[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.







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