunities for success in the future.
• some children still chose to live on the streets. they had gotten used to the freedom there (can do drugs and play with friends when they want) and also if their families were there it became home.
• some don't like rules of the shelter.
• see streets as normal and enjoyable with friends.
• all said health was either neutral or improved
• hospitals view them as bad, ask for bribes, don't give them service, make them pay more, judge them, don't give proper care.
• get abused by police and older street kids^[3]

Source 4:^[4]

• India accounts for over 20% of childrens deaths due to preventable diseases
• quality of life is bad because of no access or bad treatment in schools and healthcare places.
• many regard street children as criminals and irritations
• lots of diseases and infections, bad health conditions and envrionments, bad nutrition
• bad health for many many reasons such as bad access, environment, bad living and working, bad shelters, bad diets, starvation, etc
• usually get treated at private clinics or stores
• public health services not helpful because far away, transport hard, crowded, loss of a days work.
• may be less girls on the streets because they are needed in households while boys leav ehome to work
• 74% street children living in hosues that are cramped with their families
• 17% lliving on streets of the neighborhood. in groups together.
• 5% in markets
• 3% by restaurants
• 1% around bus stands.
• 26% comprised children who don't live with families or are not in touch anyone.
• 76% Fathers dead or not present
• very large family size 2-11 confirms that children are considered useful in terms of making wages and solving the family's poverty
• children suffer from fever then dysentery
• dirt causes them to have lunch and cough and throat issues
• skin issues, fever, cold, diarrhea are biggest issues
• many have wounds, TB, and other
• drinking water have to stand in line for hours and sometimes even pay
• have to think about daily earnings and transport and how to pay. more considered about wages and not missing work. skip going to the doctor to work.
• health services disclude people who are unaccompanied minors from receiving them
• urbanization in causing street children
• self employed so no employment regulation.^[4]

Source 5:^[5]

• experience abuse in the moderate and severe category. severe = 36.6% and moderate = 61.8%
• boys more abused than girls- longer hours, more tedious and difficult work, greater risk and abuse.
• more abuse with higher age and income - as income increases, more hours, more risky environments and jobs, more abuse.
• 11 million children on streets in urban areas
• street children result from poverty, alcoholic fathers, large families, death of parents, bad relationships with new parents (step-parents).
• drop out from school and bad school performance, behavior issues in school, drug use, bad parent relationships, unemployment, low literacy, slums and bad housing
• physical to sexual to emotional abuse
• exploited and victims- parents abuse them due to stress/depression/alcohol, go to the streets and find groups of kids that form a hierarchy and highest up abuse younger children. groups help survive and protect themselves.
• often maltreatment and abuse go together
• get multiple forms of abuse
• verbal and psychological abuse most, then general abuse and neglect, health abuse, physical abuse last
• only 1.6% in the moderate abuse category
• don't get contracts in work, bad health facilities and care, no insurance and social security sometimes.
• work long hours with low wages in horrible conditions, exposed to unhealthy environments and unsafe places, cruel and abusive work environments
• depression, antisocial, negative
• data shows that high levels of one type of abuse are correlated with high levels of other abuse as well^[5]

Source 6: ^[6]

• migration of families from rural poor to cities
• children flee from homes of poverty, violence, opppresion, being exploited.^[6]
• NGOs - mainly in capitals and huge cities
• Salam Baalak Trust NGO - Delhi since 1989
  • helps neglected street children regardless of SES etc
  • 3500 street children
  • operates 4 shelter homes
  • 24 hour care for about 220 children at a time.
  • safe and secure
  • food, education, health and mental health services
  • activities and fun
  • taught how to use skills to make a profit
  • has a mental health program as well

Source 7:^[7]

• JWN act is to improve infrastructure of slums and places the homeless live
• has a lot of info on MDG and different acts in place

Sector Healthcare in India

Source 1:^[10]

• 377 million urban population from 2011 census
• many moving from villages to cities
• live in slums
• poverty line is 1000 rupees per month
• the problem of healthcare access arises not in huge cities but in rapidly growing smaller cities. here, less available options for different healthcare, less organized government and services.
• compared to rural areas, urban areas don't know what they are doing in terms of deliveries/ births. many babies are born not in the hospital which can lead to the low mortality in cities.
• there have been some initiatives but overall system is terrible compared to rural where they are organized and more in charge of deliveries.
• lack of accountability and cooperation of many departments related to healthcare
• there are some initiatives that have been put into place.
• hard to say and identify an establishment responsible fro providing urban health services. in rural- district admin is in charge of providing these services. it is very clear cut that way.
• urban healthcare right now is primarily secondary and tertiary, not primary care
• some cities have focussed on getting services to slums
• Government of India has a Twelfth Plan that will expand the National Rural Health Mission for the whole country = National Health Mission.
• incorporates National urban health Mission. which is in 779 cities and towns of populations 50,000 each. this focusses on getting primary health services to those who need it of the urban poor.
• one Urban Public Health Center for 50,000 population.
• want to fix current facilities and add new ones.
• plans for every small government in cities and towns to take charge in planning healthcare facilities prioritized for urban poor in ALL and ANY slums and other underserved groups. including sanitation, drinking water.
• also includes a community outreach plan
• part of is in an initiative called reproductive, maternal, newborn and child health and adolescent strategy: focuses on reaching unreached people in slums, the homeless, street children, construction workers, temporary migrants, etc.
• there are two concerns for healthcare for babies which include both quantity and quality. unlisted slums are excluded from services, where small municipal governments aren't located there is less health services. quality is due to bad infrastructure, resources, equipment, providers.
• people use non-governmental private sector services in slums and non slums. think about ability to pay. but largely understaffed, bad practice common. 3x payment than in public place. lots available around cities though. been efforts to join public and private sectors.
• health inequalities in urban areas due to residence, socioeconomic status, unlisted slums.

Source 2:^[11]

• private healthcare has grown a lot more than public
• 65% of households utilized private sources
• access in health care has been one very important aspect of utilization of health services
• access to information as well
• wider accessibility to healthcare in urban areas compared to rural
• private is higher for urban areas 74% compared to rural 61% usage of private.
• females had >60% in both.
• lower standard of living use public more compared to middle or high class.
• responsiblity of governing to provide health services that are acceptable and affordable to all citizens
• as age increases more use public
• so government should provide more and better/newer public health services
• to obtain universal health care, it is important for policy makers and those in government to acknoledge the form of health care the majority of public is using. especially when there are high costs for services, public is very important. very important for low standard of living people. subsidized public healthcare very important. they are what lots of people rely on.
• must consider budget and be sure to allocate to public health care facilities to ensure the poor aren't left in stress to meet payments and lack of health resources.
• females use it more so do better in maternal and child heath as well.

Source 3:^[12]

• inequalities in health are the result of differential distribution of services, power, resources.
• inequalities in access to health care: national immunization in 2005-6 was 44%. only 40% give birth in a health building in 2005-6.
• women in top classes are 6 times more likely to deliver in a health facility than bottom quintile.
• inequality in financing also affects access
• health expenditure can actually cause poverty - happened for half the households that have fallen to lowest classes.
• people with the greates need for healthcare are the ones who don't have access to it.
• acess = ability to receive some services of a specific quality at a sepcific cost/inconvenience
• access to maternal and child health
• immunizations vary by SES, household education.
• 58% in urban, 39% in rural got immnized
• gender gap increased
• rich people use more public services than poor even though poor use them more
• rich have longer stays in hospitals in inpatient and more likeley to be admitted into public
• access depends on gender, SES, education, wealth, rural vs urban.
• entry into hospitals is determined by^^
• physical access: >70% rural population has this issue. beds in gov hospitals urban twice as many as in rural.
• usually vulnerable groups are together in clusters where there are no services
• distance- outreach programs are necessary to reach isolated groups of people who are marginalized.
• costs are also there
• insufficient drugs and medicines
• rajasthan: 40% did not have a medical degree and 20% hadn't done secondary education = private providers.
• out of pocket payments
• costs have increased in private sector
• drug costs also high
• no control on prices
• National Rural Health Mission- outreach strategies for isolated.
• need to take a new approach, more local in each state. use these equity principles and make them into policies and implement.

Source 4:^[13]

• community based health insurance can assist in providing services to areas with disadvantage in terms of available sources. emphasize responsibility and governance in local terms.
• reform health insurance and its reach in India
• universal healthcare should slowly yet steadily be expanded to the entire population. should be mandatory
• both private and public sectors should be involved to ensure poor areas reached. this should increase health access to poor. furthermore, no money exchange at the time of use.

Source 5:^[14]

• healthcare outreach and access are the two major problems identified in this paper. there is a gap between the two and India is lacking in both. Without outreach, services aren't spread everywhere, and then in places where money is less they cannot afford the regular health services so there is no access.
• India has failed to target millenial development goals related to health.
• to achieve MDG, need three things: provision, utilization, and attainment.
• gap between the three
• out of pocket costs affects access- medical and non-medical
• private public partnerships initiative. right now there is no competition between pharmacies and medical service shops. so going to combine the two my having infrastructure be public and private do medicines below the highest price it can be. this is what the government of different states have decided to do.
• reduced cost of medicines through a program called Fair Price Shops.
• reduced cost of hospital treatments/stays by the Rashtriya Swasthya Bima Yojana program. this program states that these costs will be reimbursed for those living below the poverty line.
• non-medical costs can be helped by National Rural Telemedicine Network.
• All three are through the PPP.
• RSBY right now had 37 million households covered with129 million poor in 2015
• Fair Price Shops:
  • cheaper cost for medicines, drugs, implants, prosthetics, orthopedic devices, etc.
  • over 23% don't have enough money for treatment so don't get it
  • 63% lack regular access to necessary medications
  • fair price shops will be at government hospitals
  • are not branded so doctors have to prescribe the generic name
  • the private partners are chosen by finding the one with the greatest discount on the goods
  • this program has a very low cost for the governemnt as shops already exist in hospitals. for private sector, cost is low as well because less cost for advertising a brand since generic. with huge benefit.
  • doctors are prescribing 60% generic drugs.
  • was introduced in WB in 2012.
  • cost of treatment has reduced
  • 93 stores by end of 2012
  • 250 croroes of discounts from dec 2012-nov 2014
  • have benefited 85 lakh people
  • so this can be a solution to affordability for healthcare access
• Rashitrya Swasthya Bima Yojana:
  • up to 30,000 rupees
  • covers pre-existing conditions no matter what
  • fixed rates for other issues
  • up to five members in a family can be covered
  • the family does have to pay at least 30 rupees to register in the program
  • central (75%) and state governments (25%) finance the scheme.
  • can be both public and private hospitals and insurers involved
• National Rural Telemedicine Network:
  • connects many healthcare institutions together so that other doctors can help with diagnosis, consultations, opinions.
  • this makes it cost effective as country is connected in a big network
• results show that need to create better infrastructure to improve healthcare.
• also show that success depends on the location. need to have better health infrastructure in concentrated areas.
• outreach programs can help with this.
• this study only considered Maharashtra and West Bengal but should be spread out.
• many do not have access because: lack of services close by, long wait time, lack of fundings, ailment not considered serious enough to assist with.
• even with this RSBY program, high OOP for non-medical things deters people from accessing healthcare.
• need a market for private sector participation in rural areas.
• RSBY has stopped many from falling into poverty due to healthcare
• outreach, affordability, access lacking
• when used together all three are very efective
• expand all of them

Source 6:^[15]

• finance is a key component of equality for access to healthcare
• proportion of public resources assigned to healthcare one of the lowest in the world - 1/5 is financed publicly
• countries with universal access to healthcare have financing of it by many agencies combined or a single public agency
• india has most private healthcare in world
• largest financing of healthcare is OOP
• Round National Sample Survey of 1995/6 showed that 40% people sell or borrow assets to pay for hospitalizations
• half of the bottom two quintiles go into debt/ sell assets
• but only 1/3 of the top quintile does
• lots of households do not survive with illness at the same level
• need to gear the system towards universal healthcare
• need to get more public financing of healthcare
• need to have access organized in one large system that everyone can access with no problems or barriers^[15]

Source 7:^[16]

• 82% of the population is rural
• 74% of doctors are urban, serve only 28% of the population
• government wants to create a cadre of rural doctors
• the National Rural Health Mission task force for medical education and proposed by other governmental organizations, creating a new cadre of doctors for rural areas.
• course to take
• reason for lack of access in rural areas is due to lack of human resources
• shortage of professionals working in rural areas
• public health sector is 18% of total outpatient care, 44% inpatient care. private sector 58% of hospitals, 29% beds in hospitals and 81% of doctors.
• rural population depends on 'quacks'
• 1.4 million doctors in india
• compulsory rural service for junior doctors.
• shortage of infrastructure in public health
• even under new NRHM most new construction of hospitals are urban

Source 8:^[17]

• according to WHO's World Health Statistics of 2007, in terms of public funding of healthcare as a percent of GDP, India ranked 184/191 countries.
• public spending on healthcare stagnated 0.9 to 1.2 as a percent of GDP in past two decades 1990-2010.
• however, OOP expenditure is 75% the expenditure on healthcare.
• overall, 74% private funded
• 26% public spent
• 40% hospitalized are pushed into poverty or life debt
• poorer pay disproportionately more than the rich as a percent of their total earnings than the rich --> ill and bad access to health
• access is given to those who can pay for it; financial situation determines access
• healthcare costs have inflated 10-12% a year
• with more advancements in medicine, cost of treatment increases more

Source 9:^[18]

• qualified physicians are usually in more urban districts
• human resources are drivers of healthcare adequacy
• urbanization explains this partly
• private doctors are in districts becuase they tend to be specialized in some field and so are in urban areas where higher demand and financial ability
• urbanization explained public doctors being in urban areas less because they are payed a salary regardless
• tribes and ex-untouchable castes are isolated or live dispersed. 2/3 of indian laborers that have high transmission of poverty through generations
• getting doctors to rural areas as well as making them stay has been difficult due to lack of housing, healthcare, good education, drinking water, electricity, roads, transportation
• amount of physicians negatively correlated with amount of lower castes. they have lower status and thus political power and maybe thats why they have lower social status.
• in this state of MP

Source 10:^[19]

• need to hold a ration card
• has been recognized by World Bank, UN as one of the best health insurance schemes in the world
• 30 rupees registration fee.
• receive in-patient payment up to 30,000 rupees per family every year.
• in 25 states of india
• 33 million families
• 4.3 million people have been treated with it
• even if eligible to get a card, often people don't
• people may not use card if they have it
• in Maharashtra, those on higher up on the ladder in higher SES have a card more than those in lower. same with usage.
• in UP, geography made a difference - those in outskirts of towns less likely to have a card than those that live in the center of villages/towns.
• in UP, the village council with which they were associated makes a difference in card usage as well.
• in Maharashtra, households with electricity were more likely to have

Source 11:^[20]

• tax financed program
• has info on state wide health insurance schemes to spread healthcare!!
• probability of having outpatient OOP expenses increased by 23%
• household non-medical spending increased due to it
• study states that RSBY hasn't provided much support or improvement for financial situations of poor households in healthcare.
• increased opportunities for work and income with RSBY due to healthcare coverage - they don't have to worry about getting hurt

Source 12:^[21]

• bad infrastructure
• bad organization of health delivery systems
• social exclusion of many populations
• overcrowding in urban areas
• etc = problems of why bad healthcare in cities
• strategies for improvement = PPP, monthly nutrition and health days, special attention to most at risk populations, strengthen existing systems
• three tiers to work at: community level including outreach, urban health center level including fixing infrastructure/existing systems, and secondary/tertiary level = PPP

Summarizing and Synthesizing

Areas: Homelessness in India

Introduction:

(Add this information to the existing section)

The Universal Declaration of Human Rights defines 'homeless' as those who do not live in a regular residence due to lack of adequate housing, safety, and availability.^[1] India defines 'homeless' as those who do not live in Census houses, but rather stay on pavements, roadsides, railway platforms, staircases, temples, streets, in pipes, or other open spaces.^[1] There are 1.77 million homeless people in India, according to the 2011 census, consisting of single men, women, mothers, the elderly, and the disabled.^[1] Furthermore, there is a high proportion of mentally ill and street children in the homeless population.^[2] There are 18 million street children in India, the largest number of any country in the world, with 11 million being urban.^[3][5] A family of four members has an average of five homeless generations in India.^[1]

Problems/causes:

(Add to existing section)

Homelessness is in part a direct result of families migrating from rural to urban cities and urbanization.^[6][4] Once reaching cities, homeless attempt to create shelters out of tin, cardboard, wood, and plastic.^[1] Slums can provide an escape, yet individuals often cannot afford them.^[1] Homeless individuals may experience abuse, maltreatment and lack of access to schools and healthcare.^[5][4] Diseases and infections, unsafe health environments, unhealthy nutrition which can lead to starvation, and unsound shelters often result in a low quality of life.^[4]

Street Children:

(Add this information to the existing section)

According to UNICEF, street children can be broken up into four sections: at-risk children who live with family but work on the streets for income, children who primarily stay on the street but have some residence with family, children who spend most of their lives on the street and do not live with or contact family, and finally abandoned children who are on their own with no adult figures.^[3] Children flee homes of poverty, violence, oppression and exploitation and eventually reside on the streets.^[6] In families with 2-11 children, they are exploited to earn wages to support their relatives by working on the streets.^[4] They are often privy to exploitation and physical and mental abuse due to familial stress, depression, and alcohol abuse.^[5]

Furthermore, children live on the streets as a result of urbanization, poverty, unemployment, alcoholic families, death of parents, bad relationships with new parents, and drug use.^[5] Street children often have bad performance and behavior issues in school and may eventually drop out, leading to low literacy.^[5] These tie into a cycle perpetuating poverty and homelessness.

In terms of living, 74% of street children live in houses that are cramped with their families, 17% live together on the streets of their neighborhood, 5% in markets, 3% by restaurants, and 1% by bus stands.^[4] Because of these living conditions, street children have more physical and mental health issues than non-street children.^[3] They often suffer from medical conditions such as dysentery and fever. Dirt found on the roads can result in coughs, throat, and skin issues, as well as colds.^[4] Many have wounds or Tuberculosis.^[4] To collect drinking water, street children may stand in line for hours. They usually obtain medical treatment at cheap stores or private health clinics; public health services are not helpful because they are situated far away, are crowded, and often require paid transportation.^[4] Additionally, street children face two major barriers to taking care of their health: firstly, most children have no insurance or social security. Secondly, children are more concerned about wages than health. Thus, they would prefer to give up healthcare over missing a day of earnings.^[4] Furthermore, others perceive and judge street children as criminals and burdens. Health services often disregard them, especially if they are unaccompanied minors.^[4] Assuming children will ask for bribes, hospitals abstain services, increase prices, or refuse them proper care.^[3] These issues can cause street children to become depressed or antisocial with negative approaches to life.^[5]

Street children suffer from multiple forms of abuse.^[5] Most experience verbal and psychological abuse, some experience general abuse and neglect, fewer suffer from health abuse, and a small number from physical (including sexual) abuse.^[5] Data shows that high levels of one type of abuse are correlated with high levels of another, with amount of abuse increasing with age and income.^[5] Often, abuse comes from manipulative employers and occupations.^[5] Because street children tend to be self-employed as opposed to contractual, there is no employment regulation.^[4] Additionally, studies show that boys are more abused than girls on the streets.^[5] Boys tend to work longer hours at more tedious occupations with greater risk and bad environments.^[5] Additionally, girls remain in households to work whereas boys leave homes to find employment.^[4] Finally, abuse can stem from children with hierarchy on the streets.^[5] Members of a group help protect each other to survive. However, older member often abuse the younger children.^[5]

Non-governmental services:

(create a new section)

Drop in centers have shown to help street children.^[3] In capitals and large cities, NGOs are involved with these centers.^[6] One such organization known as Salam Baalak Trust (SBT) has been operating in Delhi since 1989.^[6] SBT runs four homeless shelters open 24 hours a day for around 220 children at a time. This organization has helped 3,500 street children.^[6] SBT shelters offer free clothing, food, education, health and mental health services.^[6] Thus, children can play without worrying about adult responsibilities such as acquiring food.^[3] Furthermore, SBT shelters are safe and secure for children.^[6] Centers provide support systems with non-judgmental staff and supervisors as well as opportunities for growth. As many children often do not get support from their parents, families or others on the streets, children seek trust in the staff and consider them to be family.^[3] They learn good morals and habits, including reduced drug use and hygiene.^[3] Additionally, they are taught how to utilize their skills to create a business.^[6] Children at drop in centers believe they have more opportunities for success in the future.^[3]

However, some children do not realize that they will have to adapt to non-street life in drop in centers. They get accustomed to the freedom on the streets, including drug use and playing with friends at their leisure.^[3] If their families live on the streets, the streets become a normal home for them.^[3] Some children also do not like the rules of the shelter. Thus, they chose against living in drop in centers.^[3]

Governmental services:

(create a new section)

The Housing and Urban Development Corporation (HUDCO) had a policy for the homeless known as Night Shelters for Urban Shelterless, applicable to urban areas in 1988 to 1989.^[8] It gave 20,000 rupees a year to homeless shelters, 50% paid by the government, 50% paid by loans from HUDCO or sponsors. In 1992, the Ministry of Urban Development renamed it to Shelter and Sanitation Facilities for Footpath Dwellers in Urban Areas.^[8] The department decided to maintain these shelters as dorm-like refuge for nights and social areas in the day. However, in 2005 it was discontinued as states lacked funding.^[8]

The Government of India has formed new policies for affordable housing and shelters in urban areas in the past few decades. However, shelters provide a temporary solution as they are not permanent and do not replace the right to housing.^[1] According to the Commissioners of the Supreme Court, a shelter is a covered space where homeless people can feel safe and secure, and is accessible by anyone.^[8] It should provide protection from the environment, safety and security, a place to keep belongings, and a place to drink water and use sanitary bathrooms.^[8] The government states that homeless shelters ideally be in localities where there are a lot of homeless people.^[8] To improve infrastructures in slums, the Supreme court mandated a new mission known as the Jawaharlal Nehru National Urban Renewal Mission.^[7] This stated that for cities of over 5 lakhs in population size, shelters must contain good water, toilets, baths, cooling, heating, ventilation, lights, emergency lights, fire safety, recreation spaces, TVs, first aid, shelter from mosquitoes and rodents, beds, kitchens and utensils, counseling, childcare facilities, and transport for emergencies.^[9]

However, the 2010 report by Commissioners of the Supreme Court portrayed conditions in night time shelters as horrendous. According to the court, these shelters are barely an improvement from the streets.^[1] The homeless population eligible cannot enjoy the shelters at night as that is their time of employment, thus defeating the purpose of the shelter.^[1] Furthermore, the data collected from survey analysis of homeless shelters showed the following: the shelters are majority male consisting of wage workers, taxi and rickshaw drivers, and tourists. The lack of women in shelters suggests that either women don't find shelters helpful or that there is low tendency for families to seek shelters.^[1] The shelters have inadequate bedding, water, bathrooms, tools, gas for cooking, rodent control, activity space and non-functional first aid. Additionally, there is bad lighting, ventilation, and fire safety. Women and children do not have their own shelters.^[1] Thus, the bare minimum of government demands are not being met.^[1]

In response to this report, the Supreme Court mandated there be one shelter to house 100 people in a population.^[1] They declared that shelters must be run all day, every day of the year and consist of beds, bathrooms, water, healthcare and first aid services.^[1] 62 cities participated in this.^[1] Finally, in 2013 the Indian government started the National Urban Livelihood Mission program which mandated guidelines for states on how to create and utilize shelters.^[9]

Sectors: Healthcare in India

I propose re-organizing this page. I want to convert the 'Rural Health' section into an Access to Healthcare section, in which I would have Rural and Urban subsections, and Rural south India and north India as sub-subsections or the Rural subsection. I could discuss access to urban health care in the urban section (the current urban section is more about urban health, less about access). I believe access is important enough to have its own unique section.

Access to Healthcare (overall main section):

(create this as the intro to the new section on access to healthcare, before introducing rural and urban)

There are 1.4 million doctors in India.^[16] Yet, India has failed to reach its Millennium Development Goals related to health.^[14] The definition of 'access' is the ability to receive some services of a certain quality at specific cost and convenience.^[12] The healthcare system of India is lacking in three factors related to access to healthcare: provision, utilization, and attainment.^[14] Provision, or the supply of healthcare facilities, can lead to utilization, and finally attainment of good health. However, there currently exists a huge gap between these factors, leading to a collapsed system with insufficient access to healthcare.^[14] Differential distributions of services, power, and resources have resulted in inequalities in healthcare access.^[12] Access and entry into hospitals depends on gender, socioeconomic status, education, wealth, and location of residence (urban versus rural).^[12] Furthermore, inequalities in financing healthcare and distance from healthcare facilities are barriers to access.^[12] Additionally, there is a lack of sufficient infrastructure in areas with high concentrations of poor individuals.^[14] Large numbers of tribes and ex-untouchables that live in isolated and dispersed areas often have low numbers of professionals.^[18] Finally, health services may have long wait times or consider ailments as not serious enough to treat.^[14] Those with the greatest need often do not have access to healthcare.^[12]

Initiatives to improve access

(create a new subsection in overall access to healthcare after rural and urban)

The Twelfth Plan

(create a new sub-subsection under initiatives)

The government of India has a Twelfth Plan to expand the National Rural Health Mission to the entire country, known as the National Health Mission.^[10] Community based health insurance can assist in providing services to areas with disadvantaged populations.^[13] Additionally, it can help to emphasize the responsibility of the local government in making resources available.^[13] Furthermore, according to the Indian Journal of Community Medicine (IJOCM) the government should reform health insurance as well as its reach in India. The journal states that universal healthcare should slowly yet steadily be expanded to the entire population. Healthcare should be mandatory and no money should be exchanged at appointments.^[13] Finally, both private and public sectors should be involved to ensure all marginalized areas are reached. According to the IJOCM, this will increase access for the poor.^[13]

Public-Private Partnership

(create a new sub-subsection under initiatives)

One initiative adapted by governments of many states in India to improve access to healthcare entails a combination of public and private sectors. The Public-Private Partnership Initiative (PPP) was created in the hopes of reaching the health-related Millennium Development Goals.^[14] It consists of three separate projects with different focuses: Fair Price shops which aim to reduce the costs of medications and treatment options; Rashtriya Swasthya Bima Yojana which reimburses those under the poverty line; and National Rural Telemedicine Network which assists with non-medical costs. This initiative was analyzed in the states of Maharashtra and West Bengal.^[14]

Fair Price Shops aim to reduce the costs of medicines, drugs, implants, prosthetics, and orthopedic devices. Currently, there is no competition between pharmacies and medical service stores for the sale of drugs.^[14] Thus, the price of drugs is uncontrolled.^[12] The Fair Price program creates a bidding system for cheaper prices of medications between drugstores and allows the store with the greatest discount to sell the drug. The program has a minimal cost for the government as fair price shops take the place of drugstores at government hospitals, thus eliminating the need to create new infrastructure for fair price shops.^[14] Furthermore, the drugs are unbranded and must be prescribed by their generic name.^[14] As there is less advertising required for generic brands, fair price shops require minimal payment from the private sector.^[14] Fair Price Shops were introduced in the West Bengal in 2012. By the end of the year, there were 93 stores benefiting 85 lakh people. From December 2012 to November 2014, these shops had saved 250 crore citizens.^[14] As doctors prescribe 60% generic drugs, the cost of treatment has been reduced by this program. This is a solution to affordability for health access in West Bengal.^[14]

The largest segment of the PPP initiative is the tax-financed program, Rashtriya Swasthya Bima Yojana (RSBY).^[20] The scheme is financed 75% by the central government and 25% by the state government.^[14] This program aims to reduce medical out-of-pocket costs for hospital treatment and visits by reimbursing those that live below the poverty line.^[14] RSBY covers maximum 30,000 rupees in hospital expenses, including pre-existing conditions for up to five members in a family.^[14] In 2015, it reached 37 million households consisting of 129 million people below the poverty line.^[14] However, a family has to pay 30 rupees to register in the program.^[19] Once deemed eligible, family members receive a yellow card.^[19] However, studies show that in Maharashtra, those with a lower socioeconomic status tend to not use the service, even if they are eligible.^[19] In the state of Uttar Pradesh, geography and council affect participation in the program. Those in the outskirts of villages tend to use the service less than those who live in the center of villages.^[19] Additionally, studies show household non-medical expenses as increasing due to this program; the probability of incurring out of pocket expenses has increased by 23%.^[20] However, RSBY has stopped many from falling into poverty as a result of healthcare.^[14] Furthermore, it has improved opportunities for family members to enter the workforce as they can utilize their income for other needs besides healthcare.^[20] RSBY has been applied in 25 states of India.^[19]

Finally, the National Rural Telemedicine Network connects many healthcare institutions together so doctors and physicians can provide their input into diagnosis and consultations.^[14] This reduces the non-medical cost of transportation as patients do not have to travel far to get specific doctor's or specialty's opinions.^[14]

The results of the PPP in the states of Maharashtra and West Bengal show that all three of these programs are effective when used in combination. They assist in filling the gap between outreach and affordability in India.^[14] However, even with these programs, high out-of-pocket payments for non-medical expenses are still deterring people from healthcare access.^[14] Thus, scholars state that these programs need to be expanded across India.^[14]

National Urban Health Mission

(create a new sub-subsection in initiatives)

The National Urban Health Mission (NUHM) works in 779 cities and towns with populations of 50,000 each.^[10] As urban health professionals are often specialized, current urban healthcare consists of secondary and tertiary, but not primary care.^[10][18] Thus, the mission focusses on exapnding primary health services to the urban poor.^[10] The initiatve recognizes that urban healthcare is lacking due to overpopulation, exclusion of populations, lack of information on health and economic ability, and unorganized health services.^[21] Thus, NUHM has appointed three tiers that need improvement: Community level (including outreach programs), Urban Health Center level (including infrastructure and improving existing health systems), and Secondary/Tertiary level (Public-Private Partnerships).^[21] Furthermore, the initiative aims to have one Urban Public Health Center for each population of 50,000 and aims to fix current facilities and create new ones. It plans for small municipal governments to take responsibility for planning healthcare facilities that are prioritized towards the urban poor, including unregistered slums and other groups.^[10] Additionally, healthcare services include sanitation and drinking water, community outreach programs to further improve access, and monthly health and nutrition days to improve community health.^[10][21]

National Rural Health Mission

(create a new sub-subsection in initiatives)

To counteract the issue of a lack of professionals in rural areas, the government of India wants to create a 'cadre' of rural doctors, as proposed by the National Rural Health Mission (NRHM) and other governmental organizations.^[16] The National Rural Health Mission has outreach strategies for disadvantaged societies in isolated areas.^[13] They propose creating a course for medical students that is centered around rural healthcare.^[16] Furthermore, they want to create a compulsory rural service for younger doctors in the hopes that they will remain in these areas.^[16] However, the NRHM has failings. For example, even under the NRHM, most new construction of health related infrastructure occurs in urban cities.^[16] Many scholars call for a new approach that is local and specialized to each state's rural areas.^[13]

Financing Healthcare

(create a new subsection in overall Access to Healthcare)

Despite being one of the most populous countries, India has the most private healthcare in the world.^[15] Out-of-pocket private payments make up 75% of the total expenditure on healthcare.^[17] Only one fifth of healthcare is financed publicly.^[15] This is in stark contrast to most other countries of the world.^[17] According the World Health Organization in 2007, India ranked 184 out of 191 countries in the amount of public expenditure spent on healthcare out of total GDP.^[17] In fact, public spending stagnated from 0.9% to 1.2% of total GDP in 1990 to 2010.^[17]

Medical and non-medical out-of-pocket private payments can affect access to healthcare.^[14] Poorer populations are more affected by this than the wealthy. The poor pay a disproportionately higher percent of their income towards out-of-pocket expenses than the rich.^[17] The Round National Sample Survey of 1955 through 1956 showed that 40% of all people sell or borrow assets to pay for hospitalization.^[15] Half of the bottom two quintiles go into debt or sell their assets, but only a third of the top quintiles do.^[15] In fact, about half the households that drop into the lower classes do so because of health expenditures.^[12] This data shows that financial ability plays a role in determining healthcare access.^[17]

In terms of non-medical costs, distance can also prevents access to healthcare.^[12] Costs of transportation prevent people from going to health centers.^[14] According to scholars, outreach programs are necessary to reach marginalized and isolated groups.^[12]

In terms of medical costs, out-of-pocket hospitalization fees prevent access to healthcare.^[14] 40% of people that are hospitalized are pushed either into lifelong debt or below the poverty line.^[17] Furthermore, over 23% of patients don't have enough money to afford treatment and 63% lack regular access to necessary medications.^[14] Healthcare and treatment costs have inflated 10-12% a year and with more advancements in medicine, costs of treatment will continue to rise.^[17] Finally, the price of medications rise as they are not controlled.^[12]

There is a major gap between outreach, finance and access in India. Without outreach, services cannot be spread to distant locations.^[14] Without financial ability, those in distant locations cannot afford to access healthcare.^[14] According to scholars, both of these issues are tied together and are pitfalls of the current healthcare system.

Urban Health- Access to Healthcare:

(create a new sub-section in overall access to healthcare)

The problem of healthcare access arises not only in huge cities but in rapidly growing small urban areas.^[10] Here, there are fewer available options for healthcare services and there are less organized governmental bodies.^[10] Thus, there is often a lack of accountability and cooperation in healthcare departments in urban areas.^[10] It is difficult to pinpoint an establishment responsible for providing urban health services, compared to in rural ares where the responsibility lies with the district administration.^[10] Additionally, health inequalities arise in urban areas due to difficulties in residence, socioeconomic status, and discrimination against unlisted slums.^[10]

To survive in this environment, urban people use non-governmental, private services which are plentiful.^[10] However, these are often understaffed, require three times the payment as a public center, and commonly have bad practice methods.^[10] To counter this, there have been efforts to join the public and private sectors in urban areas.^[10] An example of this is the Public-Private Partnerships initiative.^[14] However, studies show that in contrast to rural areas, qualified physicians tend to reside in urban areas.^[18] This can be explained by both urbanization and specialization. Private doctors tend to be specialized in a specific field so they reside in urban areas where there is a higher market and financial ability for those services.^[18]

Rural Access to Healthcare overall section:

(edit an existing section but create it into a sub-section of healthcare access)

Rural areas in India have a shortage of medical professionals.^[16] 82% of the Indian population is rural.^[16] Yet, 74% of doctors are in urban areas that serve the other 28% of the population.^[16] This is a major issue for rural access to healthcare. The lack of human resources causes citizens to resort to fraudulent or ignorant providers.^[16] Doctors tend not to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, electricity, roads and transportation.^[18] Additionally, there exists a shortage of infrastructure for health services in rural areas.^[16] Finally, urban public hospitals have twice as many beds as rural hospitals, which are lacking in supplies.^[12]

Private Health centers:

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In Rajasthan, 40% of practitioners did not have a medical degree and 20% have not competed a secondary education.^[12] The private sector consists of 58% of the hospitals in the country, 29% of beds in hospitals, and 81% of doctors.^[16] Costs of the private sector are only increasing.^[12]

Public Healthcare Section:

(edit an existing section, add to the end)

The public health sector encompasses 18% of total outpatient care and 44% of total inpatient care.^[16] Middle and upper class individuals tend to use public healthcare less than those with a lower standard of living.^[11] Additionally, females and elderly use public services more.^[11] Considering the goal of obtaining universal health care, scholars request policy makers to acknowledge the form of healthcare the many are using. Scholars state that the government has a responsibility to provide health services that are affordable, adequate, new and acceptable for its citizens.^[11] Public healthcare is very necessary, especially when considering the costs incurred with private services.^[11] Many citizens rely on subsidized healthcare.^[11] The national budget, scholars argue, must allocate money to the public health sector to ensure the poor are not left with the stress of meeting private sector payments.^[11]

My Contributions to Wikipedia

Sector- Homelessness in India

1. First, I added to the introduction of this page (11 sentences). I deleted some existing info as my contribution covered it (2 sentences).
2. Second, I posted on the talk page of Homelessness in India about removing some information about abuse fom the 'street children' section and moving it to a different page entirely.
3. I moved the information to the Street Children in India page under the 'abuse' section where the information fits better. Look at talk page of either Homelessness in India or Street children in India for reference and more information on this change.
4. Added my information to the page by creating a new section titled 'efforts to assist' and a subsection 'non-governmental services' (18 sentences).
5. Re-organized the layout / structure of the page to be more logical and to fit my information in better.
6. Moved info from 'summary' to 'introduction'. deleted summary title.
7. Removed the 'problem' section by renaming it to 'causes'. moved some of my info from intro to this section (4 sentences).
8. Added information to the 'street children' section (31 sentences). Incorporated the existing information into my own.
9. Created the 'governmental services' section.
10. Added information to the 'governmental services' section (24 sentences).
11. Moved some info from 'a growing concern' to the intro.

Areas- Healthcare in India

1. Re-named the Rural section of the article to 'Access to healthcare' and reformatted the rural part of the page. Added a new section known as 'Urban access' to the overall Access to healthcare section. Confirmed the changes on the talk page. Look at talk page for reference: Talk: Healthcare in India.
2. Added information to the general 'Access to healthcare' section.
3. Created a new subsection called 'Initiatives' and a sub-subsection called 'The Twelfth Plan' and added information there (8 sentences).
4. Created a new subsection called 'Urban Areas' and added information there (12 sentences).
5. Added more information interspersed among the already existing public healthcare section (8 sentences).
6. Added more info interspersed among the already existing private healthcare (3 sentences).
7. Added information to the rural access to healthcare section, interspersed with the existing info (8 sentences).
8. Created the new section called 'National Urban Health Mission' under Initiatives.
9. Added information to the NUHM section (8 sentences).
10. Created the new section called 'National Rural Health Mission' under Initiatives.
11. Added information to this NRHM section (7 sentences).
12. Moved pre-existing information from the 'rural areas' section about NRHM to the NRHM section created in step 10. Incorporated this info with the info I added.
13. Created a new section called 'Financing healthcare' under Initiatives.
14. Added my information to the financing healthcare section (26 sentences).
15. Created a new section called 'Public-Private Partnerships' under Initiatives.
16. Added my information to the PPP subsection under Initiatives (36 sentences).