Dr. Sandul Yasobant
I am working as a Junior Researcher at Center for Development Research (ZEF), University of Bonn, Germany. Prior to this, I was working as Health system Researcher with Indian Institute of Public Health- Gandhinagar (IIPHG), India. My research interests include health system & policy research, One Health, Urban Health & Governance, physical activity and quality of life, health risk assessment, occupation & disability epidemiology.
Supervisors: Prof (Dr) Walter Bruchhausen and Prof (Dr) Deepak Saxena
Phone: +49-152-11-899-163
Address: Center for Development Research (Zentrum für Entwicklungsforschung)
Walter Flex Str.3, 53113 Bonn, Germany
Supervisors: Prof (Dr) Walter Bruchhausen and Prof (Dr) Deepak Saxena
Phone: +49-152-11-899-163
Address: Center for Development Research (Zentrum für Entwicklungsforschung)
Walter Flex Str.3, 53113 Bonn, Germany
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partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005.
The scheme aims to provide free institutional childbirth services in accredited private health facilities to women
from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility
with the intention of service being free to the user. This community-based study estimates CY uptake among
eligible women and explores factors associated with non-utilization of the CY program.
Methods: This was a community-based cross sectional survey of eligible women who gave birth between January
and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by
trained research assistant to collect information on socio-demographic details, pregnancy details, details of
childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the
factors associated with non-utilization of the CY program.
Results: Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered
at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who
belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6,
95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY
program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of
required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY
program overall paid more than women who delivered in the free public facilities.
Conclusion: Uptake of the CY among eligible women was low after almost a decade of implementation.
Community level awareness programs are needed to increase participation among eligible women. OOP expense
was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy
which needs to be studied. There is also a need to ensure financial protection of women who have C-section.
substantial socio-economic losses. Professional drivers are particularly at high risk for developing back pain and
neck pain from prolonged sitting and vehicular vibration. This study assesses ergonomic exposure on the
developmental risk of WMSDs among bus drivers.
Methodology: A total of 280 male drivers with acute body pain in any region were randomly selected for the study,
and ergonomic information on driver’s seat was collected using a validated questionnaire. Then the exposure and
risks of developing WMSDS were assessed using Quick Exposure Check (QEC), Rapid Entire Body Assessment
(REBA), Rapid Upper Limb Assessment (RULA) and Nordic Musculoskeletal Questionnaire (NMQ).
Results: The results of QEC showed that back and shoulder had very high exposure followed by neck and wrist.
REBA revealed that nearly half (46%) of the drivers were at high risk of developing WMSDs, whereas14% were at
very high risk and 29% were at medium risk. As per RULA, 46% of bus drivers needed further ergonomic
investigation and modification of workstation/work style, indicating that the risk for WMSDs is potentially high.
Among others, 29% were at moderate risk and 14% were at low risk, whereas 11% were at very high risk, requiring
immediate change. From NMQ, it was found that 26% of drivers had musculoskeletal problems in the neck, 24% in
the back, 20% in the upper limbs (shoulder and wrists were equally affected), 6% in the knees and 4% in the ankles.
Conclusion: The current study evaluated the risks of developing WMSDs among bus drivers. Exposure to unsafe
ergonomic practices/conditions and health risks were evident from the findings of the study. Prospective studies are
necessary to confirm the cause and effect in this association. Ergonomic intervention measures with workplace
health promotion activities need to be implemented in order to reduce the risk of WMSDs among bus drivers.
most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable
emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the
public sector combined with financial barriers to accessing private sector obstetrician services preclude this
underserved population from availing lifesaving functions of comprehensive EmOC such as C-section.
In order to overcome this limitation, Government of Gujarat initiated a unique publicprivate partnership
program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers
to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY,
private sector providers render obstetric care services to poor women at no cost to patients. This paper
examines the CY’s effectiveness in improving availability of CEmOC services between 2006 and 2012 in three
districts of Gujarat, India.
Methods: Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected
in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used
along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10
was used to analyze the availability of services using two-step floating catchment area (2SFCA) method.
Results: Our analysis suggests that the availability of CEmOC services within reasonable travel distance has
greatly improved in all three study districts as a result of CY. We also show that the declining participation
of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability
of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a
comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance.
Conclusions: This paper demonstrates how GIS could be useful for evaluating programs especially those
focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for
programmatic planning, particularly for optimizing resource allocation.
This chapter analyses the trends in maternal mortality in India, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health indicators and suggests future actions to improve the situation. Geographical vastness and enormous sociocultural diversity mean that maternal mortality and maternal health care utilization varies across India, and uniform implementation of health-sector reforms is not possible. Improved documentation of maternal healthcare utilization and maternal health indicators including maternal deaths is recommended. Implementation of evidence-based, focused strategies along with effective monitoring is important for making meaningful difference in improving maternal health care utilization along with building a strong health system to make sustainable progress in maternal mortality reduction.
partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005.
The scheme aims to provide free institutional childbirth services in accredited private health facilities to women
from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility
with the intention of service being free to the user. This community-based study estimates CY uptake among
eligible women and explores factors associated with non-utilization of the CY program.
Methods: This was a community-based cross sectional survey of eligible women who gave birth between January
and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by
trained research assistant to collect information on socio-demographic details, pregnancy details, details of
childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the
factors associated with non-utilization of the CY program.
Results: Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered
at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who
belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6,
95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY
program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of
required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY
program overall paid more than women who delivered in the free public facilities.
Conclusion: Uptake of the CY among eligible women was low after almost a decade of implementation.
Community level awareness programs are needed to increase participation among eligible women. OOP expense
was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy
which needs to be studied. There is also a need to ensure financial protection of women who have C-section.
substantial socio-economic losses. Professional drivers are particularly at high risk for developing back pain and
neck pain from prolonged sitting and vehicular vibration. This study assesses ergonomic exposure on the
developmental risk of WMSDs among bus drivers.
Methodology: A total of 280 male drivers with acute body pain in any region were randomly selected for the study,
and ergonomic information on driver’s seat was collected using a validated questionnaire. Then the exposure and
risks of developing WMSDS were assessed using Quick Exposure Check (QEC), Rapid Entire Body Assessment
(REBA), Rapid Upper Limb Assessment (RULA) and Nordic Musculoskeletal Questionnaire (NMQ).
Results: The results of QEC showed that back and shoulder had very high exposure followed by neck and wrist.
REBA revealed that nearly half (46%) of the drivers were at high risk of developing WMSDs, whereas14% were at
very high risk and 29% were at medium risk. As per RULA, 46% of bus drivers needed further ergonomic
investigation and modification of workstation/work style, indicating that the risk for WMSDs is potentially high.
Among others, 29% were at moderate risk and 14% were at low risk, whereas 11% were at very high risk, requiring
immediate change. From NMQ, it was found that 26% of drivers had musculoskeletal problems in the neck, 24% in
the back, 20% in the upper limbs (shoulder and wrists were equally affected), 6% in the knees and 4% in the ankles.
Conclusion: The current study evaluated the risks of developing WMSDs among bus drivers. Exposure to unsafe
ergonomic practices/conditions and health risks were evident from the findings of the study. Prospective studies are
necessary to confirm the cause and effect in this association. Ergonomic intervention measures with workplace
health promotion activities need to be implemented in order to reduce the risk of WMSDs among bus drivers.
most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable
emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the
public sector combined with financial barriers to accessing private sector obstetrician services preclude this
underserved population from availing lifesaving functions of comprehensive EmOC such as C-section.
In order to overcome this limitation, Government of Gujarat initiated a unique publicprivate partnership
program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers
to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY,
private sector providers render obstetric care services to poor women at no cost to patients. This paper
examines the CY’s effectiveness in improving availability of CEmOC services between 2006 and 2012 in three
districts of Gujarat, India.
Methods: Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected
in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used
along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10
was used to analyze the availability of services using two-step floating catchment area (2SFCA) method.
Results: Our analysis suggests that the availability of CEmOC services within reasonable travel distance has
greatly improved in all three study districts as a result of CY. We also show that the declining participation
of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability
of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a
comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance.
Conclusions: This paper demonstrates how GIS could be useful for evaluating programs especially those
focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for
programmatic planning, particularly for optimizing resource allocation.
This chapter analyses the trends in maternal mortality in India, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health indicators and suggests future actions to improve the situation. Geographical vastness and enormous sociocultural diversity mean that maternal mortality and maternal health care utilization varies across India, and uniform implementation of health-sector reforms is not possible. Improved documentation of maternal healthcare utilization and maternal health indicators including maternal deaths is recommended. Implementation of evidence-based, focused strategies along with effective monitoring is important for making meaningful difference in improving maternal health care utilization along with building a strong health system to make sustainable progress in maternal mortality reduction.