National Health Systems Resource Centre

Abstract Introduction Globally, the proportion of older persons is steadily increasing. In India, 8% of the population is above 60 years of age, rising to 12.6% in Kerala, the highest among all states. To address the growing health needs of this demographic, the Ministry of Health and Family Welfare launched the National Programme for Health Care of the Elderly (NPHCE) in 2010–2011. This study evaluates the implementation and impact of NPHCE across five districts in Kerala—Kozhikode, Thrissur, Pathanamthitta, Alappuzha, and Idukki—and examines its key achievements and challenges. Methods A cross-sectional, concurrent mixed-method design was used. Quantitative data were collected through structured questionnaires and observation checklists, while qualitative insights were obtained from Key Informant and In-Depth Interviews. Results The quantitative findings show that NPHCE has expanded from five pilot districts to all fourteen, establishing geriatric wards, outpatient clinics, and elderly-friendly infrastructure. However, implementation remains uneven, with disparities in staffing, infrastructure quality, and service utilisation across districts, indicating inconsistencies in accessibility and care delivery. Qualitative findings reveal that while accessibility and comfort for older adults have improved, persistent challenges remain due to workforce shortages, limited funding, and inadequate transport facilities. Beneficiaries also reported social isolation, economic vulnerability, and barriers to essential healthcare. Strengthening human resources, interdepartmental coordination, and community participation were emphasised to enhance programme effectiveness. Conclusion Kerala’s decentralised healthcare model provides a strong foundation for elderly care. However, addressing political, financial, and operational challenges remains critical to improving the quality of life for the state’s ageing population.

The burden of oral diseases is rising in India, affecting individuals across all socioeconomic strata. Although the National Oral Health Policy and Programme aim to improve access to affordable and quality healthcare through public facilities, challenges in implementation persist. In Kerala, oral disease prevalence is high despite a dentist-to-population ratio four times higher than the WHO’s recommendation. In a context where private healthcare providers dominate service delivery and out-of-pocket expenditure remains high, it is essential to explore the perspectives of public sector dental professionals on the delivery and utilisation of existing services in government dental outpatient centres - to reinforce current capacities and develop strategies to address service gaps. A qualitative study was conducted through interviews (key informant and in-depth) with public sector dental healthcare providers. Thematic analysis was used to interpret the data. Providers identified facilitators such as affordability of services, responsive administration, outreach activities, and additional government schemes in the service of vulnerable groups. Key barriers identified were staffing shortages, infrastructural limitations, and insufficient oral health literacy. To address these gaps, providers recommended expanding the dental workforce, upgrading infrastructure with dental laboratories, and promoting oral health awareness in schools and communities. Insights from public sector dental healthcare providers highlight important systemic and policy-level factors underlying service provision and utilisation. These perspectives are vital for developing contextually responsive strategies to enhance the capacity of existing public dental services amidst growing disease burden.

Recognizing the significant impact that NAMs can have in biomedical research and drug development, many key funding bodies in India have also taken concrete steps to propel such technologies.In 2019, the Indian Council of Medical Research (ICMR) developed a white paper on alternatives to animal use (Swaminathan et al., 2025).Very recently, two key research groups in India working on such non-animal human-relevant technologies have been recognized as ICMR -Collaborating Centres of Excellence 6 .Biotechnology Industrial Research Assistance Council (BIRAC), Department of Biotechnology (DBT) released a call for proposals for developing in vitro and in vivo preclinical models for drug discovery in 2023 7 .In this workshop it was discussed how we can fast-track these efforts via dedicated investments and strategic partnerships to develop precise, affordable, and indigenous human-relevant technologies.The Biomedical Research for the 21 st Century (BioMed21) Collaboration Workshop was jointly organized by Humane World for Animals India and BIRAC, DBT, Government of India (GoI), along with the Division of Strategic Alliances, Office of Principal Scientific Advisor (PSA), GoI as the outreach partner to bring together national and international stakeholders from academia, industry, and key funding bodies. Workshop inaugurationAlokparna Sengupta (Managing Director, Humane World for Animals India) welcomed the participants and stated how the organization is promoting a shift towards advanced human biologybased technologies in preclinical safety and biomedical research via a combination of science, policy, education, and training.The workshop was inaugurated by Dr Jitendra Kumar (Managing Director, BIRAC, DBT), who emphasized the relevance of the workshop and recognized the area of human-based technologies as one of the emerging areas in biomedical research and drug development.He commented that the low success rate of the current drug development pipeline called for better model systems, but more efforts towards awareness are needed.1 https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2022/new_DC_rules/NDCTR_G.S.R.%20175(E)%20dt_09.03.2023_Use%20of%20induced%20Pluripo-tent%20Stem%20Cells%20additional%20testing%20methods.pdf 2 https://www.fda.gov/news-events/press-announcements/fda-announces-plan-phase-out-animal-testing-requirement-monoclonal-antibodies-and-other-drugs 3 www.nih.gov/news-events

ABSTRACT Background Chronic conditions cause notable health and economic burdens. While health insurance enables access to healthcare, its effects on chronic care outcomes remain under-explored. Objective To examine the association between health insurance coverage and cardiometabolic risk factors among people with chronic conditions in India. Methods Data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) and Solan studies, including 2,926 adults with chronic conditions were analyzed using propensity score weighting to evaluate the associations between health insurance and cardiometabolic risk factors (HbA1c, low-density lipoprotein cholesterol [LDLc], and blood pressure [BP]) and self-reported health status (measured using European Quality of Life Visual Analogue Scale [EQ-VAS]). Mediation analysis evaluated healthcare visits as a potential mediator. Results Among 2,926 respondents meeting criteria, mean (SD) age was 54.6 years (11.8), and 1630 (55.7%) were women. Health insurance coverage was low (6.5%) and more prevalent among men, higher-income groups, and rural vs urban residents. Insured participants had lower mean diastolic BP (84.8 vs 86.0 mmHg), mean LDLc (113.3 vs 117.2 mg/dl), mean HbA1c (6.9% vs 7.5%), and higher health status (EQ-VAS: 74.6 vs 69.1) than uninsured participants, respectively (p < 0.05). Mediation analysis showed healthcare visits strongly mediated the relationship between insurance and BP and partially mediated effects on LDLc, HbA1c, and self-rated health. Conclusion Health insurance coverage was associated with better cardiometabolic risk profiles and health status, largely mediated by increased healthcare utilization. Expanding insurance coverage to include outpatient chronic care services should be prioritized to improve health outcomes in low- and middle-income countries.

Abstract Taxi and auto-rickshaw drivers in India represent a vital yet marginalized segment of the urban workforce, routinely exposed to occupational hazards that adversely affect their health. Despite these risks, public health interventions tailored to their needs remain limited. The review identifies chronic exposure to air pollution as a key contributor to the high prevalence of respiratory illnesses among drivers. In addition, prolonged sitting and inadequate vehicle ergonomics are linked to musculoskeletal disorders, particularly involving the back and neck. Mental health problems are widespread, often aggravated by socio-economic challenges including low income, job insecurity, and limited access to healthcare. The findings underscore the pressing need for targeted public health strategies and policy reforms to protect and promote the health and well-being of this underserved yet indispensable workforce.

This article reviews the current status of the Integrated Child Development Services (ICDS) Scheme, India; the largest Early Childhood Care and Development (ECCD) programme in the world, at 50 years of its existence. While there has been substantial advance of this scheme in terms of coverage and quality, its thrust has remained on providing supplementary nutrition and much more needs to be done to achieve truly universal and comprehensive ECCD services. The major issues besetting favourable outcomes relate to inadequate investments resulting in poor infrastructure, inadequately remunerated and capacitated ICDS workers and an overcentralisation resulting in a critical lack of community engagement and contextual adaptation. Social legislation is likely to be required to promote the rights of very young children through the reinvigoration of this scheme.

BackgroundThe prevalence of hypertension and diabetes, which often coexist and significantly contribute to the burden of noncommunicable diseases (NCDs), is increasing in India. This study examines the sex-stratified prevalence, coexistence, and bidirectional risks of hypertension and diabetes across states with varying epidemiological transition levels (ETLs) and identifies high-burden hotspots.MethodsThis study analysed data from the fifth round of the National Family Health Survey, covering 614,426 women and 556,199 men aged 30 years and above, with biomarker information on both diabetes and hypertension. The age-standardized prevalence was estimated, and adjusted risk ratios (ARRs) were obtained on multivariate logit scale. Bivariate maps, spatial autocorrelation and hotspot analyses were conducted using ArcGIS Pro to identify geographic clusters associated with twin epidemics.ResultsIndividuals diagnosed with hypertension or diabetes were, on average, nearly a decade older than those without. Hypertension prevalence was 30.3% (95%CI:30.14–30.48) among men and 28.6% (95%CI:28.47–28.79) among women, whereas diabetes prevalence was at 19.7% (95%CI:19.58–19.88) in men and 17.4% (95%CI:17.22–17.50) in women. Among individuals with diabetes, 43.1% (95%CI:42.67–43.53) of men and 43.9% (95%CI:43.48–44.36) of women had hypertension, whereas 28.1% (95%CI:27.75–28.37) of hypertensive men and 26.6% (95%CI:26.33–26.93) of hypertensive women were diabetic. Hotspots for twin epidemics were identified in coastal regions, including the southern states with high ETLs, as well as the northern states with high-ETLs and the country’s northeastern region. ARR estimates revealed that the risk of hypertension among individuals with diabetes was 39% higher (95%CI:1.38–1.40) in men and 41% higher (95%CI:1.39–1.42) in women than in individuals without diabetes. Similarly, the risk of diabetes among individuals with hypertension was 51% higher (95%CI:1.49–1.52) in men and 55% higher (95%CI:1.53–1.57) in women than in individuals without hypertension.ConclusionOur findings highlight the progressive nature of the twin epidemics of diabetes and hypertension, with an increased risk of onset associated with advanced age. The presence of one condition substantially elevates the likelihood of developing the other, highlighting their bidirectional relationship. Achieving Sustainable Development Goal target 3.4 requires addressing these intersecting epidemics as a unified entity for effective management. Targeted interventions should prioritise high-burden hotspots for integrated care strategies to mitigate the twin epidemics of diabetes and hypertension.