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[op-ed snap] Powering rural healthcare

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Indian Public Health Standards, National Health Policy, etc.

Mains level: The article talks about an interesting connection between renewable energy and Indian health care system. The UPSC is known to ask questions on these type of issues. Very important.


News

What is the issue?

  1. Around 38 million Indians rely on health facilities without electricity
  2. Without access to regular power supply, numerous life-saving interventions cannot be undertaken

‘Powering Primary Healthcare through Solar in India: Lessons from Chhattisgarh’

  1. It is a study published by Council on Energy, Environment and Water (CEEW)
  2. It has evaluated 147 primary healthcare centres (PHCs) across 15 districts in Chhattisgarh
    HIGHLIGHTS OF THE STUDY
  3. It highlights the role of solar energy in bridging the gaps in electricity access in rural healthcare facilities
  4. The Rural Health Statistics 2016 data has found, of the functional PHCs, 4.6% are not electrified
  5. The fourth round of District Level Household and Facility Survey data indicates that one in every two PHCs in rural India is either unelectrified or suffers from irregular power supply
  6. Positive part: The CEEW study found that the solar-powered PHCs in Chhattisgarh admitted over 50% more patients
  7. And conducted almost twice the number of child deliveries in a month compared to the power-deficit PHCs without a solar system
  8. The ability of solar-powered PHCs to maintain cold chains to store vaccines and drugs and operate new-born care equipment has significantly improved

How can renewable power sources help in this situation?

  1. They could help PHCs augment or even substitute traditional grid-based power systems
  2. It can facilitate reliable and uninterrupted electricity supply critical for 24/7 emergency services, deliveries and neonatal care, as well as inpatient and outpatient services

Continuous power supply has improved efficiency of PHCs in Chhattisgarh

  1. Continuous electricity supply must be ensured to cold chains at PHCs, especially in rural Chhattisgarh, which has an infant mortality rate that is higher than the average for rural India
  2. Further, patients showed more willingness to get admitted for treatment at the solar-powered PHCs due to facilities like running fans
  3. Also, 90% of PHCs with solar systems reported cost savings due to lower electricity bills or reduced expenditure on diesel

Can solar systems be scaled up in Rural India?

  1. Scaling-up solar-powered systems across PHCs in rural India is dependent on three factors
    FIRST
  2. To recognise the critical nature of electricity access in the entire health system infrastructure
  3. The Indian Public Health Standards has set minimum service-level benchmarks for all activities of PHCs, indicating that every PHC should have power supply with a back-up option
  4. The National Health Policy 2017 reiterates the commitment to improve primary healthcare by strengthening infrastructure
    SECOND
  5. The second is the ability to adapt solar systems around the local needs and considerations of PHCs including the burden of disease, weather, terrain, and power availability
    THIRD
  6. There must be a focus on making ‘Solar for Health’ a national priority

The way forward

  1. Significant opportunities exist to simultaneously address the multisectoral goals of energy access, energy security, resource management, and health outcomes
  2. Solar power for healthcare in Chhattisgarh is a crucial opportunity
  3. With evidence that scaling this initiative can meet national and regional ambitions for energy access and improved health outcomes

[op-ed snap] Universal health coverage is the best prescription

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Health Policy-2017, Clinical Establishments Act, Universal Health Care, Sustainable Development Goals

Mains level: Improving healthcare system in India


Context

Recent incidents of conduct of high-profile corporate hospitals

  1. Three recent incidents involving the health-care sector in Delhi have sparked widespread outrage over the alleged mercenary motives and callous conduct of high-profile corporate hospitals
  2. Two cases involved children with dengue who died soon after leaving these hospitals in a serious condition after their families were presented huge hospitalisation and treatment bills
  3. The third case involved a live premature baby being “declared dead” and handed over to the parents wrapped in plastic

Major issues

  1. Three major issues are involved when we assess health care: access, quality and cost
  2. Access to readily reachable, trustworthy and affordable health care is a major challenge before poorly served rural areas and overcrowded urban areas
  3. The inadequacy of organised primary health services here is compounded by a weakness at the intermediate level of care in many district hospitals and nursing homes
  4. Government institutions of advanced care suffer from low budgets and a lack of managerial talent

Steps to improving access

  1. The pathway to improving access lies in expanding the network of public sector facilities at all levels
  2. This calls for
  • higher levels of public financing,
  • investment in training and incentivised placements of more health personnel and
  • improved management through the creation of a public health management cadre

3. These measures have been envisaged in the National Health Policy, 2017 and need urgent and earnest implementation

Steps to improving quality of care

  1. There must be an emphasis on the benefit and safety of tests and treatment
  2. It must be ensured that satisfaction levels of patients, families, care providers in the nature of institutional processes as well as human interactions are met
  3. This requires ensuring conformity to accepted scientific and ethical standards
  4. The Clinical Establishments Act is a good beginning, in moving health-care facilities towards registration, ensuring compliance with essential standards of equipment and performance, adopting standard management guidelines, grievance redress mechanisms, and respecting encoded patient rights

Managing cost

  1. High out-of-pocket spending on health care leads to unacceptable levels of impoverishment
  2. Both private insurance and employer provided insurance can cover only small population segments
  3. Government-funded social insurance schemes do not provide financial protection as they cover only part of the hospitalisation cost and none of the expenses of prolonged outpatient care which forms a higher percentage of out-of-pocket spending
  4. The solution lies in doubling the level of public financing to at least 2.5% of GDP by 2019, rather than 2025, as proposed in the National Health Policy
  5. Also by pooling tax funding, all Central and State insurance schemes and employer-provided health insurance into a “single payer system”
  6. It can be managed by an empowered autonomous authority which purchases services from a strengthened public sector and, as necessary, from empanelled private health-care providers

Universal Health Care is solution

  1. The UHC provides the framework in which all three elements can be integrated
  2. It is now also enshrined in the Sustainable Development Goals

India will need 2.07 million more doctors by 2030, says study

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: Specially mentioned in the syllabus


News

Particulars of the report

  1. According to the report, to achieve a modest doctor-to-population ratio of 1:1,000, India will need 2.07 million more doctors by 2030
  2. The study was published in the Indian Journal of Public Health
  3. The prospects of the numbers increasing over the next 15-year period, it looks like an impossible task to achieve even a modest doctor-population ratio of 1:1000 by 2030
  4. Due to non-availability of data, the leakage of doctors for reasons such as those who discontinued medical practice due to change in profession, death or for any other reason during 1979-2014 (35-year period) is assumed to be zero

Comparison of the results of the study by WHO’s comment

  1. According to the World Health Organization (WHO) and the ministry of health, India has seven doctors per 10,000 people
  2. The research paper found that there were only 4.8 practising doctors per 10,000 people available in India in 2014

[pib] Health Ministry and ICMR launch India Hypertension Management Initiative (IHMI)  

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: India Hypertension Management Initiative

Mains level: Rising incidents of diseases like diabetes, hypertension etc.


News

  • The India Hypertension Management Initiative (IHMI) is a collaborative project of Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare (MoHFW), State Governments, World Health Organization (WHO), and Resolve to Save Lives initiative of Vital Strategies.
  • The primary goal of this project is to reduce morbidity and mortality due to CVDs, the leading cause of death in India, by improving the control of high blood pressure, which is a leading risk factor for CVDs among adults in India.
  • IHMI will be progressively rolled out in 25 districts in the first two years across districts selected by the Health Ministry for expansion of active screening and intensification of treatment activities for hypertension.

Aim:

  • To reduce disability and death related to cardiovascular disease (CVD),
  • The leading cause of death in India, by improving the control of high blood pressure (hypertension), reducing salt consumption and eliminating artificial trans-fats, leading risk factors for CVD.
  • To raise awareness about NCDs amongst families regarding packaged food and processed foods with excessive salt and trans-fat.
  • Need for incorporating yoga in one’s life for prevention and management of hypertension.

Essential Components

  • It will support the adoption of standardized simplified treatment plans for managing high blood pressure.
  • ensure the regular and uninterrupted supply of quality-assured medications, task sharing so health workers who are accessible to patients can distribute medications already prescribed by the medical officer, and patient-centered services that reduce the barriers to treatment adherence.
  • Data on hypertension will be improved through streamlined monitoring systems, and the lessons learned and practice-based evidence will inform further interventions to improve cardiovascular care.
PIB

[op-ed snap] The Missing Healing Touch

 Note4students
Mains Paper 2 : Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Prelims level: not much

Mains level: 2015 question: Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest?


News

Context
  1. Seven-year-old girl, Aadya, lost her life due to dengue-related complications in Fortis Hospital Gurugram last month.
  2. Root cause: the government has increasingly ceded space to the private sector in matters related to health.
  3. Despite, the article 47 mandating the improvement of public health as among the primary duties of government.
Growth of Private Sector
  1. Result of the government’s failure to provide affordable, accessible and equitable healthcare.
  2. Widened demand-supply gap and government’s inability to provide quality health care.
  3. 2007 paper in the EPW :“high absenteeism, low quality in clinical care, low satisfaction levels with care and rampant corruption plague the system.”
  4. High Level Expert Group formed by Planning Commission: “From 8 percent in 1947, the private sector now accounts for 93 per cent of all hospitals.
Attempts at Regulation
  1. The Clinical Establishments (Registration and Regulation) Act, 2010, model legislation for hospitals regulation by state governments has had a low uptake.
  2. Standard Treatment Guidelines for specific conditions and diseases not taken seriously.
  3. The West Bengal Clinical Establishments (Registration, Regulation and Transparency) Act, 2017, and the Karnataka Private Medical Establishments (Amendment) Bill, 2017 have been criticised as draconian.
  4. Insurance companies could work as a de facto check on false billing. But health insurance has penetrated only 3-4 per cent of the country’s population.
National Health Policy 2017
  1. Lays out a roadmap for public-private partnerships in healthcare.
  2. Recognises primary care will forever be in the domain of the government
  3. Talks of “strategic purchasing” of secondary and tertiary care from the private sector.
Conclusion
  1. For success of public-private partnership in healthcare, either the private sector should raise its trust quotient or
  2. the government should devise an effective regulatory mechanism to drill transparency into the private healthcare system.

[op-ed snap] How to free Indians from the medical poverty trap

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Generic medicines, bioequivalence

Mains level: Issues related to health sector and way forward


Context

Dichotomy in medicine sector

  1. India is the largest supplier of generic drugs in the world
  2. Indian pharmaceutical companies have famously succeeded in pushing down the cost of medication in many countries across the world
  3. Yet, too many Indian citizens do not get access to medicines owing to high costs

Problems

  1. Thin insurance cover that leads to most patients paying for medical expenses out of their pockets after they have been diagnosed with an ailment
  2. Medicines are a major component of total health expenses—72% in rural areas and 68% in urban areas
  3. Healthcare costs pushed 60 million Indians below the poverty line in 2011

Government’s role

  1. The government is aware of the problem, which is why it has been fixing the prices of “essential medicines” for some time, and even medical devices such as stents and knee replacement caps from this year
  2.  But the solution of the government right now—price control—is suboptimal

Generic medicines

  1. Generic medicines are affordable versions of the drug, introduced after a company loses patent over a medicine
  2. These medicines are sold either by their salt-name or by a brand (called branded generics)
  3. For example, Crocin is a branded generic whose active ingredient is paracetamol

What can be done?

  1. Cheaper generics are one of the important factors for reducing healthcare cost
  2. The practice of generic substitution is strongly supported by health authorities in many developed countries where bioequivalence tests are mandatory

Challenges before generic medicines can become mainstream

  1. The poor regulatory regime has dented perceptions about the quality of generic drugs
  2. Since generic products don’t advertise—and save costs that way—the good-quality manufacturers are not able to compete with shoddy manufacturers on cost
  3. The incentive to cut costs increases as massive government contracts are allocated to the lowest bidder

Back2Basics

Bioequivalence

  1. In most countries, the generic drug manufacturers have to prove “bio-equivalence”, i.e. the generic medicine works the same way, to the same extent and for the same purpose, as the originally patented drug
  2. The regulations in India until April 2017, required bioequivalence testing only during the first four years of a drug becoming available for generic production
  3. After four years, manufacturers only need permission from the state licensing authorities that don’t demand the data
  4. The law has changed to require bioequivalence tests for some classes of generic medicines, but its coverage is not universal

[op-ed snap] States of healthcare

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Health related studies, research, etc. are important for the Mains exam. Also, they are specially mentioned in the Mains syllabus.


News

Context

  1. Data from Global Burden of Disease study(given in the article) will help states chart their individual Health Targets
  2. States need to beef up disease monitoring systems

How health status changes around the world?

  1. Health status of populations across the world changes over time in response to socio-economic, demographic, nutritional, scientific, technological, environmental and cultural shifts
  2. Reason behind health transitions: Such health transitions have been especially profound in the past half-century due to sweeping
    (1) industrialisation,
    (2) rapid urbanisation and
    (3) relentless globalisation in most parts of the world

Why is it necessary to understand these health transitions?

  1. It is necessary to understand, and even predict, the patterns and dynamics of health transition so that multi-sectoral actions can be taken to protect and promote the health of populations

Why was ‘Global Burden of Disease’ initiated?

  1. The Global Burden of Disease study was initiated 26 years ago to chart the changing patterns of disease-related death and disability from 1990 onwards
  2. Working areas: Since then, estimates are periodically provided for years of life lost to premature mortality as well as for years of disease-related disability that is weighted for severity
  3. A combined measure of these two metrics is expressed as the loss of Disability Adjusted Life Years (DALYs) attributable to any disease or risk factor

First-of-its-kind Indian effort to map state-level disease burdens

  1. It was undertaken by over 1,000 experts of the Public Health Foundation of India, in partnership with the Indian Council of Medical Research and the team that leads the global study
  2. The results, reported recently, highlight significant trends common to all states as well as important differences between them

Results of the study:
Life expectancy at birth improved in India

  1. Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males
  2. However, life expectancy of women in Uttar Pradesh is 12 years lower than that of women in Kerala, while the life expectancy of men in Assam is 10 years lower than that of men in Kerala

Under-five mortality rate

  1. The under-five mortality rate has reduced substantially in all states in these 25 years
  2. But there was a four-fold difference in this rate between the highest, in Assam and Uttar Pradesh, as compared with the lowest in Kerala in 2016
  3. India has wide gaps to bridge: The under-five mortality of India is six times higher than Sri Lanka and burden of child and maternal malnutrition 12 times higher than in China

Different classes of diseases

  1. Communicable, maternal, neonatal, and nutritional diseases contributed to 61 per cent of India’s disease burden in 1990. This dropped to 33 per cent in 2016
  2. But the share of non-communicable diseases in the disease burden increased from 30 per cent in 1990 to 55 per cent in 2016
  3. Statewise trends: Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases
  4. But this ratio is much lower in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan

Five leading individual causes of disease burden in India

  1. In 2016, three of the five leading individual causes of disease burden in India were non-communicable
  2. The ischaemic heart disease and the chronic obstructive pulmonary disease are the top two causes
  3. And stroke the fifth leading cause

Causes behind different diseases

  1. A group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes
  2. Ambient air pollution and household air pollution both rank high as risk factors in 2016
  3. The former rising(air pollution) and the latter(household pollution) declining in the past 25 years

The study will help us in making Health strategy of individual states

  1. These data highlight the need to develop specific strategies to address the major contributors to disease burden within each state
  2. The data will help to tailor customised state-level responses while summated time trends will help the National Health Policy to set and track the progress towards country-level targets

The way forward

  1. The broad national agenda should be elimination of malnutrition, reduction of child and maternal mortality, control of infectious diseases and containment of risk factors contributing to non-communicable diseases
  2. This report provides each state the GPS to chart their individual journeys towards those goals, from different starting points.

[op-ed snap] Paradise Papers, Gorakhpur

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Connection between tax avoidance and Health Budget of India


News

Two important incidents

  1. Paradise Papers: the new set of documents on offshore finances being investigated in collaboration with the International Consortium of Investigative Journalists (ICIJ) and Suddeutsche Zeitung, Munich
  2. These documents show a link to 714 Indian names
  3. Recent tragedy in Gorakhpur: 30 children die in 48 hours at Gorakhpur’s BRD Hospital, six due to encephalitis

Relation between the two incidents

  1. While the two stories seem to be unrelated, they are intimately linked
  2. As, revenue lost due to corporate tax avoidance(as shown in the paradise papers) could fund universal healthcare

Need of a Higher Health Budget

  1. A major reason for India’s health care crisis is that it spends only about 1.3 per cent of its GDP on health when the global average is 6 per cent
  2. The High Level Expert Group (HLEG) on universal health coverage (UHC) submitted its report in November 2011
  3. It estimated that financing the proposed UHC system will require expenditure on health to be stepped up to at least 2.5 per cent of GDP by 2017 and 3 per cent by 2022
  4. The National Health Policy 2017 also intends on gradually increasing public expenditure to 2.5 per cent by 2025

How can we improve our health budget?

  1. It will probably not be possible to do so until India’s tax to GDP ratio(which at 1.7 per cent is one of the lowest in the world) is raised
  2. This could be done if India had the political will to stop hemorrhaging its tax revenues due to the legal and illegal ways employed by the corporate sector

‘Revenue loss’ around the world

  1. Revenue losses due to tax avoidance are around $500 billion globally (Alex Cobham and Petr Jansky, March 2017)
  2. In addition, the studies show that the intensity of losses is substantially greater in low and lower middle-income countries
  3. So at one end we have countries such as Guyana and Chad, that are likely to be losing a staggering 7 per cent of GDP to tax avoidance and at the other end we have the UK losing only 0.02 per cent

India’s Position on revenue loss

  1. India falls somewhere in between. It is estimated to be losing 2.34 per cent of GDP due to corporate tax avoidance
  2. This is significantly more than the 1.3 per cent of GDP that it currently spends on healthcare and more than enough to help it reach its target of 2.5-3.0 per cent to achieve universal health coverage

The way forward

  1. Tax havens are at the heart of the inequality crisis, enabling corporations and wealthy individuals to dodge paying their fair share
  2. This prevents countries from funding vital public services and combating poverty and inequality, with especially damaging effects for developing countries like India
  3. The corporate sector needs to stop discussing whether these tax minimising schemes are legal or illegal
  4. Schemes that are causing revenue losses that could prevent two children younger than five dying every minute in India are at least highly unethical

Tuberculosis cases: Govt announces steps to check under reporting

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the TB

Mains level: Government aim of eliminating TB by 20125


News

Directions to Private hospitals

  1. The union health ministry has asked private hospitals to notify it all cases of the disease reported in their facilities
  2. The government is aiming to eliminate tuberculosis (TB) by 2025

Why this direction?

  1. The aim is to check under-reporting of tuberculosis, which has been flagged as a major area of concern by UN health agency World Health Organisation (WHO)

Other steps by the government

  1. The ministry will also set up two 24X7 call centres — in Maharashtra and Uttar Pradesh — so that patients can avail all information related to the disease by calling up these toll free numbers
  2. The ministry has also roped in the Indian Medical Association for further sensitisation of the health institutions

Level of TB in India

  1. According to a report by the WHO, despite the reduction, India topped the list of seven countries accounting for 64% of the 10.4 million new tuberculosis cases worldwide in 2016
  2. India along with China and Russia accounted for almost of half of the 490,000, multi drug-resistant TB (MDR- TB) cases registered in 2016

Fewer TB deaths in India: WHO

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

The following things are important from UPSC perspective:

Prelims Level: Particulars of the TB disease, Click here

Mains level: The WHO reports on India are important for Mains.


News

Decline in TB deaths

  1. According to a report from the WHO, death from tuberculosis in India saw a 12% decline from last year even as the number of new cases saw a 5% increase
  2. With 1.7 million new cases in 2016, India continued to be the largest contributor to the global burden with up to a quarter of the 6.3 million new cases of TB
  3. In spite of this year’s dip, India accounts for about 32% of the number of people worldwide who succumbed to the disease

Government’s plan against TB

  1. The government has committed to achieve a ‘90-90-90 target’ by 2035 (90% reductions in incidence, mortality and catastrophic health expenditures due to TB)

India has the second highest unvaccinated children for measles in world

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Measles

Mains level: Important report showing inability of Indian government to counter the disease. 


News

New report on Measles

  1. According to a report by the the US Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF and the World Health Organization (WHO), around 20.8 million children across the world are still missing their first measles vaccine dose
  2. More than half these unvaccinated children live in six countries
    (1) Nigeria (3.3 million), (2) India (2.9 million), (3) Pakistan (2.0 million), (4) Indonesia (1.2 million), (5) Ethiopia (0.9 million), and (6) Democratic Republic of the Congo (0.7 million)

India’s situation

  1. India has the second highest population of children who haven’t been vaccinated against measles
  2. It happened despite the government’s focused campaign to check the highly contagious infection

Back2basics

Measles

  1. Measles is a highly contagious infection caused by the measles virus
  2. Initial signs and symptoms typically include fever, often greater than 40 °C (104.0 °F), cough, runny nose, and inflamed eyes
  3. Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik’s spots.
  4. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms.
  5. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.[5][6] Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others
  6. Rubella (German measles) and roseola are different diseases.

[op-ed snap] The case for a public health cadre

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: Not much

Mains Level: Specially mentioned in the Mains Syllabus


News

Context

  1. The article talks about a service, on the lines of the IAS, which can improve India’s health-care delivery

Different committees in the past supporting dedicated personnel for public health management

  1.  Mudaliar Committe(1959): It had observed that “personnel dealing with problems of health and welfare should have a comprehensive and wide outlook and rich experience of administration at the state level”
  2. Kartar Singh Committee(1973): It had said that “doctors with no formal training in infectious disease control, surveillance systems, data management, community health related problems, and lacking in leadership and communication skills, with no exposure to rural environments and their social dynamics, nor having been trained to manage a facility or draw up budget estimates, were ill-equipped and misfits to work in public facilities”
  3. Other observations: It was also felt that “the medical education that [a doctor] receives has hardly any relevance to the conditions in which he would be required to work, either in the state-run health programme or even in private practice
  4. Since medical education is based almost entirely on the western model, and where he is more suitable for the conditions that prevail in western countries than in his own

12th Five Year Plan and the National Health Policy, 2017

  1. They have also strongly advocated establishing a public health management cadre to improve the quality of health services
  2. How: by having dedicated, trained and exclusive personnel to run public health facilities

Public health cadre by Odisha

  1. It has notified the establishment of a public health cadre in the hope of ensuring vast improvement in the delivery of health care

Why India’s Health care system should have a cadre?

  1. Doctors with clinical qualifications and even with vast experience are unable to address all these challenges, thereby hampering the quality of our public health-care system
  2. Doctors recruited by the States and the Ministry of Health and Family Welfare (through the UPSC) are to implement multiple, complex and large public health programmes besides applying fundamental management techniques
  3. In most places, this is neither structured nor of any quality
  4. In the absence of a public health cadre in most States, doctors with hardly any public health knowledge is required to implement reproductive and child health or a malaria control programme
  5. Further, at the Ministry level, the highest post may be held by a person with no formal training in the principles of public health to guide and advise the country on public health issues
  6. With a public health cadre in place, we will have personnel who can apply the principles of public health management
  7. And may avoid mistakes such as one that led to the tragedy in UP as well as deliver quality services

The Way Forward

  1. Such an exclusive department of public health will help in developing the recruitment, training, implementation and monitoring of public health management cadre
  2. Doctors recruited under this cadre may be trained in public health management on the lines of the civil service
  3. Financial support for establishing the cadre is also to be provisioned by the Central government under the Health Ministry’s budget

Underweight and obese children: Alarm bells ring at both ends in India, Lancet study raises concern

Obese fat boy check heart by stethoscope. Tight shirt of pajamas,healthy concept

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: BMI

Mains Level: These days, Obesity is a serious health issue among children.


News

A new study in The Lancet

  1. The study was released on World Obesity Day on October 11
  2. The study looked at BMI (body mass index) trends in 200 countries from 1975-2016
    (a) Obese Population
  3. It has found that the number of obese girls in age group 5-19 has risen from 5 million to 50 million in 40 years
  4. And that of boys from 6 million to 74 million.
    (b) Underweight Polpulation
  5. The researchers say that if current world trends continue, “obese” will soon be more common than “underweight”

Results of the study on India

  1. India has among the largest shares of underweight children and teenagers
  2. And at the other end, it is part of a trend that has seen the number of obese under-20s worldwide rising tenfold in 10 years
  3. In India, the prevalence of obesity is between 1-2 %
  4. The prevalence of mild to severe underweight under-20s in India is 22.7% among girls and 30.7% among boys

Why is obesity increasing among children?

  1. The middle class and upper middle class in India have fewer children and tend to overfeed them under the pretext of pampering
  2. As per the Lancet study, the percentage is between 1-2 in India but these will increase as social structures are changing in India

Back2basics

Body Mass Index(BMI)

  1. The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual
  2. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in metres

East, NE States score high in curbing infant mortality

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Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: What IMR is, SRS bulletin.

Mains Level: IMR is an important health factor.


News

What is IMR?

  1. Infant Mortality Rate(IMR) is counted as the number of deaths per 1,000 live births

Data released by the Sample Registration Survey (SRS) bulletin

  1. According to the SRS’ data, states from the east and northeastern part of the country have registered a significant drop in IMR
  2. The all-India IMR has also decreased from 37 in 2015 to 34 in 2016
  3. The SRS bulletin, published by the office of Registrar General of India\

Statewise performance

  1. Bihar, which has the highest density of population in the country, has recorded a drop of four points in IMR from 42 in 2015 to 38 in 2016
  2. In Assam, the IMR has dropped from 47 to 43 and in Jharkhand, it has dropped from 32 to 29
  3. In Odisha, the IMR have dropped from 46 to 44
  4. West Bengal, which has been showing a steady decline over the past few years, has recorded a drop of one point from 26 in 2015 to 25 in 2016

Impact evaluation: Why flagship BPL health insurance scheme is in rather poor health

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Note4students

Mains Paper 1: Social issues | Social empowerment

From UPSC perspective, the following things are important:

Prelims level: Indian Council of Medical Research, World Health Organisation, RSBY

Mains level: Necessity of Impact evaluation, performance of big-ticket government schemes and other related issues


News

Indian makes it to WHO leadership

  1. The head of the Indian Council of Medical Research, Dr Soumya Swaminathan, has become the first Indian on the global leadership team of the World Health Organisation

Quantitative evaluation of the Rashtriya Swasthya Bima Yojana (RSBY)

  1. One of the main objectives of any health insurance scheme is to provide financial coverage (or risk protection) by reducing such burden while enhancing use of healthcare
  2. RSBY has not been able to reduce out-of-pocket payment for healthcare for the poor, and they face the catastrophic impact of such payments

Where is India going wrong with RSBY?

  1. Outpatient care comprises up to 70% of total healthcare utilization in India and 60% of total health expenditure
  2. It has by far been excluded from RSBY coverage
  3. Because OP is not covered, people could delay seeking care until they are more severely ill, which is costly both from the perspective of costs and health
  4. Despite rising healthcare costs, the scheme continues to be capped at Rs 30,000 since 2008
  5. For a family of 4 or 4.5 persons, this is grossly inadequate

Positive impact of the scheme

  1. One positive impact of the scheme was in non-medical spending
  2. The poor increased their household consumption level, or non-medical spending, after RSBY intervention
  3. This can be called “virtual income transfer”

Other such regional schemes and their impact

  1. An evaluation of the Yeshasvini scheme in Karnataka by researchers from Delhi University reported an over 70% reduction in out-pocket spending and a 30% reduction in borrowings
  2. Evaluating the Rajiv Aarogyasri scheme in Andhra Pradesh in 2012, the nonprofit think tank Centre for Global Development found reduced inpatient out-of-pocket spending among enrolled families in phase I of the study, but relatively small impacts on outpatient out-of-pocket spending, and catastrophic payments

Back2Basics

Rashtriya Swasthya Bima Yojana (RSBY)

  1. RSBY, a tax-financed health insurance that is managed through private insurance companies, was introduced in 2008 for inpatient care to Below Poverty Line (BPL) families
  2. The scheme aims to provide health insurance coverage to the unrecognized sector workers belonging to the BPL category and their family members shall be beneficiaries under this scheme
  3. Scheme enables them to receive inpatient medical care of up to ₹30,000 per family per year in any of the empanelled hospitals
  4. The scheme has won plaudits from the World Bank, the UN and the ILO as one of the world’s best health insurance schemes

Health ministry approves new tuberculosis drug

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Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Bedaquiline and Delamanid.

Mains level: The New drug will help in countering the multi-drug resistant (MDR) issue.


News

New Drug against Tuberculosis

  1. The technical group on tuberculosis in the ministry of health has given approval to ‘Delamanid’
  2. The ‘Delamanid’ is in its phase 3 clinical trials
  3. Health Ministry will initially conduct a trial with this drug on over 400 patients in a controlled manner
  4. New Drug will be included in the Revised National TB Control Program (RNTCP) from this month in parallel to Bedaquiline, another therapy

Reason behind this approval

  1. Due to the increasing number of multi-drug resistant (MDR) and extensive drug resistant (XDR) tuberculosis cases in India

Government’s expectations from the ‘Delamanid’

  1. Delamanid has proved effective in many clinical trials in South Africa and Japan
  2. Taking a cue from this, government are expecting that over 70-80% patients will respond to tuberculosis treatment

Back2basics

Bedaquiline

  1. Bedaquiline, sold under the brand name Sirturo, is a medication used to treat active tuberculosis
  2. It is specifically used to treat multidrug-resistant tuberculosis (MDR-TB) when other treatment cannot be used
  3. It should be used along with at least three other medications for tuberculosis
  4. It is used by mouth

[op-ed snap] The cold facts: on tracking influenza outbreak

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Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: The article effectively targets India’s bad surveillance system in Health Sector


News

Context

  1. The article talks about India’s bad surveillance system and how it is affecting the strategy to eradicate influenza viruses like H1N1 and H3N2

H1N1 outbreaks in India

  1.  H1N1 landed on Indian shores in 2009, and from that year outbreaks have been an annual occurrence
  2. The worst was in 2015, when 2,990 people succumbed to it
  3. This year the virus has been particularly active; mortality, at 1,873 by the last week of September, is quickly catching up with the 2015 toll
  4. In comparison, official figures show 2016 to be a relatively benign year, with an H1N1 death toll of 265

Problems with official figures of infected persons

  1. These figures only capture H1N1 numbers, a practice that has been adopted in response to the severity of the 2009 pandemic
  2. But influenza was present in India even before 2009 in the form of H3N2 and Influenza B virus types
  3. Out of these, H3N2 is capable of causing outbreaks as big as H1N1, and yet India does not track H3N2 cases as extensively as it does H1N1
  4. All this indicates that India’s surveillance systems are still poor and underestimate the influenza burden substantially

Influenza in rural areas

  1. It has found that influenza accounts for nearly 20% of fevers across rural areas in 10 Indian States — fevers that are often undiagnosed and classified as “mystery fevers”
  2. During the years when the H1N1 burden is low in these regions, H3N2 and Influenza B circulation tends to spike

Other issues originated from India’s poor surveillance system

  1. Researchers from the MIT pointed out, India submits a very small number of H1N1 genetic sequences to global open-access databases for a country of its size and population
  2. Why is sequencing important: Sequencing is important because it can detect mutations in genetic material that help the virus evade human immune systems, making it more deadly
  3. Because India does not sequence a large enough sample of viral genomes, it would be missing mutations that could explain changes in the lethality of the virus

The way forward

  1. Vaccination is the best weapon that India has against this menace
  2. Because Oseltamivir, the antiviral commonly deployed against flu, is of doubtful efficacy unless administered early enough
  3. Yet, India has far stayed away from vaccinating even high-risk groups such as pregnant women and diabetics
  4. Better surveillance of influenza will possibly change this perception by revealing the true scale of this public health issue

India’s infant mortality rate declines 8% in 2016

Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.

From UPSC perspective, the following things are important:

Prelims level: IMR

Mains level: IMR is a crucial health factor.


News

Decline in infant mortality rate (IMR)

  1. India has attained an 8% decline in the IMR in 2016 from a year ago
  2. According to the Sample Registration System (SRS) bulletin, IMR has declined to 34 per 1,000 live births last year from 37 per 1,000 live births in 2015
  3. The Bulletin is released by the Office of the Registrar General
  4. It attributed the improvement to countrywide efforts to expand health services coverage, including reproductive, maternal and newborn health services

More takeaways from the bulletin

  1. IMR declined in 29 states and Union territories, was stable in two states and increased in five states and Union territories
  2. The highest decline of 7 points was reported by Chandigarh and the highest increase of 6 points was reported by Arunachal Pradesh

Private: [op-ed snap] Who knew healthcare was so complex

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Challenges that government can face after accepting NITI Aayog’s recommendations


News

Context

  1. The op-ed talks about Indian Health Sector and NITI Aayog’s recommendations on it
  2. NITI Aayog’s recommendation to improve access
    (1) reduce out-of-pocket expenditure
    (2) create infrastructure and
    (3) augment capacity at district hospitals for non-communicable diseases (NCDs), is urgent and necessary

NITI Aayog’s Plan to improve Indian Health Sector

  1. The NITI Aayog’s solution is to incentivize the private sector via public private partnerships (PPPs)
  2. And the government will provide land, infrastructure, capital for viability gap funding, and patients via referrals from public screening programmes
  3. In return, the government fixes the price of basic services to ensure a reasonable rate of return
  4. The first assumption here is that if sufficient incentive were provided to the private sector, through land and capital, then it would earn a reasonable return on equity and decide to enter

Possible Challenges of the above system

  1. The above plan(by NITI Aayog) suffers from two challenges
    (1) It will attract private players with the greatest capacity to manipulate the system and not necessarily the most efficient ones
    (2) In a competitive environment, performance of a firm changes over time depending on new and better management practices and technology
    Firms with dynamic efficiency survive, while others stagnate

Other Challenges
Challenge related to tariff

  1. Tarrifis non-negotiable and fixed by government
  2. The biggest constraint in expanding health services is shortage of qualified human resources like onco-surgeon, clinical cardiologist and specialized nurses
  3. To induce migration from metros to smaller cities, private players will have to pay higher compensation
  4. With fixed tariffs, this lowers profitability of the venture
  5. For viability, there will be cost-cutting, potentially lowering the quality and quantity of care

Challenge related to key performance indicators (KPIs)

  1. Unfortunately, riskiness of patients is not considered while assessing quality of care
  2. If payment is linked to KPIs, which are not adjusted for risk, then private players are disincentivized from treating risky patients while over-treating safer patients

Challenge related to payments

  1. It creates three types of patients: (1) government-sponsored, (2) self-paying, and (3) patients insured under government schemes
  2. Government-sponsored patients are more expensive because 70% of their payment is released within 30 days while 30% is released within 45 days after “due diligence”
  3. For self-paying patients, funds are transferred within 15 days of receipt
  4. Facilities, therefore, prefer self-paying patients and are reluctant to provide the same level of services to government-sponsored patients who are typically poorer

[op-ed snap] Indicators that matter: on the quality of public healthcare

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: After the recent UP incident, it has become a hot topic of discussion. Also, it is specially mentioned in the Mains Syllabus.


News

Context

  1. The article talks about the low quality health services in India and suggests some ways to improve Health Sector.

Poor Performance of Indian Health Sector

  1. According to the latest Global Burden of Disease Study, which ranks countries on the basis of a range of health indicators, India has the 154th rank
  2. It much below China, Sri Lanka and Bangladesh

Low Health Budget in States

  1. Health is a State subject
  2. It implies that the primary responsibility of providing quality health services to the people lies with the States
  3. But States have been reducing their health-care spending efforts in relation to total government spending
  4. In 2013-14, the per capita public expenditure on health in U.P. was Rs. 452
  5. Such low spending cannot be expected to deliver much
  6. The number of primary health centres, the first point of contact for patients in the rural areas of U.P. went down from 3,808 in 2002 to 3,497 in 2015
  7. These statistics show that health has never been a political priority in the State
  8. The government’s lack of understanding of the importance of public health has played the most important part in U.P.’s health predicament

Consequences of bad Health Services on poor people

  1. As public health-care provisioning is becoming more limited and the quality of services deteriorating, people are left with no option but to seek services from private providers
  2. Every year, around 60 million people become impoverished through paying health-care bills in India
  3. More than 20% of people do not seek health care, despite being unwell, because of their inability to pay for it

Things we can learn from other countries

  1.  The experience from other nations that have done relatively well in health suggests that political commitment to health is a prerequisite for improving the health scenario of any country
  2. For instance, Thailand has enacted a law to make quality health care a constitutionally guaranteed right
  3. Thailand has undertaken structural reforms in the health sector to achieve the goals stated in the Health Act
  4. Even before it started reforms to attain universal health coverage, it began massive investments to build public health facilities in rural areas
  5. Cuba did the same thing many decades ago
  6. Health care is a right there and the government assumes the fiscal and administrative responsibility of ensuring access to free health care

The Way Forward

  1. The tragedies in Uttar Pradesh should be a loud and clear call for our policy makers
  2. The government’s approach towards health needs to be radically changed
  3. We need more resources available for health
  4. Health needs to be integrated as a pillar of development and it must be recognised as a public good

Nationwide programme to test all TB patients

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: GeneXpert

Mains level: Effective step to counter TB problem in India.


News

Nationwide Programme against TB

  1. Health authorities will commence a nationwide programme to test every tuberculosis (TB) patient for signs of resistance to first-line drugs
  2. This could also reveal a large number of hidden tuberculosis patients, as well greater numbers of those with multiple infections of TB and HIV

Level of TB problem in India

  1. India tops the world in the number of tuberculosis cases, the WHO estimates that possibly as many as a million Indians with TB could be outside government scrutiny
  2. In 2015 alone, nine million Indians were tested for suspected tuberculosis and about 900,000 were confirmed to be ailing from it
  3. Nearly 3% of new TB cases and 18% of prevalent cases are believed to be drug resistant

Universal Drug Sensitivity Test

  1. The new policy, called the Universal Drug Sensitivity Test, will be implemented using a molecular diagnostic test called GeneXpert
  2. GeneXpert is a US-developed technology tool being used worldwide since 2010
  3. It can detect the TB bacterium as well check for resistance to rifampicin, one of the standard key TB drugs, within 90 minutes
  4. Conventional tests take at least a day or more and require well-trained personnel for similar results

Alternative to GeneXpert

  1. GeneXpert kits are known to be expensive, as well as requiring air-conditioned settings and reliable electricity access for optimal output
  2. The Indian Council of Medical Research (ICMR) is in the process of testing a cheaper alternative to GeneXpert called Truenat MTB
  3. Truenat MTB is reportedly more portable, battery-operated, and performs as well at lower costs

Forging the ‘New Delhi Consensus’ on health

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Issues related to Indian Health Sector and there solution


News

Context

  1. In the Article, writer talks about the Public health policy of the Central Government

Government is less sensitive on health issues

  1. The Gorakhpur tragedy shows that healthcare is not a political priority till the point there are large-scale deaths
  2. Systemic issues which effects health sector often do not receive the importance they deserve
  3. The Government has implemented many reforms in health sector
  4. But the contradictory nature of the policy moves suggests the lack of a coherent policy framework to deal with India’s health challenges

Difference stands of Health Ministry and the NITI Aayog

  1. The Health Ministry do not support PPP Model(in health sector) but NITI Aayog supports it
  2. The conflict between the health ministry and the planning body is not new
  3. The previous UPA regime witnessed a similar argument between the former Planning Commission and the ministry as well

Are subsidized Health Insurance products a solution for Indian Health Sector?

  1. Economies which tend to depend heavily on medical insurance tend to have higher expenditure on healthcare on aggregate
  2. The US is a classic example, where the widespread provision of subsidized insurance products has led to a sharp escalation of costs
  3. A tendency to over-utilize medical services, and adopt expensive innovative procedures even when evidence of their effectiveness is lacking has made health spending in the US extremely inefficient

How can Preventive Public Health contribute to India?

  1. It can counter Indian Health care problems
  2. One example would be a well-functioning drainage and waste management system
  3. It, by lowering the chances of infectious diseases can contribute to overall welfare and reduces health expenses

Is Swacch Bharat Abhiyan a good Preventive Public Health Policy?

  1. The Swachh Bharat (Clean India) has marked a radical change when it was announced
  2. However, the narrow focus of the programme has meant that its impact will be far lesser than what it could have been
  3. The programme has progressed slower than planned, and not all of the toilets that have been built are being used

The way forward

  1. It is time the Indian government should reconsider its approach and identify a priority list of interventions in healthcare based on the desirability and cost-effectiveness 
  2. It is very likely that in the process, the bias in Indian health policy against preventive healthcare will be corrected
  3. Such a process will also help clarify the role of the state in healthcare
  4. And will also help forge a political consensus across parties and states on which areas need attention the most

After stent, price of knee implants capped: 60 per cent rate cut

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Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NPPA

Mains level: Good step by government. It will drastically decrease the price of Knee surgeries, which will be very helpful for middle class and poor families


News

Capping of Prices

  1. The Central government has capped the prices of knee implants in the range of Rs 54,720 to Rs 1,13,950,  exclusive of the GST
  2. Why: To check unethical profiteering and exploitative pricing at the cost of the patients in an unregulated market
  3. The average price reduction of knee implants after this cap would be in the range of 59 per cent to 69 per cent

Drug Prices Control Order (DPCO)

  1. The DPCO of 2013 authorises the Central Government to fix the ceiling price or retail price of any drug (or notified medical devices)
  2.  According to the NPPA,  Central Government has found that such “extraordinary situation in the case of knee implants does exist
  3. The National Pharmaceutical Pricing Authority (NPPA) and the Department of Pharmaceuticals (DOP) come under Ministry of Chemicals and Fertilisers

[op-ed snap] On rural India’s health systems: the health checklist

 

Image SourceNote4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Q.) “Equity in access to doctors, diagnostics and medicines for rural India must be a priority.” Examine.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Problems and solutions related to Indian Rural Health Sector.


News

Context

  1. The article presents a brief picture of Rural Health Sector in India

Some proofs of Bad Health Sector in India

  1. Recently happened crisis at the Baba Raghav Das Medical College in Gorakhpur
  2. The CAG’s report on reproductive and child health under the National Rural Health Mission for the year ended March 2016
  3. In Uttar Pradesh, the CAG found that about 50% of the primary health centres (PHCs) did not have a doctor, while 13 States had significant levels of vacancies

Main Issues

  1. Government’s inability to absorb the funds allocated
  2. Shortage of staff at primary health centres (PHCs)
  3. Community health centres (CHCs) and district hospitals
  4. lack of essential medicines
  5. broken-down equipment and unfilled doctor vacancies

Government’s Efforts

  1. The Centre has set ambitious health goals for 2020
  2. And is in the process of deciding the financial outlay for various targets under the National Health Mission
  3. The goals also includes reduction of the infant mortality rate to 30 per 1,000 live births, from the recent estimate of 40

What we need to achieve health goals?

  1. This will require sustained investment and monitoring
  2. We also need access to a health facility with required medical and nursing resources within a 3-km radius, from every individual
  3. Our disease surveillance system needs to be strengthened in both community and hospital settings, to provide reliable real-time data
  4. Periodic quality audits must include technical, administrative and social audits
  5. To make this happen, we need to invest in training and deploying professionals in public health management at different levels of the system

The Way Forward

  1.  Government doctors must be well paid but barred from private practice
  2. Giving access of doctors, diagnostics and medicines to the rural population has to be a priority for the National Health Mission

8.8 million blind in India in 2015, says study in Lancet

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Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Important issue related to Health Sector


News

A Study by the Lancet Global Health journal

  1. According to the study, 8.8 million people in India were found to be blind in 2015
  2. And another 47.7 million people had moderate and severe vision impairment

Level of Problem around the world

  1. According to the study, there are an estimated 36 million people worldwide, who are blind and this is set to increase to almost 115 million people by 2050
  2. This increase will be seen in developing countries in Asia and sub-Saharan Africa

Is this problem increasing?

  1. The rates of blindness and vision impairment have decreased in recent years
  2. The number of cases has risen as the world population has aged

[pib] Brush your facts regarding National Health Mission (NHM)

  1. National Health Mission (NHM): has 2 Sub-Missions, viz. the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM)
  2. While NRHM was launched in April 2005, launch of NUHM was approved by the Cabinet on 1st May 2013
  3. 3 main programmatic components: Health System Strengthening in rural and urban areas, (RMNCH+A) interventions and control of Communicable and Non-Communicable Diseases.
  4. RMNCH+A: Reproductive-Maternal-Neonatal-Child and Adolescent Health

[pib] What is Family Planning 2020?

  1. Family Planning 2020 (FP2020) is a global partnership that supports the rights of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have.
  2. FP2020 is an outcome of the 2012 London Summit on Family Planning
  3. India is a signatory to FP2020
  4. FP2020 is based on the principle that all women, no matter where they live should have access to lifesaving contraceptives
  5. What are the steps taken by India?
  6. Introducing New Contraceptive Choices: The current basket of choice has been expanded to include new contraceptives viz. Injectable contraceptive, Centchroman and Progrsterone Only Pills (POP)
  7. Refurbishing Contraceptive Packaging: The packaging for Condoms, OCPs and ECPs has now been improved and redesigned so as to increase the demand for these commodities.

Note: These schemes and international commitments can be used as healthy points to differentiate your answers in Mains. FP2020’s focus is on family planning and these are unique initiatives by GOI around contraceptives and its promotion

HIV community rejects AIDS Bill in current form

  1. What: The HIV community rejected the long awaited HIV/AIDS Bill in its current form
  2. It demanded removal of the phrase “as far as possible” from the proposed legislation
  3. The current version of the HIV Bill has shocked the HIV community as it dilutes rights to access treatment
  4. The Bill was approved by the Cabinet in Oct and was expected to guarantee the rights of India’s 2.4 million HIV positive community
  5. Problems with current version of Bill: The Bill has been amended to state that governments are required to focus on prevention — and not on treatment — that too, as far as possible
  6. The public health legislation is first on the list of legislative business of the RS with Health Minister J.P. Nadda set to move the Bill

[op-ed snap] E-pharma sales need to adhere to a “code of conduct”

  1. Drugs and Cosmetics Act, 1940, requires a retailer to check a licensed and registered doctor’s prescription in the presence of a pharmacist
  2. Prescription drug abuse — using dated prescriptions or using medicines legally bought by a person who no longer needs them — is rampant
  3. The Drug and Cosmetics Act, 1940, is not equipped to deal with e-pharma business
  4. The Internet Pharmacy Association’s Self Regulating Code of Conduct asks e-pharmacies to process scheduled medicines against a valid copy of prescription of a registered medical practitioner
  5. Ensure that no schedule X and other sensitive habit-forming medicines are processed through their platform
  6. Online pharmacy sector has also been asked to devise mechanisms to address consumer queries or grievances
  7. Advantage of e-pharmacy: They can aggregate supplies, making otherwise-hard-to-find medicines available to consumers across the country
  8. Steps needed: Proper tracking and monitoring of sales of drugs, checking the authenticity of online pharmacists and scrutinise prescriptions and details of patients
  9. Care should be taken to ensure patients’ privacy

[op-ed snap] Healthcare system needs to be restructured

  1. Centers for Disease Control: fights against infectious diseases
  2. Traditionally, WHO has been the leader in global public health issues but a funding crunch has tied its hands for many years now. Steadily, the US’ CDC is rising to the challenge
  3. India’s public healthcare system is struggling to provide even basic primary care to all its citizens
  4. There is enough scope to convert this enormous burden of disease into an opportunity for innovation and global leadership
  5. India has had some major successes such as containing HIV infections and leprosy and eradicating polio
  6. Limitations: Particularly with the vertical model for disease control (specific programmes for specific diseases) which do not allow an integrated approach
  7. Anti-malaria programme has been converted into a broad-based National Vector Borne Disease Control Programme
  8. This includes interventions against other vector-borne infectious diseases such as dengue and chikungunya
  9. Comprehensive review and restructuring of the healthcare system needed
  10. Focus on upgrading primary healthcare centres, manned by a well-trained cadre of health professionals required

[pib] What is Pradhan Mantri Surakshit Matritva Abhiyan?

  1. Aim: To provide fixed-day assured, comprehensive and quality antenatal care universally to all pregnant women on the 9th of every month
  2. A package of antenatal care services would be provided to pregnant women in their 2nd / 3rd trimesters
  3. Support from private sector doctors to supplement the efforts of the government
  4. IMP: Identification and follow-up of high risk pregnancies and red stickers would be added on to the Mother and Child Protection cards of women with high risk pregnancies
  5. OBGY specialists / Radiologist/ Physicians working in the private sector are encouraged to volunteer for the campaign. Just encouraged. No coercion.

[op-ed snap] Time to fight tobacco menace

  1. Context: Nations from around the world gather in Delhi to advance global commitment to tobacco control
  2. Need: to advance our own health and SDGs
  3. Measures that can be taken: GST legislation offers the government an opportunity to use taxation policy for public health and development and tax ‘demerit’ goods heavily
  4. Heavy tobacco taxation: an immediate need
  5. Single most cost-effective for persuading tobacco users to quit tobacco use
  6. High level consumption of smokeless tobacco made India the world leader in head, neck and throat cancers
  7. Tobacco use, a primary risk factor for NCDs — heart disease, strokes, diabetes, cancer and chronic lung diseases
  8. Philippines Model: passed “Sin Tax Reform Law”
  9. Simplified complex tobacco tax structure and increased rates by 341% for low-priced brands in the first year
  10. Increased revenues earmarked for financing country’s universal health care programme

Health spending: How States splurge on salaries

  1. Main finding: Bulk of the total public money spent in State-level healthcare system is not spent on medical services, but goes to wages and salaries of human resource.
  2. Wages and salaries account for 86 per cent of the total public expenditure in Punjab, 72 per cent in Maharashtra, 65 per cent in Kerala, 52.5 per cent in Madhya Pradesh and 35 per cent in Odisha.
  3. However, the per capita ‘total cost of care’ — which includes money spent by patients as well as that spent by the government on paying salaries to staff, for health subsidy etc — is mostly cheaper in the public sector than in the private sector.
  4. Source: A study of State Health Accounts of Kerala, Tamil Nadu, Odisha, Maharashtra, Madhya Pradesh and Punjab. Public Health Foundation of India in collaboration with the State governments, studied health accounts for these six States for the year 2013-14.
  5. The findings show important contribution by other sources. For instance, in Maharashtra, 23 per cent of healthcare money comes from local bodies.
  6. For the first time, Health Accounts Estimates have been conducted at the state level in India.

[op-ed snap] Doctor is not in

  • Theme: The Indian Health System and need for changes.
  • The Indian health system: India follows a vertical approach in its health sector, which focuses on disease-specific national programmes.
  • While these have been successful, there is a need to strengthen health systems to deal with problems like the annual outbreak of diseases like dengue and chikungunya, as well as to prepare for the upcoming onslaught of non-communicable diseases such as cancer and diabetes.
  • As per the World Health Organisation (WHO), an effective and efficient health system consists of six key building blocks — service delivery, medicines, information, health workforce, financing and governance.
  • The way ahead: To fix India’s healthcare scenario, what is most needed is “systems thinking” to strengthen the country’s health system in its entirety, with an equal focus on disease prevention, health promotion, and disease diagnosis and treatment.
  • This translates into ramping up our commitment to disease surveillance and data collection systems, better medical research, health workforce training and staff-retention programmes, public provision of quality healthcare and nutrition services, equal access to safe and efficacious medicines, increased public financing for healthcare and nutrition, and effective public and financial management of our national healthcare and nutrition service delivery programmes.
  • There is an urgent need to ensure health and nutrition service delivery as health and nutrition are inextricably linked to each other.
  • The political leadership cutting across party lines needs to come together and look at new and more efficient ways to deliver healthcare to our citizens keeping in mind India’s changing demographic and epidemiological profile.

Let’s know more about The Global Hunger Index (GHI)

  1. Calculated each year by the International Food Policy Research Institute (IFPRI)
  2. Designed to comprehensively measure and track hunger globally and by country and region
  3. Highlights successes and failures in hunger reduction and provides insights into the drivers of hunger
  4. By raising awareness and understanding of regional and country differences in hunger, the GHI aims to trigger actions to reduce hunger
  5. Indicators: Proportion of the undernourished in the population, prevalence of wasting in children under five years, prevalence of stunting in children under five years and the under-five mortality rate

Which of the following is/ are the indicator/s used by IFPRI to compute the Global Hunger Index Report? [Prelims 2016]

1- Undernourishment
2- Child stunting
3- Child mortality

Select the correct answer using the code given below.

(a) 1 only

(b) 2 and 3 only

(c) 1, 2 and 3

(d) 1 and 3 only

Global Hunger Index (GHI), 2016- III

  1. Globally, the Central African Republic, Chad, and Zambia were estimated to have the highest levels of hunger
  2. For the developing world, the GHI score is estimated to be 21.3
  3. It is at the lower end of the ‘serious’ category
  4. Bright spots: The level of hunger in developing countries has fallen by 29% since 2000, with 20 countries reducing their GHI scores by around 50% each since 2000
  5. If hunger continues to decline at the same rate it has been falling since 1992, around 45 countries, including India, Pakistan, Haiti, Yemen, and Afghanistan will still have ‘moderate’ to ‘alarming’ hunger scores in year 2030
  6. This is far short of the United Nations’ goal (SDG) to end hunger by 2030
  7. India is slated to become the world’s most populous nation in just six years
  8. Hence, it’s crucial that we meet this milestone with a record of ensuring that the expected 1.4 billion Indians have enough nutritious food to lead healthy and successful lives

Global Hunger Index (GHI), 2016- II

  1. Two out of five children below five years of age are stunted in India
  2. Stunting: Measures chronic malnutrition and affected children’s height would be considerably below the average for their age
  3. Improvements: At the end of 2016, around 15% of the country’s population was undernourished, down from 17% at the end of 2009
  4. Prevalence of wasting in children has declined from 20% in 2010 to 15% in 2015
  5. Stunting in children below the age of five has also declined from 48% to 38.7%
  6. The under-five mortality rate has declined from 6.6 to 4.8 over the same period

Global Hunger Index (GHI), 2016- I

  1. India: 97th out of 118 countries
  2. Scored 28.5 on the GHI index, up from 36 in 2008
  3. Since 2000, the country has reduced its GHI score by a quarter
  4. Still rated with ‘serious’ hunger levels in the 2016 Index
  5. Behind Nepal, Sri Lanka, Bangladesh, among others, but ahead of Pakistan and three other Asian countries
  6. Only the fifth highest rank in the whole of Asia, better than only North Korea (98), Pakistan (107), Timor-Leste (110) and Afghanistan (111)
  7. Also, the lowest rank among BRICS nations, with Brazil in the top 16, Russia at 24, China at 29 and South Africa at 51
  8. Last year: 80th out of 104 countries

Early childhood development should be a priority for India

  1. Source: A recent study by Program in Global Health Economics and Social Change at Harvard Medical School
  2. The numbers of children at risk of poor development fell from 279.1 million in 2004 to 249.4 million in 2010
  3. China and India have contributed the most to reducing the number of children at risk of poor development over the past decade
  4. Yet, India continued to have the largest number of children at risk in 2010
  5. 52% of the country’s 121 million children less than 5 years of age were at risk
  6. Children under 12 years of age have the highest poverty levels among all age groups, especially in low income countries
  7. Children at risk of poor development: Those who were either stunted (height-for-age below two standard deviations from the median of the international reference population recommended by the WHO in 2006) or were living in extreme poverty (less than $1.25 a day at 2005 international prices)

Not licensed to heal: ‘Foreign doctors’ flunk qualifying test

  1. Only a woefully small percentage of doctors with foreign degrees equivalent to the MBBS get to practice in the country — at least legally
  2. Around 70-80% of these students fail to clear the mandatory screening examination conducted by the National Board of Examinations (NBE)
  3. Since 2002, it has been mandatory for all Foreign Medical Graduates (FMGs) to clear an examination Foreign Medical Graduates Examination (FMGE) to secure a Medical Council of India (MCI) registration, without which they cannot practice in India
  4. In the most recent test, only 600 out of the 5,349 candidates (11.2%) passed despite relaxed examination norms and the opportunity to take the test innumerable times
  5. Countries: A number of the unsuccessful students have graduated from medical universities in China, Russia and Ukraine, which are a big draw for Indians aspiring to be doctors
  6. Why students go there? These countries offer undergraduate degrees equivalent to the Indian MBBS at a far lower cost and without the tough entrance examinations and admission process

Let’s know more about Janani Suraksha Yojana

  1. The JSY was launched in 2005 as part of the National Rural Health Mission (NRHM)
  2. Aim: To improve maternal and neonatal health by promotion of institutional deliveries (childbirth in hospitals) among poor pregnant women
  3. It is a 100% centrally sponsored scheme it integrates cash assistance with delivery and post-delivery care
  4. The scheme is under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States (LPS)
  5. It has identified ASHA, an accredited social health activist as a link between the Govt and the poor pregnant women to encourage institutional deliveries among the poor women

Janani Suraksha Yojana pays dividends: Study- II

  1. The usage of maternal healthcare services by the OBC, Dalit, Adivasis and Muslim women increased between the surveys
  2. Women in their early twenties were more likely to avail of each of the three maternal health care services as compared to their older women
  3. Also, the incidence of women availing maternal healthcare services decreases with the increase in the number of children they have delivered
  4. Significance: While previous studies had shown the impact of JSY in reducing maternal mortality, it was not known if it had reduced socioeconomic inequalities

Janani Suraksha Yojana pays dividends: Study- I

  1. Source: A study conducted using data from two rounds of the India Human Development Survey (IHDS)- conducted in 2004-05 and 2011-12
  2. Equity: JSY has led to an enhancement in the utilisation of health services among all groups
  3. This is especially among the poorer and underserved sections in the rural areas, thereby reducing the prevalent disparities in maternal care
  4. The increase in utilisation of all three maternal healthcare services between the two rounds is remarkably higher among illiterate or less educated and poor women

Leading risk factors

  1. Source: The Global Burden of Diseases report
  2. For both sexes, the leading risk factors are high systolic blood pressure, fasting plasma glucose, ambient particulate matter, household air pollution, and unsafe water
  3. Smoking is a bigger risk factor for Indians than even cholesterol and iron deficiency
  4. Childhood under-nutrition and lack of whole grains also figure in list
  5. Iron-deficiency anaemia is the leading cause of years lived with disability in the case of India
  6. This is followed by lower back and neck pain, sense organ diseases, and depression

Under 5 deaths

  1. Source: The Global Burden of Diseases report
  2. In 2015 alone, the number of under-5 deaths in India was 1.26 million
  3. The number of stillbirths alone was 0.53 million
  4. India recorded the largest number of under-5 deaths in 2015, at 1.3 million (1.2–1.3 million), followed by Nigeria (726,600) and Pakistan (341,700)
  5. Neonatal pre-term birth complications, lower respiratory infections, diarrhoeal diseases and measles were some of the leading causes of under-5 mortality
  6. The rate of under-5 deaths was 48.9 deaths per 1,000 live births. For every 1,000, live births there were 29.06 neonatal deaths (0-27 days after birth), 20.25 stillbirths, 11.74 post-neonatal (28 days to 1 year) deaths, and 8.80 deaths during the 1-4 years

Discuss: Remember a recent report about babies falling victim to microbial resistance? You can expand the dimension of this topic by adding those facts with these in an answer

Slower reduction in MMR

  1. Source: The Global Burden of Diseases report
  2. Along with Nepal and Bhutan, India has registered a slower reduction in maternal mortality rate (MMR)
  3. MMR was reduced by a little over 50% in 25 years (1990 to 2015), from over 130,000 deaths in 1990 to nearly 64,000 deaths in 2015

Other reasons of mortality

  1. Source: The Global Burden of Diseases report
  2. Injuries killed 0.6 million males and 0.3 million females in 2015 alone
  3. India had the highest number of suicide deaths in the world last year, with nearly 132,000 deaths in men and over 76,000 deaths in women
  4. At 0.36 and 0.31 million, neonatal disorders killed nearly equal number of males and females
  5. The other leading causes of deaths last year in both sexes were ischemic stroke, haemorrhagic stroke, TB, lower respiratory infections and diarrhoea

Non-communicable diseases killed more Indians in 2015- Global Burden of Diseases

  1. Source: The Global Burden of Diseases report
  2. In 2015, India, like other developed countries, had more number of deaths caused by non-communicable diseases (NCDs)
  3. In the case of males, deaths due to NCDs (3.6 million) were more than double that were caused by communicable diseases (1.5 million), while it was nearly double in females
  4. Cardiovascular diseases were the leading cause of death in both sexes in India — 1.6 million in males and 1.1 million in females
  5. The next biggest cause of deaths was chronic respiratory diseases — 0.68 million in males and 0.5 million in females

HIV and AIDS Bill, 2014 gets approval- II

  1. Step in right direction: The Bill comes at a time when the national HIV programme has weakened due to Budget slashes and patients are facing drug shortages across the country
  2. Way ahead: We also need to address the inadequate funding, the procurement system that is resulting in drug shortages and the lack of clarity in the HIV policy
  3. Stats: There are approximately 21 lakh persons estimated to be living with HIV in India
  4. The percentage of patients receiving antiretroviral therapy (ART) treatment currently stands at a mere 25.82% as against the global percentage of 41%, according to the 2015 Global Burden of Diseases (GBD)

HIV and AIDS Bill, 2014 gets approval- I

  1. Cabinet approved the long-awaited amendments to the HIV Bill, granting stronger protection to the country’s HIV community
  2. Aim: Seeks to prevent stigma and discrimination against people living with HIV
  3. Discrimination: Will bring legal accountability and establish a formal mechanism to probe discrimination complaints
  4. What kind of discrimination? Accessing healthcare, acquiring jobs, renting houses or in education institutions in the public and private sectors, provision of insurance
  5. Redressal: Will allow families that have faced discrimination to go to court against institutions or persons being unfair
  6. Privacy: No person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order

Discuss: In India, the social ostracism and stigma is even more virulent than the virus when it comes to prejudice and the stigma for people living with HIV (PLHIV). Why does this happen? How can it be addressed?

Quacks dominate rural healthcare, says survey- III

  1. Determinant of quality care: The socio-economic status of a village and not household determines the quality of care people receive
  2. Households with low socio-economic status in villages with high socio-economic status were able to access more competent health care providers
  3. But households with low socio-economic status located in villages with low socio-economic status use low quality care

Quacks dominate rural healthcare, says survey- II

  1. State PHCs: Despite the availability of state primary care centres and the competence of doctors in this sector, doctors in the public sector spent on an average only 2.1 hours a day seeing patients
  2. Why? Fewer patients actually approach them
  3. Competency: Doctors with formal training are more competent as they exhibited higher correct diagnosis and correct treatment rates than health-care providers trained in alternative medicine and those without any training whatsoever

Quacks dominate rural healthcare, says survey- I

  1. Source: A survey of 23,000 households across 100 villages in rural Madhya Pradesh, published in the journal Health Affairs
  2. While the number of private health care providers has increased, many of them had no formal medical training
  3. On average, people had access to 11 health-care providers in a village
  4. 71% of these providers were in the private sector but only 51% of them had any formal medical training
  5. In terms of primary care visits, the private sector accounted for 89%, of which 77% were to the providers who had no formal training
  6. In contrast, only 11% of all primary care visits were to the public health sector and only 4% were to providers with an MBBS degree

Name all recalcitrant officers, SC tells Delhi

  1. Delhi Govt (AAP): Blamed the spread of chikunguniya infection in the national capital on officers hesitant to work
  2. Officers are not willing to take any responsibility and files are sent to the Lieutenant Governor’s office for clearance
  3. SC: File an affidavit on oath giving their (officers’) full details
  4. And you (govt) will be personally responsible for any false facts
  5. Context: The hearing was based on a suo motu PIL petition concerning the suicides of parents of Avinash, a 7-year-old boy who died of suspected dengue in 2015
  6. The boy died after allegedly being denied treatment by five private hospital

WHO report sounds alarm on doctors in India- II

  1. Density of doctors: Including allopathic, ayurvedic, homoeopathic and unani, at the national level was 80 doctors per lakh population compared to 130 in China
  2. Nurses and midwives: India had 61 workers per lakh population compared to 96 in China
  3. There is substantial variation in the density of health workers across States and districts where better-off States seemed to afford more doctors plus nurses per capita

WHO report sounds alarm on doctors in India- I

  1. Report: The Health Workforce in India
  2. Findings: Almost one-third (31%) of those who claimed to be allopathic doctors in 2001 were educated only up to the secondary school level
  3. Also 57% did not have any medical qualification
  4. Rural: The situation is far worse, where just 18.8% of allopathic doctors had a medical qualification
  5. Female healthcare workers- 38% of the total- were found to be more educated and medically qualified than their male counterparts

High out of pocket expenditure (OOPE) on health

  1. OOPE: The money individuals pay on their own rather than being covered by insurance or health benefits
  2. It has been estimated to be around Rs. 2.9 lakh crore or 69% of total health expenditure (THE) in the country
  3. This is alarmingly high and India stands among the highest in this metric worldwide
  4. Half of all the household money that is spent on healthcare- around Rs. 1.5 lakh crore- goes to pharmacies which includes chemists, community and independent pharmacies

Low public spending on health

  1. Source: National Health Accounts (NHA) Estimates for the financial year 2013-14, recently released by the Health Ministry after almost a decade
  2. Total: India spent a total of Rs. 4.5 lakh crore on healthcare in 2013-14 at 4% of the GDP, of which Rs. 3.06 lakh crore came from households
  3. Public spending: Abysmally low, constituting around 29 % of the total health expenditure- 1% of GDP
  4. Preventive care: Gets just 9.6% of the total money that flows in India’s healthcare system, including all the government-funded national health programmes such as the National Disease Control Programmes

Indians spend 8 times more on private hospitals than on govt. ones

  1. Source: National Health Accounts (NHA) Estimates for the financial year 2013-14, recently released by the Health Ministry after almost a decade
  2. Indians spent 8 times more on private hospitals and twice as much on transporting patients compared to costs in government hospitals
  3. Considering all revenue sources, including government funding, expenditure on private hospitals is double that on government hospitals
  4. NHA: monitors the flow of resources in the country’s health system and provides details of health finances

Way ahead for regulation of medical devices

  1. According to the World Health Organisation, the methodology used for medicines cannot be replicated with medical devices when it comes to ‘essentiality
  2. Moreover, coronary stents is a category and not products, just like antibiotics/vaccines are also a category of medicines, which have different drug molecules within them, which can be essential
  3. Way ahead: Singular focus on capping prices of stents will not help improve access to medical devices for patients, as it will not impact the overall procedure cost and will limit the introduction of innovative products
  4. More clarity and a comprehensive, consultative multi-stakeholder approach that involves contributions from all stakeholders is the need of the hour

Health Ministry’s notice on reducing coronary stent price

  1. News: Health Ministry issued a notification adding coronary stents to 2015 National List of Essential Medicines (NLEM)
  2. Aim: To bring down prices of stents
  3. Concern: The medical device industry- the price control mechanism would not bode well in creating a conducive environment for FDI in the country
  4. Confederation of Indian Industry (CII): The decision is contradictory to its recent efforts to press forward with legislation that would create separate and appropriate laws for medical devices
  5. Devices v/s drugs: Given the clear distinction between medical devices and drug formulations, the methodology for price control of drug formulations cannot be applied to devices
  6. Medical devices in India are regulated under the Drugs & Cosmetics Act
  7. Background: In response to the government’s call, CII members have already submitted their proposal of voluntary price reduction to the Ministry of Health
  8. This has enabled access of ‘value stent’ at CGHS prices below Rs. 25,000 to all patients

Bar coding of drugs to come soon

  1. News: An integrated approach would be undertaken to ensure that sub-standard medicines are weeded out
  2. To be implemented by the Drug Controller General of India (DCGI) along with the Union Health Ministry
  3. Bar coding for medicines, training for drug manufacturers and an integrated approach toward zero tolerance for sub-standard medicines to be followed
  4. Aim: Drugs to be made available to the common man with 100% potency and that aren’t sub-standard
  5. Background: Circulation of sub-standard medicines in the market has come down from 10% in 2002 to 4-4.5% currently
  6. Though India has a barcode system in place for exported medicines, no system is there for domestically produced and imported medicines

Aizawl has highest incidence of cancer in men: Report

  1. Context: According to latest cancer data, Aizawl has the highest incidence of cancer in men while Arunachal Pradesh has highest number of cancer in women
  2. The data was released by the Indian Council of Medical Research (ICMR) collected under Population-Based Cancer Registry (PBCR) programme
  3. Cause: High usage of tobacco in daily life of North eastern states
  4. Top five cancer in men: Lung, Stomach, Prostate, Oesophagus , Brain
  5. In women: Breast, Cervix, Ovary, Thyroid, Mouth
  6. In case of stomach cancer, Chennai has highest incidences than Aizawl

Elderly women outnumber men, says NSS report

  1. News: India has more elderly women than men with the sex ratio of the country’s 60-plus population recorded at 1033 in the 2011 Census, up from 1029 in the 2001 census
  2. The share of 60-plus women is higher than that of men in both rural and urban areas
  3. Reason: Women are living longer than men and outlast their husbands by an average of 7 years
  4. Challenge: This is feminisation of ageing, which in the context of a developing country like India, brings with it health and financial concerns
  5. Women traditionally have a much lower economic status than men in the household

Govt sacks some foreign-funded consultants

  1. Context: India is firing dozens of foreign-funded health experts working inside the government
  2. It is seen as part of a broader clampdown to reduce the influence of NGOs on policy
  3. Impact: Signature programmes to combat HIV/ AIDS and tuberculosis may suffer
  4. Magnitude: Of the nearly 140 people who run India’s HIV/AIDS programme, 112 are consultants seconded from foreign organisations

Govt plans pharma zones to reduce API imports

  1. Context: Govt is considering setting up specified pharmaceutical zones
  2. Aim: To boost domestic manufacture of active pharmaceutical ingredients (APIs)
  3. Why? To reduce the country’s dependence on China for the raw material that is used to produce drugs
  4. Dependence: India has a heavy dependence on China for APIs, importing 90-100% APIs for more than 10 types of drugs
  5. Some of these are crucial drugs such as antibiotics and anti-diabetic medicines

What are APIs?

  1. What? API is the ingredient in a pharmaceutical drug that is biologically active
  2. Any drug is composed of two components- first is the actual API, which is the central ingredient
  3. The second is known as an excipient & refers to the substance inside the drug or tablet
  4. API is the chemically active substance, which is meant to produce the desired effect in the body

Norms for clinical trials eased

  1. News: Health Ministry has amended the Drug and Cosmetics Act (D&C Act)
  2. Context: This exempt clinical trials conducted at academic institutions from taking the hitherto mandatory permission from Drug Controller General of India (DCGI)
  3. Aim: To speed up innovation and research in India
  4. Move is a setback for those working towards a safer, more transparent clinical trials regime
  5. Background: Clinical trials came under SC scrutiny in 2013, after at least 370 deaths were attributed to Serious Adverse Events (SEAs) during
    such trials
  6. In 2013, SC ruled that no new clinical trials be permitted until the regulatory mechanism was reformed
  7. Relevance: Amendment to the D&C Act follows recommendations by the Professor Ranjit Roy Choudhury Committee

Health Ministry launches GIS-enabled HMIS application, self-printing of e-CGHS Card

  1. News: Two major Digital initiatives to provide easy access to health services to the public, GIS-enabled HMIS application and the self-printing of e-CGHS card
  2. Context: To strengthening public health systems and providing user-friendly health services in the country
  3. About: GIS-enabled HMIS (Health Management Information System) services will provide comprehensive data on a GIS platform on 1.6 lakh
    Govt Health facilities
  4. HMIS is a web-based monitoring system, to monitor health programmes and provide key inputs for policy formulation and interventions
  5. Self-printing of the E-CGHS (Central Government Health Scheme) card, provide ease and access to all beneficiaries such as the pensioners who may find it difficult to go to the CGHS centres for renewal
PIB

Kayakalp awards felicitate Public Health Facilities

  1. Context: Felicitation ceremony of Kayakalp awardees for their work in maintaining high standards of sanitation and hygiene in public health facilities
  2. Objectives of Kayakalp awards scheme:
  • To promote cleanliness, hygiene and infection control practices in public health care facilities
  • To incentivize and recognize such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control
  • To inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation
  • To create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes
PIB

PPP for district hospitals: NITI

  1. Context: Recent presentation on the outcomes in the health sector by NITI Aayog
  2. Govt is in process of developing a framework for PPP in district hospitals
  3. Why? To improve the service levels of district hospitals
  4. Also, India is on track to meet 12th Plan targets in total fertility rate and under-five mortality by 2017

Did you know about OCD?

  1. About: Neurobiological disorder caused by the deficiency of a neuro-chemical in the brain called serotonin
  2. Which triggers obsessions that are characterised by repetitive thoughts which are intrusive in nature
  3. Context: OCD traps a person in a vicious cycle of obsessions, and this leads to anxiety, fear, tension or irritation
  4. Engaging in compulsive behaviour allows the person to lower that anxiety temporarily, but a fresh obsession is triggered soon enough
  5. How to Treat?: Depending on the severity of the case, the doctor treats the patient through medication or cognitive behavioural therapy (CBT)
  6. In some cases, due to their severity, doctors use medicines and CBT to treat the patient

OCD, the ‘silent enemy’

  1. News: 3 in every hundred people suffer from some form of obsessive compulsive disorder (OCD), and they may not even be aware of problem
  2. Context: Most people fail to seek treatment at the initial stages but approach a specialist only after 3 or 4 years of suffering from the condition
  3. By then, the treatment becomes difficult as the obsession may have reached an uncontrollable state
  4. Effects: Person suffering from chronic and long-lasting disorder has uncontrollable, recurring thoughts and behaviours, and feels the urge to repeat an action over and over again
  5. What to do? When this causes substantial amount of anxiety and distress and affects family and social life, then person should approach a specialist and seek help

Health Ministry launches project Clean Street Food

  1. Aim: To raise the safety standards of foods sold on streets across the capital city of New Delhi
  2. Training: To 20,000 roadside vendors on aspects of health and hygiene, in the first phase
  3. Partnership: Food Safety and Standards Authority of India(FSSAI) with Ministry of Skill Development & Entrepreneurship
  4. Under Recognition of: Prior Learning (RPL) category of Govt’s flagship skills training scheme- Pradhan Mantri Kaushal Vikas Yojana (PMKVY)
  5. Significance: Project shall upgrade the skills of the street food vendors and also contribute to preventive and promotive health
PIB

Rotavirus vaccine by month-end

  1. News: Indian Council of Medical Research will launch the rotavirus vaccine through the national immunisation programme soon
  2. Background: In Mar, 2015, India launched its first indigenously developed Rotavirus vaccine “Rotavac”
  3. It will be initially provided to all children in AP, Haryana, Odisha and HP and later expanded across the country
  4. Impact: It is expected to bring down the large number of infant deaths due to the Rotavirus diarrhoea in India and across the globe

A New Health Protection Scheme announced

  1. Context: A serious illness of family member(s) causes severe stress on the financial condition of poor and economically weak families, shaking the foundation of their economic security
  2. To help families: Govt will launch a new health protection scheme which will provide health cover up-to rupees 1 lakh per family
  3. For Senior citizens: an additional top-up package up to Rs.30,000 will be provided
  4. Another initiative: 3,000 stores under Prime Minister’s Jan Aushadhi Yojana will be opened during 2016-17
  5. This will reinvigorate the supply of generic drugs
PIB

Low awareness among employees about health cover benefit

  1. Context: Recent ICICI Lombard survey
  2. Finding: Employees have very low awareness about the benefits offered under the group health scheme of their organisations
  3. Only 19% were aware of all benefits provided by the health insurance scheme
  4. Only 8% find the assured sum adequate
  5. Way forward: There could be health care assistance models which would come up in the industry
  6. Staying with an insurer for group health scheme for a longer duration would enable more accountability and better services

Birth Companions allowed during Delivery in Public Health facilities

  1. News: Health Ministry has allowed birth companions during delivery in public health facilities
  2. Objective: To reduce Maternal Mortality Ratio and Infant Mortality Rate
  3. Importance: It signifies India’s commitment under SDGs
  4. The WHO promotes labor companionship as a core element of care for improving maternal and infant health
PIB

Know about Birth companions

  1. Birth companions are women who have experienced the process of labour and provide continuous one – to – one support to other women experiencing labour and child birth
  2. Birth companions provide emotional support, advice regarding coping techniques, comfort measures to pregnant women
  3. Benefits: It is a low cost intervention that has proved to be beneficial to the women in labour
PIB

What is Jaundice?

  1. Context: Jaundice is a term used to describe the yellowing of the skin and the whites of the eyes
  2. Caused by: A build-up of a substance called bilirubin in the blood and body’s tissues
  3. Types: Pre-hepatic jaundice, intra-hepatic jaundice, post-hepatic jaundice
  4. Who’s at risk? Intra-hepatic and post-hepatic jaundice are more common in middle-aged and elderly people than in the young
  5. Pre-hepatic jaundice can affect people of all ages, including children

Health Minister urges Himachal Govt to take necessary steps to check Jaundice

  1. Context: Health and Family Welfare Minister expressed concern over the situation arising out of outbreak of jaundice in Shimla, Himachal Pradesh
  2. News: Minister urged the state government to take all necessary steps to handle the situation while assuring full support from the Centre in this regard
  3. Relevance: Union Health Ministry sanctions Rs 70 lakh for Indian Council of Medical Research(ICMR) study on Jaundice in Shimla
  4. Aim: To conduct a study so that reoccurrence of this situation can be avoided
  5. Experts’ advise: Sanitation and cleanliness in affected areas need to be improved and contamination of water needed to be checked
PIB

Collect health insurance cess

  1. Context: The Indian govt’s expenditure in healthcare is amongst the lowest in the world due to tight fiscal discipline
  2. Background: India spends 4.2% of its GDP on healthcare out of which only 1% is contributed by the public sector
  3. Importance: Every $1 invested in the healthcare industry helps to generate $4 through its ancillary industries
  4. Need: To provide health insurance to all citizens as significant percentage of private spending is out-of-pocket
  5. How?- Collect a health-insurance cess for general citizens including BPL population and mandating subscription-based contributions from the organised sector

Learn more about Arogya Fair?

  1. Aim: To showcase and promote the strengths, efficacy and affordability of the AYUSH systems of medicines
  2. The Fair also offered useful information related to AYUSH through information centers setup by Ministry of AYUSH
  3. The live yoga demonstrations by the Center for Research and Yoga & Naturopathy attracted large no of visitors
  4. Various endangered herbal and medicinal plants were showcased at the Herbarium & Museum by Center Council for Research in Ayurvedic Sciences

4-day National Arogya Fair-2016 at Dehradun concludes successfully

The 8 Free Government (AYUSH) clinics served more than 1000 patients in four days

  1. The Arogya Fair was organized by the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa & Homoeopathy (AYUSH)
  2. Thousands of visitors benefited from the information gathered about AYUSH Systems in 4 days
  3. The Fair attracted immense participation from all stakeholders, residents, practitioners, academicians, corporates, institutes, university heads and students
  4. Themes – Immune system, Homeopathy in Women’s disorders, Treatment in Ayurveda, Yog se Arogya and
    Non-Communicable Diseases management in Siddha System
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What are parasitic worms?

  1. India has the highest burden of parasitic worms in the world
  2. Parasitic worms in children interfere with nutrient uptake
  3. This can contribute to anaemia, malnourishment, and impaired mental and physical development
  4. According to Children in India report, 48% of children under the age of 5 years are stunted and 19.8% are wasted
  5. This indicating that half of the country’s children are malnourished

Health Ministry launches National Deworming initiative

National Deworming initiative to benefit more than 27 crore children in 536 districts of the country

  1. The Union Health Minister stated that India shall be in the forefront of the war against Neglected Tropical Diseases
  2. The Ministry had first launched National Deworming Day (NDD) in 2015 which was implemented in 11 States/UTs, targeting children aged 1 to 19 years
  3. The National Deworming Day will mobilize health personnel, state governments and other stakeholders
  4. To prioritize investment in control of Soil Transmitted Helminth (STH) infections—one of the most common infections
  5. It aims to create mass awareness about the most effective and low-cost STH treatment— administering Albendazole tablets
  6. Deworming has been shown to reduce absenteeism in schools, improve health, nutritional, and learning outcomes
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What is NFHS?

  1. The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  2. It is a collaborative project of the International Institute for Population Sciences (IIPS),Mumbai, India and 2 more partners.
  3. NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from UNICEF.
  4. NFHS-4 is being conducted under the stewardship of the Ministry of Health and Family Welfare, coordinated by the IIPS, Mumbai.

32% of girls in AP got married before 18. Says who?

  1. The data on State wide key health indicators of the NFHS is out.
  2. What’s NFHS? National Family Health Survey.
  3. The shocking trend was prevailed across the Andhra Pradesh, despite functioning of Child Protection Committees at various levels in the district.
  4. This survey was the fourth in the series and was released on Tuesday by the Ministry of Health and Family Welfare.

Mixed diagnosis on lifestyle diseases

Public health policy should take cognisance of ‘new’ lifestyle diseases

  1. Although, there’s still a long way for much of India to come anywhere near the infant mortality rate levels of Kerala (13) and Tamil Nadu (21) .
  2. Most states have registered significant improvements in maternal and child health indicators compared to the last survey that was carried out in 2005-06.
  3. On the negative side, we are also witnessing the emergence of “new” diseases linked mainly to unhealthy diets and sedentary lifestyles of people.
  4. Virtually all states have a high proportion of men consuming alcohol — from a quarter to well over half — alongside a worrying decline in sex ratios.
  5. These are indicative of a deeper social malaise in a country where growth and rising incomes also create tensions and uncertainties of a different kind.
  6. Public health policy cannot afford to ignore them, even while continuing the fight against the “old” problems of mortality and under-nutrition.

The unmet health challenge

India has to use its newly created wealth to alter a dismal record of nutritional deprivation, ill-health.

  1. The first set of data from the National Family Health Survey-4 shows that percentage of underweight children declined from 39 to 34% over a decade.
  2. We need to make access to nutrition and health a right for all.
  3. Asserting this right would require the strengthening of the Integrated Child Development Services scheme
  4. Even within the ICDS, there is a clear deficit in caring for the needs of children under three.
  5. Other key areas requiring intervention are access to antenatal care, reduction of high levels of anaemia among women, and immunisation.
  6. There is a need to assess the health of citizens more frequently than the current NFHS cycle of seven to 10 years allows.

National Family Health Survey- 4 (2nd update)

A part of India’s touted demographic dividend — the population below 15 years of age — has decreased in the past decade.

  1. Sikkim has highest decline with 23.1% from 30.7%, followed by MP- 7% decrease.
  2. Our standard of living has shown a rise during the last decade.
  3. Standard of living includes 5 parameters – sanitation facilities, clean cooking fuel source, electricity connection, clean drinking water source and using iodised salt.
  4. Uttarakhand is the only state which showed significant improvement in all five parameters.

The case for going universal

Maternity entitlements are an important policy tool for encouraging better maternal health. We need to do away with conditionality in cash transfer scheme.

  1. 2013-2014 Rapid Survey on Children finds that a little less than half of the women aged 15-18 are underweight.
  2. Maternal nutrition is so poor that Indian women actually weigh less at the end of pregnancy than sub-Saharan African women do at the beginning.
  3. Government should put new emphasis on educating women and their families about weight gain during pregnancy.
  4. It should combat the common, though false, notion that women should eat less, not more, during pregnancy
  5. But conditional transfers solve only demand problems while India chiefly faces supply problems ie unavailability of health services.
  6. Also the need to document the fact that conditions have been met invites corruption.

Let’s know about some more findings of NFHS-4

  1. Indian States have seen some improvements in child nutrition over the last decade, but over one-third children’s are still stunted, and over one-fifth underweight.
  2. Karnataka has recorded a decline in use of modern family planning methods by married women, with just over 50% using them.
  3. Karnataka’s preference for male children appears to be only getting worse with child sex ratio declining to 910 now.

Widespread lack of HIV awareness among Indian adults

  1. The latest National Family Health Survey (NFHS) data findings reveal widespread ignorance about HIV/AIDS among adults in India.
  2. This is seen as a direct result of budget cuts, with information, education and communication (IEC) measures and targeted intervention activities coming to a screeching halt.
  3. The Ministry has historically relied heavily on IEC activities, since prevention is the only key method of curbing and reversing the epidemic.

Let’s know about National Programme for Health Care of the Elderly

  1. The programme has envisaged to provide promotional, preventive, curative and rehabilitative services in an integrated manner for the elderly.
  2. It provides free and specialized health care facilities exclusively for the elderly people through the State health delivery system.
  3. It also seeks to develop specialized man power and to promote research in the field of diseases related to old age.
  4. Beneficiaries – All elderly People (above 60 years) in the country.

Health Ministry to establish two National Centres of Ageing

  1. Govt of India has approved establishment of 2 National Centres of Ageing at AIIMS, New Delhi and Madras Medical College, Chennai.
  2. This is under the tertiary level component of National Programme for Health Care of the Elderly (NPHCE) during the 12th FYP Period.
  3. These National Centres of Ageing are expected to be Centres of Excellence in the field of Geriatric Care in the country.
  4. The functions of the National Centres will be-
    • Health care delivery
    • Training of health professionals
    • Research activities along with 200 bedded in-patient services
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Let’s know about National Family Health Survey (NFHS)?

  1. NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  2. Three rounds of the survey have been conducted since the first survey in 1992-93.
  3. The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health.
  4. Ministry of Health and Family Welfare had designated the International Institute for Population Sciences, Mumbai as the nodal agency to conduct NFHS-4.

National Family Health Survey- 4 Phase-1

It covered 11 states – Goa, Meghalaya, Uttarakhand, Tripura, Tamil Nadu, Sikkim, Madhya Pradesh, Karnataka, Haryana, Bihar, West Bengal.

  1. Average sex ratio is 985 in 2015-16 as compared to 1000 in 2005-06 (Last NFHS).
  2. Only Uttarakhand saw an increase in sex ratio. All other states saw a disturbing fall in sex ratio.
  3. Women’s literacy has increased 12.15% since 2005-06.
  4. Institutional deliveries increased by 32.8% in last decade where Karnataka, MP, Bihar saw huge rise of 54.6%, 44.8%, 43.9% respectively.
  5. Almost all mothers have received antenatal care for their most recent pregnancies, and an increasing number of women are receiving the recommended four or more visits by the service providers.
  6. IMR declined in all the states and union territories surveyed—ranging from a low of 10 in Andaman and Nicobar Islands to a high of 51 deaths per 1000 live births in Madhya Pradesh.
  7. Except in Madhya Pradesh, Meghalaya and Bihar, all states and the union territories have achieved replacement level of fertility.
  8. Child marriages also saw a reduction- 13.17% for females & 6.7% for males.
  9. Child malnutrition as well as MMR have declined significantly.

Rashtriya Swasthya Bima Yojana to be tech-driven

  1. The universal health cover programme is under review to reduce its premium requirement and wider coverage.
  2. Because of its high loss ratio, public sector insurance companies have been unable to procure reinsurance coverage.
  3. The performance of the Pradhan Mantri Fasal Bima Yojana is expected to provide guidance on how high-tech content can make a difference
  4. Larger use of digital data will do away with the role of patwaris and junior district-level officials to use their discretion to figure out the extent of cropping and to measure the extent of the loss.

Healthcare service providers want tax sops in Budget

Healthcare Federation of India (Nathealth), which represents hospitals, medical equipment manufacturers, and insurance companies, has few demands from upcoming budget.

  1. Patient treatment service is currently exempted from service tax and this should continue under GST regime (which would put various sectors under purview of service tax) for at least 10 years.
  2. Increase in tax holidays for establishment of healthcare facilities in non-metros from 5 to 10 years and rise in tax exemption limits on preventive health check-up.
  3. Increase depreciation rate applicable on medical and pathological equipment and medical devices from 15 to 30 per cent and extend tax incentives to hospitals with 50 beds.
  4. This initiative will extend benefits to smaller facilities and will encourage healthcare facilities in Tier-II and -III cities.
  5. Creation of funds to boost medical innovation and healthcare infrastructure in India.

On Good Governance Day, Health Minister announces 4 new IT-based initiatives

  1. A major IT initiative, Kilkari is an audio-based mobile service that delivers weekly audio messages to families about pregnancy, childbirth and child care.
  2. A new mobile-based application, Mobile Academy, has been developed through which about 9000,000 ASHAs will be trained using mobile services.
  3. By making the Revised National TB Control Programme (RNTCP) more patient-centric.
  4. Under dedicated toll free number initiative, callers can give a missed call to get complete support for diagnosis, treatment and support on national toll free number.
  5. ‘M-Cessation’ will be an IT-enabled tool to help tobacco users to quit tobacco.
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Mainstreaming of AYUSH is one of the strategies in NHM

National Policy on Indian Systems of Medicine & Homoeopathy, 2002, envisages integration of AYUSH with the Health Care Delivery System.

  1. This seeks to provide affordable and quality health care in order to improve the existing health care delivery system.
  2. The engagement of AYUSH Doctors/Paramedics and their training is supported by the Department of Health & Family Welfare.
  3. The support for AYUSH infrastructure, equipment/furniture and medicines are provided by Ministry of AYUSH under shared responsibilities.
  4. Medical Council of India (MCI) and IMA have consulted on issue of permitting the medical practitioner.
  5. Under the AYUSH system of medicine to practice allopathy treatment in a limited way.
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Let’s know more about Stillbirth rate?

  1. The birth of an infant that has died in the womb (strictly, after having survived through at least first 28 weeks of pregnancy).
  2. State health officials attribute this to socio-cultural factors and misconceptions and taboos in society, especially in rural areas.
  3. It is mainly because women face many difficulties relating to accessibility, affordability and quality issues when utilising healthcare facilities during pregnancy in rural areas.

Karnataka has highest stillbirth rate

According to the Sample Registration Survey (SRS) 2013 Karnataka has the highest stillbirth rate in India. That is, 12 deaths per 1,000 births.

  1. The survey notes that Karnataka’s perinatal mortality rate stands at 30 per 1,000 live births.
  2. This is higher than the country’s average of 26 per 1,000 births.
  3. Stillbirths and perinatal mortality are the only two health indicators where Karnataka fares badly.
  4. Higher number of stillbirths also grossly indicates the low pre-natal and natal care for pregnant women in primary health centres.

Do governments have a role to play in healthcare? And how?


 

  1. Pure capitalist markets say that the invisible hand of the market will produce the best possible outcomes.
  2. But, we know that such markets do not by design have the ability to provide public goods to all. Why?
  3. What are public goods? We will see the definition later.
  4. Hence, even the market purists relent and say that provision of public goods is a legitimate part of government intervention in the economy.
  5. But what should we do for healthcare? There are more factors involved than just pricing of drugs.
  6. You have asymmetric distribution, communication gaps between providers & patients and so on.

The comprehensive healthcare alternative

Rescuing Maternal and Child Health-only systems, which have become under-resourced and have built a very high-cost but low-performance culture, will be a challenging task.

  1. Given the rising burden of non-communicable diseases, there is an increasing demand to build health systems that can address concerns.
  2. Indian government has chosen to stay focussed on Maternal and Child Health (MCH). But is the most effective way to deliver on the MCH goals to build an MCH-only health system, or does it need a completely different approach?
  3. At the community level,need of Clinic-based obstetric and emergency care on offer, and, within a reasonable travel distance, hospital-based emergency care.
  4. Indian government has recently mooted the concept of a health and wellness centre (HWC) that is intended to be more comprehensive health care.
  5. If HWCs (the erstwhile sub-centres) are able to address all of the necessary MCH conditions, then it becomes possible for the next level centre to provide a much broader range of care upon referral by the HWC.
  6. Clearly, building such a system to serve only MCH needs will not be cost-effective nor will it keep all of the necessary personnel gainfully employed.Having a much wider range of conditions would be the only sustainable way to address this concern.
  7. Building such a broad-based system will need a substantial investment for which political commitment desired.
  8. Fact that the Indian (MCH-focussed) health system is currently able to cope only with conditions that account for fewer than 25 per cent of the Years of Life Lost (YLL).
  9. The difficulty that health systems in India, designed as MCH-only systems,become chronically under-resourced and have now built a very high- cost but low-performance culture.
  10. For various good reasons, 68 countries, including low income and middle income countries, have chosen to use health-specific taxation such as mandatory payroll deduction.
  11. For countries such as India and China, which also have a large informal sector, since mandatory payroll deduction is not an available option for a large segment of the population, the direct sale of healthcare packages or insurance becomes additionally necessary.
  12. Bihar and Himachal Pradesh states,continues to battle with high levels of IMR and MMR and a high level of poverty. Tamil Nadu and Kerala have brought those rates under control.
  13. Building comprehensive healthcare systems which reflect the realities of each State will not only yield strong benefits on problems such as IMR and MMR but will also, over time, help build health systems that respond to a much a wider set of concerns.

Narrowly focussed health systems on the other hand risk falling short not only on their goals but also make it difficult, if not impossible, to build broader health systems for the future.

Let’s know about COPD?

  1. COPD is a non-communicable lung disease that progressively robs sufferers of breath.
  2. COPD is caused by tobacco, smoking, biomass fuel smoke and exposure to industrial pollution, fumes and environmental pollutants.
  3. It is the third leading cause of death worldwide and in India approximately 15 million suffer from COPD.
  4. Studies indicate that 25-50% of people with clinically significant COPD don’t even know they have it.
  5. That is because the early stages of COPD are often unrecognised.

Now, COPD to take your breath away

  1. Some recent studies have indicated that Chronic Obstructive Pulmonary Disease (COPD), a progressive disease that makes it hard to breathe is on the rise in the Capital.
  2. Doctors in the city are now being advised to identify and counsel patients who visit them with the problem.
  3. According to experts, after pollution, lack of awareness about this condition is the major reason for increased risk of COPD deaths.

Bengal government to train quacks as health workers

  1. The WB govt. has decided to train informal health care providers, referred to as quacks, operating in rural areas of the State.
  2. They will be acknowledged as village health workers with clear delineation of the care that they can provide.
  3. A standard operating procedure will be prepared in consultation with clinical pharmacologist, physician, surgeon and administrators.
  4. This is a very positive step as informal heath care providers operating in rural areas needs to be integrated to the health system.

Cabinet approves setting up of National Resource Facility for Bio-medical Research (NARF)

Setting up of a National Resource Facility for Bio-medical Research (NARF) at Genome Valley in Hyderabad by the Indian Council for Medical Research (ICMR).

  1. Institution will be first of its kind for quality laboratory animals for basic and applied biomedical research in country.
  2. It will be developed as a world-class facility for breeding and housing of animals.
  3. Such as primates, cabines and other specialized models such as transgenic and knockout rodents required for testing of various R&D products.
  4. Facility will create, develop and provide access to a range of laboratory animals and technological resources for advancement of biomedical research in country.
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What does Maternal and Neonatal mortality actually mean?

  1. A neonatal death is defined as a death during the first 28 days of life (0-27 days).
  2. 56% of under-5 child mortality in India is from neonatal mortality.
  3. Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy.
  4. India accounts for the maximum no. of maternal and neonatal deaths in the world.
  5. Literacy and social issues are major factors that have led to high maternal deaths.

India tops child deaths due to pneumonia and diarrhoea: study

The report stated that India accounts for one out of five child deaths due to the two diseases.

  1. India carries the highest burden of pneumonia and diarrhoea deaths in children, latest report of John Hopkins Bloomberg School of Public Health said.
  2. In 2015, a projected 2.97 lakh pneumonia and diarrhoea deaths are estimated in children aged less than five in country.
  3. Of the projected 5.9 million deaths of children (aged less than five) in 2015 across the world.
  4. Pneumonia was the top killer at 16 per cent, while diarrhoea came second at 9 per cent share globally.
  5. India had fallen short of the MDG targets of reducing under five-year-olds’ child mortality by two-thirds from 1990 till 2015.

What does JSY intend to do?

  1. Janani Suraksha Yojana was launched in 2005 to reduce Maternal Mortality rate and increase institutional deliveries.
  2. The scheme offers a cash assistance package starting from Rs 700 up to Rs 2,000 to women in rural areas and Rs 600 up to Rs 1000 in Urban areas.
  3. The special focus was on Low Performing States and Empowered Action Group States such as UP, Bihar, Rajasthan and MP.

Does increased spending mean improved maternal mortality?

  1. The Central government has spent Rs 12,330 crores under Janani Suraksha Yojana (JSY) in the last 10 years and 8,37,19,668 have availed the scheme since its inception.
  2. The scheme saw an increased spending of 20% between 2009-10 and 2014-15.
  3. Institutional Deliveries increased from 38.7% to 72.9% since the launch of JSY.
  4. Kerala, MH and TN have MMR of below 100 with Andhra Pradesh and WB likely to follow soon.
  5. Despite considerable dropdown in MMR, Empowered Action Group states along with Assam have a lot of ground to cover.
  6. Of the total JSY beneficiaries reported in 2014-15, nearly 87% belong to rural areas.

Nutrition bureau axed, anti-poverty schemes starved

The National Nutrition Monitoring Bureau (NNMB) has been shut down by the Union Health Ministry.

  1. Reason to shut down, as bureau was running in project mode and Government programmes that run in a project mode for this long are not sustainable.
  2. NNMB provides a good understanding of what people eat and what, therefore, can be culturally accepted nutritional interventions.
  3. NNMB plays a very important role in projecting data in terms of what people are eating.
  4. The data gathered by the NNMB informs the policy intervention to address under-nutrition.

National Nutrition Monitoring Bureau, has a mandate to generate data on the nutritional status of socially vulnerable groups, established in 1972 by Indian Council of Medical Research (ICMR).

RSBY failing to provide risk cover

An evaluation of the Rashtriya Swasthya Bima Yojana (RSBY) has concluded that the scheme had little or no impact on medical impoverishment in India.

  1. Despite high enrolment in RSBY, health expenditures have steadily increased for both in-patients and outpatients, over the last two decades.
  2. A major design flaw in RSBY is its narrow focus on secondary and tertiary care hospitalisation.
  3. The govt.-financed health insurance models are designed with the intention to address low-volume, high-value financial transactions.
  4. These health transactions could result in catastrophic expenditure and impoverishment of households.

WHO cautions against slashing health spending

Health sector ‘should not be seen as a black hole of expenditures’, says WHO director general Margaret Chan

  1. India is confronted with rising disease burden, worsening pollution and growing shortage of clean drinking water and sanitation.
  2. In this year’s Union budget, Rs.33,152 crore allocated for health and family welfare for fiscal 2016.
  3. India spends about 1.2% of its GDP on public health.
  4. It missed the United Nations Millennium Development Goals targets for infant mortality, under-five mortality and maternal mortality.
  5. Many of India’s health challenges are linked to the poor state of sanitation. It tops the world in open defecation.

India has the highest number of people living below poverty line of $1.6 per day, according to the World Bank.

Expert team conducts rapid assessment to declare India Yaws-free

  1. Yaws is a chronic infectious skin disease caused by treponema pallidum subspecies pertenue.
  2. It affects the skin, bone and cartilage and if left untreated, can lead to deformities of the nose and leg bones.
  3. In India the disease was eliminated in Sep, 2006, but field assessment are being conducted to ensure that it has been fully eradicated.
  4. This disease was found more in tribal pockets and hence, elimination has been one of the success stories for public health.

Blood banks can borrow blood units from one another

This decision is expected to sort out the issue of shortage.

  1. Union Ministry of Health & Family Welfare made a major modification in the National Blood Policy (NBP), 2002.
  2. The Ministry took this decision as part of reforms to the handling of blood units in the country.
  3. It will increase the availability of essential life saving medicines like immunoglobulins, human albumin and clotting factors which are all derived from plasma.
  4. Reduce the country’s dependence on import of these products.

National Blood Policy aims to ensure easily accessible and adequate supply of safe and quality blood and blood components procured from a voluntary non-remunerated blood donor in well equipped premises, which is stored and transported under optimum conditions.

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National Health Profile highlights poor doctor-patient ratio

The National Health Profile 2015 is prepared by the Central Bureau for Health Intelligence.

  1. The new official data shows, every govt. hospital serves an estimated 61,000 people in India, with one bed for every 1833 people.
  2. There is a steady increase in out-of-pocket private expenditure on health, with the cost of medicines and hospitalisation accounting for the largest share of the household expenditure.
  3. India spends less of its GDP on health than some of the world’s poorest countries.
  4. The Centre’s share of total public expenditure on health has fallen over the last two years.
  5. Non-communicable diseases are on the rise with cardiovascular diseases accounting for a quarter of deaths from non-communicable diseases and cancer accounting for 6%.

Health gives nod to use of injectable contraceptives

Deoxy medroxy progesterone acetate (DMPA) is an injectable drug that prevents pregnancy for three months.

  1. The Health Ministry has given in principle nod to the introduction of injectable contraceptives for women in the family planning programme.
  2. India should provide the option of DMPA in its family planning programme to widen the basket of contraceptive choices for women.
  3. DMPA has a female hormone that prevents the egg from being released from the ovary. It is injected into the arm or buttock muscle.

[Discuss] Health as a Fundamental Right

Should India make health a fundamental right? Impediments and Opportunities.


 

We go back to time and start the discussion with this –

The draft National Health Policy 2015 (NPH) released by the National Democratic Alliance (NDA) government on 31 December 2014 seems to have its heart in the right place.

The idea of making health a fundamental right is an old, comfortable, feel-good debate. So let’s consider its broad contours. The case in favour can be summed up as follows: the right to health is a natural corollary of the right to life and, therefore, denying someone healthcare is like denying a living human being the right to live out her natural life span.

What is the case against?

India celebrated 1st National Deworming Day

  1. The first national deworming day was celebrated on 10 Feb, 2015.
  2. Agency – Ministry of Health and Family Welfare.
  3. It aims to protect more than 24 crore children in the ages of 1-19 years from intestinal worms by providing Albendazole tablets.
  4. India is now targeting intestinal worms among the children to achieve the status of being “Worm-free”
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Questions (attempt in the comments section)

1

Analyse the finding of the first phase of the latest national family health survey (NFHS-4).

2

Briefly analyse the findings of NFHS-4 in the areas of maternal healthcare, fertility and family planning and child health.

3

The fourth round of the National Family Health Survey (NFHS) for 15 States has revealed worrying levels of stunting and lack of healthy weight among children in India. What measures need to be taken to address this problem? Critically discuss.







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