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Background India has recently renewed emphasis on non-allopathic systems of medicine as a means to address the health needs of its populace. Earlier in 2002, its national health policy had sought to ‘revitalize’ community-based health knowledge and practices – jointly christened ‘local health traditions’. Yet policy texts remain silent on the actual means by which ‘revitalization of local health traditions’ should take place. Our research sought to understand the policy lessons of and for revitalization of local health traditions in the three Southern Indian states through an ethnographic inquiry in 2014–2016. Methods Our inquiry included a narrative synthesis of policy texts tracing the history of governance processes and mechanisms pertaining to traditional medicine, including local health traditions, linking this to the activities of non-governmental organizations (NGOs) and networks involved in “revitalization”. Through in-depth interviews, observations and case studies, we sought to understand the life worlds of local health tradition practitioners and what revitalization meant to them. Our method revealed that beyond a purely academic inquiry, we needed an (inter)action that would give greater voice to these perspectives and views leading to hosting an interactive dialogue among practitioners, NGO representatives, academics, and government officials. Results Our ethnographic inquiry unraveled the problematic of a litotic approach to local health traditions as those which are non- institutionalized, non- certified, non -documented; assuming the state to be the only source of power and legitimacy. Revitalization discussions were restricted (and often misled) by such an approach. Local health practitioners and others directed us to interesting possibilities of revitalization either through participatory modes of documentation of traditional health knowledge, strengthening existing collective forums for formal social recognition, and building pedagogical institutions that promote experiential learning. Conclusion Were we not enabled by ethnography as a method that changes its shape apace with emerging findings, we would have not been able to comprehensively answer our questions. This is critical because not only was this already a marginalized area of inquiry, but with any other method we risked reinforcing inequities by imposing epistemological and other hierarchies on our participants– whom we would argue were partners - in arriving at our conclusions.

Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

Power is a growing area of study for researchers and practitioners working in the field of health policy and systems research (HPSR). Theoretical development and empirical research on power are crucial for providing deeper, more nuanced understandings of the mechanisms and structures leading to social inequities and health disparities; placing contemporary policy concerns in a wider historical, political and social context; and for contributing to the (re)design or reform of health systems to drive progress towards improved health outcomes. Nonetheless, explicit analyses of power in HPSR remain relatively infrequent, and there are no comprehensive resources that serve as theoretical and methodological starting points. This paper aims to fill this gap by providing a consolidated guide to researchers wishing to consider, design and conduct power analyses of health policies or systems. This practice article presents a synthesis of theoretical and conceptual understandings of power; describes methodologies and approaches for conducting power analyses; discusses how they might be appropriately combined; and throughout reflects on the importance of engaging with positionality through reflexive praxis. Expanding research on power in health policy and systems will generate key insights needed to address underlying drivers of health disparities and strengthen health systems for all.

Associations, unions and other organised groups representing health workers play a significant role in the development, adoption and implementation of health policy. These representative health worker organisations (RHWOs) are a key interface between employers, governments and their members (both actual and claimed), with varying degrees of influence and authority within and across countries. Existing research in global health often assumes—rather than investigates—the roles played by RHWOs in policy processes and lacks analytical specificity regarding the definitional characteristics of RHWOs. In this article, we seek to expand and complicate conceptualisations of RHWOs as key actors in global health by unpacking the heterogeneity of RHWOs and their roles in policy processes and by situating RHWOs in context. First, we define RHWOs, present a typology of RHWO dimensions and discuss perceived legitimacy of RHWOs as policy actors. Next, we unpack the roles of RHWOs in policy processes and distinguish RHWO roles in regulation from those of regulatory agencies. The final sections situate RHWOs in political and labour relations contexts, and in sociohistorical contexts, with attention to institutional frameworks, professional hierarchies and intersectional factors such as race, gender, sexuality, class, caste and religion. We conclude by outlining research gaps in the study of RHWOs and policy, and by encouraging global health researchers and practitioners to incorporate an expanded focus on these actors. Taking this approach will generate a wider range of strategies to better engage these organisations in policy processes and will ensure stronger health workforce policies globally.

Background: Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. Methods: This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated. Results: A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies). Conclusion: We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.

First National Conference on Bringing Evidence into Public Health Policy (EPHP 2010) Bangalore, India 10-11 December 2010 Author details1-Institute of Public Health, Bangalore, IndiaEMPTY Supplemental Information: [...] ASHA looked upon themselves as another cadre of state healthcare services accountable to the medical supervisor in the primary health centre rather than the Panchayat and the community.

Four out of five adults with diabetes live in low- and middle-income countries (LMIC). India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families) play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care. The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India. We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs) and were interviewed by two trained researchers exploring patients' experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool. Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults. There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level, enhancing patient centredness and continuity in delivery of care. Our findings also point to the need to provide social services in conjunction with health services aiming at improving status of women and elderly in families and society.

The majority of maternal health interventions in India focus on increasing institutional deliveries to reduce maternal mortality, typically by incentivising village health workers to register births and making conditional cash transfers to mothers for hospital births. Based on over 15 months of ethnographically informed fieldwork conducted between 2015 and 2017 in rural Assam, the Indian state with the highest recorded rate of maternal deaths, we find that while there has been an expansion in institutional deliveries, the experience of childbirth in government facilities is characterised by obstetric violence. Poor and indigenous women who disproportionately use state facilities report both tangible and symbolic violence including iatrogenic procedures such as episiotomies, in some instances done without anaesthesia, improper pelvic examinations, beating and verbal abuse during labour, with sometimes the shouting directed at accompanying relatives. While the expansion of institutional deliveries and access to emergency obstetric care is likely to reduce maternal mortality, in the absence of humane care during labour, institutional deliveries will continue to be characterised by the paradox of \"safe\" births (defined as simply reducing maternal deaths) and the deployment of violent practices during labour, underscoring the unequal and complex relationship between the bodies of the poor and reproductive governance.

Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels—local, national and global—and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low-and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems—(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power. Le pouvoir se manifeste implicitement ou explicitement à plusieurs niveaux—local, national et mondial—et se manifeste par l’interface de chaque acteur, façonnant ainsi toutes les actions, processus et résultats. L’analyse et la participation au pouvoir offrent un substantiel potentiel permettant d’améliorer notre compréhension des causes sous-jacentes de l’iniquité et de notre capacité à promouvoir la transparence, la responsabilité et l’équité. Cependant, peu d’études et d’analyses ont été faites sur le rôle du pouvoir dans les politiques et les systèmes de santé, en particulier dans le contexte des pays à revenu faible ou intermédiaire. Afin d’amener les chercheurs et les praticiens à s’engager davantage dans le concept du pouvoir au sein des systèmes et des politiques de santé, nous partageons un aperçu général du concept de pouvoir et énumérons 10 excellentes ressources relatives au pouvoir dans les politiques et systèmes de santé des pays à revenu faible ou intermédiaire, passant des dispositifs exemplaires, aux commentaires et aux travaux empiriques. Nous avons entrepris d’identifier ces ressources dans un processus à deux étapes. D’abord, nous avons mené un exercice de collaboration impliquant le crowdsourcing et la validation participative, exercice qui a permis de compiler les 24 articles proposés. Par la suite, nous avons effectué une analyse documentaire structurée en quatre phases, qui a permis d’examiner 38 articles. Nous présentons les 10 ressources sélectionnées dans les caté- gories suivantes afin de faire ressortir les principales facettes des publications relatives au pouvoir dans les politiques et les systèmes de santé: 1) Ressources qui explorent de manière globale la façon dont le pouvoir façonne les politiques et les systèmes de santé; et 2) exemples de travaux de recherche empiriques cohérents relatifs au pouvoir dans les politiques et les systèmes de santé, représentant divers niveaux d’analyse, de régions géographiques et de compréhensions conceptuelles du pouvoir. Nous concluons par un bref débat sur les principales lacunes des publications tout en suggérant des approches méthodologiques supplémentaires permettant d’étudier le pouvoir. 权力是理解和转变卫生政策与体系的重要概念。权力在地 方、国家和全球多个层次或明或暗地体现出来, 在每个行动者 接触点都存在, 因此影响了所有行动、过程和结果。分析和应 对权力可以帮助我们理解不平等的潜在原因, 提高我们推进透 明、负责和公平的能力。但是目前还缺少对卫生政策和体系 中的权力的研究和分析, 特别是对中低收入国家的研究。为便 于卫生体系和政策领域研究者和从业者更加理解权力的概念, 我们对权力这一概念进行了概述, 并列出了10个关于中低收入 国家卫生政策与体系中权力的资源, 涵盖了典型框架、评论和 实证研究。我们通过两个阶段来确定这10个最佳资源。首先, 采用众包结合参与式验证的协作实践找到24篇推荐文章。然 后, 进行四个阶段结构式文献综述, 回顾了38篇文献。选中的 10篇文献分为下列两类, 以突出卫生政策与体系权力相关文献 的关键内容： （1） 对权力如何影响卫生政策与体系以及如何 研究权力进行总体概念性探索； （2） 卫生政策与体系权力的 实证性研究范例, 覆盖不同分析层次、地域和对权力的概念理 解。我们对文献的关键空白进行了简要讨论, 并推荐了权力研 究的一些新方法 El poder es un concepto crítico para comprender y transformar las políticas y los sistemas de salud. El poder se manifiesta implícita o explícitamente en múltiples niveles - local, nacional y global- y está presente en cada interfaz de actor, por lo tanto, configura todas las acciones, procesos y resultados. Analizar e involucrarse con el poder tiene un potencial importante para mejorar nuestra comprensión de las causas subyacentes de la inequidad y nuestra capacidad para promover la transparencia, la responsabilidad y la ecuanimidad. Sin embargo, el estudio y el análisis del papel del poder en las políticas y sistemas de salud, particularmente en el contexto de los países de ingresos bajos y medios, ha estado ausente. Para facilitar un mayor compromiso con el concepto de poder entre investigadores y practicantes en los sistemas de salud y el ámbito de las políticas, compartimos una amplia visión general del concepto de poder y enumeramos una lista de 10 excelentes recursos sobre el poder en la política y en los sistemas de salud en países de ingresos bajos y medios, que abarcan marcos ejemplares, comentarios y trabajo empírico. Llevamos a cabo un proceso de dos etapas para identificar estos recursos. Primero, realizamos un ejercicio de colaboración que involucró una convocatoria abierta y la validación participativa, lo que resultó en 24 artículos propuestos. Segundo, realizamos una revisión estructurada de la literatura en cuatro fases, resultando en la revisión de 38 artículos. Presentamos los 10 recursos seleccionados en las siguientes categorías para resaltar facetas claves de la literatura sobre el poder y las políticas y los sistemas de salud: (1) recursos que brindan una exploración conceptual global sobre cómo el poder da forma a las políticas y sistemas de salud, y cómo investigarlo; y (2) ejemplos de un fuerte trabajo empírico sobre el poder y las políticas y sistemas de salud, y la investigación que representa varios niveles de análisis, regiones geográficas y la comprensión conceptual del poder. Concluimos con una breve discusión de brechas claves en la literatura y sugerencias para enfoques metodológicos adicionales para estudiar el poder.