The poor in India are worst affected due to COVID-19 pandemic. The nationwide lockdown though an effective safety measure, has made their condition more pathetic. As per, World Bank 2020 estimates, there are around 50.7 million people in India living in extreme poverty with income of $1.90 per day. The Government of India has announced several remedial measures to tackle economic as well humanitarian crisis but its effective implementation is a major challenge due to enormity of the problem and the large number of affected people. Moreover, the measures announced are based on top-down approach and not on detailed assessment of impact on different sections of the population. The different segments of the poor have suffered from the impact of the pandemic and subsequent lockdown, in different proportions. They have suffered from severe financial losses. In this chapter, we have made detailed assessment of impact of the pandemic on individuals, different sectors of economy and on Micro, Small and Medium Enterprises (MSMEs). The measures announced by the Prime Minister are discussed along with their implications for the poor and MSMEs. At the lowest end of the spectrum, are the migrant labors who are worst affected. They are required to travel for their homes due to loss of livelihoods and require immediate relief. At the other end, are the skilled labors working in organized or unorganized sectors, who have not lost their jobs but are facing reduction in wages. In order to make the systematic assessment of the requirements, we have grouped the people in three categories namely high impact, medium impact and low impact and have assessed the requirements for each category. So also, it is deliberated as to what extent, the government measures address their requirements. The gaps are identified and detailed suggestions are made. Major structural changes such as extensive use of information and communication technology, development of on-line platforms for education, strengthening of rural infrastructure, development of ...
AbstractSustainable development goals adopted by the United Nations in 2015 emphasize on poverty reduction and inclusive growth. In India, development policies focusing on poverty reduction have been implemented since independence. However, there is evidence of rising inequality and slowing down of the rate of poverty reduction, after the introduction of economic reforms. The state governments in India have an important role to play in poverty alleviation. Thus, it is necessary to measure the performance of the states in respect of the same. Data envelopment analysis is used by considering input variables, namely, growth, development expenditure, irrigation, and government performance. Percentage of non‐poor is used as an output variable. This paper measures efficiency with which poverty has been alleviated in 19 states covering 90% population, for the years 2006, 2010, and 2014. Resource‐rich states are found to be inefficient, whereas states with resource scarcity use them efficiently. Moreover, poor states with lower per capita gross domestic product (GDP) are found to be more efficient as compared to those with higher per capita GDP. The states with high incidence of poverty are found to be catching up with states with low incidence of poverty. It is found that inequality and high indebtedness adversely impact the efficiency of states.
In spite of efforts of six and half decades, poverty reduction in the country is not in sight. Rightly therefore, the 11th and 12th Five-Year Plans focus on inclusive growth. In order to compare the performance of different states or regions, a comprehensive measure of financial inclusion is necessary which takes into account all its aspects. Review of literature on the subject reveals that measures so far suggested take into account only the supply side. This article suggests a measure taking into consideration supply, demand and infrastructure dimensions. It also takes into account the factors such as population growth, law and order situation and corruption, which have adverse impact on the factors which lead to financial inclusion. These adversely impacting factors are termed as drag. Separate indices are developed for three dimensions, namely, supply, demand and infrastructure, and a composite index of these three dimensions is computed. Also an index of drag factors is calculated. A comprehensive financial inclusion index is arrived at by modifying the former index by giving the effect of impact of drag. The index developed is comprehensive as well as flexible, in the sense that new parameters can be added to any of the dimensions including the drag, depending upon identification of parameter and availability of data. It is most suited to Indian conditions and can be used to measure comparative performance of Indian states or sub-regions of the states. It is also applicable to developing countries in general. The composite index is developed by using displaced ideal method which satisfies intuitive criteria of development index, namely, normality, anonymity, monotonicity, proximity, uniformity and signalling, collectively referred to with the acronym NAMPUS.
Early in the 21st century, the costs of health care in the United States have spiraled out of control, where the per capita spending is $9,237 per person—the highest in the world. By 2020, an estimated 20% of GDP will be spent on health care. The issue of cost and quality is now becoming a national crisis, with ∼50% of hospitals losing money on clinical operations, forcing closure of essential critical access hospitals, and forcing health care workers to relocate or change professions. This crisis will only worsen with the graying of America, as an estimated 17% of Americans will be over the age of 65 years by the year 2020. The policy and financial structures on which these changes are based are important factors of which practicing surgeons should be aware. This review discusses recent national health care policy reform and specific topics including cost-containment legislation, value-based incentives and penalties, transparency, and centers of excellence in colorectal surgery.
Préface. - Parentés et apparentements des "Africains" en immigration et autres regards sur les espaces d'origine et d'installation / Altay Manço . - L'impensé des discours sur le vécu migratoire des Africains en Occident / Joseph Gatugu . - De la colonisation politique à la colonisation symbolique : d'une servitude à l'autre. Comprendre la migration matrimoniale de la femme mauricienne vers l'Europe et la Suisse / Bhama Peerun Steiger . - Entre la réunification et la recomposition : cheminements familiaux pour les immigrants africains subsahariens au Canada / Paulin Mulatris, Georges-Malanga Liboy . - Les nouveaux célibataires géographiques africains / Joseph Gatugu . - Le divorce et ses effets au sein de la diaspora subsaharienne de Belgique / Jacques Mubalamata Kabongo . - Les jeunes issus de l'immigration subsaharienne en Belgique / Ural Manço, Mireille-Tsheusi Robert, Billy Kalonji . - Témoignages sur le vécu migratoire des familles africaines en Angleterre / Marie-Louise Hatungimana, Christine K. Muanda . - Perspectives et recommandations / Joseph Gatugu
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.