Karnataka’s Food Safety Department ordered action after 40 kebab samples showed unsafe artificial colours, extending the crackdown to Panipuri, Cotton candy, and Gobi Manchurian.
Artificial Colours in the Controversy
Some artificial colours under scrutiny include:
Sunset Yellow (Yellow 6, E110): Approved in the US but requires a warning label in the EU.
Carmoisine (Red No. 10, E122): A deep red dye often used in food.
Rhodamine B: A banned textile dye sometimes illegally used in food.
Different countries have varying regulations for these dyes. For example, tartrazine (E102 in the EU, Yellow 5 in the US) is permitted but only in limited quantities.
Legal Action against FBOs
To take legal action, the department collects a survey sample from an FBO and, if found unsafe, collects four more legal samples for further testing at the Central Food Technological Research Institute (CFTRI).
If CFTRI deems the samples unfit for consumption, the FBO is booked under the Food Safety Act and tried at a court of Judicial Magistrate of First Class (JMFC). Penalties can include a fine of up to Rs 10 lakh and imprisonment for 7 years.
Role of FSSAI in Food Safety and Colorants Regulation
The Food Safety and Standards Authority of India (FSSAI) plays a crucial role in regulating and ensuring food safety across the country under the Food Safety & Standards Act, 2006.
Ingredients legally banned in India by the FSSAI and various states initiatives:
Parameters
Details
Ingredients Banned in India
Rhodamine B: A textile dye sometimes illegally used as a food colorant.
Potassium Bromate: A flour treatment agent linked to cancer.
Oxytocin: A hormone used unethically in the dairy industry to increase milk production.
Calcium Carbide: Used for ripening fruits, which is hazardous to health.
Formalin: Used in fish preservation, which is carcinogenic.
Brominated Vegetable Oil (BVO): Used in soft drinks, which is linked to various health issues.
State Initiatives for Food Safety
Karnataka: Crackdown on use of unsafe food colorants in kebabs, pani puri, cotton candy, and gobi manchurian.
Maharashtra: Rigorous checks on milk adulteration and stringent actions against offenders.
Kerala: Implementation of ‘Safe Food’ campaign focusing on reducing pesticide use in vegetables.
Tamil Nadu: Regular inspections of street food vendors and training programs on food safety.
Delhi: Special drives to monitor and control the use of banned substances in sweets during festive seasons.
State Food Safety Index (SFSI) by FSSAI sheds light on the performance of Indian states in ensuring food safety.
PYQ:
[2021] Elaborate the policy taken by the Government of India to meet the challenges of the food processing sector.
[2018] Consider the following statements:
The Food Safety and Standards Act, 2006 replaced the Prevention of Food Adulteration Act, 1954.
The Food Safety and Standards Authority of India (FSSAI) is under the charge of Director General of Health Services in the Union Ministry of Health and Family Welfare.
Which of the statements given above is/are correct?
(a) 1 only (b) 2 only (c) Both 1 and 2 (d) Neither 1 nor 2
A seven-member high-level committee was constituted under the chairmanship of K. Radhakrishnan, former ISRO Chairman, by the Ministry of Education to reform the National Testing Agency (NTA).
About National Testing Agency (NTA)
NTA is a premier, specialist, autonomous and self-sustained testing organization to conducts entrance examinations for admission/fellowship in higher educational institutions.
It was established in 2017 with a grant amount of Rs.25 crore from the Union Government.
NTA is responsible for conducting exams such as:
Joint Entrance Examination – Main (JEE Main)
National Eligibility cum Entrance Test-Undergraduate (NEET-UG) as well as NEET PG
National Eligibility Test (NET)
Common Management Admission Test (CMAT)
Graduate Pharmacy Aptitude Test (GPAT).
The NTA is chaired by an eminent educationist who will be appointed by the Ministry of Education.
There will be a Board of Governors comprising members from user institutions.
National Testing Agency (NTA) Under Scrutiny
The NTA has been criticized after the NEET paper leak controversy and the subsequent scrapping of exams like UGC-NET due to “lack of integrity”.
The committee aims to establish a robust process for conducting various entrance examinations end to end.
NTA Reform Panel: Committee Composition
Committee Head: K. Radhakrishnan, former Chairman of ISRO and Chairman of the Board of Governors at IIT-Kanpur.
Two-Month Timeline: The committee aims to meet ten times over the next two months to develop comprehensive recommendations.
Key Issues and Focus Areas:
Data Security Protocol: Develop a manual to fix a data security protocol to prevent question paper leaks.
Printing and Process Integrity: Review processes for printing question papers, onboarding printers, and training staff to minimize external participation.
Organisational Restructuring: Consider adding a data security vertical in the NTA organogram and implementing transparent processes, requiring organizational restructuring.
Examination Investigation and Security:
Root Cause Analysis: The committee will investigate the initial cause of question paper leaks to identify and plug gaps.
Modes of Examination: Examine different modes of conducting examinations:
JEE (Mains) and JEE (Advanced) are computer-based tests.
NEET-UG is conducted in pen-paper Optical Mark Recognition (OMR) mode.
Challenges faced by NTA
Infrastructure Limitations: Currently, India lacks the infrastructure to conduct computer-based tests online for more than three lakh students simultaneously.
Large-Scale Exams: NEET-UG involves up to 24 lakh students appearing in pen and paper OMR mode at once.
Conclusion
The reforms are critical to restoring the integrity of entrance examinations in India, ensuring secure and fair testing processes.
The committee’s recommendations will play a pivotal role in shaping the future operations of the NTA and entrance examination protocols.
Back2Basic: University Grants Commission (UGC)
Details
Establishment
Came into existence on 28th December, 1953.
Became a statutory organization by an Act of Parliament in 1956.
Legislation
The UGC Act, 1956.
Nodal Ministry
Ministry of Human Resource Development (now Ministry of Education).
Responsibilities
Providing funds to universities and colleges.
Coordination, determination, and maintenance of standards of teaching, examination, and research in institutions of higher education.
Mandate
Promoting and coordinating university education.
Determining and maintaining standards of teaching, examination, and research in universities.
Framing regulations on minimum standards of education.
Monitoring developments in collegiate and university education.
Disbursing grants to universities and colleges.
Serving as a link between the Union and state governments and institutions of higher learning.
Advising Central and State governments on measures necessary for the improvement of university education.
Unique Distinction
Only grant-giving agency in India with the dual role of funding and maintaining standards in higher education institutions.
Functions
Promoting and coordinating university education.
Determining and maintaining standards of teaching, examination, and research in universities.
Framing regulations on minimum standards of education.
Monitoring developments in collegiate and university education.
Disbursing grants to universities and colleges.
Serving as a link between the Union and state governments and institutions of higher learning.
Advising Central and State governments on measures necessary for the improvement of university education.
Link Role
Acts as a vital link between Union and State governments and institutions of higher learning.
Advisory Role
Advises the Central and State governments on necessary measures for the improvement of university education.
Opposition mainly comes from traditionalists who dislike markets, industrial experience, and internships. The NEP supports Ambedkar’s vision of education focused on employability for most Indians.
About the National Education Policy (NEP)
The NEP was implemented in 2020, replacing the outdated NEP of 1986 after a delay of 34 years.
It aims to address the low employability of graduates by aligning education with the rapidly changing technological and industrial landscape.
It emphasizes a well-rounded education that includes in-depth knowledge, soft skills, technical skills, research capabilities, analytical and problem-solving abilities, and critical thinking.
The NEP shifts all programs towards outcome-based learning, with specified learning outcomes and corresponding assessments for each course.
Why Criticism of the Policy is Premature and Off the Mark?
Early Stage of Implementation: Critics argue that it dilutes core content and burdens students and educators with bureaucratic requirements, but these criticisms are considered premature.
Continuous Task: Overhauling the vast education sector is a continuous task, and many concerns are over-emphasized.
University-Specific Issues: Much criticism centers around syllabus design and content, which is a university-specific issue and not a failure of the NEP.
Provisions under NEP and Government Efforts
Credit-Based Courses: The NEP introduces credit-based courses, allowing for a flexible and multidisciplinary academic path.
Ability and Skill Enhancement Courses: These courses are designed to equip students with employability or entrepreneurial skills.
Recognition of Prior Learning (RPL): Students gaining industrial exposure related to their studies can earn credits through RPL, facilitating lifelong learning.
Revamped Curriculum and Syllabi: Emphasis on hands-on learning and continuous assessment through credited tutorials.
Internships and Practical Experiences: Integration of internships, apprenticeships, projects, and community outreach within degree programs.
Flexible Exit and Re-Entry: The NEP allows students to exit and re-enter programs, accommodating varied backgrounds and circumstances.
Way Forward
Responsive Academia: Academia should be responsive to the requirements of the masses and markets, ensuring education is aligned with employability and industrial needs.
Continuous Feedback and Updates: Institutions should continuously update their programs based on feedback from stakeholders, following the example of successful adopters like Delhi University.
Long-Term Infrastructure Development: Realizing the full potential of the NEP requires long-term infrastructure development, which should be a sustained effort.
Mains PYQ:
Q National Education Policy 2020 is in conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient the education system in India. Critically examine the statement. (UPSC IAS/2020)
On June 13, the Union government informed the Supreme Court that the scorecards of 1,563 candidates who received compensatory marks in the NEET-UG 2024 exam, held on May 5, will be cancelled.
About National Testing Agency:
National Testing Agency (NTA) has been established as a premier, specialist, autonomous and self-sustained testing organization to conduct entrance examinations for admission/fellowship in higher educational institutions.
The NTA was established in 2017 by the Ministry of Education.
NTA is responsible for conducting the
Joint Entrance Examination – Main (JEE Main)
National Eligibility cum Entrance Test-Undergraduate (NEET-UG)
National Eligibility Test (NET)
Common Management Admission Test (CMAT)
Graduate Pharmacy Aptitude Test (GPAT).
The NTA is chaired by an eminent educationist who will be appointed by the Ministry of Education.
Why has the Union government told the Supreme Court that it will cancel the scorecards of candidates who have been awarded grace marks?
Technical Issues During Exam: The cancellation stems from petitions challenging the award of grace marks to 1,563 candidates from six NEET centers due to technical issues that did not allow them the full 3.2 hours to complete the exam.
Compensatory Marks Controversy: Grace marks were awarded based on a court order and the recommendation of a committee constituted by the National Testing Agency (NTA). This move was challenged as arbitrary and lacking transparency.
Skewed Results: The committee found that the compensatory marks led to a skewed situation, thus recommending the cancellation of the scorecards for these candidates and conducting a re-test on June 23.
How did the National Testing Agency respond to the various charges against the conduct of the exams?
Formation of Committee: In response to the allegations, the NTA constituted a four-member committee to investigate the truth behind the claims, including the award of grace marks and other issues related to the conduct of NEET 2024.
Admission of Irregularities: The NTA admitted that the grace marks caused confusion and contributed to skewed results. They acknowledged technical issues and the improper awarding of grace marks.
Panel Recommendations: The panel recommended limiting grace marks to the attempted questions and concluded that it would be best to cancel the test for the affected 1,563 students.
Explanations for High Scores: NTA officials attributed the unusually high number of perfect scores (67 students scoring 720/720) to an ‘easy paper’, but still took steps to address the fairness and validity of the results by planning a re-test.
Addressing Other Allegations: The NTA’s response included acknowledging various logistical issues such as slow distribution of question papers, wrong OMR sheets, and technical delays, and they aimed to ensure better planning and execution in future exams.
Way forward:
Calls for a Re-test for All Candidates: Students and education experts argue that if the exam can be cancelled for 1,563 candidates, it should be cancelled for all 23 lakh candidates to maintain fairness. They believe that the logical step is to conduct a re-test for everyone who took the May 5 exam.
Restoring Faith in the System: The dissatisfaction expressed on social media highlights a loss of faith in the examination system. To restore confidence, students demand comprehensive measures to address the flaws and ensure a fair and transparent testing process for all candidates.
Improving Examination Conduct: For an exam of NEET’s scale and history, it is expected that organizational issues should be resolved. The NTA and government agencies need to enhance measures to prevent fraud, ensure the timely distribution of materials, and apply proper judgment to address any technical issues during the exam, aiming for a smooth and reliable process in future examinations.
Mains PYQ:
Q National Education Policy 2020 is in conformity with the Sustainable Development Goal-4 (2030). It intends to restructure and reorient the education system in India. Critically examine the statement. (UPSC IAS/2020)
This year’s theme for International Fatty Liver Day, an awareness initiative observed annually in June, is ‘Act Now, Screen Today’. This theme holds more urgency now than ever before.
Liver Diseases in recent times
Liver diseases have long been primarily linked to excessive alcohol consumption, which continues to be a major cause of advanced chronic liver disease.
However, in recent years, a new and quietly escalating threat to liver health has emerged: non-alcoholic fatty liver disease.
India’s Growing Burden of Fatty Liver Disease
Note: MASLD, or Metabolic dysfunction-associated steatotic liver disease, is a reclassification of what was previously known as non-alcoholic fatty liver disease (NAFLD).
High Prevalence Rates: The global prevalence of Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 25-30%. In India, a 2022 meta-analysis revealed that the pooled prevalence of fatty liver among adults was 38.6%. Among obese children in India, the prevalence was around 36%.
Progression of Disease: The continuous damage caused by fatty liver leads to more severe conditions such as steatohepatitis and cirrhosis, often requiring liver transplants.
Causes of Growing Burden of Fatty Liver Disease
Lack of Early Detection: Fatty liver disease often goes undetected in early stages due to lack of symptoms. Diagnosis usually occurs at an advanced stage, when significant liver damage has already taken place.
Diet and Insulin Resistance: Excessive consumption of carbohydrates, especially refined carbs and sugars, leads to metabolic problems. High carbohydrate intake results in persistently high insulin levels and insulin resistance, promoting the conversion of excess glucose into fatty acids, which are then stored in the liver.
Initiatives Taken by the Government
Integration with NPCDCS: The Ministry of Health & Family Welfare launched operational guidelines for integrating NAFLD with the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in February 2021.
Health Promotion and Prevention: The Ayushman Bharat- Health and Wellness Centres (AB-HWCs) are being used to promote healthy living and screen for hypertension, diabetes, and other common NCDs.
Personalization is the Key
Tailored Screening Tests: The selection of screening tests and their frequency should be based on individual risk factors, including family history, lifestyle, and pre-existing health conditions.
Avoiding Generic Assumptions: Clinicians should not rely solely on age or physical markers; instead, they should consider a comprehensive risk profile. Non-communicable diseases are increasingly affecting diverse populations, including children.
Integrated Health Strategies: Combining dietary modifications, regular physical activity, and effective weight management to mitigate liver disease risks.
Frequent Screenings: Regular monitoring of liver health through non-invasive tools like vibration-controlled transient elastography. Continuous assessment of liver stiffness to detect early stages of liver fibrosis and monitor treatment responses.
Active Health Management: Emphasis on the importance of individuals taking control of their health by being aware of their diet and lifestyle choices.Encouragement of frequent health screenings to detect and manage liver disease early.
Way Forward:
Awareness Campaigns: Government initiatives focus on raising awareness about the importance of liver health and the risks associated with MASLD.
Health Screenings: Programs promoting comprehensive health screenings that include physical examinations, blood tests, and abdomen ultrasounds to detect liver diseases early.
Mains PYQ
Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Persistent exclusion results in some disciplines becoming a last resort for many students with social sciences increasingly becoming a significant reservoir of the excluded in India.
Causes of Exclusion in Higher Education:
Excessive Competition: Premier institutions have stringent filtering mechanisms due to high demand, which results in significant exclusion of students.
Financial Factors: Private institutions often have high fees not regulated by statutory norms, and public institutions, facing reduced government funding, also increase fees, making education inaccessible for many.
Subject and Course Availability: There is a regional disparity in the availability of courses. Certain regions offer generic courses with outdated syllabi, limiting students’ choices and leading to exclusion.
Surge of Empirical Orientation:
Employability Perception: Courses with empirical and practical applications, like economics, are perceived to offer better employment opportunities compared to more theoretical courses like anthropology or sociology.
Policy Intervention Skills: There is a growing expectation for social science students to develop problem-solving skills similar to those of engineering students, which narrows the focus within social sciences.
Private Universities: The emergence of private universities catering to the affluent has led to a demand for courses that are less popular in public institutions, creating a dichotomy in course preference and quality.
Improving Quality of Higher Education:
Expand Quantity and Improve Quality: Increase the number of seats to accommodate excluded students and ensure concerted efforts towards enhancing the quality of education like entry based on competitive exams.
Enhance Teaching Quality: Prioritize the improvement of teaching methods and the content of courses to make education more relevant and effective for example reviewing and taking feedback on learning experiences from students.
Address Financial Exclusion: Implement measures to reduce financial barriers and prevent the widening of educational inequalities, ensuring that quality education is accessible to a broader demographic. For example, the Government can provide loans or scholarships.
Update Course Content: Regularly revise and update the syllabi to keep pace with societal changes and technological advancements, such as generative artificial intelligence.
Focus on Inclusivity: Ensure that policies and interventions in higher education focus on inclusivity, addressing the needs of diverse student populations and reducing regional disparities in course offerings.
Steps taken by Government
All India Council for Technical Education (AICTE) Initiatives: The AICTE has undertaken various initiatives to enhance the quality of technical education, such as the establishment of Deen Dayal Upadhyay KAUSHAL Kendras and the introduction of B.Voc degree programs.
University Grants Commission (UGC) Regulations: The UGC has notified regulations to improve the quality of higher education, including those related to recognition, accreditation, minimum qualifications for teachers, curbing ragging, and grievance redressal.
Scholarship and Fellowship Schemes: The UGC has launched various scholarship and fellowship schemes, such as the PG Doctoral Fellowship for SC/ST students, to promote inclusion and equity in higher education.
Conclusion: Efforts to enhance higher education, including expanding access, improving quality, and addressing financial barriers, are crucial for fostering inclusivity and equipping students for India’s future.
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)
Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Q In order 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)
Mentors comment: In the last week of May, a tragic fire at a private neonatal care nursing home in New Delhi shocked everyone. Political parties started blaming each other, and the media exaggerated by incorrectly claiming that many nursing homes in Delhi operate without a license. Despite the intense media coverage, the incident has been largely forgotten, leaving the grieving parents behind. Instead of focusing on who to blame, it’s important to recognize that such tragedies are usually the result of systemic failures—in this case, the failure of health-care regulations.
Let’s learn–
Why in the news?
Health regulations are crucial, but their implementation in India needs to be thoughtful and carefully balanced.
Regulation and standards in the Indian health care system
Excessive and Complex Regulations: Some states have over 50 approvals required under multiple regulations for each healthcare facility, creating a bureaucratic burden. Despite the complexity, there is a perception among officials that the private health sector is under-regulated.
Unrealistic Standards: Many healthcare quality standards set by the government, such as those in the Clinical Establishments (Registration and Regulation) Act, 2010, and the Indian Public Health Standards (IPHS), are considered unrealistic and difficult to implement. Only a small percentage of government primary healthcare facilities meet these standards despite their aspirational goals.
Mixed health-care system in India
Diverse Healthcare Providers: India’s healthcare system includes both government and private sector providers, ranging from single-doctor clinics and small nursing homes to large corporate hospitals, each serving different population segments.
Dominance of Private Sector: The private sector delivers approximately 70% of outpatient services and 50% of inpatient services, indicating a significant reliance on private facilities for health care by the Indian population.
Regulatory and Quality Challenges: There are disparities in regulation enforcement and quality standards between the private and government sectors, with issues such as approval delays, cost of compliance, and ensuring consistent quality care across diverse facilities.
Challenges related to mixed health-care system
Regulatory Disparities: Uneven enforcement of regulations between private and government health facilities. Overzealous regulation of private facilities while government facilities face fewer consequences for similar infractions.
Approval Delays: Sluggish approval processes for private facilities, causing operational delays and financial strain. Long waiting periods for renewal applications, even when submitted well in advance.
Cost and Accessibility: High cost of services in large corporate hospitals compared to smaller clinics and nursing homes. Limited accessibility of government facilities for certain populations, despite being free or low-cost.
Differential Standards: Impractical to hold small clinics and nursing homes to the same standards as large hospitals. Need for a tiered approach to regulation, with essential and desirable standards based on facility type.
Financial Burden: High cost of compliance with regulations for smaller facilities, potentially making health services unaffordable for patients. The a need for government subsidies or funding to help smaller providers meet regulatory standards without increasing costs for patients.
Stakeholder Involvement: Insufficient involvement of health-care providers, facility owners, and community members in the formulation of regulations. Lack of representation from various types of facilities in regulatory processes.
Public Perception and Trust: Political rhetoric and sensational media coverage undermining trust in health-care providers. Potential for increased violence against health-care providers due to public mistrust.
Infrastructure and Safety: Inconsistent emphasis on essential safety measures like fire safety across facilities. Need for equitable implementation of safety standards in all healthcare buildings.
Affordable care is one need
Role of Small Providers: Single doctor clinics and small nursing homes are crucial for providing initial access and health services, particularly for middle-income and low-income populations. These smaller providers deliver a significant portion of health services at a lower cost compared to large corporate hospitals.
Supportive Regulations: There is a need for regulations that support small providers to keep healthcare costs low and affordable. Guidelines should be practical and implementable, harmonizing multiple regulations and simplifying the application process with timely approval.
Differential Approach: Regulations should recognize the different capabilities of various health facilities. Smaller clinics and nursing homes should not be held to the same standards as large hospitals to avoid escalating costs that could be transferred to patients. Essential and desirable regulatory points should be established, with regular self-assessments and inspections to ensure compliance.
Government subsidies and funding should be considered to help smaller facilities adhere to necessary regulations without increasing costs for patients.
Why do we need to Focus on the primary caregivers?
Accessibility and Affordability: Single-doctor clinics and small nursing homes provide essential health services at a lower cost, making health care more accessible and affordable for middle-income and low-income populations.
Primary Care Foundation: Promoting primary care helps manage health issues early, reducing the burden on secondary and tertiary care facilities and supporting the goals of the National Health Policy, 2017, for people-centric, accessible, and affordable health services.
Sustainable Support: Simplified, fair, and collaborative regulatory processes, along with government subsidies, can help primary-care providers operate effectively, ensuring quality and safety without escalating costs for patients.
Conclusion: Primary health care is crucial for achieving the SDG goal of universal health coverage by providing accessible, affordable, and quality health services, thus reducing the burden on higher-level care facilities and promoting overall health equity.
The Ministry of Health and Family Welfare (MoHFW) and the Ministry of Defence (MoD) have entered into a Memorandum of Understanding (MoU) to foster collaboration in operating a special cell of Tele MANAS.
This collaboration, spanning two years, aims to establish a pilot project at the Armed Forces Medical College in Pune.
Suicides and Fratricides in Armed Forces: A Global Issue
As per information given in Parliament in April 2022, there were two cases of fratricide each year from 2019 to 2021 and one case in 2021.
In an older reply in Rajya Sabha on suspected suicide cases in the Army, the Government informed that during the years 2016 to 2018 there were 104, 75 and 80 cases, respectively.
A 2018 study correlated extended deployment to a 15% increased suicide risk in the U.S. military, the U.S. Department of Defence recorded 503 suicides among active-duty personnel in 2019.
Common reasons that forces an individual to take extreme steps are:
Family issues,
Family separation,
Prolonged deployment in difficult areas,
Continuous exposure to hazardous situations,
Traumas originated in Counter Insurgency or Counter Terrorism operations and
Wide range of Human Resource management issues.
Preventive Measures: The Army in its latest advisory issued in August 2023 stated that officers and religious teachers – at least one Pandit, Maulvi, Granthi or Pastor – are posted in each unit and selected other ranks are being trained on the nuances of counselling.
What is the Tele MANAS Initiative?
Tele MANAS, or Tele Mental Health Assistance and Networking across States, stands as India’s National Tele Mental Health Programme.
It is envisioned as the digital extension of the District Mental Health Programme (DMHP).
Its announcement came in the Union Budget of 2022.
The Ministry of Health and Family Welfare (MoHFW) serves as the nodal agency overseeing its implementation.
The primary aim is to ensure universal access to equitable, accessible, affordable, and high-quality mental health care through round-the-clock tele-mental health services.
The International Institute of Information Technology, Bengaluru, serves as the technology partner.
The nodal centre for Tele MANAS operations is located at NIMHANS, Bengaluru.
The National Health Systems Resource Centre operates within the health system domain.
Helpline numbers for assistance are 14416 and 18008914416.
The implementation structure comprises two tiers:
Tier 1: Consists of State Tele MANAS cells comprising trained counsellors and mental health specialists,
Tier 2: Comprises resources from the District Mental Health Program (DMHP) and medical colleges.
Reach and Impact
Nationwide Presence: Currently, 51 operational Tele MANAS cells operate across all 36 States and UTs, delivering services in 20 diverse languages.
Remarkable Response: Since its inception in October 2022, Tele MANAS has received over 10 lakh calls and manages a daily average of more than 3,500 calls.
National Mental Health Programme (NMHP):
The NMHP was launched by the Government of India in 1982.
It was initiated to address the significant burden of mental disorders in the population.
Mental disorders affect approximately 6-7% of the population in India.
Objectives of NMHP: Ensuring the availability and accessibility of minimum mental healthcare to all, particularly the vulnerable and underprivileged sections of the population.
As part of NMHP, the District Mental Health Program (DMHP) was introduced in 1996 during the IX Five Year Plan based on the ‘Bellary Model’:
The Bellary Model emphasizes the importance of early detection, short-term training for physicians, and health worker training in identifying individuals with mental health issues.
PYQ:
[2023] Why suicide among young women is increasing in Indian society?
With growing health disparities and inconsistent access to medical services, the need for fair and sustainable healthcare policies has never been more pressing.
Private Healthcare System in India
Private hospitals in India, especially those accredited by the Joint Commission International (JCI) and National Accreditation Board for Hospitals (NABH), are hubs of specialised care and innovation.
These institutions invest heavily in top-tier infrastructure and advanced technologies, significantly enhancing patient outcomes, particularly in complex procedures. Integration of telemedicine and remote care is common, broadening access and building patient trust.
Price Caps, Quality, and Innovation
Affordability vs. Quality: The Supreme Court’s deliberation on standardising medical procedure rates across government and private sectors highlights the tension between affordability and quality. A study indicates a 15% increase in patient dissatisfaction in hospitals under financial pressure from price caps
Impact on Innovation: Price caps could slow the development of new treatments and technologies, particularly in high-investment fields like cancer research and robotic surgery. Value-based pricing, where payments reflect health outcomes rather than service volume, is proposed as a potential solution.
Economic Implications: Properly implemented rate standardisation can alleviate healthcare disparities but must avoid destabilising providers’ economic health. Dynamic pricing models, which adjust based on medical complexity and patient financial status, are recommended. Thailand’s tiered pricing system is cited as a successful example.
Legal and regulatory challenges
No regulation on Rate Fixation: States like Rajasthan and Tamil Nadu have identified significant gaps in the provisions for rate fixation, indicating a need for more robust legal frameworks to ensure fair and standardised pricing across different regions.
Inadequate Laws as per Local Conditions: Current laws may not adequately consider local demographic and economic conditions, necessitating reforms that allow for more customised approaches to healthcare cost management.
Lack in uniform regulation: Moreover,” the Clinical Establishment Act of 2011″, aimed at setting standards for quality, transparency, and accountability, has been adopted by only a few states, and its implementation remains lax. This lack of uniform regulation allows for wide disparities in service costs and quality.
Role of Data in Shaping Policies
Data-Driven Insights: Predictive analytics can foresee the long-term impacts of rate fixation on healthcare innovations, helping policymakers adjust regulations to encourage innovation and accessibility.
Pilot Projects: Implementing pilot projects in select districts can gauge the impact of rate caps on healthcare quality and innovation.
Way Forward
Balanced Pricing Models: Implement value-based pricing where payments are linked to health outcomes rather than the volume of services provided.
Supporting Innovation: Allocate government subsidies and grants for research and development in private hospitals.
Mains PYQ
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
Q Public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/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 IAS/2022)
Mentor Comment: Health insurance, now central to India’s UHC policy, is being enhanced by digital advancements, enabling reforms akin to the U.S. but with cost-effective local adaptations. A South Indian healthcare chain recently integrated insurance and care provision, forming an Indian-style MCO. This prompts reflection on MCOs’ potential to extend universal health care in India significantly.
Let’s learn_ _
Why in the news?
Universal healthcare poses a multifaceted challenge, yet managed care organizations may offer a piece of the solution that Indian healthcare requires.
What is a Managed Care Organization?
A Managed Care Organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.
The background of Managed Care Organizations (MCOs) in the United States and India:
Evolution of MCOs in the United States:
MCOs have their origins in rudimentary prepaid healthcare practices in the 20th century.
The mainstreaming of MCOs gained momentum in the 1970s due to concerns over healthcare costs.The economic slowdown post-1970s made high insurance premiums less attractive to purchasers.
A shift occurred towards integrating insurance and healthcare provisioning functions. Focus areas included prevention, early management, and cost control, all under a fixed premium paid by enrollees.
MCOs have evolved through multiple generations and forms, deeply penetrating the health insurance market. While evidence of their effectiveness in improving health outcomes and prioritizing preventive care is mixed, they have been effective in reducing costly hospitalizations and associated costs.
Evolution of MCOs in India:
The first public commercial health insurance emerged in the 1980s.The focus has primarily been on indemnity insurance and covering hospitalization costs.
There is a significant market for outpatient consultations, valued at nearly $26 billion.
Health insurance in India has traditionally lagged behind life and general insurance. The sector faces issues such as lack of innovation and high, often unsustainable, operational costs.
As per Thomas (2011), Health insurance has played a secondary role to other forms of insurance. The industry’s operational inefficiencies and high costs have been persistent issues.
Challenges in India:
Lack of Natural Incentives for Cost Control: The evolutionary trajectory of Indian health insurance has not incentivized consumer-driven cost control.
Target Demographic: Health insurance has mainly targeted a thin, urban, well-off segment, neglecting broader demographics.
Informality in Outpatient Practices: There is widespread informality among outpatient practices, complicating efforts to standardize and regulate care.
Lack of Clinical Protocols: The absence of widely accepted clinical protocols hampers the quality and consistency of care.
Economic Viability: Unprofitable operations and unaffordable premiums pose significant economic challenges, preventing sustainable growth and systemic improvement.
Limited Impact on UHC: Private initiatives, despite their potential, are unlikely to significantly contribute to Universal Health Coverage (UHC) without public support.
Insufficient Control Over Patient Journeys: Health insurers have little control over the patient’s journey before hospitalization, limiting their ability to manage early interventions and reduce costs through comprehensive outpatient care.
Prospective Solutions and Remaining Issues:
Potential for Big Healthcare Brands: Large healthcare brands with loyal urban patient bases and substantial resources may initiate successful managed care projects.
Need for Public Patronage: Exploring managed care with cautious and incremental public patronage could be promising, indicating a need for government involvement to achieve broader impacts.
Underutilization of Outpatient Insurance: Given the low share of insurance in outpatient care spending and the average of three consultations per year per person, there is significant potential to reduce healthcare costs through early interventions and comprehensive outpatient care coverage.
NITI Aayog Report:
Outpatient care insurance scheme: In 2021, NITI Aayog released a report advocating for an outpatient care insurance scheme based on a subscription model to enhance savings through improved care integration.
Yield significant benefits: A well-functioning managed care system can yield significant benefits, including consolidating practices, streamlining management protocols, and emphasizing preventive care in the private sector.
Catering for the beneficiaries of PMJAY: The report highlights the potential of incentives under the Ayushman Bharat Mission to encourage the establishment of hospitals in underserved areas catering to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).
Conclusion: While Managed Care Organizations are not a perfect solution, they can play a role in addressing the complexities of achieving Universal Health Coverage (UHC) in India by being part of a broader strategy.
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