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Local health systems form the basis for health system resilience. Leaders’ standpoints are crucial in advancing resilience capacities and change. This study analysed how local health system leaders’ approaches to change reflect health system resilience capacities. Furthermore, we explored what triggers and hinders change during a crisis.

The data consist of purposively sampled interviews with 14 local Finnish health system leaders during the COVID-19 pandemic. Using abductive content analysis, examples of resisting, absorbing, adapting and transforming were identified. Contextual triggers and hindrances for the initiation of change processes were analysed to support understanding of health system resilience capacities at the local level.

Resilience capacities were manifested by doing standard things faster (absorption), engaging in collaborative reflections (adaptation) and reforming organisational boundaries and services (transforming). “Resisting” leaned on varied levels of reflection, with mixed responses. Triggers and hindrances varied situationally and highlighted the roles of a changing operational environment, existing practices and the social dimension (e.g. building a shared understanding).

Leaders’ standpoints and their approaches to change are rarely the focus of attention in system-centred conceptualisations of health system resilience. Leaders’ awareness of their approaches to change can affect organisational responses and health system resilience. This should be more clearly acknowledged in theoretical frameworks, leadership training, preparedness planning and crisis governance. Health system resilience capacities form intertwined, nonlinear processes that are reshaped throughout a crisis. Analysis of resistance can enrich the understanding of local-level processes.

By analysing and discussing the case study, students should be able to evaluate the factors responsible for social entrepreneurship, more specifically, Harinath Kashiganeshan as a social entrepreneur; explore the entrepreneurial intention of Kashiganeshan; understand the link between social entrepreneurship and community development; examine the role of social entrepreneurship with regard to Sustainable Development Goals; and evaluate the business model, supply chain and marketing strategies in the context of the protagonist’s.

The case study revolves around the entrepreneurial journey of Kashiganeshan, who shunned his lucrative career in the USA to revamp traditional Indian herbs for holistic health care. The protagonist returned to his roots in Pennagaram village, Tamil Nadu, India, back in 2015 and started researching the possibilities of Indian medicinal herbs which have the potential to cure complex diseases like arthritis, diabetes, anaemia and high blood pressure. While researching medicinal plants, he travelled across Tamil Nadu to identify traditional herbs with medicinal properties. He visited the local farmer’s market, interacted with them and shared the importance of organic farming. Subsequently, he became a strong advocate for organic agriculture and traditional medicine. He developed “Moringa Bullets”, made from medicinal plants to treat arthritis, diabetes, anaemia and high blood pressure. Along with preparing herbal concoction medicinal recipes, he started creating awareness towards organic farming among local communities. The motto was to help communities learn this recipe and prepare independently.

This case study is suitable for postgraduate students.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.

This paper explores current teaching and learning practices, benefits and challenges in the implementation of Internationalization at Home (IaH) in higher education.

The study follows a systematic review (SR) protocol in accordance with the PRISMA Statement, covering published research from 2018 to 2022. Through this process, we identified 58 peer-reviewed manuscripts meeting our inclusion criteria. We examined disciplines, locations of IaH, objectives pursued, modality of the IaH implementation, activities and resources used. Benefits and challenges were also analysed.

The SR reveals a growing adoption of IaH, employing various technologies and interdisciplinary methods to foster cross-cultural competence. It emphasizes diverse teaching activities and resources, aligning with digitalization trends. While IaH brings benefits like improved intercultural sensitivity, collaboration and skills development, it also faces challenges in language, technical, personal, pedagogical and organizational aspects, highlighting its complexity.

Our search focused on research from 2018 to 2022, potentially missing earlier trends, and excluded grey literature due to quality concerns. The SR emphasizes online collaborative efforts in IaH, signalling a shift to digital internationalization. Institutions should invest in supporting such practices aided by strategic university alliances. A critical approach to “Global-North” collaborations is urged, promoting geographically inclusive IaH initiatives.

This study responds to the call for critical analysis on concrete examples of IaH. Through a systematic review, it explores recent teaching and learning practices, with a particular focus on the latest technological advancements. The study specifies learning objectives and identifies relevant tools for implementing IaH initiatives.

As health-care systems worldwide grapple with complex challenges such as limited resources, qualified personnel shortages and rapid technological advancements, there is an urgent need for educational transformation in health-care professions. This urgency arises from the necessity for health-care professionals to evolve beyond traditional roles and acquire essential generic skills such as adaptative, epistemic, relational, ethical and citizenship skills – areas identified as gaps in conventional university curricula. This study aims to investigate the potential of the recovery college (RC) model, integrated into a Canadian university’s health-care curriculum, to address these gaps.

Through qualitative group interviews with eight students and three faculty members and subsequent descriptive content analysis, the authors explored the perceived outcomes of this model.

The authors discerned 15 themes within the five core categories of generic skills (epistemic, ethical, relational, adaptative and citizenship skills), with “experiential knowledge acquisition” central to the training input and other significant themes including “ethical sensitivity,” “collaborative communication,” “self-care” and “open-mindedness to diversity.” The findings highlight the RC model’s potential in fostering these crucial skills among future health-care professionals and challenging prevailing epistemic injustices in health care.

Further investigations are needed to understand the long-term effects of this model on health-care practice and to explore its potential integration into wider health-care education programs.

This study enriches understanding of the RC model’s role in health-care education, thereby proposing a significant shift toward more inclusive and effective health-care professional training.

The paper contends that the migrant workers experience a significant impact on their relations back in the place of origin. In this context, this paper aims to explore, in depth the migration of the labourers to Kashmir and the challenges experienced by them in terms of adaptation to an unfamiliar culture, health and well-being, stereotyping, limited availability of collective religious spaces and the impact of migration on their social relations with the kith and kin way back in the place of origin. This is a qualitative study based on 20 oral narratives with respondents who experienced significant socio-cultural challenges in the host societies. The evidence-based findings reveal that significant challenges are experienced by the migrant workers in Kashmir, with respect to the social and cultural aspects of their lives.

Keeping in view the nature and the objectives of the study, qualitative research approach was used to have an empathetic understanding of the experience of obstacles by the migrant workers pertaining to cultural adaptation, health and well-being, stereotyping and other hard to adjust problems. The study used a convenience sampling technique to recruit the respondents in the district Pulwama of the union territory of Jammu and Kashmir. In-depth face-to-face interviews were conducted with 12 daily wage migrant labourers who after migrating to the valley of Kashmir, experienced challenges with respect to the cultural adaptation, health and well-being, stereotyping and employment opportunities. The data was collected in the month of June and July, keeping in view the massive influx of migrant worker in the valley. While collecting data from the first ten participants, the study encountered data saturation, as the same set of responses were observed. Meanwhile, two more respondents were added to the study to ensure that no data is left out, but again the same set of response was recorded. This prompted the investigator to cease the data collection process. Moreover, the current study was conducted at a time and place convenient to participants, usually at the online e-service shops, where these daily wage migrant labourers come for money transfer and other related activities. Thematic analysis of data was practiced as per the technique of Braun and Clarke (2006), which involves becoming acquainted with the data, looking for themes, validating and refining those themes, identifying and labelling those themes and finally creating the report.

The evidence-based findings reveal that significant challenges are experienced by the migrant workers in Kashmir, with respect to the social and cultural aspects of their lives.

Original research paper.

Family planning (FP) services through the lens of human rights are not well known in Nepal. This study aims to assess Family Planning 2020: Rights and Empowerment Principles for Family Planning and identify factors affecting contraceptive use among HIV-infected women living in rural Far Western Nepal.

This study conducted a cross-sectional survey using self-designed proforma. To assess the association between contraceptive use and independent variables, this study calculated adjusted odd ratio (AOR) with 95% confidence interval (CI) using statistical package for social sciences (SPSS) V.20.

Only 37.8% of participants had access to full range of contraceptive methods, and only 57.5% of participants received proper counseling. Agency/autonomy, transparency/accountability and voice/participation were practiced by 43.7%, 23.4% and 19.7% of participants, respectively. Husband’s support (AOR = 4.263; 95% CI: 1.640–11.086), availability of FP services in their locality (AOR = 2.497; 95% CI: 1.311–4.754), employment (AOR = 3.499; 95% CI: 1.186–10.328) and postpartum period (AOR = 0.103; 95% CI: 0.023–0.475) were significantly associated with contraceptive use.

Health-care providers’ and program managers’ perspectives were not examined.

Findings of this study will be useful for making strategic plan on human rights-based approach to FP.

Expanding access to contraceptive information and services and strengthening autonomy, accountability and participation are key to human rights-based approach to FP.

This study identified that inadequate counselling, nonavailability of full range of contraceptive methods, low level of autonomy, accountability and participation were key bottlenecks in fulfilling human rights-based approach to FP.

Indonesia subscribes to rights-based principles of family planning. However, a chasm between principles and practice has long been noted on a global basis, and progress has not been well-documented. This paper aims to assess the extent to which the Indonesian national family planning program has evolved in a manner that is consistent with rights-based principles.

The primary source of data was five Indonesian Demographic Health Surveys undertaken from 1997 to 2017. The analyses were organized around three major categories of family planning-related human rights. Trend analysis and logistic regression were used in analyzing the data.

Indonesian women have considerable autonomy in family planning decision, reporting that family planning decisions were mainly made by themselves or jointly with their spouse. Although contraceptive method awareness and demand for family planning are high, Indonesia fares poorly with regard to informed choice in contraceptive method selection. Access to family planning services is comparatively high as judged by contraceptive prevalence, family planning demand satisfaction and unmet need for family planning. However, significant geographic and socioeconomic inequity were observed on many indicators, with eastern Indonesian provinces consistently lagging behind.

This paper focuses on married couple, as Indonesia has a restrictive policy to limiting access and information of family planning for other groups, unmarried youth in particular.

This paper makes an important contribution to document how effectively the prohuman rights policy orientation toward family planning has been translated into services.

The purpose of this study is to explore the integration of risk management and circular economy (CE) principles within the healthcare sector to promote sustainability and resilience. Specifically, the study aims to demonstrate how risk management can support the transition to a circular economy in healthcare supply chains. By integrating risk management practices with CE principles, healthcare organizations can identify potential risks and opportunities associated with circular initiatives.

This study adopts a qualitative research approach, using a case study methodology with semi-structured interviews conducted at primary care facilities to understand the application of CE principles in practice. The study uses fuzzy logic methods to assess and mitigate risks associated with strategies promoting CE principles. Additionally, key performance indicators are identified to evaluate the effectiveness and enhance the resilience of these strategies within healthcare supply chains.

The study highlights the critical role of robust risk management strategies in facilitating the transition to a circular economy within healthcare organizations. Primary care facilities, which are critical to frontline healthcare delivery, are particularly vulnerable to product shortages due to supply risks. This study focuses on critical protective equipment, specifically latex gloves and assesses operational risks, including supply, demand and environmental risks, using a fuzzy logic-based model. Import delays were found to be a moderate risk, typically occurring once a year. The research highlights critical KPIs for a successful CE transition within healthcare supply chains, such as on-time delivery and service quality, which are directly related to the risk of supply chain disruption. In addition, the study highlights the significant impact of other CE strategies on healthcare supply chains, including localized production and manufacturing, innovation in product development, reverse logistics, closed-loop supply chains and the adoption of lean principles.

This study provides valuable insights for healthcare organizations to optimize resource efficiency, reduce waste and promote circularity in their operations. By implementing the proposed solutions and focusing on the identified KPIs, organizations can develop strategies to achieve sustainability goals and enhance resilience in healthcare supply chains.

This study contributes to the literature by demonstrating the application of risk management in facilitating the transition to a circular economy in the healthcare sector. The use of fuzzy logic methodology offers a novel approach to assessing and mitigating risks associated with critical product failures in supply chain activities. The study’s findings provide practical guidance for healthcare organizations seeking to integrate circular economy principles and improve sustainability performance.

In the current scenario, with rapid socioeconomic transformation occurring in all aspects of society, the adversities experienced by older adults have come to the forefront. The lived experiences within joint families are making it harder for the elderly to adjust to the changed familial setup. In such a situation, they undergo many problems which are most often overlooked and considered not worthy of serious attention. Loneliness and isolation are the most crucial and serious issues experienced by the elderly within the nuclear family. After spending a significantly larger part of their lives within large families, with caring people, interdependent, adjusting to the changing familial setup has become hard and strenuous. Moreover, lack of emotional support is yet another major concern of the elderly. As they grow older, care and emotional support become necessary to maintain an effective and active life in old age. However, such emotional support and care that the joint family offered is missing in the changing familial setup. Now, in light of these issues, this paper aims to explore the multidimensional concerns of the elderly (60 years and above) who, on account of familial transitioning from joint to nuclear in Kashmir, are experiencing isolation and other, hard to adjust, life changes. The paper is based on 20 oral narratives conducted, over time, with elderly people undergoing life changes due to family transition from joint to nuclear. The finding of the study revealed that the elderly experience a greater degree of change in their lifestyle due to the family transition from joint to nuclear.

This is a qualitative study that describes the multidimensional concerns of the older adults. The study was conducted in the union territory of Jammu and Kashmir using in-depth face-to-face interviews with 20 respondents aged 60 years and above who have witnessed a transition in family from joint to nuclear and have undergone many problems during this transition. Apart from this, two interviews with the sons of older persons were also included in the study to know the status of age in the current situation. After the data was collected from the first 10 respondents, the study witnessed a data saturation, as the same set of results were obtained. Meanwhile, 3 more respondents were included in the study to make sure that no data was left behind; however, again same results were witnessed. This led the investigator to halt the data collection process. Thereafter, the data was then analyzed using Braun and Clarke's (2006) thematic analysis technique, which involved familiarizing oneself with the data, looking for themes, validating and refining themes, identifying and labeling themes and finally creating the report.

The traditional joint family is undergoing rapid transformation in the current scenario. With a trend toward the nuclearization of families, which resulted in the diminishing status of the elderly, the vulnerabilities of the elderly have come to the forefront (Kumar et al., 2014). The transition of the family from joint to nuclear can be difficult for the elderly as it involves the elderly having to adjust and adapt to a new social milieu, which can be quite complex as it involves major changes in their lifestyle and daily routine. The elderly may also experience difficulty with increased social isolation and reduced family interaction. Such problems may seem insignificant and trivial to the younger ones, but stepping into the shoes of the elderly would help us understand the intensity and vulnerability of such problems. This cultural shift is quickly making changes, in part due to the rise of individualism in modern societies and the existence of a consumerist perspective among the younger generations. Such situations lead to greater alienation and isolation among the elderly from society in general and the members of the family in particular.

The is an empirical study conducted to know the status of older adults in nuclear families.

This study aims to improve the detection and quantification of cardiac issues, which are a leading cause of mortality globally. By leveraging past data and using knowledge mining strategies, this study seeks to develop a technique that could assess and predict the onset of cardiac sickness in real time. The use of a triple algorithm, combining particle swarm optimization (PSO), artificial bee colony (ABC) and support vector machine (SVM), is proposed to enhance the accuracy of predictions. The purpose is to contribute to the existing body of knowledge on cardiac disease prognosis and improve overall performance in health care.

This research uses a knowledge-mining strategy to enhance the detection and quantification of cardiac issues. Decision trees are used to form predictions of cardiovascular disorders, and these predictions are evaluated using training data and test results. The study has also introduced a novel triple algorithm that combines three different combination processes: PSO, ABC and SVM to process and merge the data. A neural network is then used to classify the data based on these three approaches. Real data on various aspects of cardiac disease are incorporated into the simulation.

The results of this study suggest that the proposed triple algorithm, using the combination of PSO, ABC and SVM, significantly improves the accuracy of predictions for cardiac disease. By processing and merging data using the triple algorithm, the neural network was able to effectively classify the data. The incorporation of real data on various aspects of cardiac disease in the simulation further enhanced the findings. This research contributes to the existing knowledge on cardiac disease prognosis and highlights the potential of leveraging past data for strategic forecasting in the health-care sector.

The originality of this research lies in the development of the triple algorithm, which combines multiple data mining strategies to improve prognosis accuracy for cardiac diseases. This approach differs from existing methods by using a combination of PSO, ABC, SVM, information gain, genetic algorithms and bacterial foraging optimization with the Gray Wolf Optimizer. The proposed technique offers a novel and valuable contribution to the field, enhancing the competitive position and overall performance of businesses in the health-care sector.