IIT Madras is a public technical and research university located in Chennai, Tamil Nadu. Founded in 1959, it is recognised as an Institute of National Importance.

IIT Madras has been ranked as the top engineering institute in India for four years in a row by the National Institutional Ranking Framework of the MHRD

It currently offers undergraduate, postgraduate and research degrees across 16 disciplines in Engineering, Sciences, Humanities and Management. About 596 faculty belonging to science and engineering departments and centres of the Institute are engaged in teaching, research and industrial consultancy.

IIT Madras

The Government of Tamil Nadu state in India has been implementing various health sector reforms (for example, expansion and upgradation of public health facilities, provision of round the clock services in selected primary health centres and continuous availability of quality medicines decentralisation) in a bid to improve efficiency in health care. However, few attempts have been made to make an estimate of the efficiency of hospitals in Tamil Nadu as well as in India till date. The objectives of this study are: (i) to estimate the relative technical efficiency (TE) and scale efficiency (SE) of a sample of public hospitals in Tamil Nadu; and (ii) to demonstrate policy implications for health sector policy makers. The Data Envelopment Analysis (DEA) approach, a well-known operations research (OR) technique for evaluating the relative efficiency of a set of similar decision making units (DMU), was used to estimate the efficiency of these hospitals. To do so we made use of the data collected from the Directorate of Medical and Rural Health Services (DMRHS) for 29 districts of Tamil Nadu in 2004-05. The output data included are outpatient visits, number of inpatients, number of surgeries undertaken, number of deliveries and number of emergency cases. The numbers of staff members and bed strength were used as input. Of the 29 hospitals, it was found that 52 per cent were technically efficient as they had relative efficiency score 1.00 and lie on the efficiency frontier, while the remaining 48 per cent were technically inefficient and can use some of the efficient hospitals as their peers to improve their efficiency. Further, the average scale efficiency among the inefficient hospitals was 81 per cent, which implies that the scale inefficient hospitals could reduce their size by 19 per cent without reducing their current output levels.

Department of Humanities and Social Sciences

Fulltext

Journal of Health Management

Technical Efficiency and Scale Efficiency of District Hospitals: A Case Study

India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India's future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information. © 2008 Elsevier Ltd. All rights reserved.

Social Science and Medicine

Regulating India's health services: To what end? What future?

Data envelopment analysis (DEA) was used to investigate the efficiency of a set of district hospitals in the state of Tamil Nadu. These facilities naturally provide primary and secondary care, but are also expected to function as health centres, addressing mostly preventive medicine, hygiene and other public health issues. This study aimed to obtain insight on their technical efficiency in light of their particular role. We have considered all the 29 district hospitals in the state. Variables chosen to characterise production were numbers of assistant surgeons, civil surgeons, staff nurses and beds as inputs; and in-patient and outpatient visits, surgeries both major and minor, and deliveries performed as outputs. The DEA model was input-oriented, allowed for variable returns to scale, and units were ranked according to a benchmarking approach. Results indicate that eight of the 29 hospitals (27 per cent) are efficient, the DEA score being 1.0, while the remaining 21 hospitals (72 per cent) are relatively inefficient, needing to benchmark their performance with that of their peer group. © 2007, Sage Publications India Pvt. Ltd. All rights reserved.

Benchmarking the Performance of Public Hospitals in Tamil Nadu: An Application of Data Envelopment Analysis

This article investigates India's export performance of spices (whole pepper and capsicum) in the markets of the Organization for Economic Cooperation and Development (OECD) and South and Southeast Asia, which constitute a substantial market for Indian spices. A Constant Market Share model is used to decompose the growth in exports of spices into size of the market effect, market composition effect and competitiveness effect. The analysis is performed for the exports during the nineties, the period India had to resort to increased challenges of food safety. The study confirms that there has not been substantial trade effect for Indian spices due to quality issues, such as sanitary and phytosanitary regulations. This article argues that increase in exports to neighbouring regions is explained more by the increased demand and supply and not by the stringent quality requirements of traditional importing countries. © 2008 Sage Publications.

South Asia Economic Journal

SPS regulations and competitiveness: An analysis of Indian spice exports

The relationship between extent of pesticide use and signs and symptoms of illnesses due to exposure was assessed in a cross-sectional survey of 631 farmers (537 men and 94 women) in South India. Responses to questionnaires showed that 433 farmers (68.6%) sprayed pesticides themselves and were thus directly exposed. More than 75% used moderately or highly hazardous pesticides; 88% used no protection while handling pesticides. About 50% of sprayers mixed different brands. Retailers were the source of information about pesticides for 56%. The farmers reported excessive sweating (36.5%), burning/stinging/itching of eyes (35.7%), dry/sore throat (25.5%), and excessive salivation (14.1%), all more prevalent among sprayers. Among men, excessive sweating and eye and throat problems were significantly associated with exposure. There is a need to raise farmers' and authorities' awareness of the need to use protective gear when handling pesticides.

GENERAL

International Journal of Occupational and Environmental Health

Use of pesticides and its impact on health of farmers in south India

There has been much recent interest in the trade in human organs in India. This paper examines both the extent to which regulatory controls through the Transplantation of Human Organs Act (1994) are effective in curbing commercialization and the nature of the constraints on the effective implementation of this Act. The study, a politico-economic analysis of health sector regulation, is based on a stakeholder analysis drawing on the views of key decision makers, service providers, organ donors and recipients. The findings indicate widespread acknowledgement of an organs trade and highlight four major constraints on the effective implementation of the Act: the commercial interests of middlemen and service providers, the ambiguities and loopholes in the Act; the low monitoring capacity of the regulatory authorities, and the pressures and responsibilities exerted upon the Authorizing Committees. A feature of the Act is that its implementation is subject to a major incentive compatibility constraint - it is seemingly not in the interests of any of the key players, including the regulatory authorities, to restrict the organ trade. To some extent, this institutional problem is created by the specific nature of the regulatory intervention, and, as a consequence, measures involving straightforward redrafting of the regulation might go some way to addressing this incentive problem. Another solution may entail a 'harm-reduction' strategy involving a controlled trade where procurement and organ matching is carried out by a government agency (this would require, however, the prior resolution of the broader ethical question concerning the legitimacy of such trade).

Health economics, policy, and law

The trade in human organs in Tamil Nadu: the anatomy of regulatory failure.

Abstract is unavailable for this paper.

Department Of Chemical Engineering

World University root node

Advances in Chemical Physics

Molecular Theory of Liquid-Phase Vibrational Energy Relaxation

The National medical journal of India

Caesarean sections on the rise.

The early decades of this century witnessed significant developments in the approaches to control of malaria in British India. These included both large-scale preventive measures and curative treatment methods (often referred to as "cinchona" or "quinine" policy). This paper identifies a number of factors that constrained the colonial government's capacity to control malaria through effective cinchona policy. The ideal of achieving "self-sufficiency" and having an efficient form of treatment and distribution within the reach of the masses in India (as originally intended in late 1850s) was far from being achieved. Both government's policy and medical profession seemed to have contributed equally to this failure.

Parassitologia

Quinine (Cinchona) and the incurable malaria: India c. 1900-1930s

Planning for sustainable urban solid waste management (USWM) in developing countries has to address several interdependent issues such as public health, environment, present and future costs to society and the livelihood of the "actors" in the informal recycling sector. This article presents a system dynamics model which captures the dynamic nature of interactions among the various components of the USWM system in a typical metropolitan city in India. The model provides a platform for debate on the potential and systemic consequences of various structural and policy alternatives for sustainable USWM. © 1997 John Wiley & Sons, Ltd.

System Dynamics Review

Planning for sustainable solid waste management in urban India

Planning for urban solid waste management within the framework of sustainable development raises several intra-and inter-generational issues such as public health, livelihood of actors in the informal recycling sector, present and future cost to society, conservation of resources both renewable and nonrenewable, and environmental impacts of waste disposal. It is essential that planners seek to address the above issues 'interactively' by exploring various 'soft' alternatives, instead of 'preactively' extending conventional 'hard' solutions. Such an integrated approach, however, should be developed through consensus among various actors. This paper proposes a Critical Operational Research (COR) framework to facilitate consensus/conflict resolution among actors, and also aid in learning. The nonlinear goal programming model developed within the COR framework provides a platform for discussion among actors involved in urban solid waste management. Its utility as a 'learning' tool is demonstrated by applying it to a typical metropolitan city in India. The exercise highlights the limitations of techno-managerial solutions usually adopted in developing countries, and the scope for the informal sector in urban solid waste management. Copyright © 1996 Elsevier Science Ltd.

Socio-Economic Planning Sciences

Integrated solid waste management in urban India: A critical operational research framework

The purpose of public policy, both in market and non-market economies has always been to reduce barriers in access to health care. To achieve this purpose, it has to address certain questions: What does equality of access to health care mean? What can be done to promote equality of access, however it may be defined?&nbsp;