Usha Manjunath
@iihmrbangalore.edu.in
Director
Institute of Health Management Research, Bangalore
RESEARCH INTERESTS
Health System Research, Management, Quality, Maternal and Child Health, Nutrition
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Aileen J, Pushpanjali K, Frank Federico, Lallu Joseph, and Usha Manjunath
SAGE Publications
Patient safety, which is both an overarching principle and a key factor in determining the quality of healthcare, continues to be a priority in healthcare systems on a global scale. A cross-sectional study in accredited Indian hospitals aimed to evaluate the HSOPSC V-2 (Hospital Survey on Patient Safety Culture). 1,603 healthcare professionals participated, assessing psychometric features using confirmatory factor analysis in SMART PLS 4. The average composite positive response rate was 64.8%. High positive responses (79%) were seen in ‘teamwork’, ‘communication about error’, and ‘hospital management support for patient safety’. However, ‘staffing and work pace’ (30%), ‘response to error’ (50%), ‘communication openness’, and ‘reporting patient safety events’ (both 59%) had lower positive responses, indicating room for improvement. Findings suggest I-HOSPSC 2.0’s content validity, reliability, and construct validity in measuring patient safety culture in Indian hospitals. It can aid administrators in assessing safety culture and improving patient safety and treatment efficacy. Notably, this is the inaugural HSOPSC V-2 validation research in the Indian healthcare context. Future research should explore the tool’s psychometric properties based on care setting levels due to substantial differences between public and private healthcare setups in India.
R Bangalore Sathyananda, A Krumeich, U Manjunath, A de Rijk, and CP van Schayck
SAGE Publications
India's healthcare system is, for a large part, organized around a vast network of Primary Healthcare Centres (PHCs) that form the pillar on which the public healthcare sector functions. The World Health Organization (WHO) has emphasized the important role that PHCs play in strengthening community health and the provision of healthcare. Although a few studies have assessed specific elements of services offered by PHCs, only a few have studied the patients’ perspectives on the functioning and performance of PHCs in the Indian context. A qualitative research methodology was employed to explore the opinions of 188 patients attending one of three PHCs in Bengaluru (India), using in-depth interviews and thematic analysis. Results showed that patients assessed PHC based on the nine themes that broadly can be classified into components of the center, and that of the personnel. The patients valued the behavioural aspects of the personnel during service delivery and should be configured into the PHC performance.
Rajeshwari Bangalore Sathyananda, Angelique De Rijk, Usha Manjunath, Anja Krumeich, Onno Van Schayck, and
Australasian College of Health Service Management
Background: Primary healthcare in India comprises health promotion and preventive health interventions at the population level, which are rendered at dedicated centres called Primary Healthcare Centres (PHCs). The performance of PHCs is vital for overall improvement in the general health of the population, specifically in a low- and middle-income country like India. It is unknown how performance at the centre level is related to performance at the provider and patient levels. The aim of this study is to explore patterns in the performance of three PHCs with a low, medium and the high number of babies delivered.
 Methodology: Primary and secondary data from the three selected PHCs were collected. Two questionnaire studies were done: one on the well-being of providers (Quality of Life and Engagement), and another on PHC performance as assessed by patients using the newly developed tool ‘Questionnaire for Patient’s Perspective on Performance of Primary Healthcare Centres’. The data from the centre, provider and patient levels were compared across the three centres using ANOVA tests.
 Results: The new tool had high internal consistency at Cronbach’s alpha score of 0.938. It was found that the PHC with the least delivery had significantly higher PHC performance in comparison with high and medium-delivery PHCs (p<0.000).
 Conclusion: The PHC performance assessment from multiple perspectives offers a realistic insight into the centres, which is valid even though agreement on the various perspectives could not be obtained. The new Q4PHC is a reliable instrument to assess PHC performance from the patient’s perspective.
Gyan Chandra Kashyap, R. Sarala, and Usha Manjunath
Frontiers Media SA
ObjectiveTo assess the impact of Spirulina Chikki supplementation on the nutritional status of children (6 months−6 years).DesignA cross-sectional study design was adopted to assess the changes in nutritional status among the children (after 12 months of intervention period). The bassline and endline assessment were carried out from September 2020 to August 2021, respectively.SettingTotal 106 villages (108 Anganwadi Centers in nine circles) from Tumkur District were covered.MethodsChildren aged 6 months−6 years were the study subjects. Anthropometric measurements viz., height, weight, and mid-arm circumference were collected from total 971 and 838 children during baseline and endline assessments correspondingly. The information on children's health and nutrition status was gathered from the mothers of sampled children. WHO's Anthro and AnthroPlus software were utilized to estimate the anthropometric measurements (Stunting, wasting, and underweight) of study participants.ResultsThe study found apparent disparities in the prevalence of stunting, wasting and underweight among the male and female children. There was a significant decline viz., 4% (28.6%-baseline to 24.5%-end line) in the prevalence of severe wasting. Also, severe stunting dropped by 6% at end line (30%-end-line to 24%-baseline). Improvement in nutritional status was evident among both female male children in all three indicators stunting, wasting, and underweight. Mid-upper arm circumference (MUAC) measurement shows substantial improvements from baseline to end line: SAM (5.3–0.6%), MAM (23–9%), and normal (72–91%). The study discloses significant improvements in the nutritional status among those children who consumed spirulina chikkis/granules for a longer duration viz., 9–10 months as compared to those who consumed for lesser duration.ConclusionsFindings reveal improvement in nutritional status among the beneficiaries who consumed spirulina chikki/granules as per the recommended quantity (amount) during the intervention period. Post intervention, spirulina chikki supplementation for nutritional intervention is implied to address large scale malnutrition among young children.
Usha Manjunath, R. Sarala, D. Rajendra, M. R. Deepashree, Maulik Chokshi, Tushar Mokashi, and Mythri Shree N.
SAGE Publications
The Accredited Social Health Activist (ASHA) programme has proven to be cost-effective and successful in addressing the growing shortage of health workers and reaching the vulnerable. ASHA’s contribution towards the improvement in maternal and child health and other health programmes at the community level is reported and acknowledged widely in literature. However, nearly 16 years into the introduction of ASHA, challenges in terms of workload, fatigue, poor work–life balance and low levels of compensation have emerged. Aim: To assess the workload on ASHAs, impact of their responsibilities on their quality of life and the potential for structured task sharing/shifting among other healthcare workers. Methodology: The study used a mixed-method approach with data and source triangulation. A multi-stage random sampling method was used to collect the data. Qualitative research was carried out to explore ASHAs’ and stakeholders’ perspectives, and a thematic analysis was undertaken using NVivo-12. ASHAs’ quality of life was also measured using the World Health Organization Quality of Life (WHO QOL)-BREF. The study was carried out in three districts of Karnataka: Mysuru, Raichur and Koppala. Results: The majority of ASHAs reported that they experience work burden in terms of population coverage, extended hours of work and additional tasks. Lack of access to transportation, inadequate support from other healthcare personnel and delayed payment of incentives add to them often feeling overworked and underpaid. The research also elicited perspectives on ASHAs’ work from different stakeholders. Findings from the study emphasise the necessity for sharing/shifting of selected tasks among other frontline health workers based on complexity and capabilities.
Rajeshwari Bangalore Sathyananda, Anja Krumeich, Usha Manjunath, Angelique Rijk, and C. P. Schayck
Wiley
Abstract Background Primary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low‐ and middle‐income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India. Methodology The authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance. Results and Conclusion The study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the ‘missing link’ in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.
Dhanya Anna Kurian, Namrata Pancholi, and Usha Manjunath
SAGE Publications
This is a story of Melam Group of Companies, a vivid example of Business Bootstrapping theory. A personal interview with the founder, Mr Kurian John Melamparambil (Padma Shri awardee) revealed how the Melam Group started a business with zero or limited resources. This case is to enlighten the young mind that it is not always huge capital/funding/venture capital/angel investing that builds a successful business. It is the determination and passion for the idea than the money that propels a business to success.
R. Bangalore Sathyananda, A. de Rijk, U. Manjunath, A. Krumeich, and C. P. van Schayck
Springer Science and Business Media LLC
Jyoti R. Munavalli, Shyam Vasudeva Rao, Aravind Srinivasan, Usha Manjunath, and G. G. van Merode
SAGE Publications
Background and context:Resource planning is performed ahead of time within outpatient clinics (OPC). Due to local control of operations (department-centric decision-making) and limited resources, O...
Usha Manjunath, C.N. Sunil Kumar, and M.S. Kailashnath
SAGE Publications
Social Health Insurance Scheme is an important innovation in health financing in India. The present study analyzed the cost and net realization by a multi-specialty/tertiary care hospital in treating the patients covered under two of the most successful Social Health Insurance Schemes—Yeshasvini and Kalaignar. A comparative analysis of the cost structure, package rates sanctioned by the schemes and the financial feasibility of the schemes for 210 surgeries in 12 specialties was conducted in a large hospital. In general, cost of consumables and manpower constituted nearly 70 per cent of the total cost. Only in four surgical categories, the tariff rate was adequate to meet the direct cost of care. Implications for improving net realization by the hospital as well as the scheme policy are discussed. Study Objectives To carry out a comparative analysis of the cost structure of the major procedures in the hospital covered under Yeshasvini and Kalaignar schemes; To compare the cost structure/s incurred by the hospital with the package rates approved by the schemes to evaluate the financial feasibility of the schemes across various departments of the hospital; and To suggest measures to reduce the costs of production for various procedures without negatively impacting the quality of care and, thereby, reduce the gap between the costs incurred by the hospital and the realization from the schemes. Methodology The cost incurred by the hospital in treating the patients covered under the two schemes—Yeshasvini and Kalaignar—for 210 surgical cases was analyzed. The costs of various resources on a per-patient basis including consumables, manpower, electricity, equipment, and use of facilities in and around the hospital were computed. Net realization by the hospital in the corresponding surgeries was computed by taking the approval amount (package rates) and total cost of care. The analysis was carried out for both the schemes by classifying data as ‘cardiac’ and ‘non-cardiac’ procedures. Results and Conclusions In general, Kalaignar scheme showed better cost recoveries than Yeshasvini scheme for similar types of cardiac and non-cardiac procedures. In all the cases studied, the major costs were attributable to cost of medicine and consumables and cost of manpower. The cost of medicine and consumables in cardiac and non-cardiac surgeries was 37 per cent and 29 per cent of the total cost, respectively. Manpower costs in the two types of surgeries were 42.5 per cent and 47.5 per cent, respectively. Net realization for all surgeries studied, showed that cardiac cases gave a better cost recovery than non-cardiac categories. It was observed that only 4 of the 12 surgical procedures studied posted earnings more than the total cost indicating low financial viability for the hospital. Implications for managers for reducing losses to the hospital are discussed. Large-scale studies on costing for various procedures across the networked and non-networked hospitals are warranted for revising package rates by the social insurance schemes.
Usha Manjunath, Bhimaraya A. Metri, and Shalini Ramachandran
Emerald
PurposeThe purpose of this article is to provide an analysis of quality management using the Malcolm Baldrige National Quality Award Criteria (MBNQA) criteria in a 300‐bed hospital in South India.Design/methodology/approachBased on Malcolm Baldrige National Quality Award (MBNQA) criteria in‐depth interviews are conducted with the heads of the departments in the case hospital. Data is analysed and compared with the MBNQA points to evaluate the performance of the hospital in all the seven criteria's of MBNQA.FindingsThe paper presents the strengths and opportunities for improvement through MBNQA criteria. The total points scored are 753 out of 1,000 points. This reveals that quality performance of case hospital is of higher level. However among all the seven criteria, the hospital has still more opportunity to improve the quality in MBNQA criteria no. 4, i.e. measure, analysis and knowledge management.Research limitations/implicationsThis study brings out a potential area of research about how the ratings and activities in the case hospital compares with other health care organisations.Practical implicationsThe outcome of this paper clearly indicates that MBNQA criteria act as a powerful tool to analyse the quality performance of the hospital. The health care organisations can use MBNQA as self‐assessment tool to evaluate and to improve the health of the hospitals. MBNQA as self‐assessment tool help the hospitals to lay the road map for world‐class performance.Originality/valueThe paper illustrates the measurement of quality performance through MBNQA to the healthcare administrators that is the first step for managing and improving quality in health care organisations. It provides lessons for those hospitals that have already started quality initiatives.