Dissemination Event: Health Seeking Pathways in Four Indian States (4IS) Study

Past Event

The National Council of Applied Economic Research (NCAER) and University of Melbourne organised an in-person event to launch their report, Health Seeking Pathways in Four Indian States (4IS) Study, at NCAER, on 27 September 2023.

At this event, the team members shared findings from their recently concluded study that help shed light on the questions of out-of-pocket spending, catastrophic health expenditure and distress financing, treatment pathways in four States of India—Odisha, Uttar Pradesh, Maharashtra, and Punjab. The rationale for the selection of these States was to better understand the differences between health seeking behaviour in more and less developed health systems at the State level in India, and to sharpen hypotheses about the evolution of health seeking behaviour as health systems develop effectively. The analysis in the study provides a baseline for health system interventions yet to be introduced, which seek to strengthen elements such as public primary care.

The multi-method study was a collaboration between Nossal Institute for Global Health, University of Melbourne, the National Council for Applied Economic Research (NCAER), India, and Population Council, India. The study delves into the following questions:

  • What factors are associated with: (a) the decision to use medical care, and (b) the choice among available medical providers?
  • What are the health expenditure consequences of both decisions, and with respect to Catastrophic and Impoverishing Health Expenditures?
  • What are the earnings-related (pertaining to wages and other sources of income of households) consequences of both decisions?
  • What are the patterns of resort (what are the common pathways between healthcare providers and provider type, including primary and higher levels; public and private; qualified and unqualified) in relation to a chronic condition common among adults, an acute condition common among children, and gynaecological problems among women?

Following are details of the study team members who made presentations at the event and the discussants who shared their comments on the study report and the presentations at the event.



Sajjan Singh Yadav is an officer of the Indian Administrative Service (IAS), with thirty years of experience in senior positions in the federal government and six state governments. He has a keen interest in health systems, health policy, and extensive experience of policy formulation and implementation in health, water, sanitation, food and nutrition, finance, and urban development. Between 2010 and 2012, he served as the Director, National Rural Health Mission (NRHM), Ministry of Health and Family Welfare, Government of India, and headed the policy division of NRHM. He has served as Secretary, Health and Family Welfare, Daman & Diu and Dadra & Nagar Haveli; as Mission Director, National Nutrition Mission, Government of India; and as Secretary to the Chief Minister, Delhi: as in-charge of Health Department in the Chief Minister’s office. He holds a DrPH from the London School of Hygiene and Tropical Medicine, University of London.

Rama Baru is a Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India. She has served on the Technical Appraisal Committee for Health Technology Assessment; the Department of Health Research, the Ministry of Health, the Government of India; and the Scientific Advisory Group, Indian Council of Medical Research, New Delhi. Her major areas of research interest include commercialisation of health services, infectious diseases, comparative health systems and health inequalities. She is the author of four books: Private Health Care in India: Social Characteristics and Trends (1998); School Health Services in India: The Social and Economic Contexts (2008); and Medical Insurance Schemes for the Poor: Who Benefits (2015). Her most recent publication is a co-edited volume titled Global Health Governance and Commercialisation in India: Actors, Institutions and the Dialectics of Global and Local (2018). She has also contributed to many edited volumes and peer-reviewed journals.

  • Event Date

    27 September 2023
  • Location

    NCAER, T2 Auditorium
  • Event Type

  • Event Mode