Journal of Health Systems <p>Health Systems approach calls for a multi-dimensional analysis of health improvement in societies and is holistic unlike a segmented approach which discretely examines factors in isolation. Such a multi-dimensional analysis is a challenging task and requires an interdisciplinary competence. The Journal of Health Systems will strive to develop and facilitate such a competence and will promote critical scholarship in this area.</p> en-US <p><strong>Journal of Health Systems (JHS)</strong> is a Peer-Reviewed Open Access Journal published bi-anually by EQUITYSER Research and Development (OPC) Private Limited, Kerala (India).&nbsp;JHS and Authors agree to the <a href=""><strong>Copyright Terms</strong></a></p> (Dr. Mayuri Gedam) (Jinbert Lordson) Sat, 30 Jun 2018 00:00:00 -0700 OJS 60 Continuous Quality Improvement in Health Care is a Journey Not a Destination <p>In today’s highly competitive and changing world, planning for the future is necessary for survival and success and preparing for the future has became crucial. The healthcare industry is currently booming in all over the world and quality management is rapidly becoming an indispensable part of a comprehensive approach for the development of quality care. It gives care providers the competitive edge needed to meet consumers’ increasing awareness of quality care delivery.</p> Seval Akgün ##submission.copyrightStatement## Sat, 30 Jun 2018 00:00:00 -0700 Transgender Health and Healthcare in India: A Review <p>The share of Transgender in overall global population is 0.5 percent of which 490000 reside in India (Census 2011). Pushed away from the mainstream society due to their socially non-confirming gender identity has implications on their health and wellbeing. This paper describes the social roots of various health and healthcare problems faced by transgender in India. The paper is based on reflections and analysis from mainly two sources of information i.e. descriptive literature review and the first-hand experience of one of the authors who completed an internship project between April and June 2017 on transgender health in Pondicherry, India. It concludes with a call for not just upgrading healthcare system but also sensitizing society to be all gender-inclusive for better health and life of transgender persons in India.</p> Rishi S Baba, Reetu Sharma Sogani ##submission.copyrightStatement## Sat, 30 Jun 2018 00:00:00 -0700 Taxonomy of Human Dignity in Institutional Childbirth <p>In the endeavour to ensuring quality health care services, various issues arise that are linked to human dignity and human rights. Human dignity in health care is recognized as the most important non-clinical and intangible dimension. In a qualitative research that is based on grounded theory, we have explored the dignity violations in institutional childbirths in Kerala, India. Key informants interviews, interviews with birthing women and participant observation of six months in labour rooms / wards are the data collection methods employed. It is found out that dignity violation is rampant in these institutions and a general theory of dignity is developed based on the findings. Recognise as a human being, regard as an individual rather than as a tool/machine, freedom from exploitation by medical care providers were common concerns of all the participants. Further, the class differences in their experiences are captured where lower class women raised concerns about discrimination, humiliating language/ tone, shouting, usage of numbers/caste names, physical violence and objectification of body. The upper class women focused more on information sharing, autonomy, use of unwanted and avoidable medical technology and financial exploitation by the health care providers. This research work also contextualises the above-mentioned issues where the conditions that promote dignity violation are present in the asymmetrical relationship between care providers and the patients. Health care providers used very reductionist approach to define human dignity of their patient. The over and inappropriate medicalisation of childbirth, lower budget allocations in the government sector, high profit orientations of the private hospitals etc., make the situation further more complex. These findings will help in developing policies to ensure more women oriented dignified birthing experiences.</p> Lekha D Bhat, Kesavan Rajasekharan Nayar ##submission.copyrightStatement## Sat, 30 Jun 2018 00:00:00 -0700 Prevalence and Determinants of Exclusive Breast- Feeding: A cross sectional study among Mother-Infant pairs attending the Immunization Clinic in a Teaching Hospital at Thiruvananthapuram, Kerala, India <p>Introduction: Breast milk is the ideal food for the babies and WHO recommends exclusive breast feeding (EBF) for 6 months in view of its protective effects on both mother and baby. The present study aimed to find out the prevalence, factors promoting and barriers for the practice of EBF.<br>Methods: A cross sectional survey design was used for the study. Sample consisted of 118 mother infant pairs attending an immunization clinic of a tertiary level hospital. <br>Results: Prevalence of EBF up to 6 months was 48.3%. Associated factors were antenatal check up at private hospital (OR=2.2,95%CI=1-4.9), urban residence (OR=2.95%CI=1-4.1), presence of knowledge regarding EBF(OR=2.5,95%CI=1.1-5.8) previous breast feeding experience (OR=2.4,95% CI=1.2-5.1) and term delivery (OR=3.6,95%CI=1.1-11.8). Perception of inadequate breast milk secretion and mother returning to job were the reasons for early cessation of EBF.<br>Conclusion: Breast-feeding classes during antenatal visits, lactation counseling, and enhancement of duration of maternity leave are the recommendations that can be forwarded on the light of the present study.</p> K V Asha, S Premini ##submission.copyrightStatement## Sat, 30 Jun 2018 00:00:00 -0700 Are Elderly Population Healthy? : A Mixed Method Study from North Gujarat, India <p>Background and Objectives: Currently, more than 12% of the Worlds elderly Population lives in India. It is projected that the proportion of elderly Indians will rise from 7.5% (91.6 million) in 2010 to 11.1% (158.7 million) in 2025. Morbidity patterns by age clearly indicate that the elderly experience a greater burden of ailments. With increasing elderly population and morbidity pattern, this study aims to understand the health status of the elderly population and its predicting factors in rural areas of northern Gujarat, India.<br>Methods: It was a mixed method study conducted among 410 elders for quantitative component and 9 elders for qualitative in-depth interview during 2014-15. A structured questionnaire &amp; in-depth interview guide were administered in vernacular language by trained social workers. Thematic analysis was conducted for qualitative data. Multivariate regression analysis was conducted with significant level of 95% CI in R version 3.0.1. <br>Results: Self-reported health status was found to be poor among one third elderly. The multivariate regression analysis indicates that females, belongs to Schedule Caste/ Schedule Tribe, lives in nuclear family with poor economic conditions, not getting choice of food, having dispute &amp; less social importance have higher likelihood of odds to have poor health status. <br>Conclusion: One-third of elderly reported poor health status in this study from Northern Gujarat. There is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the care and needs of the disabled elderly. Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly.</p> Gargi N Raval, Krupali Patel, Sandul Yasobant ##submission.copyrightStatement## Sat, 30 Jun 2018 00:00:00 -0700