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The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

The widespread uptake of digital technology tools for online teaching and learning reached its peak during the nationwide lockdown triggered by the COVID-19 pandemic. It transformed the higher education institutions (HEIs) marketplace both in developed and developing countries. However, in this process of digital transformation, several HEIs, specifically from developing countries, faced major challenges. That threatened to affect their sustainability and performance. In this vein, this study conducts a bibliometric review to map the challenges during the COVID-19 pandemic and suggest strategies for HEIs to cope with post-pandemic situations in the future.

This comprehensive review encompasses 343 papers published between 2020 and 2023, employing a systematic approach that combines bibliometrics and content analysis to thoroughly evaluate the articles.

The investigation revealed a lack of published work addressing the specific challenges faced by the faculty members affecting their well-being. The study underscores the importance of e-learning technology adoption for higher education sustainability by compelling both students and teachers to rely heavily on social media platforms to maintain social presence and facilitate remote learning. The reduced interpersonal interaction during the pandemic has had negative consequences for academic engagement and professional advancement for both educators and students.

This has implications for policymakers and the management of HEIs, as it may prove useful in reenvisioning and redesigning future curricula. The paper concludes by developing a sustainable learning framework using a blended approach. Additionally, we also provide directions for future research to scholars.

This study has implications for policymakers and HEI management to rethink the delivery of future courses with a focus on education and institute sustainability. Finally, the research also proposes a hybrid learning framework for sustainability and forms a robust foundation for scholars in future research.

This paper aims to discover and analyze the challenges hampering blockchain technology’s (BT’s) implementation in the Indian health-care sector. A total of 18 challenges have been prioritized and modeled based on an extensive literature search and professional views.

An integrated multi-criteria decision-making approach has been used in two phases. Best worst method (BWM) is used in the first phase to prioritize the challenges with sensitivity analysis to validate the findings and eliminate a few challenges. In the second phase, interpretive structural modeling is applied to the remaining 15 challenges to obtain relative relationships among them with cross-impact matrix multiplication applied to classification analysis for their categorization.

The study’s results reveal that limited knowledge and expertise, cost and risk involved, technical issues, lack of clear regulations, resistance to change and lack of top management support are the top-ranked or high-intensity challenges according to the BWM. Interpretive structural modelling findings suggest that the lack of government initiatives has been driving other challenges with the highest driving power.

This work has been conducted in the Indian context, so careful generalization of the results is needed.

This work will give health-care stakeholders a better perspective regarding blockchain’s adoption. It will help health-care stakeholders, service providers, researchers and policymakers get a glimpse of the strategies for eradicating mentioned challenges. The analysis will help reduce the challenges’ impact on blockchain’s adoption in the Indian health-care sector.

The adoption of BT is a novel concept, especially in developing countries such as India. This is one of the few works addressing the challenges to BT adoption in the Indian health-care sector.

This study aims to understand the progressive marketization of health data collection and use, through a study of its historical development in France, from the 1930s to the present day.

The authors collected a set of legal, institutional, political and media data. These came from the INA (National Audiovisual Institute), the French national newspaper websites and the websites legifrance.gouv.fr and vie-publique.fr. The authors then conducted a thematic content analysis.

The study results highlight the changes in the health-care system related to the increased use of data in France over three major periods. The first period – 1930s to 1980s – is marked by the creation of the French social security system to collect large sets of data to better manager people’s health care. The second period – 1980s to 2000s – is characterized by the adoption and assimilation of tools to manage patient data through several national and European regulations. The last period – 2000s to the present – saw the introduction of measures in favor of the digitalization of health care, and consequently of data, in parallel with the advancement of digital technologies in general. The institutional dynamics in healthcare have evolved with the nature of the actors and their practices, in connection with new perceptions about health data.

This research sheds light on the historical transformation of health data collection and use in France, revealing the involvement of diverse stakeholders, the discourses driving data development and the need for regulation. It exposes the dual nature of health data collection and use, initially sanctioned by the state and public entities but later exploited for private interests.

This study aims to analyse in the health access of Indonesian illegal migrant workers in Malaysia, during which time they were not covered by Indonesia’s national social health insurance.

This study adopted a sociolegal approach, the research approach is conducted to understand the effect of a law, policy and regulation on access to health-care access among Indonesian migrant workers working illegally in Malaysia. This research involved 110 respondents who work illegally in Malaysia. The research explored the perceptions of respondents concerning to health access services of illegal migrant workers.

The study demonstrated the weakness of provisions intended to guarantee the health access to health care of migrant workers from Indonesia illegally working in Malaysia. A decline in health status was observed, but it was not significant. Bilateral cooperation between Indonesia and Malaysia is necessary to provide a framework for Indonesia providing health care to its citizens working in Malaysia, regardless of their legal status.

This paper concerns on the Indonesia illegal migrant workers experiencing illness and the access to the health service in Malaysia, and also the implementation of international regulation to protect Indonesian illegal migrant workers in Malaysia under ASEAN Consensus on the Protection and Promotion of the Rights of Migrant Workers.

This paper aims to identify the reasons why cases of leakage of patient personal data often occur in the health sector. This paper also analyzes personal data protection regulations in the health sector from a comparative legal perspective between Indonesia, Singapore and the European Union (EU).

This type of research is legal research. The research approach used is the statute approach and conceptual approach. The focus of this study in this research is Indonesia with a comparative study in Singapore and the EU.

Cases of leakage of patient personal data in Indonesia often occur. In 2021, the data for 230,000 COVID-19 patients was leaked and sold on the Rapid Forums dark web forum. A patient’s personal data is a human right that must be protected. Compared to Singapore and the EU, Indonesia is a country that does not yet have a law on the protection of personal data. This condition causes cases of leakage of patients’ personal data to occur frequently.

This study analyzes the regulation and protection of patients’ personal data in Indonesia, Singapore and the EU to construct a regulatory design for the protection of patients’ personal data.

The results of this study are useful for constructing regulations governing the protection of patients’ personal data. The regulation is to protect the patient’s personal data like a patient’s human right.

The ideal regulatory design can prevent data breaches. Based on the results of comparative studies, in Singapore and the EU, cases of personal data leakage are rare because they have a regulatory framework regarding the protection of patients’ personal data.

Legal strategies that can be taken to prevent and overcome patient data breaches include the establishment of an Act on Personal Data Protection; the Personal Data Protection Commission; and management of patients’ personal data.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.

General Data Protection Regulation (GDPR) of the European Union (EU) was passed to protect data privacy. Though the GDPR intended to address issues related to data privacy in the EU, it created an extra-territorial effect through Articles 3, 45 and 46. Extra-territorial effect refers to the application or the effect of local laws and regulations in another country. Lawmakers around the globe passed or intensified their efforts to pass laws to have personal data privacy covered so that they meet the adequacy requirement under Articles 45–46 of GDPR while providing comprehensive legislation locally. This study aims to analyze the Malaysian and Saudi Arabian legislation on health data privacy and their adequacy in meeting GDPR data privacy protection requirements.

The research used a systematic literature review, legal content analysis and comparative analysis to critically analyze the health data protection in Malaysia and Saudi Arabia in comparison with GDPR and to see the adequacy of health data protection that could meet the requirement of EU data transfer requirement.

The finding suggested that the private sector is better regulated in Malaysia than the public sector. Saudi Arabia has some general laws to cover health data privacy in both public and private sector organizations until the newly passed data protection law is implemented in 2024. The finding also suggested that the Personal Data Protection Act 2010 of Malaysia and the Personal Data Protection Law 2022 of Saudi Arabia could be considered “adequate” under GDPR.

The research would be able to identify the key principles that could identify the adequacy of the laws about health data in Malaysia and Saudi Arabia as there is a dearth of literature in this area. This will help to propose suggestions to improve the laws concerning health data protection so that various stakeholders can benefit from it.