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This paper aims to explore the challenges and benefits arising from the involvement of Panchayati Raj Institutions (PRIs) in the provisioning of primary healthcare in a decentralised health system of India.

A qualitative study design was used in this study. Data were collected through semi-structured interviews from 89 respondents selected from nine primary health centres across the district. A thematic analytical framework approach was used to analyse the data.

The research results indicate that there are several challenges resulting from PRIs involvement, including prioritisation of service providers and users, coercive unethical work and lack of communication. However, there are some benefits associated with the involvement of the PRIs in service provisioning, including improved availability and regularity of healthcare providers at the health centres.

The implications of the findings suggest that the PRIs play an important role in healthcare provisioning; however, their involvement is ineffective due to their partial capabilities and approach, which creates a non-conducive environment.

Health issues are among the most important human concerns, and recognising and addressing the grassroot challenges help to locate, and overcome the challenges that hinder the smooth healthcare provisioning process.

National Rural Health Mission has recognised the PRIs as a platform to promote decentralised health planning and for achieving its goals in India. The PRIs are significantly involved in planning, monitoring and provisioning of primary healthcare services at grassroot level. This paper addresses the challenges and benefits that emerged due to their involvement.

The purpose of this paper is to assess disabled persons' access to health care, and highlight barriers.

A total of 245 rural men and women with physical disabilities were interviewed, to determine their level of access to healthcare services. A simple composite mean of the weighted average indices of responses on the effectiveness of healthcare provision, equity, and users' satisfaction was calculated, to assess the overall level of access of the respondents to healthcare. The qualitative component highlighted an array of barriers that prevented the disabled individuals from accessing healthcare services.

The results indicated that access to the so‐called “inclusive” public healthcare for both males and females with physical disabilities was poor. The barriers identified were related to the built environments, healthcare delivery processes, and ceiling of health subsidies. The findings suggest that the absence of advocacy of disability rights and failure to adopt circumstantial equities at dispensing levels have resulted in the collapse of the promotion of disability rights at grassroots levels.

The study is location specific (rural), and it mainly focuses on individuals with physical disabilities in working‐age (15‐35 years) to assess their access to the rural healthcare.

Having an effective healthcare provision in an area and its equal access to both males and females is crucially important for their social and economic development. In this paper, the assessment of access to healthcare provides both an aggregated and a disaggregated picture by gender, which is poor for individuals with physical disabilities.

The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.

Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.

Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.

By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.

The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

The purpose of this paper is to describe physical and mental health characteristics of incarcerated youth both internationally and in New South Wales (NSW) Australia. To outline current practices in the provision of mental and physical healthcare for incarcerated youth internationally and in NSW.

Population relevant literature will be outlined as applicable. Health service delivery will be discussed, with an emphasis on the experiences of NSW physical and mental health service provision for incarcerated youth.

This paper illustrates that in NSW there was a parity of provision between physical and mental healthcare, though there were deficits in what should ideally be provided. Internationally there was clear evidence that current minimum standards of healthcare in both physical and mental healthcare domains remain unmet.

Provision of physical and mental healthcare for incarcerated youth warrants global improvement. Further research into current provisions, across jurisdictions and subsequent standardisation of practice, will improve health outcomes for this vulnerable group.

This is the first paper to describe mental and physical healthcare provision in NSW for incarcerated youth framed within the broader context of international health service provision for similar populations.

The purpose of this paper is to investigate the significance of value co-creation to the UK animal healthcare sector from the perspective of the key industry stakeholders: clients, veterinarians and paraprofessionals.

Value co-creation constructs in the sector were identified and measured using a mixed methods approach comprised of qualitative NVivo© thematic analysis of depth interviews (n=13) and quantitative exploratory factor analysis (EFA) (n=271).

Qualitative results revealed nine underlying dimensions regarding service delivery in the sector: trustworthiness, communication, value for money, empathy, bespoke, integrated care, tangibles, accessibility and outcome driven service. EFA of professional survey data loaded onto seven latent factors, with strong value co-creation dimensions identified.

The sampling process is sufficiently representative and diverse to present meaningful and valuable results, however, surveying should be extended to include the client group. Due to the originality of the research replication of the study will be beneficial to the broader understanding and application of value co-creation to the high-involvement services of animal healthcare.

Recognition of the importance of value co-creation to the sector should encourage professional stakeholders to develop and adopt integrated models of service provision and to provide improved levels of service quality.

The paper makes an original contribution to knowledge regarding value co-creation in respect of high-involvement service provision. Its findings should be of value to academics interested in value co-creation in service sectors as well as animal healthcare practitioners seeking to offer better value and quality service provision.

This paper aims to explore patients' satisfaction with access to treatment in both the public and private healthcare sectors in London.

Qualitative and quantitative methods were employed to determine patients' levels of satisfaction. A semi‐structured face ‐to‐face non‐probability quota sampling and a probability sample drawn from multistage cluster sampling methods were employed.

The results revealed varying access experiences among public and private care users. Public, as opposed to private, healthcare users experience unsatisfactory outcomes in relation to service climate factors (e.g. getting attention from doctors, time taken to get appointments, access to core treatment and opening hours). Overall, while women are more disadvantaged by spatial accessibility to treatment than men, both public and private healthcare users indicate major problems in accessing healthcare despite the myriad intervention strategies aimed at ameliorating the situation in both sectors. Therefore, access‐to‐care problems are significant and need to be addressed by managers and healthcare providers in order to improve the quality of service delivery and patient satisfaction. Private care users fare better than public users in obtaining medical care at short notice, having more agreeable opening hours for treatment and getting appointments for treatment with less difficulty.

Whereas the limitation of the study was due to its small sample size, it nevertheless will stimulate insight into further academic endeavours.

Academics and practitioners will find the results very useful when making decisions about healthcare provisions and how they can best meet user/patient satisfaction.

This study is significant in drawing on the current literature on satisfaction which is usefully applied to evaluate patients' response to the quality management initiatives in the healthcare sector.

The UK Government has now adopted Private Finance Initiative (PFI) as a major vehicle for the delivery of additional resources to the health sector in order to achieve a greater investment in healthcare facilities. The purpose of this paper is to examine the trends and risk assessment of the PFI in the healthcare sector.

The paper employed secondary data and interviews of key participants in two hospital PFI projects to highlight developments in healthcare PFI and the risk management of hospital projects.

The results show that the use of PFI in the provision of healthcare is increasing in terms of number, capital value and size of projects. What emerged in the healthcare PFI project was a usage of a plethora of risk management techniques, albeit to varying degrees. Experience appeared to be the prime risk assessment technique employed, while risk avoidance was first explored before pricing and allocating any residual risks. “Risk prompts”, such as using checklists and risk registers were also useful in the identification of risks. Among all participants, insurance cover and sub‐contracting appear to be the most prominent strategies employed for managing out the risks.

The negotiations that precede the signing of a healthcare PFI project contract had an impact on the final choice of facilities or their specifications. The two contracting parties sought a balance between an optimal allocation of risks, choice of facilities and project price. Although the risk management techniques being used are generic in nature, there is still no evidence at the moment to show that these are appropriate for PFI projects. It is important that further investigation is undertaken to assess the level of current skills in risk management techniques to deal with PFI projects and the extent to which these techniques are appropriate to tackle complex healthcare PFI projects.

The significance of investing in healthcare has been recognised during the COVID-19 period more than ever before across the globe. The COVID-19 pandemic has revealed inefficiency in the healthcare systems of many African countries which have resulted in the death of many people including healthcare workers who contracted the virus due to lack of protective equipment. Many African countries have not adequately invested in healthcare systems to prevent and urgently tackle the outbreaks of pandemics. This explains their unpreparedness to immediately address the COVID-19 pandemic that has ravaged many leading to the loss of lives. These challenges, therefore, have created the need to reflect and rethink concerted approaches to tackle this health hiccup. Consequently, this chapter discusses healthcare system challenges that have inhibited the delivery of good healthcare as well as issues of inequality in the provision of healthcare. The chapter explores the solutions to the identified challenges that can be adopted for better functioning of the healthcare system and provision of good healthcare. The chapter discusses how it costs the governments when they don't improve the healthcare systems. These costs are in form of increased strikes over demand for better remunerations, loss of manpower due to brain drain, loss of foreign currency that would come from medical tourism as well as loss of money in form of medical expenses abroad. It also highlights the benefits that accrue from improved healthcare systems. The chapter debates issues of morality about operations of private healthcare facilities and recommends appropriate measures that should be taken for better performance. The chapter recommends to the developing countries with meager resources the best model that can be adapted to better manage future pandemics, taking into account the environmental, cultural and demographic differences. The lessons that readers will pick from this chapter will go a long way in building healthcare systems that protect and shield the population against any future epidemics.

This study investigates the effect of user fees on access and waiting time in Nigeria. For access, the effect of user fees on both preventive and curative care; and the effect of user fees on waiting time at public healthcare facilities were examined. User fees are vital for the fiscal sustainability of healthcare provision for most African economies. Its imposition could debar healthcare access by the poor while its removal can reduce quality of care and induce longer waiting time.

The wave 3 of the Nigerian General Household Survey (2015/16) data was used for users of public health facilities. Access to healthcare was modelled using utilization data in a logistic regression model while waiting time was through the Negative Binomial Regression Model (NBRM).

The analyses showed significant effects of user fees on access to both preventive and curative care and on time spent waiting to make use of healthcare services. Individuals were able to access healthcare services regardless of amounts paid. Also, there was a non-negative effect of user fee imposition on waiting time.

Nigeria should improve healthcare facilities to address the enormous demand for healthcare services when designing policy for health sector.

This paper shows that even with the imposition of user fees, healthcare facilities could still not cater for the rising healthcare needs of the populace but cautioned that its abolition may not be a preferred option.

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana.

Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation.

The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates.

The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic.

The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system.

The national health insurance scheme was found to be the financing option for prisoners’ access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention.

This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.