Rakesh Parashar

Bio: Rakesh Parashar is an academic researcher from Oxford Policy Management. The author has contributed to research in topics: Health policy & Medicine. The author has an hindex of 4, co-authored 12 publications receiving 32 citations. Previous affiliations of Rakesh Parashar include United States Agency for International Development & Tata Institute of Social Sciences.

Power analysis in health policy and systems research: a guide to research conceptualisation

Abstract: 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.

Emerging SARS-CoV-2 variants can potentially break set epidemiological barriers in COVID-19.

Abstract: Young age, female sex, absence of comorbidities, and prior infection or vaccination are known epidemiological barriers for contracting the new infection and/or increased disease severity. Demographic trends from the recent COVID-19 waves, which are believed to be driven by newer SARS-CoV-2 variants, indicate that the aforementioned epidemiological barriers are being breached and a larger number of younger and healthy individuals are developing severe disease. The new SARS-CoV-2 variants have key mutations that can induce significant changes in the virus-host interactions. Recent studies report that, some of these mutations, singly or in a group, enhance key mechanisms, such as binding of the receptor-binding domain (RBD) of the viral spike protein with the ACE2 receptor in the host-cells, increase the glycosylation of spike protein at the antigenic sites, and enhance the proteolytic cleavage of the spike protein, thus leading to improved host-cell entry and the replication of the virus. The putative changes in the virus-host interactions imparted by the mutations in the RBD sequence can potentially be the reason behind the breach of the observed epidemiological barriers. Susceptibility for contracting SARS-CoV-2 infection and the disease outcomes are known to be influenced by host-cell expressions of ACE2 and other proteases. The new variants can act more efficiently, and even with the lesser availability of the viral entry-receptor and the associated proteases, can have more efficient host-cell entry and greater replication resulting in high viral loads and prolonged viral shedding, widespread tissue-injury, and severe inflammation leading to increased transmissibility and lethality. Furthermore, the accumulating evidence shows that multiple new variants have reduced neutralization by both, natural and vaccine acquired antibodies, indicating that repeated and vaccine breakthrough infections may arise as serious health concerns in the ongoing pandemic. This article is protected by copyright. All rights reserved.

Emerging SARS-CoV-2 Variants Can Potentially Break Set Epidemiological Barriers in COVID-19

Abstract: Younger age, female sex, absence of comorbidities, and prior infection or vaccination are known epidemiological barriers for contracting the new infection and/or increased disease severity. Demographic trends from the recent COVID waves, which are believed to be driven by new SARS-CoV-2 variants, indicate that the aforementioned epidemiological barriers are being breached and a larger number of younger and healthy individuals are developing severe disease. The new SARS-CoV-2 variants have key mutations that can induce significant changes in the virus-host interactions. Recent studies report that, some of these mutations, singly or in a group, enhanced key mechanisms, such as binding of the receptor-binding domain (RBD) of the viral spike protein with the ACE2 receptor in the host cells, increased glycosylation of spike protein at antigenic sites, and proteolytic cleavage of the spike protein, leading to improved host cell entry and replication of the virus. The putative changes in the virus-host interactions imparted by the mutations in the RBD sequence can potentially be the reason behind the breach of the observed epidemiological barriers. Susceptibility for contracting SARS-CoV-2 infection and the disease outcomes are known to be influenced by host expressions of ACE2 and other proteases. The new variants can act more efficiently, and even on the lower concentrations of the viral entry receptor and associated proteases, thus can have more efficient host cell entry and greater replication resulting in higher viral load and prolonged viral shedding, and widespread tissue injury, and severe inflammation leading to increased transmissibility and lethality. Furthermore, the accumulating evidence that multiple new variants show reduced neutralization by natural and vaccine acquired antibodies, indicating repeated and vaccine breakthrough infections may arise as serious health concerns in the ongoing pandemic.

Implementation of “health systems approach” to improve vaccination at birth in institutional deliveries at public health facilities; experience from six states of India

Abstract: Introduction: Newborn vaccination is an integral part of routine immunization program in India, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level. Materials and Methods: A situation analysis was conducted through a mixed-methods approach to identify the lacunae in the health system and the same was used to develop an implementation strategy to improve newborn vaccination coverage across the six priority states. Results: Issues in stewardship and human resource, vaccine-related stock-outs, and poor service delivery were some of the reasons for low facility-level vaccination coverage. After implementation of a health system–based strategy, the new born vaccination improved from 55% to 88% across 10 quarters of program implementation. Factors such as sensitization of stakeholders, vaccination on holidays, rigorous documentation, and supportive supervision of health staff were primary reasons for improvement in service delivery. Conclusion: Importance of newborn immunization at birth is well established. The results from six states prove that “health systems approach” as an implementation strategy is a viable tool to improve newborn immunization at birth.

Global Health: Global Strategy for Women's, Children's, and Adolescents' Health 2016-2030

Abstract: 1. The Executive Board at its 144th session agreed to the inclusion of a proposed item on women’s, children’s and adolescents’ health on the provisional agenda of the Seventy-second World Health Assembly. It further agreed that a single report would be submitted on maternal, infant and young child health that included a description of progress made towards universal coverage of maternal, newborn and child health interventions and on newborn health, which had been specified under item 20.3 of the draft provisional agenda presented in document EB144/41 Rev.1.

Global impact of delta plus variant and vaccination

Abstract: The "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)" variant strains identified in India consist of three main lineages ("double mutant" variant): Kappa variant, Delta variant, and B.1.618. It is believed that the delta variant lacks the 484K/Q mutation, which has now been related to vaccination resistance. Currently, 63 Delta variant genomes with the K417N mutation were recognized by the GISAID. Delta plus variant (AY.1 variant or B.1.617.2.1) is the modified version of the delta variant which has brought a devastating second COVID-19 wave in India and it has been declared as a "variant of concern (VOC)" by the World Health Organization. As of 28th November 2021, more than 500 cases of delta plus variant have been reported in 12 countries, in particular in the US, UK, and India.

Power analysis in health policy and systems research: a guide to research conceptualisation

Abstract: 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.