Access to care for the poor living with chronic disease in India : an analysis of selected national health policies

Cette recherche sur les barrières à l’accès pour les pauvres atteints de maladies chroniques en Inde a trois objectifs : 1) évaluer si les buts, les objectifs, les instruments et la population visée, tels qu'ils sont formulés dans les politiques nationales actuelles de santé en Inde, permettent de répondre aux principales barrières à l’accès pour les pauvres atteints de maladies chroniques; 2) évaluer les types de leviers et les instruments identifiés par les politiques nationales de santé en Inde pour éliminer ces barrières à l’accès; 3) et évaluer si ces politiques se sont améliorées avec le temps à l’égard de l’offre de soins à la population pour les maladies chroniques et plus spécifiquement chez les pauvres. En utilisant le Framework Approach de Ritchie et Spencer (1993), une analyse qualitative de contenu a été complétée avec des politiques nationales de santé indiennes. Pour commencer, un cadre conceptuel sur les barrières à l’accès aux soins pour les pauvres atteints de maladies chroniques en Inde a été créé à partir d’une revue de la littérature scientifique. Par la suite, les politiques ont été échantillonnées en Inde en 2009. Un cadre thématique et un index ont été générés afin de construire les outils d’analyse et codifier le contenu. Finalement, les analyses ont été effectuées en utilisant cet index, en plus de chartes, de maps, d'une grille de questions et d'études de cas. L’analyse a tété effectuée en comparant les barrières à l’accès qui avaient été originalement identifiées dans le cadre thématique avec celles identifiées par l’analyse de contenu de chaque politique. Cette recherche met en évidence que les politiques nationales de santé indiennes s’attaquent à un certain nombre de barrières à l’accès pour les pauvres, notamment en ce qui a trait à l’amélioration des services de santé dans le secteur public, l’amélioration des connaissances de la population et l’augmentation de certaines interventions sur les maladies chroniques. D’un autre côté, les barrières à l’accès reliées aux coûts du traitement des maladies chroniques, le fait que les soins de santé primaires ne soient pas abordables pour beaucoup d’individus et la capacité des gens de payer sont, parmi les barrières à l'accès identifiées dans le cadre thématique, celles qui ont reçu le moins d’attention. De plus, lorsque l’on observe le temps de formulation de chaque politique, il semble que les efforts pour augmenter les interventions et l’offre de soins pour les maladies chroniques physiques soient plus récents. De plus, les pauvres ne sont pas ciblés par les actions reliées aux maladies chroniques. Le risque de les marginaliser davantage est important avec la transition économique, démographique et épidémiologique qui transforme actuellement le pays et la demande des services de santé.

Gender bias in children's health care utilisation in Kerala, India

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Estereotipo, frontera y género : una lectura negociada de tres cintas de la India María

Jouée par María Elena Velasco depuis la fin des années 1960, la India María met en scène une indienne « authentique » qui, malgré son statut et ses limitations sociales, dénonce le traitement des institutions auxquelles elle est soumise : les systèmes politique, judiciaire, économique et religieux. Néanmoins, lors des premières projections des films sur le grand écran, la critique portait essentiellement sur les aspects superficiels et a réprouvé la façon dont les indiens et le Mexique étaient représentés, car jugée réactionnaire. Au début des années 1990, des chercheurs ont commencé à étudier ses films en proposant une lecture « négociée » : ils s’intéressent à l’effet humoristique produit sur le public par sa performance et ses aventures, en même temps qu’ils reconnaissent l’ambigüité du personnage et des narrations, tout en soulignant les discours ethnique et de classe. À travers l’analyse de Tonta, tonta pero no tanto (Bête, bête, mais pas trop) de Fernando Cortés (1972), Ni de aquí ni de allá (Ni d’ici ni de là-bas) de María Elena Velasco (1988), et Sor Tequila (Sœur Tequila) de Rogelio González (1977), mon mémoire contribue à cette lecture en étudiant trois sujets : le stéréotype cristallisé dans ce personnage, afin de démontrer comment celui-ci permet une critique de la société mexicaine ; les nouveaux enjeux culturels auxquels le système néolibéral affronte les autochtones ; et la transformation du masculin et du public à travers une construction alternative du féminin.

A Tangled Web? Asking the Gender Question in the Multilateral Development Banks’ Law and Justice Policies in India

Over the course of the last two decades, IFIs (most prominently the World Bank) have begun acknowledging the centrality of human development as an essential element of the economic development process if the growth aimed at is to be holistic and sustainable. Strikingly, there is no agreement on the manner in which this approach is to be achieved, especially in the field of gender and development. This paper focuses on the issue of whether the Multilateral Development Banks’ policies have truly attempted at implementing their stated model of gender mainstreaming through their programmes and projects in India, with a specific focus on the legal sector, since that sector has both instrumental and intrinsic value for gender rights advocates. This article will aim at reviewing their approach towards rule of law projects and the manner in which gender equality norms have or have not been addressed within that framework; it will end with recommendations as to the necessary issues which gender programmes must address within the rule of law framework in order to achieve the Millennium Development Goal of gender equity.

Impact of the elderly on household health expenditure in Bihar and Kerala, India

Dans le contexte d’une population vieillissante, nous avons étudié l’impact de la présence de personnes âgées sur les dépenses catastrophiques de santé (DCS), ainsi que leur impact sur trois effets reliés (le fait d’éviter des traitements, la perte de revenu, et l’utilisation de sources de financement alternatives). Nous avons utilisé les données d’une enquête du National Sample Survey Organization (Inde) en 2004, portant sur les dépenses reliées à la santé. Nous avons choisi un état développé (Kerala) et un état en voie de développement (Bihar) pour faire une comparaison des effets de la présence de personnes âgées sur les ménages. Nous avons trouvé qu’il y avait plus de DCS au Kerala et que ceci était probablement lié à la présence accrue de personnes âgées au Kerala ce qui mène à plus de maladies chroniques. Nous avons supposé que l’utilisation de services de santé privés serait lié à une augmentation de DCS, mais l’effet a varié en fonction de l’état, du présence d’une personne âgée, et du type de service utilisé (ambulatoire ou hospitalisation). Nous avons aussi trouvé que les femmes âgées au Bihar utilisait les services de santé moins qu’elle ne devrait, que les ménages ayant plus de 4 personnes ont possiblement un effet protecteur pour les personnes âgées, et que certains castes et group religieux ont dû emprunter plus souvent que d’autres groupes pour payer les frais de santé. La présence de personnes âgées, les maladies chroniques, et l’utilisation de services de santé privées sont tous liés aux DCS, mais, d’après nos résultats, d’autres groupes retardent les conséquences économiques en empruntant ou évitant les traitements. Nous espérons que ces résultats seront utilisés pour approfondir les connaissances sur l’effet de personnes âgées sur les dépenses de santé ou qu’ils seront utilisés dans des discussions de politiques de santé.

Impact of Western Ghats Orography on the Weather and Climate over Southern Peninsular India-A Mesoscale Modelling Study

The thesis gives a general introduction about the topic include India, the spatial and temporal variation of the surface meteorological parameters are dealt in detail. The general pattern of the winds over the region in different seasons and the generation and movements of the thermally and dynamically originated local wind systems of Western Ghats region has been studied. The modification of the prevailing winds over region by the Palghat Gap and its effect on the mouth regions pf the gap is analysed in great depth. The thesis gives the information of climatic elements of the mountain region such as energy budgets, rainfall studies, evaporation and condensation and the variation in the heat fluxes over the region. The impact of orography is studied in a different approach. The type of hypothetical study gives more insight into the control of mountain on the distribution of meteorological parameter over the study region and helps to quantify the impact of the mountain in varying the weather climate of region. The detailed study of the hydro-meteorological aspects of the main river basins of the region also should be included to the climatic studies for the total understanding of the weather and climate over the region.

Dynamic and Thermodynamic Structure of the Monsoon Boundary Layer over India

The objective of the study is to examine the dynamic and thermodynamic structure and the variations that occur in the surface layer during the pre-monsoon, onset and post-monsoon periods over the Indian region. The variations caused during the occurrence of micro and mesoscale systems, structure and variation in the marine boundary layer over the Indian region is also investigated. The drag coefficient computed indirectly also shows variation during various seasons. The thermodynamic structure of the atmosphere shows variation during the various seasons. The onset monsoon causes lowering of the Lifting Condensation Levels. The outcome of the study is expected to provide a better understanding of the structure and variations in the boundary layer over India, which is useful for many applications especially for numerical modeling studies.

An Integrated Hydro geological Study of the Muvattupuzha River Basin, Kerala, India

The present investigation on the Muvattupuzha river basin is an integrated approach based on hydrogeological, geophysical, hydrogeochemical parameters and the results are interpreted using satellite data. GIS also been used to combine the various spatial and non-spatial data. The salient finding of the present study are accounted below to provide a holistic picture on the groundwaters of the Muvattupuzha river basin. In the Muvattupuzha river basin the groundwaters are drawn from the weathered and fractured zones. The groundwater level fluctuations of the basin from 1992 to 2001 reveal that the water level varies between a minimum of 0.003 m and a maximum of 3.45 m. The groundwater fluctuation is affected by rainfall. Various aquifer parameters like transmissivity, storage coefficient, optimum yield, time for full recovery and specific capacity indices are analyzed. The depth to the bedrock of the basin varies widely from 1.5 to 17 mbgl. A ground water prospective map of phreatic aquifer has been prepared based on thickness of the weathered zone and low resistivity values (<500 ohm-m) and accordingly the basin is classified in three phreatic potential zones as good, moderate and poor. The groundwater of the Muvattupuzha river basin, the pH value ranges from 5.5 to 8.1, in acidic nature. Hydrochemical facies diagram reveals that most of the samples in both the seasons fall in mixing and dissolution facies and a few in static and dynamic natures. Further study is needed on impact of dykes on the occurrence and movement of groundwater, impact of seapages from irrigation canals on the groundwater quality and resources of this basin, and influence of inter-basin transfer of surface water on groundwater.

Export Competitiveness of Software Industry In India

The study was motivated by the need to understand factors that guide the software exports and competitiveness, both positively and negatively. The influence of one factor or another upon the export competitiveness is to be understood in great depth, which is necessary to find out the industry’s sustainability. India is being emulated as an example for the success strategy in software development and exports. India’s software industry is hailed as one of the globally competitive software industry in the world. The major objectives are to model the growth pattern of exports and domestic sales of software and services of India and to find out the factors influencing the growth pattern of software industry in India. The thesis compare the growth pattern of software industry of India with respect to that of Ireland and Israel and to critically of various problems faced by software industry and export in India and to model the variables of competitiveness of emerging software producing nations

Geochemistry of Rare Erath Elements and Trace Metals along the Western Continental Shelf of India

Rare earth elements have occupied an important role in marine geochemical research, particularly as used in the format of REE abundance patterns to describe the geochemical pathways in marine sedimentation and authigenesis. This study concentrates on the distribution pattern of Rare earth elements in the sediments, behavior of Eu and Ce with respect to their occurrence in multiple oxidation states. It also concentrate the depth wise variation of sediment REEs from near shore areas (30m) to deeper depths 200m) in the Arabian Sea. It includes the downcore variation of REEs and other trace elements in the sediment cores and a comparison between the REE distributions of Arabian Sea sediment with the sediments of Andaman Sea. The study gives a general introduction regarding the importance of RRE studies, its occurrence and abundance, electronic configuration, lanthanide contraction, oxidations states and REE supply to the ocean, seawater and sediments.

Petrography, Geochemistry and Diagenesis of Coral Deposits of Kavaratti and Minicoy Islands, Lakshadweep, India

In the present thesis the petrographic, geochemical and digenetic variability of the sediments in the islands of Kavaratti and Minicoy has been investigated .The beach profile studies show that in the Kavaratti lagoon beach, the slope is steeper in the southern and south central part than in the northern end’s marginal deposition is taking place in the northern end of the Kavaratti island, whereas a marginal erosion is observed at the southern end. In Minicoy the slope of the lagoon beach is gentle in the south and is slightly steeper at the northern part of the beach. The southern and northern beach sections show a marginal deposition. Based on the mineralogical and geochemical studies it is concluded that the main digenetic changes observed is the transformation of aragonite to LMC.The transformation takes place mainly in the vadose zone and is caused by the abundance of fresh water infiltration.

Geochemical, Sedimentological And Remote Sensing Studies Of Kayamkulam Estuary, South West Coast Of India- A Gis Approach

In this study, an attempt has been made to find the textural, geochemical, sedimentological characteristics of sediments and water phases of the kayamkulam estuary located in the Southwest coast of Kerala, besides the impact of gas based thermal power plant located at the northern part of the estuary. Estuaries are an important stage in the transport of the solid weathering product of the earth’s crust. These weathered products or sediments are complex mixtures of a number of solid phases that may include clays, silica, organic matter, metal oxides, carbonates, sulfides and a number of minerals. Studies on the aquatic systems revealed the fact that it posses severe ecological impairments due to heavy discharge of sediments from 44 rivers, the continued disposal of pollutants rich materials from industries, sewage channels, agricultural areas and retting yards

Studies on Ilmenite of Chavara and Manavalakurichi Deposites, Southwest Coast of India

The present work attempts to trace the variation in the physical and chemical behavior of ilmenite, since its release from country rocks and subsequent transportation to the coast through the progressive weathering environments of laterite, sedimentary rocks, rivers and estuarine systems. Since the hinterland of the study area consists of crystalline and sedimentary rocks and their weathered forms (laterites), the contribution of each lithological system to the beach placer is attempted. The results of the study show that the most magnetic fraction contains more content of altered phases than the relatively unweathered fractions. The fractions separated above 0.35A define a high grade of ilmenite ore enriched in Ti content. The lattice volume generally decreases with alteration. The magnetic studies revels that the Chavara ilmenite are found to be made up to low magnetic crops with about 46% of the bulk ilmenite constituted by fractions separated at above 0.35A. In the Manavalakurichi ilmenite on the other hand, around 91% of the beach ilmenite is made of fractions separated at or below 0.3A

Macrobenthos of the Shelf Waters of the West Coast of India

The work was carried out with an objective to know the quantitative and qualitative nature of the macrobenthos in relation to the existing hydrographical parameters and sediment characteristics. With the above two cruises were conducted to collect materials. Representative samples were collected from each degree square of the western continental shelf. The study deals with the hydrographic parameters. The bottom water temperature, salinity and dissolved oxygen were measured. The findings showed variations according to depth and latitude. The study gives the details of sediment characteristics of the study area. 7 different types of substrata were noticed. It also explains the macro faunal composition and diversity, and the standing stock of macrobenthos. The wet-weight and numerical abundance of macrobenthic groups are included. The thesis discusses the relation between hydrography and macrobenthos, and sediment characteristics and macrobenthos, based on the results obtained by statistical analysis of the data. It also investigates the relation between macrobenthos and fishery.

Studies on the Nature and Chemistry of Sediments and Water of Periyar and Chalakudy Rivers, Kerala, India

The present study is an attempt to address issues related to sediment properties like texture, mineralogy and geochemistry as well as water quality of two important rivers of central Kerala-the Periyar and the Chalakudy rivers. The main objectives of the study are to investigate the textural and mineralogical characteristics as well as transportation and depositional mechanisms of the sediments of Periyar and Chalakudy rivers, to find out the geochemical variability of organic carbon, phosphorus and certain major (Na,K,Ca and Mg) and minor/trace(Mn,Pb,Ni,Cr, and Zn) elements in the bulk sediments and mud fraction of these rivers, to evaluate the status of heavy metal pollution registered in the sediments of these rivers, to assess the physico-chemical characteristics and water quality of Periyar and Chalakudy rivers and to estimate the dissolved nutrient flux through the Periyar and Chalakudy rivers into the receiving coastal waters. The granulometric characteristics as well as statistical parameters of the sediments of Periyar and Chalakudy rivers depend on the flow pattern controlled by the gradient of the terrain. Compared to Periyar, fluctuations in the dispersal of particles are more in Chalakudy river. In Periyar river, the P and Fe in bulk sediments show a positive correlation with C-org, while in Chalakudy river, both the elements are related to THM concentration. In general, C-org, Fe and P Shows an increasing trend downstream. In Periyar river, the P and Fe in bulk sediments show a positive correlation with C-org, while in Chalakudy river, both the elements are related to THM concentration. Among these two rivers, the pollution of water is several fold higher in Periyar river due to influx due to influx of considerable quantity of liquid and solid wastes of industrial/domestic/urban origin. Nutrient analysis reveals 2-3 times increase in N and P during monsoon season whereas SiO2-Si shows a decreasing trend.