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GS Paper: GS2-13.Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

  • [17th May 2024] The Hindu Op-ed: Health advice to take with no pinch of Salt

    PYQ Relevance:

    [2022] The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? 

    [2020]  Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.

    Note4Students: 

    Prelims: NA 

    Mains:  Hypertension, WHO’s HEARTS Strategy, India’s Hypertension Control Initiative (IHCI)

    Mentor’s Comment: Hypertension, a major but overlooked risk factor for heart attacks and strokes, causes 10.8 million preventable deaths annually, surpassing risks like tobacco use and high blood sugar. The WHO’s 2023 report reveals that 1.3 billion adults globally have hypertension, with 46% unaware of their condition. In India, 311 million adults suffer from hypertension, triple the number with diabetes.

    Let’s learn___

    Why in the News?

    Over the past three years, the COVID-19 vaccine has attracted significant public attention as a potential risk factor for blood clot formation, leading to sudden cardiac arrest.

    What is Hypertension?

    Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher).
    It is common but can be serious if not treated.
    Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.

    WHO Report on Hypertension

    • 2023 WHO Report: In 2023, the World Health Organization (WHO) released its first-ever report on hypertension titled “Global Report on Hypertension: The Race against a Silent Killer.”
    • Silent Killer: Hypertension is often called a silent killer because people are usually unaware of their high blood pressure until they develop complications.
    • Leading Cause of Death: High blood pressure causes more deaths than other leading risk factors, such as tobacco use and high blood sugar.
    • Rising Numbers: The number of adults with hypertension nearly doubled since 1990 to reach 1.3 billion.
    • Awareness and Control: Globally, an estimated 46% of adults with hypertension are unaware of their condition, and less than half (42%) are diagnosed and treated. Only one in five adults (21%) with hypertension has it under control.

    Hypertension in India

    • Prevalence in India: The Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study estimates that in India, 311 million people (or one in every three adults) have hypertension.
    • Comparison with Diabetes: In India, adults with hypertension are threefold of the estimated 101 million people living with diabetes.

    Dietary Salt and Hypertension

    • Impact of Excess Salt: Excess dietary salt intake (five grams or more per day) is a key risk factor for hypertension and contributed to two million cardiovascular disease deaths in 2019.
    • Benefits of Reducing Salt Intake: Research shows that reducing salt intake can reduce cardiovascular disease risks by 30% and mortality by 20%.
    • Salt Consumption in India: Indian adults consume on average eight to 11 grams of salt per day, which is approximately twice the WHO-recommended daily intake.
    • Deaths Due to High Salt Intake: High salt intake is responsible for an estimated 175,000 deaths in India.

    Hypertension across Socio-Economic Groups

    • Universal Impact: Hypertension affects all socio-economic groups.
    • Health Camps Findings: A Delhi-based NGO, Foundation for People-centric Health Systems, conducted 50 health camps in five localities of Delhi and Gurugram from October 2023 to March 2024, screening and treating around 12,000 people.
    • Detection in Low-Income Groups: Many were women, migrant workers, and rickshaws and taxi drivers from low-income groups. A large number were found to have diabetes and hypertension, with most cases detected for the first time in these camps, indicating gaps in awareness, detection, and treatment.
    Back2Basics: India’s Hypertension Control Initiative (2021):

    Objective: India aims to put 75 million people with hypertension and/or diabetes on standard care by 2025.

    Initiation and Expansion: The IHCI, a collaborative project of ICMR, Ministry of Health and Family Welfare/Directorate General of Health Services, WHO India, and other partners, was initiated in November 2017 in 25 districts across five states and expanded to 140-plus districts of India in 2023.

    Strategies: IHCI follows five simple and scalable strategies implemented through primary health care:

    -Simplified drug and dose-specific treatment protocols for primary-care settings.
    -Strengthening the drug supply chain by including protocol-based drugs in the State essential drug list, forecasting drugs based on morbidity, and ensuring adequate budget allocation in annual plans.
    -Team-based and decentralized care.
    -Patient-centric measures such as dispensing 30 days of medicine during each patient visit.
    -Use of information systems for program monitoring.

    Programmatic Learnings from IHCI

    • Access and Utilization: Nearly six years of IHCI implementation has resulted in two major learnings:
      • Simple treatment protocols with fewer drugs, reliable drug supply, linking patients to facilities closer to home for follow-up, and engaging teams increase access and utilization of health services from government facilities.
      • Simplified program monitoring makes performance assessment quantifiable and actionable.
    • Recognition: The IHCI won the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award.

    Future Goals and Prevention

    • Global Goals: Seventy-six million cardiovascular deaths and 450 million disability-adjusted life years (DALYs) could be avoided if countries achieve 50% population hypertension control by 2050.
    • India’s Targets: An estimated 4.6 million deaths can be prevented in India by 2040 if half the hypertensive population has its blood pressure under control, helping to achieve targets under the National Health Policy and global commitments like universal health coverage.

    Way Forward

    • Raise Awareness: Educate the public about the risks and long-term adverse impacts of untreated hypertension. High blood pressure can affect multiple organs, including the heart, kidneys, brain, and eyes.
    • Scale Up Evidence-Based Interventions: Expand successful programs like IHCI. Use strategies and lessons from such experiences to design interventions for other lifestyle diseases like diabetes and chronic kidney diseases.
    • Focus on Non-Modifiable Risk Factors: Address non-modifiable risk factors such as family history, age over 65 years, and pre-existing comorbidities like diabetes and/or kidney disease. Focus on healthy adults with known non-modifiable risk factors.
    • Reduce Dietary Salt Consumption: Implement strategies like “SHAKE the salt habit” under WHO’s HEARTS strategy:
      • Surveillance to measure and monitor salt use.
      • Harness industry to promote and reformulate foods with less salt.
      • Adopt standard labelling and marketing.
      • Educate and communicate to empower individuals to eat less salt.
      • Support environments that promote healthy eating.

    Conclusion: As hypertension continues to exact a heavy toll on global health, concerted efforts are needed to raise awareness, implement evidence-based interventions, and promote healthier lifestyles. By prioritizing hypertension control initiatives and fostering a culture of preventive healthcare, we can mitigate the devastating impact of this silent killer on communities worldwide.

    With inputs from:

    https://www.thehindu.com/opinion/lead/health-advice-to-take-with-no-pinch-of-salt/article68183434.ece

  • The impact of 50 years of vaccination on children worldwide 

    Why in the News?

    On the occasion of World Immunisation Week observed from 24th to 30th April, the Indian Academy of Paediatrics has launched a campaign to focus on routine immunization as the ‘Birth Right’ of a Child.

    About Measles Vaccination

    • This vaccine protects against 3 diseases: Measles, Mumps, and Rubella (MMR).
    • Centre for Disease Control and Prevention (CDC) recommends children get two doses of MMR vaccine, starting with the first dose at 12 -15 months of age, and the second dose at 4-6 years of age. Teens and adults should also be up to date on their MMR vaccination.

    Indian Government Initiatives:

    • World Immunization Week: The Indian Academy of Paediatrics (IAP) launched a campaign during World Immunisation Week (April 24-30) focusing on routine immunization as a fundamental right of every child. IAP urged the government to expedite the introduction of the HPV vaccine and typhoid conjugate vaccine to address significant public health burdens.
    • Vaccination made within the country:
      • DTP Vaccine: 93% of surviving infants received the third dose of the DTP vaccine.
      • Measles Vaccine: 90% of infants received the second dose of the measles vaccine. The measles vaccine has been the most significant in reducing infant mortality, accounting for 60% of lives saved through immunisation since 1974.
      • Present issues include inequitable distribution of vaccines, inability to reach 90% coverage, human resource gaps, and financing problems. In 2022, 33 million children missed a measles vaccine dose, with 22 million missing the first dose and 11 million missing the second dose.

    Impacts of Immunisation Globally:

    • Lives Saved: Immunisation efforts have saved an estimated 154 million lives globally over the past 50 years, equating to six lives every minute of every year.
    • Infant Mortality Reduction: 101 million of the lives saved were infants. Vaccination against 14 diseases has reduced infant deaths by 40% globally and by over 50% in Africa.
    • Diseases Targeted: Vaccines have contributed to reducing deaths from diseases like Diphtheria, Haemophilus Influenzae Type B, Hepatitis B, Japanese Encephalitis, Measles, Meningitis A, Pertussis, invasive Pneumococcal disease, Polio, Rotavirus, Rubella, Tetanus, Tuberculosis, and Yellow fever.

    Conclusion: Immunisation saves lives, reduces infant mortality, and prevents outbreaks by protecting against infectious diseases, ensuring healthier communities, and securing a better future for children worldwide.

    Mains PYQ:

    Q What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines? (UPSC IAS/2022)

  • Meeting Nutrition challenge: What new guidelines prescribe?

    Why in the news? 

    According to the National Institute of Nutrition (NIN), approximately 56.4% of India’s overall disease burden is linked to poor dietary habits.

    Guidelines by the National Institute of Nutrition (NIN): 

    The NIN, operating under the Indian Council of Medical Research (ICMR), has issued comprehensive guidelines on nutrition for vulnerable groups, including pregnant and lactating women, children, and the elderly.

    • Preventive Measures: A healthy diet coupled with regular physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.
    • Nutrition for Mother and Child: Proper nutrition from conception to the age of 2 years is crucial for optimal growth and development, preventing undernutrition, micronutrient deficiencies, and obesity in both mothers and children.
    • Suggested general dietary principles: The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
    • Group-Specific Guidelines:
    1. Pregnant women: Small frequent meals for those experiencing nausea and vomiting. It recommends the consumption of lots of fruit and vegetables, especially those high in iron and folate content.
    2. Infants and children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. After the age of 6 months, complementary foods must be included.
    3. Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fiber. Apart from pulses and cereals — with at least one-third as whole grains — at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed.

    Key concerns as per the National Institute of Nutrition (NIN):

    • Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
    • Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
    • High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
    • Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.

    Other concerns related to the “Dual nutrition challenge”

    • Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
    • However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.

    Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).

    Mains PYQ: 

    Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018

  • Giving primacy to Human Development

    Why in the News?

    Two recent reports reveal some important facets of India’s Development.

    • The Human Development Report 2023-24, published by the UNDP, takes a comparative perspective and maps the achievements in the area of human development.
    • A paper published by the World Inequality Lab in March 2024 provides long-term trends in income and wealth inequality in India between 1922 and 2023.

    About HDI:

    The Human Development Index (HDI) is a measurement system used by the United Nations to evaluate the level of individual human development in each country. It was introduced by the U.N. in 1990.

    How is the HDI measured?

    The HDI is the geometric mean of the three dimensions above, with indices calculated separately for each country using data on life expectancy, schooling and per capita income. The final result always gives a value between 0 and 1 which defines, according to the UNDP, the four degrees of human development detailed below:

    • Very high: countries with a HDI above 0.80.
    • High: countries with a HDI between 0.70 and 0.80.
    • Medium: countries with a HDI between 0.55 and 0.70. (India is here)
    • Low: countries with a HDI below 0.55.

    India’s poor ranking in HDI:

    • Regional Trends: India’s HDI ranking has improved marginally over the years, but it still lags behind several countries, including Bhutan, Bangladesh, Sri Lanka, and China. In 2022, India ranked 134 out of 193 countries.
    • Low HDI Value: Despite the incremental improvement in ranking, India’s HDI value remains relatively low. The HDI value increased from 0.633 in 2021 to 0.644 in 2022.
    • Gender Inequality Index (GII): While India showed improvement in its GII ranking in 2022, moving from 122 out of 191 countries in 2021 to 108 out of 193 countries in 2022, significant gender disparities persist. Notably, India faces one of the largest gender gaps in labor force participation rates, with a substantial difference between men (76.1%) and women (28.3%).
    • Medium Human Development Categories: India’s HDI ranking places it within the medium human development category alongside countries like Myanmar, Ghana, Kenya, Congo, and Angola.

    Key concerns related to Human Development:

    • Increasing Disparity Between Countries: The report underscores a concerning trend of growing inequality between countries, particularly between those at the upper and lower ends of the Human Development Index (HDI).
    • Economic Concentration: The concentration of economic power in a few countries is exacerbating global inequality. Nearly 40% of the global trade in goods is controlled by just three or fewer countries
    • Tech Company Dominance: The dominance of large technology companies further exacerbates inequality, with the market capitalization of the top three companies surpassing the GDP of the majority of countries.

    Widening inequality:

    • Income Disparities in India: The study from the World Inequality Lab reveals stark income disparities in India, with the bottom 50% of the population receiving only 15% of the national income.
      • Conversely, the top 1% earns on average 23 times more than the average Indian, and the top 10,000 individuals earn 2,069 times the average Indian.
    • Reduction of Middle-Class size: During the period from 2014 to 2022, the incomes of the middle 40% of the income distribution have grown slower than the bottom 50%. This trend suggests a potential reduction in the size of the ‘middle class.
    • High Household Debt and Low Savings: Household debt levels in India have reached a record high of 40% of GDP, while net financial savings have plunged to 5.2% of GDP.

    Way Forward: 

    • Promote Inclusive Growth Policies: Implement policies that prioritize inclusive growth, focusing on reducing income disparities, and enhancing access to education, healthcare, and economic opportunities for all segments of society.
    • Enhance Social Safety Nets: Strengthen social safety nets to provide support to vulnerable populations, including targeted welfare programs, universal healthcare coverage, and unemployment benefits.

    Mains PYQ: 

    Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive.(UPSC IAS/2019)

  • The government’s new PhD guidelines will make Universities more Elite

    Why in the news?

    The UGC chairperson announced that students with four-year undergraduate degrees can now appear for the National Eligibility Test (NET), an exam that certifies eligibility for lectureship in colleges and universities in India, and PhD programs.

    Key Implication of this Announcement:

    • Lowering of Standards: Allowing students with four-year undergraduate degrees to appear for the National Eligibility Test (NET) and pursue PhD programs without a Master’s degree may lead to concerns about the lowering of academic standards.
    • Quality of Teaching: Concerns arise regarding the quality of teaching in universities and colleges if fresh undergraduate students are recruited to teach other undergraduate students.
    • Impact on University Rankings: The decision may have implications for the rankings and reputation of Indian universities, particularly those with prestigious tags like the Institution of Eminence and high NAAC ratings.
    • Dilutes the perception: Allowing candidates to pursue a PhD in a subject unrelated raises concerns about the diversity and interdisciplinary nature of research.
      • The decision to broaden access to PhD programs may be aimed at dismantling the perception of PhD as an elite qualification.
      • However, critics may argue that diluting the entry requirements for PhD programs could undermine the rigor and prestige associated with earning a doctorate.
    • Impact on Research Culture: Lowering the barriers to entry for PhD programs may have implications for the research culture and scholarly integrity within academic institutions.

    Measures to maintain standards for the National Eligibility Test (NET):

    • Retain Postgraduate Degree Requirement: Maintain the requirement of a postgraduate degree for appearing in the NET to ensure that candidates have a solid foundation in their respective fields of study.
    • Reintroduce MPhil Programs: Reinstate MPhil programs to provide an intermediary step between postgraduate and doctoral studies. MPhil programs offer an opportunity for students to further develop their research skills and prepare for doctoral-level research.
    • Enhanced Mentoring and Preparation Period: Implement a structured mentoring program for NET aspirants to help them transition from undergraduate to postgraduate and eventually doctoral-level research.
    • Specialized Entrance Exams for PhD Programs: Instead of eliminating separate entrance exams for PhD programs, consider introducing specialized entrance exams that assess candidates’ research aptitude, subject knowledge, and suitability for doctoral-level research

    Way Forward: 

    • Promote Interdisciplinary Research: Encourage interdisciplinary research by providing opportunities for collaboration and exchange across different academic disciplines.
    • Maintain Research Standards: Uphold rigorous standards for doctoral research and teaching positions to ensure the quality and integrity of academic programs. Implement quality assurance mechanisms to monitor and evaluate the standards of the NET and PhD programs.

    Mains PYQ: 

    Q The quality of higher education in India requires major improvement to make it internationally competitive. Do you think that the entry of foreign educational institutions would help improve the quality of technical and higher education in the country. Discuss.(UPSC IAS/2015).

  • [8 May 2024] The Hindu Op-ed: A dignified peaceful passing is everyone’s right

    Mains PYQ Relevance: 

    Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018)
    Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)

    Note4Students: 

    Prelims: Right to life; Right to health; Right to die with dignity;

    Mains: Judicial Intervention in Health Care sector;

    Mentor comments: Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.

    Let’s learn

    —

    Why in the News?

    Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant. 

    • Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.

    What is the difference between Life support System and Palliative Care?

    Life support SystemPalliative Care System
    What is it?It aims to prolong life by artificially maintaining vital bodily functions.It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
    Treatment It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
    GoalsTo sustain life, even if it means prolonging the dying process.To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
    TimingUsed in critical, end-stage illness when curative treatment is no longer possible.Can be provided at any stage of a serious illness, even alongside curative treatments.

    End-of-Life Practices: West vs. India

    • West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
    • Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
    • Indian Scenario:
      • 70% of incurable patients die on life support in ICUs, alone.
      • The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
    What is the LAMA/DAMA Practice?

    Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.

    Its Causes:  Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.

    The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.

    Challenges in Indian Context:

    • ICU Routinisation: 
      • Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal 
      • In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
    • Lack of Legal Clarity:
      • Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
      • Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
      • The term “Passive Euthanasia” is considered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.

    Initiatives taken on Palliative Care and Living Wills:

    • By WHO:
      • WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
      • World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”. 
    • By India (through Judicial intervention):
      • SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
        • India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health’ includes the ‘Right to palliative care’.
      • SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.

    Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.

  • Court’s nudge on Hospital charges, a reform opportunity

    Why in the news? 

    The SC while hearing a PIL in February’24, directed the Central Government to find ways to regulate the rates of Hospital Procedures in the Private sector.

    • The SC also warned against applying Central Government Health Scheme (CGHS) rates for treatment services at private healthcare facilities until standardized rates are set.

    About Central Government Health Scheme (CGHS) Rates:

    CGHS is a health care scheme provided by the Indian Government for its central government employees and pensioners.

    • Commencement Year: 1954
    • Objective: To provide comprehensive health coverage to Central Government Employees (Allopathy/Homoeopathy)
    • Present change: The rates of the Central Government Health Scheme (CGHS) for general surgery have been revised since February 2024.

    Benchmark for Pricing:

    • Standard Treatment Guidelines (STGs): These can establish relevant clinical needs, the nature and extent of care, and the costs of total inputs required.
      • They address confounders and ensure clinical autonomy while enabling the valuation of healthcare resources consumed for precise cost determination.
    • Pooled payments by government: Formulating and adopting STGs require providers’ revenues to be tied to fewer payers.
      • This necessitates reimbursements from pooled payments with low Out-Of-Pocket (OOP) payment levels, supported by the government.
    • Coordination between payers and providers: Governments can support the agreement on pricing that provides a reasonable and sustainable surplus over input costs.
      • However, the ability of providers to access markets with OOP payments could hinder this effort.

    Challenges faced during benchmarking of the price:

    • Private sector issues 
        • Private sector dominance: In India, over half of the total health expenditure is OOP, with the private sector predominantly composed of small-scale providers. Standardizing rates faces implementation uncertainties, and enforcement mechanisms for adherence remain unclear.
        • Resistance from providers: Concerns arise about the feasibility of regulatory measures if providers do not adhere to prescribed procedure rates, as seen in various health schemes.
    • Weak implementation
      • Limitations of regulations: While price caps can influence behavior in the short term, weak enforcement mechanisms lead to temporary effects as the overall environment remains unchanged.
      • Enforcement challenges: Despite suggested measures, enforcement remains weak, with only a fraction of states and union territories implementing the Clinical Establishment Act.
    • Data-related issues: Although the insurance industry initiated STGs for hospitals in 2010, progress was hindered by a lack of representative and accurate costing data due to limited participation from private hospitals.

    Government Initiatives:

    • Developing STGs: The Pradhan Mantri Jan Arogya Yojana and the Department of Health Research have made significant strides in developing STGs for common conditions and adopting a comprehensive costing framework.
    • Efforts are also ongoing to create an Indian version of Diagnostics-Related Groups (DRGs)

    Way Forward:

    • Addressing anticipated challenges: Anticipated challenges in implementing rate standardization policies need to be identified and addressed proactively to ensure successful outcomes.
    • Evidence-based policy: Conduct rigorous research and evaluation to generate evidence on the impact of regulatory measures on affordability, care quality, and provider behavior, informing future policy decisions.
    • Ensuring broader stakeholder participation: It is essential to involve a wide range of stakeholders in the development and implementation of rate standardization policies to increase their effectiveness and acceptance.

    Mains PYQ 

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • Towards a less poor and more equal country

    Why in the news? 

    In March, World Inequality Lab, a Global Research Center focused on inequality and public policies, published in a paper titled, ‘Income and Wealth Inequality in India, 1922-2023: The Rise of the Billionaire Raj’. 

    Income and wealth inequality as per the World Inequality Lab: 

    • Income Inequality: In 2022-23, the top 1% of Indians received 22.6% of the national income, the highest in a century. The top 0.1% earned nearly 10% of the national income. Wealth inequality was also stark, with the top 1% holding 40.1% of the wealth in 2022-23, the highest since 1961.
    • Wealth Inequality Trends: Wealth concentration increased significantly between 1961 and 2023. The top 10% held 65% of the wealth in 2022-23, up from 45% in 1961. The bottom 50% and middle 40% saw declines in their share of wealth.
    • Comparison with Other Countries: India’s wealth inequality, while not as extreme as in Brazil and South Africa, increased threefold between 1961 and 2023. India’s income inequality is among the highest globally, surpassing South Africa, Brazil, and the U.S.
    • Impact of 1991 Economic Reforms: Inequality increased notably after the 1991 economic reforms in India. Growth in China has been broad-based compared to India, resulting in lesser income inequality despite higher growth rates in China.

    Present Dilemma in Human Development:

    • The Human Development Report (HDR) 2023-2024 ranked India 134 out of 193 countries. 
    • India is now the fifth-largest economy but it still ranks lower than Sri Lanka, Bhutan, and Bangladesh in human development. Its economic growth has not translated into growth in human development.

    Measures to Improve Human Development:

    • Investment in Education: Ensure access to quality education for all, from primary to higher levels. Focus on improving educational infrastructure, teacher training, and curriculum development.
    • Healthcare Access and Quality: Expand access to affordable and quality healthcare services, including preventive, primary, and specialized care. Invest in healthcare infrastructure, medical personnel, and technology.
    • Poverty Reduction: Implement social welfare programs to provide basic needs such as food, shelter, and clothing to the disadvantaged. Promote inclusive economic growth to create employment opportunities and increase household incomes.

    Conclusion: The Indian government has taken several steps including the creation and organization of women’s self-help groups, sending civil servants to areas with poor levels of human development,  and implementing land reforms. However, a major necessity of raising awareness is through an organic approach.

     

    Mains PYQ 

    Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive (UPSC IAS/2019)

     

  • SC allows termination of pregnancy of minor rape survivor

    Why in the news? 

    The Supreme Court on Monday used its extraordinary powers under Article 142 of the Constitution to do “complete justice” to permit the medical termination of pregnancy of a 14- year-old rape.Her pregnancy is nearing 30 weeks. The minor became aware of her condition only at a very late stage.

    Article 142

    • Article 142 of the Indian Constitution grants extraordinary powers to the Supreme Court of India to deliver complete justice. It empowers the Supreme Court to pass any order or issue any writ necessary for doing “complete justice” in any cause or matter pending before it, even if the case does not fall directly within its jurisdiction. 

    Distinctive features of Article 142:

    • Extraordinary Powers: Article 142 grants the Supreme Court of India extraordinary powers to deliver complete justice. These powers are exceptional and not restricted by the ordinary limitations of jurisdiction or procedure.
    • Wide Discretion: The provision grants the Supreme Court wide discretion in passing orders or issuing writs to achieve complete justice.  
    • Non-obstante Clause: Article 142 begins with a non-obstante clause, which means that the powers conferred by this article prevail over any other provision of the Constitution or law. This underscores the supremacy of the Supreme Court’s authority in exercising these powers.
    • Judicial Activism: Article 142 is often invoked to enable the judiciary to intervene in matters where existing laws or legal provisions are inadequate or where there are gaps in the law. This enables the court to play an active role in shaping legal principles and addressing societal concerns.

    Medical Termination of Pregnancy (MTP) Act 2020

    • Gestation Limits: The Act allows for the termination of pregnancy up to 20 weeks with the opinion of one registered medical practitioner.
    • For termination between 20 to 24 weeks, the opinion of two registered medical practitioners is required.
    • The upper gestation limit has been increased from 20 to 24 weeks for special categories of women, including survivors of rape, victims of incest, differently-abled women, and minors.
    • Medical Board: In cases of substantial foetal abnormalities diagnosed by a Medical Board, the upper gestation limit does not apply.
    • The Medical Board consists of a gynaecologist, a paediatrician, a radiologist or sonologist, and other notified members.
    • Privacy Protection: The Act ensures the protection of privacy for women who have terminated their pregnancy. The name and other details of the woman are not to be revealed except to authorized individuals.

    Conclusion: 

    Need to take Measures to prevent rape in society by providing education on consent, promoting gender equality, ensuring swift and awareness about severe punishment for perpetrators, enhancing support for survivors, and fostering a culture of respect.

    Mains PYQ

    Q ‘Constitutional Morality’ is rooted in the Constitution itself and is founded on its essential facets. Explain the doctrine of ‘Constitutional Morality’ with the help of relevant judicial decisions.

  • Centre releases curriculum framework for three to six-year-olds

    Why in the news? 

    For the first time ever, the Central government has released curriculum advisable to be taught to children aged three to six-years-old

    Objective of Aadharshila 

    • The early childhood education curriculum is expected to bridge foundational literacy and numeracy gaps which may arise in later school years

    Who Launched?

    • The Ministry of Women and Child Development (MWCD) has released the National Curriculum for Early Childhood Care and Education 2024 titled ‘Aadharshila,’ on the lines of the National Education Policy 2020 and the National Curriculum Framework.

    Where? 

    • Aadharshila (translated as foundation stone) is a detailed 48-week curriculum meant for learning in the age-group of three to six-year-olds in anganwadis.

    Significance Aadharshila’s Curriculum

    • Structure of Curriculum: The curriculum is organized on a weekly basis, comprising 48 weeks of learning over a three-year duration. It is designed to cater to children aged three to six attending anganwadis.
    • Initiation Phase: The curriculum begins with four weeks of initiation, focusing on academic activities to help children transition from home to the anganwadi center. These activities are engaging and involve fun and free play.
    • Exploration Phase: The subsequent 36 weeks are dedicated to exploration, free play, conversation, creation, and appreciation. Activities during this phase include storytelling, singing rhymes, art and craft, and other engaging activities. Storytelling themes often revolve around conflict resolution, responsibility, and cooperation.
    • Learning Objectives: Children learn various concepts such as colors, shapes, numbers, body parts, family and friends, listening and responding to instructions, basic counting, and themes like seasons, festivals, and food.

    Anganwadi 

    • Anganwadi services in India are a part of the Integrated Child Development Services (ICDS) scheme, which was launched on 2 October 1975.
    • The main objective of the Anganwadi programme is to improve the nutritional and health status of children in the age group of 0-6 years, to lay the foundation for proper psychological, physical, and social development of the child, and to reduce the incidence of mortality, morbidity, malnutrition, and school dropout.

    Conclusion: The release of ‘Aadharshila’ marks a significant step in early childhood education, aiming to bridge foundational gaps. To enhance its effectiveness, continuous monitoring, teacher training, and community involvement are essential.

    Mains PYQ 

    Q National Education Policy 2020 isin conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient education system in India. Critically examine the statement (UPSC IAS/2020)