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

  • The advent of a holistic approach to ‘one health’

    Why in the news? 

    In the past, we have seen that there is interdependence between humans, animals, and the environment has been made increasingly evident with the emergence of pandemics such as COVID-19.

    • It is not just humans who are affected by pandemics but also livestock — an example being the outbreak of lumpy skin disease that has spread across countries.

    Why an integrated idea like the ‘One Health’ Mission is needed?

    One Health is an interdisciplinary approach that recognizes the interconnectedness of human health, animal health, and environmental health. It emphasizes collaboration across various sectors, including medicine, veterinary science, ecology, and public health, to address health challenges comprehensively.

    Key features of National One Health Mission:

    • Intersectoral Collaboration: The mission aims to coordinate, support, and integrate all existing One Health initiatives in the country, including the Ministries of Health and Family Welfare, Fisheries, Animal Husbandry and Dairying, Environment, and Science and Technology
    • Integrated Disease Surveillance: The mission implements integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases, including zoonotic diseases, and improve overall pandemic preparedness and integrated disease control.
    • Consolidation of data: The mission creates an integrated, science-based environment where researchers from various disciplines can use laboratories as necessary and generate requisite inputs for One Health Science, including databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists.

     Challenges in National One Health Mission

    • Limited Database: There have been limited efforts to develop databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists to understand and respond to the drivers that threaten health and optimize the effectiveness of public health systems in achieving these goals within each sector.
    • Lack of Awareness and Understanding: The lack of awareness and understanding of the One Health concept among stakeholders hinders collaborative efforts required to address complex public health issues
    • Funding Constraints: Funding constraints are a significant barrier to implementing One Health interventions, especially in low- and middle-income countries that may need more resources to invest in One Health initiatives

    Conclusion: To address challenges in the National One Health Mission, efforts must focus on enhancing data collection, raising awareness among the stakeholders, and securing adequate funding. These measures are essential for effective implementation and holistic health management.

  • Why have ‘Madrasas’ been in the spotlight in Uttar Pradesh? | Explained

    Why in the news? 

    Recently the three-judge Supreme Court Bench stayed a ruling of the Allahabad High Court on the U.P. Board of Madrasa Education Act 2004 calling it an infringement of the Fundamental Rights guaranteed under the Constitution.

    • Earlier, the HC had dubbed the U.P. Board of Madrasa Education Act “Unconstitutional” and asked for immediate closure of the madrasas. It called for the relocation and integration of the madrasa students with regular schools.

    Why are madrasas in the spotlight?

    • Uttar Pradesh has approximately 25,000 madrasas, out of which 16,500 are recognized by the U.P. Madrasa Education Board.
      • Only 560 madrasas receive grants from the government, leading to complaints of delayed payment and salary arrears.
      • Irregular madrasas, often lacking resources, provide only elementary learning.
    • In 2022, the U.P. Government ordered a survey to identify unrecognised or illegal madrasas.
    • A Special Investigation Team (SIT) was formed to investigate alleged foreign funding sources for the madrasas, claiming over ₹100 crore had been received from abroad over three years. However, evidence supporting these claims was not made public.

    About Uttar Pradesh Board of Madarsa Education Act, 2004:

    • The Act sought to oversee and administer the operations of madrasas (Islamic educational institutions) in Uttar Pradesh, providing guidelines for their establishment, recognition, curriculum, and management.
    •  It led to the formation of the Uttar Pradesh Board of Madarsa Education, tasked with regulating and supervising madrasa activities throughout the state.

    Concerns Regarding the Act:

    • Limited Curriculum: Upon examination of madrasa syllabi, the High Court noted a curriculum heavily focused on Islamic studies, with limited emphasis on modern subjects.
    • Conflict with Higher Education Standards: The Act raised concerns regarding its conflict with Section 22 of the University Grants Commission (UGC) Act, 1956, which led to questions about its compliance with higher education norms

    Conclusion: Madrasas in Uttar Pradesh are under scrutiny due to a recent Supreme Court stay on the Allahabad High Court ruling, citing infringement of fundamental rights. Concerns persist over grants, quality of education, and compatibility with higher education standards.

  • Implementing Universal Health Coverage

    Why in the news?

    On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.

    Background:

    • On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
    • In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).

    BACK2BASICS:

    About National Health Policy, 2017:

    It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality.

     

    What are the challenges in the Implementation of UHC in India? 

    • Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
      • While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
    • Migrant Population and Urban Slums:  Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
    • Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
    • Lack of Healthcare Infrastructure and Human Resources:  India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
    • The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.

    Suggestive Measures:

    • Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
    • Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
    • Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
    • Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.

    Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.

    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)

  • [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    [8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

    PYQ Relevance:

    Mains: 
    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 CSE 2015) 
    Q) 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? (UPSC CSE 2022) 

    Prelims:
    With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker?  (UPSC CSE 2012) 
    1) Accompanying women to the health facility for antenatal care checkups
    2) Using pregnancy test kits for early detection of pregnancy
    3) Providing information on nutrition and immunization
    4) Conducting the delivery of babySelect the correct answer using the codes given below:
    (a) 1, 2 and 3 only
    (b) 2 and 4 only
    (c) 1 and 3 only
    (d) 1, 2, 3 and 4

    Note4Students: 

    Prelims: National Health Policy; Ayushman Bharat;

    Mains: Health Issues in India; Universal Health Coverage;

    Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation. 

    Let’s learn. 

    —

    Why in the News?

    The World Health Organization (WHO) has declared health to be a fundamental human right. 

    • India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
    About World Health Day 2024:

    World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice. 

    Theme for 2024: “My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services. 

    There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 

    What is meant by Health Equity?

    ‘Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 

    WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:

    • Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
    • Significance:
      • Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
      • Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
    What does the Indian Statistics say?

    1) 2011 Census: 

    Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound. 

    2)National Family Health Survey (NFHS)-5 (2019-21) 

    Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.

    3)Public Health Foundation of India:
    Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. 
    • Limitations in India:
      • Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
      • Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
      • Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
      • Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.

    Initiatives Taken by Government:

    • Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
    • National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.

    Way Forward:

    • Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
    • Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs. 
    • Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
    • Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.

  • Two States: a comparison on access to life-saving C-sections

    Why in the News?

    The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.

    • This indicates the necessity for corrective measures to address the situation.

    What is a Caesarean section? 

    It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.

    It is often performed because vaginal delivery would put the mother or child at risk.

     

    Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.

    • High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
    • High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
    • Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.

    Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:

    • Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
    • Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
    • Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
    • Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
    • High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.

    Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.

    Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.

    PYQ Mains 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

     https://www.indiatoday.in/health/story/rise-in-c-section-deliveries-despite-decrease-in-pregnancy-complications-iit-madras-study-2521773-2024-04-01

  • [27 March 2024] The Hindu Op-ed: A cry for help, a call for reflection and action

    [27 March 2024] The Hindu Op-ed: A cry for help, a call for reflection and action

    PYQ Relevance:

    Mains: 

    Q) The Right of Children to Free and Compulsory Education Act, 2009 remains inadequate in promoting an incentive-based system for children’s education without generating awareness about the importance of schooling. Analyse. (UPSC IAS/2022) 

    Q) Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their status and performance? (UPSC IAS/2016) 

    Note4Students: 

    Prelims: NA;

    Mains: Governance; Education;

    Mentor comments: In contemporary Indian society, there is a noticeable shift in family structures with a weakening of crucial connections between children and their families. This in turn impacts a child’s ability to engage with their society and environment. The unyielding quest for scholastic distinction often overshadows the social facets of a student’s existence, driving them to sacrifice interpersonal bonds and pursuits that are essential for a well-rounded persona. It is disconcerting to find young students voicing their inner turmoil on social media, signaling distress which ultimately increases suicidal cases as highlighted by the NCRB Report.

    Let’s learn. 

    —

    Why in the News?

    The unyielding quest presents the issue with educational systems often cause many an Indian student to go into a spiral, with tragic outcomes.

    • The transformation of socio-economic dynamics is not only instilling a sense of despondency among youth but is also becoming a cause for stress in their academic endeavors.
    What does the Recent Report say?

    In 2022, according to data in the “Accidental Deaths and Suicides in India 2022” report by the National Crime Records Bureau (NCRB), over 13,044 Indian students ended their lives — 7.6% of the total suicide fatalities in that year. 
    In 2023, there were reports of youngsters preparing for various competitive exams in Kota ending their lives.
    Based on police records, 15 students faded away in 2022; 18 in 2019, and 20 in 2018. 

    Coaching Industry and Governance in Kota:

    • Every year, over 2,00,000 aspirants from every corner of India flock to Kota in pursuit of ‘academic excellence’, to prepare rigorously for ‘coveted’ entrance examinations such as the JEE and the National Eligibility-cum-Entrance Test (NEET).
    • The number of suicides (students) rose from 10,335 in 2019, to 12,526 in 2020, to 13,089 in 2021. As in NCRB data (2018), nearly 95,000 students faded away between 2007-18.

    Preventive Measures Taken by Local Institutes and Governance:

    • By Local Institutes in Kota:
      • Hostels have been equipped with ‘anti-suicide features’ that include devices fixed to ceiling fans to prevent children from harming themselves and iron grills across balconies and passageways. 
      • In the push towards professional development, there is specialized training in mess administration, psychological support, behavioral counseling, and an emphasis on overall student welfare. 
    • By Local Government in Kota:
      • The local government has stopped all routine testing in coaching institutes for over two months as a temporary measure. 
      • The Kota police have pushed hostel wardens to become more proactive by endorsing campaigns such as “Knock on the Door.” At the same time, kitchen workers and meal service providers have been encouraged to alert authorities immediately if they notice students missing their meals or leaving their food untouched.

    Challenges wrt. present Educational purveyors and Social Facets in India:

    • Intense Competitions: India with an increase in Population, lacks the generation of suitable job opportunities, moreover, a limited number of seats in government institutions, and the high fees charges in private institutions have all created a climate where there is intense competition. 
    • Social and Family Expectations: The relentless strain of competition plays on the young student, which is made worse by the pressures imposed on the child by parents without understanding their child’s wishes. Many face harsh criticism for failing to ‘meet expectations’. 
    • Lack of Government Interventions: According to the All India Survey on Higher Education (AISHE) report (2019-20), only 21.4% of colleges are under governmental administration, with 78.6% under private entities (as reported by the Union Education Ministry). 
    • Poverty Issue: A study in 2008 in The Lancet revealed that nearly 61% of global suicide fatalities were concentrated in Asia. Numerous families in India, face financial constraints that prevent them from providing their children with supplementary educational resources such as coaching and tuition. 
    • Lack of support from faculties: There are numerous instances of faculty members in institutions often chastising students for their subpar academic performance when they should be offering encouragement and assistance instead.

    Way Forward:

    • Building a welfare environment: Creating an atmosphere of empathy and acceptance is crucial to cancel out any potential negative consequences for our younger generation.
    • Discovering the unyielding quest: The unsolvable puzzle for scholastic distinction often overshadows the social facets of a student’s existence, driving them to sacrifice interpersonal bonds and pursuits that are essential for a well-rounded persona. This needs to be worked upon.
    • Investing in Social Infrastructure: Moreover, pupils from socioeconomically underserved communities are confronted with the stark actualities of endemic discrimination, thereby intensifying their hardships. So, there is an urgent need for our social infrastructure to grow more supportive and accommodative and support these young lives.

    https://www.thehindu.com/opinion/lead/a-cry-for-help-a-call-for-reflection-and-action/article67995431.ece

  • [25 March 2024] The Hindu Op-ed: TB Control in India Calls for person-centered Solutions

    PYQ Relevance:Mains: 
    Q) “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. ( UPSC IAS/2021) 

    Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018) 

    Prelims:
    In India, the term “Public Key Infrastructure” is used in the context of  (UPSC IAS/2020) 
    a) Digital security infrastructure
    b) Food security infrastructure
    c) Health care and education infrastructure
    d) Telecommunication and transportation infrastructure

    Note4Students: 

    Prelims: Governance; Health Care; TB Elimination Program 2025;

    Mains: Governance; Health Care Syatem in India; Issues  related to TB and measures;

    Mentor comments:  Globally, and in India, tuberculosis (TB) continues to loom large as a public health challenge impacting millions. About 85% of people who develop TB can be successfully treated with drug regimens of 6 months. Universal health coverage (UHC) is necessary to ensure that all those with the disease can access these treatments. Today although India aims for 2025, the recent TB elimination policy in India necessitates person-centered solutions to address the challenges of tuberculosis effectively. 

    Let’s learn. 

    —

    Why in the News?

    On account of World TB Day (March 24), we must recognize the needs and interests of TB patients, and the communities must form the basis of disease elimination.

    Context:

    • The theme for World TB Day 2024: ‘Yes! We can end TB!‘.
    • The MoHFW along with various development partners of the Health Ministry launched the Tuberculosis (TB) Mukt Bharat Abhiyaan in 2021 under the NSP India 2020–25 for TB Elimination in a major mission activity for ending the epidemic of TB by 2025.
    • Despite ambitious goals set by India’s health authorities to eliminate TB, the challenge is huge and progress is not fast enough. 
    Present Scenario:

    National Strategic Plan for Eliminating TB (2020-25): NSP India 2020–2025 intends to accelerate the national response to TB.
    The actions included:

    Provide top-priority reinforcements to the existing workforce;
    Scale up private provider engagement;
    Changes in approach from passive community to active community participation and ownership;
    Investment in TB surveillance staff and systems for accurate, complete and timely information;
    Deployment of new precision diagnostic tools;
    Support patients comprehensively throughout treatment;
    Redesign and pursue targeted active case finding;

    Deploy and evaluate ambitious plans to implement TB preventive treatment in households and other close contacts, children, People living with HIV (PLHIV), and other locally defined “high-risk” groups, using new and short regimens.

    Why there is a need for a person-centered approach to TB care and management?

    1) Need to Understand through shift paradigm:

    • TB as a human crisis: Tuberculosis is one of the ten major causes of mortality worldwide. The trend of increasing TB cases and drug resistance in India is very disturbing.
    • TB as a gendered crisis: Women and other gender minorities living in violently patriarchal societies face unique challenges in accessing timely diagnosis and treatment for TB. It is particularly difficult for gender minorities to seek care due to structural and social barriers, stigma in the health system, and widespread poverty.
    • TB as an economic challenge: The largest indirect cost of TB for a patient is income lost by being too sick to work. Studies suggest that on average three to four months of work time are lost, resulting in average lost potential earnings of 20% to 30% of annual household income.
    • TB as a Social and Environmental Challenge: For centuries, TB has been linked anecdotally with environmental risk factors that go hand-in-hand with poverty: indoor air pollution, tobacco smoke, malnutrition, overcrowded living conditions, and excessive alcohol use.

    2) Care needs to be more Humane 

    • Need for Strengthening Community-Based Care: Efforts are needed to strengthen community-based TB care models, empowering frontline healthcare workers to deliver comprehensive care that is closer to where patients live.
    • Need for Mental Support: This is important as survivor narratives tell us the stigma, discrimination, and mental stress they go through, not to mention the side effects of treatment.
    • Need to address discrimination: While TB can affect people of any class, religion, ethnicity, gender, and socioeconomic status, it disproportionately affects the most marginalized in society, including children, the urban poor, prisoners, and people living with HIV/AIDS. It is needed to address that disease has gone beyond being a health crisis alone.

    How technology can be tapped to address these challenges?

    • Leveraging technology and innovation: The adoption of AI and digital health solutions for TB diagnosis, adherence, and surveillance can revolutionize the way TB care is delivered and accessed in the country.
    • Working on treatments: The path to TB elimination in India requires a concerted effort to prioritize person-centered care, address social determinants of health, and embrace innovation. By investing in developing better vaccines, we can hope to ultimately eliminate this airborne disease.
      • The System for TB Elimination in the Private Sector (STEPS) has been introduced as a low-cost solution to address gaps in quality care for TB patients accessing the private sector.

    Conclusion: By adopting a holistic and person-centered approach, India can overcome the barriers that stand in the way of TB control and create a healthier future for all its citizens.

    https://www.thehindu.com/opinion/lead/tb-control-in-india-calls-for-person-centred-solutions/article67988183.ece

  • Why has Karnataka banned certain coloring agents?

    Why in the news?

    • Karnataka has become the third state in South India to prohibit the use of specific coloring agents in cotton candy and gobi manchurian due to their identified harmful effects.

    Context-

    • While the Government plans to create awareness among manufacturers, it has also urged consumers to be aware of what they are consuming.
    • The Food Safety and Standards Act, 2006 stipulates a fine of not less than ₹10 lakh and a jail term of a minimum of seven years, extending to life imprisonment, against those using banned chemical substances in food products.

    What did the survey results show?/Key findings from the sample testing

    • Presence of Harmful Chemicals: Laboratory tests revealed the presence of harmful chemicals in many samples collected from the state.
    • Cotton Candy Samples: Out of 25 cotton candy samples collected, 15 were found to be unsafe as they contained added colors, while the remaining 10 were deemed safe as they were made without added colors.
    • Gobi Manchurian Samples: Among the 171 samples of gobi manchurian collected, 107 were declared unsafe due to the presence of added colors, while 64 were considered safe as they did not contain added colors.

    What were the harmful chemicals?

    • Harmful Chemicals: The unsafe samples of cotton candy contained traces of sunset yellow, tartrazine, and rhodamine-b, while unsafe gobi Manchurian samples had tartrazine, sunset yellow, and carmoisine. Rhodamine-b, a suspected carcinogen, is already banned.
    • Restrictions on Tartrazine: Although tartrazine is an approved artificial food color, there are restrictions on its usage. It can only be used in specific packed food items, with prescribed amounts. It cannot be used in freshly prepared food items.
    • Health Concerns: The Food Safety Commissioner emphasized that prolonged consumption of snacks containing artificial colors can lead to severe diseases like cancer, highlighting the importance of the ban in safeguarding public health.

    What are the Penalties?

    • Prohibition on Artificial Colors: Rule 16 of the Food Safety and Standards Act prohibits the use of artificial colors in the preparation of gobi manchurian.
    • Approved Limits for Food Colors: While certain food colors are allowed within approved limits, non-permitted colors like rhodamine-b should not be used in the preparation of cotton candy.
    • Penalties for Offenders: Violators face severe penalties, including cancellation of licenses for commercial activities, hefty fines, and imprisonment. The Food Safety and Standards Act specifies a minimum fine of ₹10 lakh and a jail term of at least seven years, which can extend to life imprisonment, for those found using banned chemical substances in food products.

    Way Forward:

    • Enforcement and Monitoring: Health safety officials will likely conduct random checks to ensure compliance with the ban on harmful chemicals and artificial colors.
    • Public Awareness Campaigns: The government will continue its efforts to raise awareness among manufacturers and consumers regarding the risks associated with harmful chemicals and artificial colors in food products.
    • Regulatory Review: There might be a review of existing regulations and standards related to food safety to further strengthen controls and ensure comprehensive coverage of potentially risky food items beyond gobi manchurian, such as kebabs, that may use coloring agents.
    • Collaboration with Stakeholders: Collaboration between government authorities, food manufacturers, and other stakeholders in the food industry will be crucial to implement and enforce the ban effectively. This may include consultations, partnerships, and dialogues to address challenges and ensure compliance with regulations.

    Conclusion: Karnataka banned certain coloring agents in response to findings of harmful chemicals in food samples. Strict penalties and enforcement measures are in place, alongside awareness campaigns and collaboration with stakeholders to ensure compliance and safeguard public health.

  • Understanding dialysis outcome patterns in India through a nationwide study 

    Why in the News? 

    Recently, there are some findings from a nationwide private haemodialysis network’, the Lancet Regional Health-Southeast Asia, on the survival of patients receiving haemodialysis in India

    Context:

    • India has amongst the highest number of patients receiving chronic dialysis, globally estimated at around 1,75,000 people in 2018. Daily, the number of patients on dialysis has been increasing.
    • The launch of the National Dialysis Service in 2016 to improve access, and ongoing efforts to develop affordable dialysis systems, are all underlined by the rising incidence of end-stage renal disease in the country.

    What is Hemodialysis?

    A machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately.

     

    Key Highlights as per study:

    • Survival with Centre- and Patient-Level: The study found that both centre- and patient-level characteristics are associated with survival rates among patients undergoing haemodialysis.
    • Unexplained Variation Between Centres: Despite considering various centre-based characteristics, there remained unexplained variations in survival rates between dialysis centres across India. This suggests that factors beyond those accounted for in the study may influence patient outcomes.
    • Large Sample Size: The study included a substantial sample size of over 23,600 patients undergoing haemodialysis at any centre in the NephroPlus network between April 2014 and June 2019. This large sample size enhances the robustness of the study’s findings.
    • Primary Outcome: The primary outcome of the study was all-cause mortality, measured from 90 days after patients joined a center. This outcome measure provides valuable insights into patient survival rates over time following the initiation of haemodialysis treatment.
    • Consideration of Individual-Level Variables: The study accounted for various individual-level variables such as sex, smoking status, medical history (e.g., diabetes, heart disease, hypertension, hepatitis B, hepatitis C), education level, monthly household income, dialysis frequency, and vascular access. These variables offer comprehensive insights into patient characteristics and their impact on survival rates.
    • Evaluation of Centre-Level Variables: Centre-level variables, including the frequency of nephrologist visits, number of beds, number of staff, and number of patients, were also considered. These variables help assess the influence of center resources and practices on patient outcomes.

    What were the measuring differences?

    • Limited Data: The only significant study conducted previously in Andhra Pradesh used claims data from a publicly-funded insurance scheme between 2008 and 2012. It included 13,118 beneficiaries and reported a 10.2% mortality rate within six months of starting hemodialysis.
    • Absence of Centre-Level Effects: The previous study did not consider center-level effects on survival, limiting the understanding of differences in survival rates between dialysis centers, as observed in other countries.
    • Gaps in Understanding: Major gaps existed in understanding dialysis outcome patterns in India due to the absence of comprehensive studies, hindering efforts to improve patient care.
    • Lack of National Benchmark: There was no established national benchmark for survival rates among patients undergoing dialysis in India at the time of the study.
    • Need for Further Research: The study highlighted the importance of conducting more extensive research to fill the gaps in knowledge and establish benchmarks for dialysis outcomes in India.

    What is the recent issue related to the Mortality rate? 

      • Administrative challenges associated with Mortality:
        • Impact of Centre-Level Factors: Including center-level factors such as staffing, care processes, and patient volume in the analysis reduced the variability in survival rates across dialysis centers by 31%. This suggests that center-level characteristics play a significant role in influencing patient outcomes and survival rates.
        • Survival Range: After adjusting for multi-level factors, the estimated 180-day survival among patients undergoing hemodialysis ranged between 83% and 97%. This variability indicates differences in survival outcomes across dialysis centers in India.
      • Urban-Rural Divide: Patients attending rural dialysis centers experienced a 32% higher mortality rate compared to those at urban centers. This disparity underscores the unique challenges faced by rural healthcare facilities in providing hemodialysis services.
    • Patient Characteristics Associated with Mortality:
      • Catheter-Based Vascular Access: Patients using catheter-based vascular access had a higher mortality rate compared to those using arteriovenous fistula or graft access.
      • Financial Support: Patients receiving financial support for dialysis treatment through government panel schemes or private insurance had a lower mortality rate compared to those paying out-of-pocket.
      • Dialysis Vintage: There was an inverse relationship between mortality rate and dialysis vintage, with patients receiving dialysis for at least a year before joining a center experiencing a 17% lower mortality rate than those starting dialysis less than 30 days before joining.
      • Presence of Diabetes: The presence of diabetes was associated with a higher mortality rate among hemodialysis patients.

    Way Forward:

    • Establishment of National Benchmark: The study proposes the first national benchmark for survival among dialysis patients in India. This benchmark will serve as a reference point for evaluating the quality of care and outcomes across dialysis centres in the country.
    • Ongoing Quality Improvement Programs: As dialysis access continues to expand in India, ongoing quality improvement programs are crucial for ensuring that patients receive the best possible care and experience optimal outcomes at the point of care.
    • Collaborative Quality Improvement System: The authors emphasize the need for a collaborative quality improvement system across the country to address the increasing demand for dialysis services. This system should involve stakeholders at various levels of healthcare delivery to enhance standards of care and patient outcomes.
    • Understanding Multilevel Effects: It is essential to understand the multilevel effects of both centre- and patient-level characteristics on dialysis outcomes. Establishing national standards for dialysis outcomes in India requires comprehensive insights into these factors to drive improvements in care delivery.
    • Comparison and Monitoring: Establishing national benchmarks enables comparison and monitoring of dialysis centres’ performances over time. This approach facilitates the identification of variations in practice patterns and outcomes, paving the way for targeted interventions and improvements in healthcare delivery.

    Conclusion: The nationwide study on haemodialysis outcomes in India highlights disparities and the need for standardized care. Establishing national benchmarks, ongoing quality improvement, and collaborative efforts are essential for enhancing dialysis care and patient outcomes.

    Mains PYQ-

    Q- Public health system has limitations 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)

  • [pib] ULLAS Initiative

    Why in the news

    • The Department of School Education and Literacy (DoSEL), Ministry of Education recently conducted the Foundational Literacy and Numeracy Assessment Test (FLNAT), under the ULLAS – Nav Bharat Saaksharta Karyakram Initiative.

    Foundational Literacy and Numeracy Assessment Test (FLNAT)

     

    • FLNAT is a nationwide assessment test conducted as part of the ULLAS initiative.
    • It aims to evaluate the foundational literacy and numeracy skills of registered non-literate learners aged 15 and above.
    • The assessment covers three aspects – Reading, Writing, and Numeracy – and is conducted in all districts of participating states/UTs.
    • The test plays a crucial role in assessing the impact of teaching-learning sessions conducted under the ULLAS program and promoting literacy and numeracy skills among citizens.
    • It is conducted in the regional language of the learners, aligning with the NEP 2020’s emphasis on multilingualism
    • Qualifying learners receive a certificate from the National Institute of Open Schooling (NIOS).

     What is ULLAS Initiative?

    • ULLAS stands for Understanding Lifelong Learning for All in Society.
    • It seeks to advance lifelong learning and bridge literacy gaps among individuals aged 15 and above.
    • The program aims to equip citizens with fundamental knowledge and skills essential for personal and national development.
    • The ULLAS User-Friendly Mobile Application serves as a digital platform providing access to a wide range of learning resources via the DIKSHA portal.

    Key Features of ULLAS

    1. Emphasizes continuous learning across all stages of life.
    2. Cultivates a culture of knowledge-sharing and individual growth.
    3. Provides participants with digital literacy skills.
    4. Promotes awareness and empowerment in financial matters.
    5. Imparts vital life skills such as legal literacy and digital competence.
    6. Enhances citizenship awareness and empowerment.
    7. Grants school/university credits to student volunteers.
    8. Offers recognition through certificates, letters of appreciation, and felicitation ceremonies.

    PYQ:

    Consider the following statements:

    1. As per the Right to Education (RTE) Act, to be eligible for appointment as a teacher in a State, a person would be required to possess the minimum qualification laid down by the concerned State Council of Teacher Education.
    2. As per the RTE Act, for teaching primary classes, a candidate is required to pass a Teacher Eligibility Test conducted in accordance with the National Council of Teacher Education guidelines.
    3. In India, more than 90% of teacher -5 education institutions are directly under the State Governments.

    Which of the statements given above is/are correct?  (2018)

    1. 1 and 2
    2. 2 only
    3. 1 and 3
    4. 3 only

    Practice MCQ:

    1. Consider the following statements about the ULLAS Initiative:
    2. It focuses on Foundational Literacy.
    3. Individuals aged 15 and above are eligible under this initiative.

    Which of the given statements is/are correct?

    1. Only 1
    2. Only 2
    3. Both 1 and 2
    4. Neither 1 nor 2