All you need to know about the Mental Healthcare Bill, 2016

  1. Aim: To provide provide for mental healthcare and services for persons with mental illness
  2. Also ensure these persons have the right to live a life with dignity by not being discriminated against or harassed
  3. Definition: The Bill defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life
  4. Also, mental conditions associated with the abuse of alcohol and drugs
  5. But does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence
  6. Rights of persons with mental disabilities: Every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government
  7. Assures free treatment for such persons if they are homeless or belong to
  8. Below Poverty Line, even if they do not possess a BPL card
  9. No discrimination: Every person with mental illness shall have a right to live with dignity and there shall be no discrimination on any basis including gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class or disability
  10. Confidentiality: A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare
  11. Privacy: The photograph or any other information pertaining to the person cannot be released to the media without the consent of the person with mental illness.
  12. Advance Directive: A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be
  13. The advance directive should be certified by a medical practitioner or registered with the Mental Health Board
  14. If a mental health professional/ relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive
  15. Mental Health Authority: The Bill empowers the government to set-up Central Mental Health Authority at national-level and State Mental Health Authority in every State
  16. Registration: Every mental health institute and mental health practitioners including clinical psychologists, mental health nurses and psychiatric social workers will have to be registered with this Authority
  17. These bodies will
    • register, supervise and maintain a register of all mental health establishments
    • develop quality and service provision norms for such establishments
    • maintain a register of mental health professionals
    • train law enforcement officials and mental health professionals on the provisions of the Act
    • receive complaints about deficiencies in provision of services
    • advise the government on matters relating to mental health
  18. A Mental Health Review Board: Will be constituted to protect the rights of persons with mental illness and manage advance directives
  19. Mental Health treatment: Specifies the process and procedure to be followed for admission, treatment and discharge of mentally-ill individuals
  20. No liability: A medical practitioner or a mental health professional shall not be held liable for any unforeseen consequences on following a valid advance directive
  21. No electro-convulsive therapy: A person with mental illness shall not be subjected to electro-convulsive therapy without the use of muscle relaxants and anaesthesia
  22. Also, electro-convulsive therapy will not be performed for minors
  23. Sterilisation: Will not be performed on such persons
  24. They shall not be chained in any manner or form whatsoever under any circumstances
  25. A person with mental illness shall not be subjected to seclusion or solitary confinement. Physical restraint may only be used, if necessary
  26. Suicide decriminalised: A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code
  27. Govt’s duty: The government shall have a duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of attempt to commit suicide

Note4students:

Salient provisions can be a part of prelims question or a mains question may come as provisions and assessment of the bill.

[pib] National Framework for Malaria Elimination

The National Framework for Malaria Elimination in India 2016-2030:

Aims:

  1. To eliminate malaria (zero indigenous cases) throughout the entire country by 2030
  2. Maintain malaria-free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria

Objectives:

  1. Eliminate malaria from all 26 States including 15 low (Category 1) and 11 moderate (Category 2) transmission States/Union Territories (UTs) by 2022
  2. Reduce the incidence of malaria to less than 1 case per 1000 population per year in all States and UTs and their districts by 2024
  3. Interrupt indigenous transmission of malaria throughout the entire country, including all 10 high transmission States and Union Territories (Category 3) by 2027
  4. Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status by 2030 and beyond

Note4Students:

An important PIB newscard for Prelims.

PIB

[pib] Filaria Control Programmes

  1. National Filaria Control Programme (NFCP)
  2. Was launched in 1955 & has operational, training and research components
  3. The strategies include:
    • Vector Control
    • Detection and treatment of filarial cases
    • Delimitation of endemic areas
  4. The programme has been integrated as ‘Elimination of Lymphatic Filariasis (ELF) Programme’ under the National Vector Borne Diseases Control Programme (NVBDCP)
  5. Under National Vector Borne Diseases Control Programme (NVBDCP), funds are integrated for all the vector borne diseases including ELF and released to States/Union Territories for prevention, control and elimination of these diseases
  6. National Health Policy (2002) has laid down the goal for elimination of Lymphatic Filariasis by 2015, which has now been revised to 2017, though global goal is 2020
  7. The strategy includes:
  • Annual Mass Drug Administration (MDA) of single dose of DEC (Diethylcarbamazine citrate) and Albendazole for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease
  • Home based management of lymphoedema cases and up-scaling of hydrocele operations in identified Community Health Centres (CHCs)/ District hospitals /medical colleges

Note4Students:

Important for Prelims and Mains both.

PIB

[op-ed snap] Framing the right prescription for health expenditure

Context:

  1. India spends close to 5% of its GDP on health
  2. This appears low when compared to 18% of the U.S., data show that Organisation for Economic Co-operation and Development (OECD) countries spend 8-11%, middle-income countries close to 6%, and India’s peers, the lower-middle-income countries 4.5%
  3. By these measures, India’s health-care spending, while still somewhat low, is not unusually so
  4. However, on an index measuring country performance on the health-related Sustainable Development Goal (SDG) indicators, India ranks poorly at 143 out of 188 countries

PPP measure:

  1. If we look in terms of Purchasing Power Parity (PPP), a measure that more accurately corresponds with our actual standard of living, India is the third largest economy in the world, at almost PPP $8 trillion
  2. Given the large size of our population, our 5% allocation to health translates to a mere $267 per individual, a number far lower than the OECD average of $4,698

Pooling of expenditure:

  1. India has among the lowest pooled expenditure for health care; between 2004-2014, approximately 4-7% of households fell below the poverty line as a result of high out-of-pocket expense
  2. Pre-payment and pooling of resources are critical to ensure financial protection against catastrophic health shocks
  3. The extent of pooling is determined by the government’s tax allocation to health and insurance coverage in the country
  4. India’s low tax to GDP ratio and allocations of around 5% of general government expenditure to health impact the total quantum of funds available
  5. Countries such as Thailand which have a comparable tax to GDP ratio have prioritised health within their budgets and allocate 13% of it to health care
  6. To increase pooled funds for health care, India needs to both provide a significantly higher level of allocation to health care in its annual Budgets, as in Thailand
  7. As well as extend schemes such as the Employees’ State Insurance Scheme (ESIS) — currently a mandatory insurance scheme only for low-wage earners in the formal sector in India — to all employees
  8. Gradually the informal sector, both in upper and lower income, can be included by making it mandatory for all residents to buy into national or state health insurance schemes as has been successfully done in Kyrgyzstan, China, and South Korea

Government control:

  1. Successful health systems, the world over, including entirely free market developed economies such as Germany, Switzerland, South Korea, and Japan, do not necessarily have the government as a provider
  2. Nevertheless, they all have a high degree of direct government control on the services that are offered- the pricing of health services, referral pathways, and treatment protocols that are followed
  3. Governments such as those of Japan and Switzerland exercise direct price controls on services like how much physicians and hospitals may charge
  4. Similar to the control in some mandated drug pricing, setting a price control on what hospitals and physicians may charge for their services, are critical elements that India may consider
  5. The other area could be instituting licensing processes for hospitals, similar to the Certificate of Need process in the U.S., which can help a regionally-equitable distribution of hospitals by incentivising the setting up of facilities in poorly served areas

The road ahead:

  1. Significant, strategic shifts in the level of control that the government exerts on both the financing and provision of health are urgently required
  2. India can build on learning from core design principles from global experiences, including prioritising resources for health within government budgets, pooling existing resources, and greater government control over the health sector
  3. It can also allow for a customised approach based on its context. Such a path will allow India to deliver on quality health care and equitable health outcomes to all of its people

Note4Students:

Read this op-ed for answer in Mains. You might be asked a question on heathcare, since this topic is very much in news these days.

[op-ed snap] Are injectable contraceptives advisable?

Context:

Different perspectives on injectable contraceptives are presented here:

Perspective 1:

  1. Instead of putting its efforts into improving the delivery of existing contraceptive methods, the government has recently chosen to introduce the injectable contraceptive, depot medroxyprogesterone acetate (DMPA), which is known to have adverse effects on women’s health
  2. The articulation of population as a ‘problem’ or talking in terms of a ‘population explosion’ is deeply problematic, for it brings with it the spectre of ‘control’ and eventually, in a country like ours, control over women’s body and fertility
  3. Countries that have achieved lower fertility rates have done so due to economic and social development and improvements in public services, including health services
  4. Simply put, if a family is convinced that their one child or two children will not only survive but be healthy, they won’t have more children
  5. Women, even rural women, today want fewer children
  6. However, they are forced to have more children due to several reasons that range from economic compulsions, lack of negotiating power within the family, to limited access to health services including contraceptive services
  7. Women’s groups and various health groups have been cautioning the government for decades against introducing injectable contraceptives in the public health system
  8. Case against injectables:
  • First, there are concerns regarding the preparedness of the government health system to implement this contraceptive method
  • DMPA may be easy to administer, but health workers need to be capable of assessment before administering it and of managing side effects that some women may experience
  • DMPA requires administration once every three months
  • The Government of India guidelines on the injectable contraceptive mention side effects like menstrual changes, irregular bleeding, prolonged/heavy bleeding, amenorrhea (stopping of menstruation), weight gain, headaches, changes in mood or sex drive, and decrease in bone mineral density
  • Moreover, studies from Africa have shown that the risk of HIV infection may increase for women who have been administered injectable contraceptives
  • Second, the government needs to introspect whether existing methods have been made available to people through informed choice, in a safe manner
  • Regular stock-outs of oral contraceptives and condoms, lack of training to the auxiliary nurse midwife or ANMs on intrauterine contraceptive devices (IUCDs), instances of lack of informed consent for post-partum IUCD, and the rampant violation of the guidelines for sterilisation, which in 2014 led to the deaths of 13 women, all reflect gaps in implementing and monitoring such programmes
  • It is strange that while the existing contraceptive methods are not being provided properly, the government has gone on to introduce a method that raises so many questions and may prove to be more complicated in its implementation
  • Why didn’t the government put all its efforts into promoting male vasectomy, for instance, which is a safer option and less of a problem for women?
  • By introducing DMPA in the public health programme, the government also has to answer whose interests are actually being served. There are serious concerns that some agencies are pushing this for profit
  • Experience from the private sector, where these contraceptives had been made available previously, shows that very few women had opted for injectable contraceptives

 

Perspective 2:

  1. The Health Ministry is in the process of introducing injectable contraceptives in the National Family Planning Programme (NFPP), with the aim to expand the basket of choices available to women
  2. Introducing modern methods of family planning is a major part of the reproductive, maternal, newborn, child, and adolescent health (RMNCH+A) strategy to improve maternal and infant health indicators, with a special focus on delaying the first birth and the spacing between births
  3. Including injectable contraceptives in the NFPP will ensure access to preferred contraceptive methods for women
  4. Every new programme has to go through a cycle of proper training and capacity-building
  5. Under RMNCH+A, government is trying to ensure that Indian women make an informed choice when they pick a type of family planning or spacing method
  6. Health Ministry is taking quality assurance seriously and is in the process of doing away with the camp approach and in is progressing in a phased manner
  7. It is being ensured that there is information provided to the couple on all the contraceptives available in the basket of choices
  8. Nobody can force this on women in this country, coercion is against the law and the programme is not target-driven
  9. Injectable contraceptives are just an option
  10. The ministry is trying to change the fact that female sterilisation remains the more popular choice, accounting for over 75% of contraceptive use in India. It disempowers them
  11. Sterilisation should be the last choice
  12. As far as the debate around the side effects of the injections is concerned, this drug has been rigorously vetted
  13. The World Health Organisation and most professional bodies have advocated its use
  14. The programme focuses on telling women about all the choices she has available, depending on her situation
  15. There has been concern about the effect of an injectable contraceptive on bone density and it has to be categorically stated that the bone marrow density is reversible
  16. Global data show that the average number of doses a woman takes is around two to four at a stretch, which is sufficient for her to space her next birth, thereby giving her time to recover from the stress of childbirth and a chance for the child to get the attention she needs to grow
  17. The Ministry will introduce the drug in a phased manner and only make injectable contraceptives available when there is capacity to deliver counselling at the health facility
  18. Further, the Ministry is painfully aware that male participation needs to increase and a programme specifically designed to increase male participation

Note4Students:

The op-ed gives two perspectives of using injectable contraceptives and. Broadly, the debate is important for Mains. Remember the name of the drug for Prelims.

[pib] Cancer Treatment for Economically Weaker Section

Some of the steps taken by Central Government are as follows:

  1. The treatment of Cancer in many of State and Centre Government institutions is free for BPL patients and subsidized for others
  2. Implementation of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) upto district hospital level
  3. Further, the guidelines for population level screening of common cancer viz. Cervix, Breast and Oral have been released to the State Governments for implementation
  4. To enhance the facilities for tertiary care of cancer, the Central Government is implementing a Tertiary Care Cancer Centre Scheme to support the setting up of State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country
  5. Supporting Cancer care under new AIIMS and State Government Medical Colleges being upgraded under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY)
  6. The Government is providing financial assistance to patients living below poverty line for life threatening diseases under the schemes such as Rashtriya Arogya Nidhi (RAN), Health Minister’s Cancer Patient Fund (HMCPF), State Illness Assistance Fund (SIAF) and Health Minister’s Discretionary Grant (HMDG)
  7. Affordable Medicines and Reliable Implants for Treatment (AMRIT) outlets have been opened at 41 Institutions/Hospitals with an objective to make available Cancer and Cardiovascular Diseases drugs and implants at discounted prices to the patients
  8. Jan Aushadhi stores are set up by Department of Pharmaceuticals to provide generic drugs at affordable prices

Note4Students:

Information here can be used as points in a Mains answer

PIB

Tamil Nadu model drastically reduces response time in heart attack care

  1. A unique model of heart attack care has brought down the time taken respond to cardiac episodes from 900 minutes to 170 minutes in Tamil Nadu
  2. The landmark study, reduces the symptom-to-door time by effective, early and rapid reperfusion — restoring blood flow through blocked arteries, typical after a heart attack
  3. Primary PCI: Traditionally, a heart attack is treated by two strategies of re-perfusion
  4. If a patient arrives at a hospital equipped with a catheterisation laboratory or ‘cath lab’, a procedure known as Primary PCI is performed — an urgent balloon angioplasty
  5. The patient is then ‘Thrombolysed’ — treated to dissolve clots in blood vessels, improve blood flow, and prevent damage to tissues and organs before being discharged
  6. The new STEMI India model uses the pharmaco invasive strategy, which can be administered in any small hospital or even in the ambulance
  7. STEMI India: A not-for-profit organisation
  8. Need of new model: Any heart attack treatment programme should consider the huge manpower and infrastructure deficiencies that exist in India
  9. Blindly following the American or European system would not be feasible in this country
  10. The Classic STEMI India model has a hub hospital, where a cath lab is available and primary PCI is done for patients directly presented at these hospitals
  11. These are linked to peripheral spoke hospitals, where thrombolysis is done following which the patient is shifted within three to 24 hours to the hub hospital for invasive treatment

Note4students:

The details of medical procedures are not important but note the points why the new model is needed in India.

[op-ed snap] You Pay More, You Get More

Context:

  1. Recently, the finance ministry has asked the All India Institute of Medical Sciences, New Delhi, to review its user charges
  2. AIIMS should review money charged from patients for OPD registration, lab tests, room and bed rentals, etc.
  3. The user charges at AIIMS were last reviewed 20 years ago and since then, its expenditure has grown manifolds
  4. Therefore, it was essential to revise these charges — a clear indicator that revision implied an imminent increase in charges

How will this effect?

  1. This recommendation stands to affect millions of poor Indians who look towards AIIMS as a last resort
  2. Unfortunately, the model of development such measures promote is far from people-centric

A welfare step?

  1. In recent times, successive elected governments have acted more in favour of private players than in the interest of public enterprises
  2. We have seen this “corporate connivance” of the state in many sectors, including education, roadways, telecom, even in health
  3. The move is against welfare economics and should worry us as much as the proposed opening up of a separate registration counter at the AIIMS for “VIP” patients
  4. The counter for VIP patients had to be scrapped in face of faculty opposition

Delivering health care:

  1. In the absence of a universal, institutional arrangement to pay for patients’ health needs (medical insurance, for example), low charges are the only respite for the poor
  2. For an average Indian, it is not easy to reach a healthcare delivery point, more so in rural hinterlands
  3. Besides quality, accessibility and affordability of healthcare, biases of gender, caste, illiteracy and economic deficiency play a pivotal role in healthcare delivery
  4. Despite free treatment at government hospitals, more than 75% of healthcare in India is through private players

Steps needed:

  1. It is essential for policymakers to consider that those who do make it to a government healthcare provider are either exempted or minimally charged
  2. This will facilitate the flow of patients to a government healthcare set-up like the AIIMS and will hopefully be a factor in reducing the patient “leak” into expensive private set-ups
  3. An elected government should promote its services (at least concerning health and education) among those who have elected it to power
  4. This opens up government systems to critical appraisal, which in turn will lead to the betterment of these services
  5. The propagandists of increasing user charges make a simple argument: You pay more, you get more. The issue is not so simple.

Increased charges:

  1. Studies from India have shown that increasing user charges within the government healthcare set-up has reduced the utilisation of the health services at least two-fold
  2. From amongst all government healthcare set-ups in the country, the AIIMS enjoys the most stocky budget and an increase in user charges will only add a minuscule amount of profit while taking away a significant chunk of patients
  3. This is no less than actual denial of tertiary, world-class healthcare services to the masses
  4. Before levying higher user charges, the government should audit the utilisation of resources (and money) to large hospitals like the AIIMS
  5. It is possible that the amount unutilised might be equal to, or less than, the user charges it proposes to impose

Humanity:

  1. A more humane approach would be to further reduce/exempt user charges as has been shown in a number of studies from low and middle-income countries
  2. Cutting subsidies to private enterprises like health insurers could be a way of preventing the extra burden on the end user
  3. An actual increase in the annual health budget by the government will go a long way in preventing the burden of charges to be passed on to its citizens

Note4Students:

Note down the points for Mains answer.

[pib] Initiatives under the Family Planning Programme

New interventions under Family Planning:

  1. Mission Parivar Vikas: for substantially increasing the access to contraceptives and family planning services in the high fertility districts of seven high focus states (Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam) with TFR of 3 and above
  2. New Contraceptive Choices: The current basket of choice has been expanded to include the new contraceptives viz. Injectable contraceptive, Centchroman and Progrsterone Only Pills (POP)
  3. Redesigned Contraceptive Packaging: The packaging for Condoms, OCPs and ECPs has now been improved and redesigned so as to influence the demand for these commodities
  4. New Family Planning Media Campaign: A 360 degree media campaign has been launched to generate contraceptive demand
  5. Enhanced Compensation Scheme for Sterilization: The sterilization compensation scheme has been enhanced in 11 high focus states (8 EAG, Assam, Gujarat, Haryana)
  6. A new IUCD (Cu 375) with 5 years effectivity has been introduced in the programme as an alternative to the exiting IUCD (Cu 380A with effectivity of 10 years)
  7. Scheme for Home delivery of contraceptives by ASHAs at doorstep of beneficiaries

Scheme for ASHAs to ensure spacing in births:

  1. Under the scheme, services of ASHAs are being utilized for counselling newly married couples to ensure delay of 2 years in birth after marriage and couples with 1 child to have spacing of 3 years after the birth of 1st child

Celebration of World Population Day & fortnight (July 11 – July 24):

  1. The World Population Day celebration is a step to boost Family Planning efforts all over the country
  2. The event is observed over a month long period, split into an initial fortnight of mobilization/sensitization followed by a fortnight of assured family planning service delivery

On-going Interventions under Family Planning Programme:

  1. Increasing male participation and promotion of ‘Non Scalpel Vasectomy’’
  2. Operating the ‘National Family Planning Indemnity Scheme’ (NFPIS) under which clients are insured in the eventualities of deaths, complications and failures following sterilization and the providers/ accredited institutions are indemnified against litigations in those eventualities
  3. Accreditation of more private/ NGO facilities to increase the provider base for family planning services under PPP
  4. Improving contraceptives supply management up to peripheral facilities

Strategies adopted by Jansakhya Sthirta Kosh/National Population Stabilization Fund for Population Control:

  1. Prerna Strategy: for helping to push up the age of marriage of girls and delay in first child and spacing in second child birth in the interest of health of young mothers and infants. The couple who adopt this strategy awarded suitably. This helps to change the mindsets of the community
  2. Santushti Strategy: invites private sector gynaecologists and vasectomy surgeons to conduct sterilization operations in Public Private Partnership mode. The private hospitals/nursing home who achieved target of 10 or more are suitably awarded as per strategy

NPTEL:

  1. National Programme on Technology Enhanced Learning (NPTEL), is an initiative by seven Indian Institutes of Technology (IIT Bombay, Delhi, Guwahati, Kanpur, Kharagpur, Madras and Roorkee) and Indian institute of science (IISC) for creating course contents in engineering and science
  2. Challenges of Rapid Population Growth in India among others are:
  • Providing employment to growing population
  • Problem of utilisation of manpower
  • Over-strained infrastructure
  • Pressure on land and other renewable natural resources
  • Increased cost of production
  • Inequitable distribution of income

Note4Students:

Important for prelims an mains both.

PIB

Remove the words ‘as far as possible’ from HIV Bill: patients

  1. News: Members of the People Living with HIV group protested demanding the deletion of the term ‘as far as possible’ from the HIV/AIDS (Prevention and Control) Bill
  2. Background: The crucial public health legislation, aimed to guarantee rights to India’s 2.4 million strong HIV community, was approved by the Cabinet in October
  3. However, it was immediately rejected by the HIV networks, as the phrase ‘as far as possible’ left it entirely open to interpretation
  4. Since 2006, when the Bill was drafted, India’s People Living with HIV (PLHIV) community has been demanding right to complete treatment
  5. The current bill protects the community from bias
  6. But the bone of contention is Section 14 (1) which asks State governments to provide Anti Retroviral Treatment (ART) and diagnostics services for Opportunistic Infections like tuberculosis for free, as far as possible
  7. Criticism: The government’s constant refusal to delete the phrase ‘as far as possible’ from the chapter of treatment shows their lack of commitment towards the lives of HIV positive people
  8. This Bill without free and complete treatment is merely a piece of paper

Note4students:

Note the issue for both prelims and mains.

Global fund to help solve India’s HIV drug crisis

  1. Context: Shortage of the child-friendly HIV syrup, Lopinavir
  2. India is likely to procure the drug from a rapid supply facility routed through the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), a multilateral donor agency

Note4students:

In continuation of a recent news of the drug’s manufacturing being stopped due to un-cleared bills by govt.

India runs out of life-saving HIV drug for children

  1. News: Desperate over withdrawal of a life saving drug, children living with HIV (CLHIV) have written to Prime Minister Narendra Modi for help
  2. The letter: The pharmaceutical company Cipla has in various forums cited delay in payments by the national programme for the HIV medicines by several years and even non-payment of its dues in many cases
  3. Profits on child doses of HIV medicines are small and delayed payments are having a chilling effect on the ability of the National AIDS Control Organisation (NACO) to convince the company to participate in the bids it invited annually
  4. Mfg stopped: Stocks of Lopinavir syrup — a child friendly HIV drug — ran out after Cipla, the sole manufacturer of the drug, stopped manufacturing it
  5. Why? Over the issue of non-payment from the Health Ministry
  6. Cipla is the dominant player in the Indian market across the HIV segment and has not stopped participating in government tenders after the Health Ministry failed to pay Cipla for consignments sent in 2014
  7. Emergency tender: Faced with a crisis, the Health Ministry has instructed State AIDS Control Societies (SACS) to purchase from local markets
  8. However, since the syrup has gone out of production, they are not available in retail markets

Note4students:

Know about the name of the drug for prelims. The issue as a whole is important for mains. The drug stock out issue has happened earlier too.

West Bengal passes Bill to rein in private hospitals

  1. Context: The West Bengal Assembly passed The West Bengal Clinical Establishments (Registration, Regulation and Transparency Bill) Bill 2017
  2. Aim: Overhauling private healthcare and taking stringent measures against health institutions indulging in medical negligence and corrupt practices
  3. It repealed The West Bengal Clinical Establishment (Regulation) Act, 2010 passed by the Left Front government
  4. The law aims at bringing transparency, ending harassment of patients and checking medical negligence in private hospitals and nursing homes
  5. The law also covers clinics, dispensaries and polyclinics

Note4students:

Few such important legislations and schemes by state govt’s are also necessary to be read for prep. It can be a prelims question as to what state recently took this measure or can be quoted in mains as an example that can be replicated elsewhere.

[op-ed snap] Chewing the cud

Context:

  1. The majority of India’s population resides in rural areas making the uplift of the rural sector extremely important for the development of the nation
  2. To bridge the divide between urban and rural India, rural development has been the focus of various government schemes and policies since Independence
  3. The cow-based rural economy and the use of five key products from cow called Panchgavya- milk, curd, ghee, dung and urine- is a part of daily life in the Subcontinent
  4. The use of Panchgavya in food, medicine, agriculture, etc. is already in practice in various parts of rural India

Cow products:

  1. Cow milk has a prominent place in the diet of people, from an infant to an elderly person
  2. Worldwide, substantial research has been done highlighting the medicinal significance of A2 milk produced by indigenous cows, which prevents disorders like obesity, arthritis, type 1 diabetes among children, autism,
  3. Curd and buttermilk have been found useful in many gastrointestinal disorders and are recommended as a food practice in Ayurveda
  4. Similarly, ghee from indigenous cows has been used since time immemorial for its benefits
  5. This makes milk, curd and ghee an integral part of the food system but their properties are yet to be subjected to technical validation

Health issues:

  1. Due to lifestyle disorders and synthetic food, the health of people is a grave concern nowadays
  2. Globally, scientists are facing the challenge of multiple drug resistance in micro-organisms, presence of antibiotic residues in the food chain, associated allergies, etc.
  3. It is been scientifically proven that most of the modern-day systems use antibiotics and steroids, leading to weakening of innate immune-efficiency
  4. A WHO report mentions antibiotics will become almost ineffective over the next two decades

Alternative to antibiotics:

  1. In the light of this, research into sustainable alternatives is being carried out globally
  2. Two US patents on cow urine (No. 6,896,907 and 6,410,059) have been granted for its medicinal properties, particularly as a bioenhancer and as an antibiotic, antifungal and anticancer agent
  3. These milestones highlight the potential role of cow urine in treatment of bacterial infections and cancer, and demonstrate that cow urine can enhance the efficacy and potency of other drugs

Agro-chemicals:

  1. A lot of work has been done on hazardous agro-chemicals being used in agriculture and affecting the food-supply chain
  2. The world is now shifting towards organic agriculture
  3. Improving soil fertility through microflora from Panchgavya products has been practiced for many years
  4. The three strains – Bacillus lentimorbus NBRI0725, B. subtilis NBRI1205, and B. lentimorbus NBRI3009 — isolated from Sahiwal cow milk have the ability to control phytopathogenic fungi and promote plant growth under field conditions, increase tolerance for abiotic stresses and solubilise phosphate under abiotic stress conditions
  5. Research has also found that screening of bacterial strains isolated from milk under in-vitro conditions possesses the ability to suppress various plant pathogenic fungi

Cow dung:

  1. It is traditionally believed that cow dung has antiseptic, anti-radioactive and anti-thermal properties
  2. Only about 40% of the dung from cows is used as fuel in rural areas
  3. The quantity of dung used annually in the existing 2.7 million family type biogas plants is estimated to be 22 tonnes
  4. Traditionally, cow-dung cakes are used for food preparation and while burning these cakes, the temperature never rises beyond a certain point; ensuring overheating does not destroy the nutrients in the food
  5. The use of cow-dung in biogas as a non-fossil fuel is being considered for vehicles and cooking

Ongoing Research:

  1. The Centre for Rural Development and Technology (CRDT) at IIT-Delhi is a nodal centre for rural development for the last 37 years to take the benefits of scientific research to rural areas
  2. Through a national workshop and subsequent consultations with key national experts, the team at IIT Delhi identified five key topics of research: uniqueness of indigenous cows, Panchgavya in agriculture, medicine and health, food and nutrition and for utilities

Note4Students:

The central idea is to upgrade the valuable, technically validated knowledge from the sphere of “traditional knowledge” and put them in synchronisation with mainstream scientific discourse. The op-ed should be read in the light of bring villages and rural, traditional practices to the mainstream and benefitting from rural economy.

[op-ed snap] The right to choice

Context:

  1. The Supreme Court declined a woman’s plea to abort her 26-week-old foetus detected with Down’s Syndrome
  2. Senior advocate Colin Gonsalves argued that it was the woman’s constitutional right to terminate her pregnancy
  3. It was contended that the congenital abnormality found in her foetus and the woman’s anguish about the future were the reasons for her decision

Why did Court decline the woman’s plea?

  1. The court refused permission for abortion, calling the foetus “a life”
  2. It said the Medical Termination of Pregnancy Act of 1971 places a 20-week ceiling on termination of pregnancy

A special case:

  1. This case is different from the ones that have preceded it
  2. In January, the same Bench of Justices S.A. Bobde and L. Nageswara Rao had relaxed the 20-week cap to permit another woman to terminate her 24-week pregnancy
  3. The foetus in that case was diagnosed with anencephaly — a congenital defect in which the baby is born without parts of the brain and skull
  4. The court had said abortion was necessary to preserve the woman’s life
  5. In the case of the foetus with Down’s Syndrome, the court said the foetus posed no danger to the woman’s life

Medical Termination of Pregnancy (Amendment) Bill of 2014:

  1. Had the draft Medical Termination of Pregnancy (Amendment) Bill of 2014 been implemented as law, this case would not have come to court at all
  2. The Bill amends Section 3 of the principle Act of 1971 to provide that “the length of pregnancy shall not apply” in a decision to abort a foetus diagnosed with “substantial foetal abnormalities as may be prescribed”
  3. Besides increasing the legal limit for abortion from 20 weeks to 24 weeks, the draft Bill allows a woman to take an independent decision in consultation with a registered health-care provider
  4. Under the 1971 Act, even pregnant rape victims cannot abort after 20 weeks, compelling them to move court
  5. With the 2014 Bill in limbo, the Supreme Court has agreed to look into whether a wider interpretation ought to be given to phrases like “risk to the life of the pregnant woman” and “grave injury to her physical and mental health”
  6. Legal experts have argued that medical science and technology have made the 20-week ceiling redundant and that conclusive determination of foetal abnormality is possible in most cases after the 20th week of gestational age

At least 3% of the 26 million births annually in India involve severe foetal abnormalities. They receive no proper medication, because the medical science hardly provides any. Besides, neither the new born, nor the parents are given any support to lead an easier life. Under such circumstances the Court should relax abortion laws.

Note4Students:

Important for pre and mains both. Pre can ask salient provisions and mains may ask critical analysis of provisions with suggestions to improve.

Supreme Court ‘no’ to plea to abort foetus with disorder

  1. The Supreme Court refused a woman’s request for permission to abort her 26-week-old foetus detected with Down’s Syndrome, a genetic disorder
  2. The woman had sought an exemption under the Medical Termination of Pregnancy Act of 1971
  3. The Act bars abortion if the foetus has crossed the 20-week mark
  4. An exception to the law is made if a registered medical practitioner certifies to a court that the continued pregnancy is life-threatening for either the mother or the baby
  5. However, SC declined the woman’s plea saying Down’s Syndrome does not qualify as a life-threatening factor
  6. There is no physical risk to the mother from the pregnancy

Note4students:

Not directly important but a case on similar issue had come up where SC allowed a rape victim to abort even after 20 weeks. This is just to follow up on the development on the issue. Know about the 20 week provision in the Act for prelims.

Why India needs the rubella vaccine?

  1. India has set an ambitious target of eliminating measles and controlling congenital rubella syndrome (CRS), caused by the rubella virus, by 2020
  2. India has already eliminated polio six years ago and maternal and neonatal tetanus and yaws in 2016
  3. While two doses of measles vaccine given at 9-12 months and 16-24 months have already been part of the national immunisation programme, it is the first time that the rubella vaccine has been included in the programme
  4. Since the rubella vaccine will piggy-back on the measles elimination programme, there will be very little additional cost
  5. WHO: A single dose of rubella vaccine gives more than 95% long-lasting immunity
  6. All children aged nine months and 15 years will be administered a single dose of the combination vaccine
  7. Measles: Is highly infectious and is one of the major childhood killer diseases
  8. Of the 1,34,000 measles deaths globally in 2015, an estimated 47,000 occurred in India
  9. The introduction of the second dose of the measles vaccine and an increase in vaccine coverage have led to a sharp decline in deaths in India — from an estimated 1,00,000 deaths in 2010 to 47,000 in 2015
  10. Rubella: Unlike measles, rubella is a mild viral infection that mainly occurs in children
  11. But a woman infected with the rubella virus during the early stage of pregnancy has a 90% chance of transmitting it to the foetus
  12. The virus can cause hearing impairments, eye and heart defects and brain damage in newborns, and even spontaneous abortion and foetal deaths
  13. Of the 1,10,000 children born with CRS every year globally, an estimated 40,000 cases occur in India alone

Why opt for a campaign?

  1. With the target set for 2020 to eliminate measles and control CRS, there is a compelling need to create a solid wall of immunity in all children up to 15 years in one go at the earliest
  2. That can be achieved only if immunisation is carried out in a campaign mode by targeting 410 million children nationwide within 18 months

Phased campaign

  1. Since the Pune-based Serum Institute of India is the only manufacturer of the vaccine, the measles-rubella vaccination campaign is being introduced in phases
  2. Karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep are covered in the first phase
  3. The entire country will be covered in four phases in 18 months
    Following the campaign, two doses of the combination vaccine will become a part of the national immunisation programme
  4. All children will receive the vaccine free at 9-12 months and 16-24 months of age

Is it possible to achieve the goal by 2020?

  1. According to Dr. Jacob John, co-chairman of the India Expert Advisory Group for measles and rubella, it is eminently doable
  2. Though the goal is only to eliminate measles and control rubella by 2020, both viruses can be eliminated if their transmission can be broken
  3. For that to happen, the vaccine coverage has to be over 95% during the campaign and in the immunisation programme that follows it
  4. Now the measles vaccine coverage for the first dose is about 87% and 70% for the second dose
  5. Under the routine immunisation programme, the reach of the first dose of the measles vaccine shot up from 56% in 2000 to 87% in 2015
  6. Furthermore, India has to ramp up surveillance of both diseases, maintain outbreak preparedness, respond rapidly to outbreaks by vaccinating all children in a community and ensure effective and timely treatment of cases anywhere in the country

According to the WHO, elimination of measles will help to achieve Sustainable Development Goal’s target 3.2, which aims to end preventable deaths of children under 5 years by 2030

Note4students:

Very important info for mains. Also the campaign, feasibility, way forward points mentioned are important for a mains answer. The numbers and too many details need not be remembered though.

[op-ed snap] Ageing with dignity

Context:

  1. India’s celebrated demographic dividend has for decades underpinned its rapid economic progress
  2. A countervailing force may offset some of the gains from having a relatively young population: rapid ageing at the top end of the scale

Cause of concern:

  1. This is a cause of deep concern for policymakers as India already has the world’s second largest population of the elderly, defined as those above 60 years of age
  2. This 104-million-strong cohort continues to expand at an accelerating pace, it will generate enormous socio-economic pressures as the demand for healthcare services and tailored accommodation spikes to historically unprecedented levels
  3. It is projected that approximately 20% of Indians will be elderly by 2050, marking a dramatic jump from the current 6%

Health and social care:

  1. However, thus far, efforts to develop a regime of health and social care that is attuned to the shifting needs of the population have been insufficient
  2. More mature economies have created multiple models for elder care, such as universal or widely accessible health insurance, networks of nursing homes, and palliative care specialisations, it is hard to find such systemic developments in India
  3. Experts also caution that as the proportional size of the elderly population expands, there is likely to be a shift in the disease patterns from communicable to non-communicable, which itself calls for re-gearing the health-care system toward “preventive, promotive, curative and rehabilitative aspects of health”
  4. Advocacy and information campaigns may be necessary to redirect social attitudes toward ageing, which often do not help the elderly enjoy a life of stability and dignity

Realities of ageing:

  1. The ground realities faced by the elderly include abandonment by their families, destitution and homelessness, inability to access quality health care, low levels of institutional support, and the loneliness and depression associated with separation from their families
  2. On the one hand, the traditional arrangements for the elderly in an Indian family revolve around care provided by their children
  3. According to the National Sample Survey Organisation’s 2004 survey, nearly 3% of persons aged above 60 lived alone
  4. The number of elderly living with their spouses was only 9.3%, and those living with their children accounted for 35.6%
  5. Many among the younger generation within the workforce are left with less time, energy and willingness to care for their parents, or simply emigrate abroad and are unable to do so, senior citizens are increasingly having to turn to other arrangements
  6. In the private sector, an estimated demand for 300,000 senior housing units, valued at over $1 billion, has led to a variety of retirement communities emerging across the country, in addition to innovations in healthcare delivery for this group
  7. Yet the poor among the elderly still very much depend on the government to think creatively and come up with the resources and institutions to support their needs

Note4Students:

The ageing population is indeed a concern for the society. The topic is important for Mains, where you might be asked to give suggestions on improving the condition of ageing population and socio-economic changes that need to be brought in the country for them.

[op-ed snap] Necessary limit

Context:

  1. Capping the prices of medical stents, which are used to treat coronary artery disease, by the National Pharmaceutical Pricing Authority (NPPA)
  2. It is an extreme regulatory measure necessitated by the market failure that afflicts the overall delivery of health care in India

Importance of this step:

  1. Rising costs have led to impoverishment of families and litigation demanding regulation
  2. Given the overall dominance of private, commercial, for-profit health institutions, and the asymmetry confronting citizens, correctives to bring about a balance are inevitable
  3. Two important pointers to the need for cost regulation are available from research published in The Lancet in December 2015:
  • Nearly two-thirds of the high out-of-pocket expenditure on health incurred by Indians went towards drugs;
  • Even the meagre research data available showed that there was irrational use of medical technologies, including cardiac stents and knee implants
  1. Regulated prices can, therefore, be expected to make stents more accessible to patients who really need them, helping them avoid using up the weak insurance cover available
  2. It will also reduce the incentive for unethical hospitals to use them needlessly

Importance of stents:

  1. There are over 60 million diagnosed diabetics in the country
  2. And the average age at which the first heart attack strikes Indians is 50, a decade earlier than people in developed nations
  3. At appropriate prices, and with a health system that pools the cost among all citizens, it would be possible to provide access to stents and other treatments for all

Market-determined pricing:

  1. Health-care providers often demand market-determined pricing of medical technologies on the ground that newer ones will not be available under a regulated regime
  2. In the case of cardiac stents, this argument does not hold water since stakeholder consultations held by the NPPA in January revealed that there are ‘huge unethical markups’ in the supply chain
  3. It would serve the cause of medical innovation if costing is transparent, and a system of risk pooling is introduced to help patients get expensive treatment without high out-of-pocket spending

Improving access to medicines:

  1. It was estimated five years ago by the Planning Commission’s expert group on universal health coverage that raising spending on public procurement of medicines to 0.5% of GDP (from 0.1%) would provide all essential medicines to everyone
  2. What is necessary, is, a two-pronged approach to improve access to medicines and technology
  3. The Centre should monitor expenditures jointly in partnership with the community, use regulation where needed, and raise public spending on health
  4. Well-considered price control is a positive step, but more needs to be done
  5. The latest measure provides an opportunity to expand the availability of stents, and by extension angioplasty procedures, in the public health system
  6. District hospitals should offer cardiac treatments uniformly. This should be a priority programme to be completed in not more than five years

Note4Students:

The op-ed is important for question on healthcare in Mains.

Hope for young cancer patients

  1. A unique Donate a Life fund with the current corpus of ₹2.13 crore, is maintained with contributions from philanthropists, trusts, donors and some private companies
  2. The fund is the brainchild of doctors at the Bhagwan Mahaveer Cancer Hospital
  3. The hospital was grappling with a large number of patients who were unable to bear the cost of expensive cancer treatment
  4. The entire cost of treatment, including medicines, investigation, bed, nursing and doctors’ consultation, is borne by it
  5. The fund’s beneficiaries are children below 14 years suffering from three types of curable blood cancers – acute lymphoblastic leukaemia low risk, acute promylocytic leukaemia and Hodgkin’s lymphoma

Note4students:

Can be a prelims tit-bit, Just know the name and purpose of the fund.

Govt.’s target to root out TB by 2025 unachievable, say doctors

  1. Issue: The government’s plan to eradicate tuberculosis by 2025 seems an unachievable target
  2. This is especially at a time when India is battling a crisis of antibiotic resistance and a few drugs in the pipeline
  3. The mention of TB in Budget has come as a welcome move, but experts say the government will have to look at various initiatives rather than simply focusing on antibiotics
  4. Fact check: An estimated 2.8 million people suffer from TB, which is 217 per one lakh population
  5. A significant number of them are drug resistant mainly due to late diagnosis or a haphazard medication course
  6. The problem is we are focusing on antibiotics which are very limited now
  7. We need to focus on the preventive habits such as coughing, sneezing etiquettes which should be engraved from childhood
  8. A TB patient releases 3,000 to 5,000 TB bacilli in one cough. If we ignore these basics, the TB war is going to be a huge failure

Note4students:

Remember the target and the obstacles that stand in its way for mains answer.

[pib] What is single vaccine for dual protection?

  1. What: The Ministry of Health and Family Welfare launched Measles Rubella (MR) vaccination campaign
  2. Where: The campaign against these two diseases will start from five States/UTs (Karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep) covering nearly 3.6 crore target children
  3. How: Following the campaign, Measles-Rubella vaccine will be introduced in routine immunization, replacing the currently given two doses of measles vaccine, at 9-12 months and 16-24 months of age
  4. All children aged between 9 months and less than 15 years will be given a single shot of Measles-Rubella (MR) vaccination irrespective of their previous measles/rubella vaccination status or measles/rubella disease status
  5. MR vaccine will be provided free- of- cost across the states from session sites at schools as well as health facilities and outreach session sites
  6. Measles vaccine is currently provided under Universal Immunization Programme (UIP). However, rubella vaccine will be a new addition
  7. Measles immunization directly contributes to the reduction of under-five child mortality, and with combination of rubella vaccine, will control rubella and prevent CRS in country population

Note4Students:

The information is important for Prelims and may also be used as a point in the Mains answer. Also focus the bold key points.

Back2Basics:

Measles:

  1. Measles is a deadly disease and one of the important causes of death in children
  2. It is highly contagious and spreads through coughing and sneezing of an infected person
  3. Measles can make a child vulnerable to life threatening complications such as pneumonia, diarrhoea and brain infection

Rubella:

  1. Rubella is generally a mild infection, but has serious consequences if infection occurs in pregnant women, causing congenital rubella syndrome (CRS), which is a cause of public health concern
  2. CRS is characterized by congenital anomalies in the foetus and newborns affecting the eyes (glaucoma, cataract), ears (hearing loss), brain (microcephaly, mental retardation) and heart defects, causing a huge socio-economic burden on the families in particular and society in general
  3. Through implementation of rubella vaccination strategies the incidence of rubella has been substantially reduced in many countries
PIB

[op-ed snap] Targeting old scourges

Context:

  1. Reference in the Union Budget to new elimination targets for some major communicable diseases
  2. It barely hints at the enormous burden carried by millions in India with tuberculosis, kala-azar (leishmaniasis), filariasis, leprosy and measles
  3. It would appear incongruous that an emerging economy with no timetable for universal health coverage and a lack of political will to loosen its purse strings for higher government expenditure has set ambitious deadlines to rid itself of deadly scourges

The case of TB:

  1. Last year it was revealed that India has a higher burden of new patients with TB than estimated earlier — 2.8 million in 2015 compared to 2.2 million in the previous year
  2. This amounts to a quarter of the world’s cases
  3. The promise of a well-funded five-year scheme to meet the TB challenge beginning in 2017 is welcome
  4. New elimination deadline- 2025

The case of leprosy:

  1. India’s campaign on leprosy is in reality a ‘post-elimination’ struggle resulting from complacency
  2. It announced at the end of 2005 that it had eliminated it as a public health problem, based on a rate of less than one person in 10,000 having it
  3. Such self-congratulatory moments weakened both policy focus and funding in some pockets in eastern India, where it exceeded the accepted prevalence rate
  4. Districts of ‘high endemism’ show the battle was never truly won

Steps needed:

  1. Steady progress will depend on improved capabilities in the health system to meet the daily drugs requirement and a feeling of ownership at the State level
  2. The World Health Organisation has been pointing to the lack of integration of private practitioners with the national mission on tuberculosis for guaranteed access to drugs, and lack of continuous monitoring of such patients
  3. Detecting new cases early and preventing them from progressing to disability-inducing grade two level is crucial
  4. Rehabilitation of patients is also a weak spot

Some good news:

  1. Kala-azar, though underreported and mainly confined to Bihar and Jharkhand, is a promising candidate for elimination in the current year
  2. Since the few thousand cases are caused by a protozoal parasite with no animal reservoir; control of the vector, the sand fly, holds the key
  3. If good medical protocol is pursued, pockets of filariasis in many States can be removed
  4. Rehabilitation programmes for these diseases require more resources and policy support

Having set concrete goals, the Centre must now demonstrate its seriousness by moving away from the flawed policies of the past.

Note4Students:

Take down the points for writing a Mains answer. The information in Bold is important for Prelims examination.

Back2Basics:

Tuberculosis (TB):

  1. It is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB)
  2. Tuberculosis generally affects the lungs, but can also affect other parts of the body
  3. Most infections do not have symptoms; in which case it is known as latent tuberculosis
  4. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss
  5. Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze

Leprosy:

  1. Leprosy, also known as Hansen’s disease (HD), is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis
  2. Initially, infections are without symptoms and typically remain this way for 5 to 20 years
  3. Symptoms that develop include granulomas of the nerves, respiratory tract, skin, and eyes
  4. This may result in a lack of ability to feel pain, thus loss of parts of extremities due to repeated injuries or infection due to unnoticed wounds
  5. Leprosy is thought to occur through a cough or contact with fluid from the nose of an infected person
  6. Leprosy occurs more commonly among those living in poverty
  7. The two main types of disease are based on the number of bacteria present: paucibacillary and multibacillary
  8. The two types are differentiated by the number of poorly pigmented, numb skin patches present, with paucibacillary having five or fewer and multibacillary having more than five
  9. Leprosy is curable with a treatment known as multidrug therapy

Universal screening for diabetes, hypertension and cancer

  1. The Union Health Ministry has decided to implement universal screening for diabetes, hypertension and three types of cancer for everyone over 30 years in 100 districts where the original UPA plan for a similar screening exercise failed to take off
  2. The project is known to have been pushed by Prime Minister Narendra Modi who last year had set a deadline for the Ministry to come up with a screening framework for cancer
  3. The target is to ensure that once there is a fullscale rollout, every Indian is screened for these diseases at least once in three years

Note4students:

The info about the programme is important for prelims. See b2b about status of different diseases. It can be quoted in mains answer to bring objectivity.

Back2basics:

  1. Hypertension and diabetes are the first warning signs of heart disease and stroke, commonly referred to as cardiovascular diseases
  2. Cardiovascular diseases (CVDs): Have now become the leading cause of mortality in India
  3. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for more than 80% of CVD deaths
  4. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100,000 population in India is higher than the global average of 235 per 100,000 population
  5. Cancer: India’s cancer burden is also a growing concern
  6. Data compiled by the Central Bureau of Health Intelligence (CBHI) shows that in 2012 the total number of cancer cases reported in India were 10,57,204
  7. In 2013 that figure rose to 10,86,783, in 2014 it was 11,17,269, and in 2015 it stood at 11,48,692
  8. According to projections by Universal screening in 100 districts for diabetes, hypertension, cancer CBHI, which analysed cancer time trends, in five years, the total number of cases in men will touch 6,22,203, while in women the figure will stand at 6,98,725
  9. Pre-cancerous lesions in case of mouth and cervix and growths in case of breast can be detected early enough to ensure intervention
  10. While India does have a programme for screening of non-communicable diseases, cancer screening has been a virtual non-starter despite successive health reports presenting a grim picture of India’s cancer burden
  11. India’s National Cancer Control Programme: Was initiated in 1975-76
  12. In 2010, it was integrated with the national programmes for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 100 districts where screening was to be done for some forms of cancer
  13. Status unknown: Five years on, the Ministry of Health does not know how many people have been screened for cancer
  14. Dearth of trained personnel is one of the main reasons for the screening programme’s failure

[pib] What is Centre of Integrative Oncology?

  1. Context: Centre of Integrative Oncology would be inaugurated at National Institute of Cancer Prevention and Research (NICPR), Noida
  2. Objective: The main objective of the Centre is to build collaborations in the areas of cancer prevention, research and care
  3. Advantage: This would pave the way to carry forward the ongoing bilateral dialogue and facilitate collaboration with stake holders, both national and international, like National Cancer Institute, USA

Note4Students:

This is an important step for fighting the deadly disease of cancer. The government must further endeavor to lower the cost of treatment for cancer, so that even the poorest of the poor can afford it. Note down the details for Prelims.

PIB

Mother, child bearing brunt of weak health services

  1. Context: The Economic Survery 2016-17
  2. Health and fertility: Show sign of growing regional inequality among the Indian states
  3. While life expectancy of Indians has improved, mother and children were bearing the brunt of a weak health system
  4. Despite growing rapidly on average, there is sign of growing regional inequality among the Indian states
  5. This is puzzling because the underlying forces in favour of equalization within India — namely strong and rising movements of goods and people — are strongly evident
  6. Reason: One possible hypothesis that there might be governance traps that impede the catch-up process
  7. But why such traps persist if competitive federalism is forcing change upon the lagging states remains an open question
  8. Life expectancy: The Indian states are close to where they should be given their level of income
  9. However, this is not true of IMR, suggesting that the ‘mother and child’ (discussed also in last year’s Survey) bear the brunt of weaker delivery of health services
  10. Fertility: What really stands out in the international comparison is fertility and how much better the Indian states are performing than their international counterparts on that metric
  11. These unusually large declines in fertility have strong — and positive — implications for India’s demographic dividend going forward

Note4students:

This is but a bit of economic survey. Whole eco survey will be covered systematically in time to come. Needless to say that it is important for whole UPSC preparation.

[pib] Know about India’s Membership in the International Vaccine Institute (IVI), South Korea

  1. The Union Cabinet has given its approval to the proposal for India’s taking full membership of the International Vaccine Institute (IVI) Governing Council
  2. The move involves payment of annual contribution of US $ 5,00,000 to the International Vaccine Institute (IVI), Seoul, South Korea

Note4Students:

The information here is important for Prelims exam. Note down the points in b2b.

Back2Basics:

International Vaccine Institute:

  1. International Vaccine Institute (IVI), Seoul, South Korea was established in 1997 on the initiatives of the UNDP
  2. It is an international organization devoted to developing and introducing new and improved vaccines to protect the people, especially children, against deadly infectious diseases
  3. In the year 2007, with the approval of Cabinet, India joined IVI
  4. In December, 2012 the Board of Trustees (BOT) of IVI approved the formation of its new governance structure
  5. As per the new governance structure of IVI, a member State has to contribute to the IVI by paying a portion of its core budget
  6. Since India is classified in Group-I, it has to pay an annual contribution of US $ 50,000
PIB

Centre shifts gears to promote organ donation

  1. What: The Centre proposes to amend the law on motor vehicles to include a choice for voluntary organ donation in new or renewed driving licences
  2. Driving licence forms will include an option to declare that the licence holder is willing to donate organs in case of accidental death
  3. A draft to amend the Central Motor Vehicles Rules, 1989, has been published, which must be implemented by the States
  4. The death rate due to road accidents in India is among the highest globally – 11 per lakh population
  5. In 2015, 1.46 lakh people were killed in road accidents in the country
  6. Since most of them die from head injuries, they can donate their organs
  7. The move is aimed at addressing a health crisis as demand for organs has risen, partly due to increase in non-communicable diseases, and donation rates remain low
  8. In 1994, India passed a law regulating donation of organs to curb trade and exploitation, and to give an impetus to donation
  9. The Organ Donation Rate of 0.26 per million in India is poor, compared with America’s 26, Spain’s 35.3, and Croatia’s 36.5 per million

Note4students:

This news is important for mains from many angles – it shows an issue related to the health sector. It can also be used in an Indian society or ethics question, seeing how our organ donation rate is poor. It can be construed as Indians lagging in philanthropy. It also shows how policy decisions in an unrelated sector (roads and health) can impact and benefit each other.

It can be useful to note down some of the statistics mentioned here, they can be used in essays or other mains papers.

[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

[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

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

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

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

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

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.

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.

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
PIB

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.

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.

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.

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.

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.

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.


:( We are working on most probable questions. Do check back this section.







Highest Rated App. Over 3 lakh users. Click to Download!!!