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

  • Moving Beyond COVID-19: Need for Contextual Understanding

    COVID-19

    Central Idea

    • COVID-19 has transitioned from a population-level challenge to more of an individual health concern, and it is time for India to shift gears and apply the lessons learned from the pandemic.

    WHO Announcements on COVID-19

    • On January 30, 2020, COVID-19 was announced as a public health emergency of international concern.
    • On May 5, 2023, WHO declared that COVID-19 was no longer a public health emergency of international concern.

    Issues of misinformation during the second wave of COVID-19 in India

    • False claims about a third wave affecting children: In April-May 2021, there was a COVID-19 misinformation blitzkrieg that a third wave in India would affect children, leading to children being repeatedly asked to wear masks and deprived of schooling and learning.
    • Lack of scientific evidence: School closure and making masks mandatory for schoolchildren had their origin in nearly identical challenges of actions not being supported by scientific evidence.
    • Influencers’ impact on public discourse: Social media influencers, not necessarily subject experts, were shaping the public discourse, which was not effectively addressed by governments.
    • Disparate viewpoints: Disparate viewpoints existed among experts and influencers living in India and abroad, with the latter making more definitive and stronger arguments for school closure and mask wearing for children in India.
    • Failure to consider local context: The sub-groups of super-specialists and those staying abroad failed to factor in the local context while coming up with their opinions.
    • Dogmatic stands of self-proclaimed experts: Self-proclaimed experts and influencers have adopted a dogmatic stand and have been selectively and conveniently using emerging evidence and published literature to support their stand, often misguiding gullible followers.
    • COVID-foreverers: A group of disparate individuals and social media groups keep insisting on the enforcement of restrictions such as universal masking at ‘the drop of the hat’, often on frivolous grounds.

    What lessons were learned from the COVID-19 pandemic?

    • The importance of preparedness: The pandemic highlighted the importance of being prepared for future outbreaks and the need for robust public health infrastructure.
    • The role of misinformation: The pandemic showed how misinformation can spread rapidly and have serious consequences, highlighting the need for better education and awareness to combat misinformation.
    • The importance of local context: The pandemic demonstrated the importance of factoring in local context when making policy decisions, as different regions and countries may face different challenges and require different interventions.
    • The danger of dogmatic thinking: The pandemic showed how dogmatic thinking can be dangerous, and the need for an open-minded and evidence-based approach to decision-making.
    • The importance of nuance and context in epidemiology: The pandemic highlighted the need for nuanced understanding of epidemiology, and the importance of taking into account the broader context when interpreting scientific studies.
    • The need for a shift in focus: With COVID-19 transitioning from a population-level challenge to more of an individual health concern, there is a need to shift the focus from COVID-19 fixation to tackling other pressing health challenges.
    • The importance of integrating COVID-19 response with general health services: The pandemic showed the need for integration of COVID-19 response with general health services, and the importance of a balanced approach to public health.

    Way forward

    • Formal training courses on the principles and practice of epidemiology should be offered by the government to prepare India for more nuanced responses to outbreaks and epidemics and to curb misinformation.
    • The government needs to integrate the COVID-19 response to general health services.
    • India’s response to surges, outbreaks, and epidemics (of any infectious disease and not just COVID-19) should be guided by a nuanced understanding of epidemiology and not unduly derailed by social media influencers.
    • Schools should not be closed for a COVID-19 uptick, and wearing masks in order to attend school should never again be made mandatory, as children were never at risk from moderate to severe COVID-19.
    • It is time to drop the COVID-19 fixation and move on to tackle other more pressing health challenges in the country.

    Conclusion

    • The COVID-19 pandemic has presented numerous challenges and lessons for India and the world. The issues of misinformation and lack of context-based policy interventions have been major obstacles in effectively tackling the pandemic. It is time to apply the lessons learned and shift focus to other pressing health challenges while being prepared to respond to future outbreaks and epidemics with a nuanced understanding of epidemiology.

    Mains Question

    Q. During the COVID-19 pandemic, how did misinformation pose a significant challenge? Discuss what lessons have we learned from it?

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    Also Read:

    Covid is no longer an Emergency: what changes?

  • Govt. program for Non-Communicable Diseases renamed

    disease

    Central Idea: The article discusses the decision by the Indian Ministry of Health and Family Welfare to rename and expand its program for the control and prevention of non-communicable diseases (NCDs).

    What are Non-Communicable Diseases (NCDs)?

    • NCDs are also known as chronic diseases, which are not caused by infectious agents and are not transmissible from person to person.
    • NCDs are long-lasting and progress slowly, typically taking years to manifest symptoms.
    • Examples of NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
    • These diseases are often caused by modifiable risk factors such as unhealthy diet, lack of physical activity, tobacco and alcohol use, and environmental factors.
    • NCDs are a major cause of morbidity and mortality worldwide, accounting for around 70% of all deaths globally.

    Why in news?

    • The addition of many new diseases and health initiatives have prompted the Indian government to expand and rename its NCD program.

    Renaming of the NCD Program and Portal

    • The Ministry has renamed the NPCDCS as the “National Programme for Prevention & Control of Non-Communicable Diseases [NP-NCD].”
    • The application or software named Comprehensive Primary Healthcare Non-Communicable Disease (CPHC NCD IT) will now be renamed “National NCD Portal.”
    • The Ministry communicated this decision to the States on May 3, 2023, through a one-page letter and asked them to adhere to the changes.

    Implementation and future action

    • The NPCDCS is implemented under the National Health Mission across India.
    • The letter addressed to Principal Secretaries and Health Secretaries of all States and Union Territories advised the government to use the new names for the scheme and portal in all their future references and correspondences with the Indian government.
    • Under NPCDCS, 677 NCD district-level clinics, 187 District Cardiac Care Units, 266 District Day Care Centres and 5,392 NCD Community Health Centre-level clinics have been set up.

    Burden of NCDs in India

    • The study ‘India: Health of the Nation’s States – The India State-Level Disease Burden Initiative in 2017’ by the ICMR estimated that the proportion of deaths due to NCDs in India has increased from 37.9% in 1990 to 61.8% in 2016.
    • The four major NCDs are:
    1. Cardiovascular diseases (CVDs)
    2. Cancers
    3. Chronic respiratory diseases (CRDs) and
    4. Diabetes
    • The study shared four behavioural risk factors – unhealthy diet, lack of physical activity, and the use of tobacco and alcohol.

    Solutions to mitigate NCD burden

    • Promote healthy lifestyle: Encourage people to adopt healthy lifestyle habits such as regular physical activity, balanced and nutritious diet, avoiding tobacco and alcohol, and getting enough sleep.
    • Increase awareness and education: Increase awareness among the public about the risk factors of NCDs and educate them about ways to prevent these diseases.
    • Improve healthcare infrastructure: Increase access to healthcare facilities, especially in rural and remote areas, to ensure early detection, treatment, and management of NCDs.
    • Implement policies and regulations: Implement policies and regulations that promote healthy living, such as increasing taxes on tobacco and alcohol products, and regulating the marketing of unhealthy food products.
    • Foster public-private partnerships: Foster partnerships between the government, private sector, and civil society organizations to work collaboratively towards preventing and managing NCDs.
    • Increase research and innovation: Increase research and innovation in the prevention, early detection, and treatment of NCDs to develop new and effective interventions.

     

     

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  • Govt. to release Manual for Organ Donation & Transplantation

    organ

    Central Idea: The National Organ and Tissue Transplant Organisation (NOTTO) is working on a transplant manual as a step-by-step guide for the implementation of organ donation and transplantation programmes in hospitals and a standard course for training transplant coordinators.

    Organ transplant in India: Key statistics

    • According to data accessed from the Health Ministry, the number of organ transplants has increased by over three times from 4,990 in 2013 to 15,561 in 2022.
    • Of the 15,561 transplants, a majority — 12,791 (82%) — are from live donors and 2,765 (18%) are from cadavers (the dead).
    • Up to 11,423 of the 15,561 organ transplants are for the kidney, followed by liver (766), heart (250), lung (138), pancreas (24) and small bowel transplants (3).
    • Most of these transplants occur in private hospitals, the numbers in government hospitals are relatively lower.

    About National Organ Transplant Programme (NOTP)

    • In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
    • Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.

    Types of Organ Donations

    • The law allows both deceased and living donors to donate their organs.
    • It also identifies brain death as a form of death.
    • Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.

    (1) Deceased donors:

    • They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
    • Uterus transplant is also performed, but it is not regarded as a life-saving organ.
    • Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
    • Brainstem death is also recognized as a form of death in India, as in many other countries.
    • After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs

    (2) Living donors:

    They are permitted to donate the following:

    • one of their kidneys
    • portion of pancreas
    • part of the liver

    Features of the NOTP

    • Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
    • Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio-material centre.
    • As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.

    More moves for facilitation:  Green Corridors

    • Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
    • Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
    • A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.

    Recent amendments

    (1) No Age Bar

    • Now an individual of any age can register for organ transplant.
    • People beyond 65 years in need of an organ donation will also be eligible to get one.
    • The government has decided to do away with a clause in the National Organ and Tissue Transplant Organisation (NOTTO) guidelines as the clause violates the Right to Life.

    (2) Doing away with domicile compulsion

    • Earlier an organ recipient could register for a prospective transplant in domicile State.
    • States like Gujarat had made it mandatory for registered patients to furnish a domicile certificate to be eligible for a transplant.
    • In November last year, the Gujarat High Court quashed the discriminatory policy of the State government.

    About NOTTO

    National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

    1. National Human Organ and Tissue Removal and Storage Network
    2. National Biomaterial Centre (National Tissue Bank)

    [I] National Human Organ and Tissue Removal and Storage Network

    • This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
    • The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
    • Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
    • It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.

    [II] National Biomaterial Centre (National Tissue Bank)

    • The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
    • It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
    • The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.

    The centre will take care of the following Tissue allografts:

    1. Bone and bone products
    2. Skin graft
    3. Cornea
    4. Heart valves and vessels

    Various issues involved

    • Lack of awareness: Lack of awareness leads to myths and misconceptions about organ donation, which further discourages people from donating organs.
    • Religious and cultural beliefs: Some religious and cultural beliefs view organ donation as a desecration of the body, which hinders organ donation.
    • Lack of infrastructure: India faces a shortage of medical infrastructure and facilities for organ donation.
    • Legal and regulatory challenges: India’s organ donation system is heavily regulated by the Transplantation of Human Organs and Tissues Act, 1994.
    • Socioeconomic factors: Poverty and lack of education can lead to reduced access to information and medical services, making it difficult for people to donate organs.
    • Organized crime: Organized criminal networks involved in organ trafficking and commercialization also create challenges for organ donation in India.
    • Stigma and Discrimination: Stigma against organ recipients, particularly those who receive transplants from other communities or castes, is also a challenge in promoting organ donation in India.

    Way forward

    • Developing a National Organ and Tissue Donation Registry: The registry could maintain a database of donors and recipients, along with their medical history and compatibility information.
    • Setting up Mobile Organ Donation Units: These units could be equipped with medical personnel and equipment to conduct donation procedures in remote areas.
    • Crowdfunding for Organ Transplant Surgeries: This could be used as a means to raise funds for organ transplant surgeries, especially for underprivileged individuals who cannot afford the cost of treatment.
    • Promoting Living Donor Transplants: Living donor transplants can help increase the number of organs available for transplantation.
    • Incentivizing for Organ Donation: Incentives could be introduced to encourage more people to donate organs. This could include tax breaks, priority access to medical treatment, and other benefits.
    • Leveraging Technology: Technology could be used to develop better donor and recipient matching algorithms, create virtual waiting lists, and streamline the donation and transplantation process.
    • International Collaboration: India could collaborate with other countries to share best practices, leverage technology, and develop new approaches to organ donation and transplantation.

     

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  • Psychedelics and its uses to treat Depression

    Central idea: The context of the article is about the use of psychedelic drugs for both recreational and medicinal purposes.

    What are Psychedelics?

    • Psychedelics are a class of drugs that alter an individual’s perception, mood, and thought processing while still allowing the individual to remain conscious and with unimpaired insight.
    • They are non-addictive and non-toxic, and cause less harm to the end user compared to illicit drugs.
    • The two most commonly used psychedelics are LSD (Lysergic acid diethylamide) and psilocybin. Researchers have also developed synthetic psychedelics.
    • In India, the Narcotic Drugs and Psychotropic Substances Act 1985 prohibits the use of psychedelic substances, except for ketamine which is used under strict medical supervision.

    History of psychedelics

    • Humans have used psilocybin and mescaline for ceremonial, healing, and spiritual rituals for millennia.
    • The modern-day use of psychedelics is commonly associated with the German chemist Arthur Heffter isolating mescaline from the peyote cactus in 1897.
    • In 1938, Swiss chemist Albert Hofmann first synthesized LSD while investigating compounds related to ergotamine.
    • LSD was widely used as a therapeutic catalyst in psychotherapy between 1947 and 1967, until it was criminalized in the US due to medical concerns and the Vietnam War.

    Experience of using psychedelic substances

    • Users of psychedelic substances report changes in perception, somatic experience, mood, thought-processing, and entheogenic experiences.
    • Perceptual distortions most commonly include the visual domain.
    • Somatic experiences may include the visceral, tactile, and interoceptive domains.
    • Mood changes may include elation, euphoria, anxiety, and paranoia.
    • Entheogenic experiences include transcendental and ineffable spiritual experiences.

    How do they work inside the body?

    • Classical psychedelics boost brain serotonin levels.
    • Psilocybin’s therapeutic effects require a ‘trip’ that is mediated by the activation of serotonin receptors.
    • Modern neuroimaging suggests that psychedelics increase the cross-talk between different brain networks, and this correlates with the subjective effects of psychedelics.

    Can psychedelic substances cause any harm?

    • Death due to direct toxicity of LSD, psilocybin, or mescaline has not been reported in the literature despite 50-plus years of recreational use.
    • Synthetic psychedelics have been associated with acute cardiac, central nervous system, and limb ischemia, as well as serotonin syndrome.

    What is Psychedelic-Assisted Psychotherapy?

    • Psychedelic-assisted psychotherapy has three types of sessions: preparatory, medication, and integration.
    • In the medication session, the patient is accompanied by a male-female co-therapist dyad and a psychedelic drug is administered in a comfortable and well-appointed room.
    • Over the next 6-8 hours, the therapists listen to the patient while maintaining a neutral therapeutic stance.
    • In the integration session, the therapists work with the patient to interpret the contents of their psychedelic experience into meaningful long-term change, based on their thoughts and ideas.

    Uses to treat Neuropsychiatric Disorders

    • Research has shown that psychedelic substances have potential therapeutic benefits in treating neuropsychiatric disorders such as treatment-resistant depression and post-traumatic stress disorder (PTSD).
    • In recent trials, a single dose of psilocybin or MDMA-assisted therapy has been shown to reduce depression scores and improve symptoms of PTSD in participants.

    Back2Basics: Narcotic Drugs and Psychotropic Substances Act, 1985

    Details
    Purpose Combat drug abuse and trafficking in India
    Scope Consolidates and amends the existing legal framework related to narcotics and psychotropic substances
    Regulations Strictly regulates and controls the production, manufacture, sale, transport, possession, and consumption of narcotic drugs and psychotropic substances
    Special Courts Establishment of special courts and appointment of special public prosecutors to handle cases related to drug trafficking and abuse
    Covered Substances Opium, heroin, cannabis, cocaine, synthetic drugs such as LSD and ecstasy
    Classification Substances classified into different schedules based on their potential for abuse and medical use
    Punishment Imposes different levels of punishment for offenses related to each schedule
    Enforcement Narcotics Control Bureau (NCB), Central Bureau of Narcotics (CBN), and state-level drug enforcement agencies
    Functions Prevention of drug abuse and trafficking, investigation and prosecution of drug offenses, rehabilitation and treatment of drug addicts

     

     

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  • India’s One Health Approach to Tackle Future Pandemics

    One Health

    Central Idea

    • The Covid-19 pandemic exposed weaknesses in the world’s health systems, including countries ranked high in the Global Health Security Index. It has also provided an opportunity to build stronger health systems to prevent and respond to future pandemics. India’s One Health approach aims to address the health of people, animals, and ecosystems together in order to prevent, prepare, and respond to pandemics.

    One Health

    What is PM Ayushman Bharat Health Infrastructure Mission (PM ABHIM)? 

    • PM ABHIM is being rolled out as India’s largest scheme to scale up health infrastructure.
    • It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.
    • Key features:
    • Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
    • Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
    • Integrated public health labs: It will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
    • Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
    • Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.

    Facts for prelims

    What is Global Health Security Index?

    • The Global Health Security Index is a tool developed to assess a country’s preparedness and ability to respond to outbreaks, pandemics, and other public health emergencies.
    • It was developed by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security, in collaboration with The Economist Intelligence Unit (EIU).
    • The Index ranks 195 countries based on their level of preparedness across six categories: 1. Prevention, 2. Detection and reporting, 3. Rapid response, 4. Health system, 5. Compliance with international norms, and 6. Risk environment.
    • The Index aims to identify gaps in preparedness and encourage countries to take action to strengthen their health security systems, particularly in the face of global health threats such as pandemics.
    • The first edition of the Index was published in 2019, and it has since been updated to reflect the evolving global health landscape.
    • Global Health Security Index 2021: India ranked 66th.

    One Health

    What is mean by One health?

    • One Health is an interdisciplinary approach that recognizes the interconnectedness of human, animal, and environmental health.
    • It emphasizes the need for collaboration between various sectors, including public health, veterinary medicine, environmental science, and others, to achieve optimal health outcomes for all.

    key components of India’s One Health approach

    • Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): The flagship program launched in October 2021 aims to prevent, prepare, and respond to pandemics. It seeks to fill the gaps in health systems at the national and state levels.
    • National Institute for One Health: The foundation for the institute was laid recently in Nagpur. It will identify hotspots for endemic and emerging zoonotic diseases to contain their spread early on.
    • Creation of a network of institutions for genomic surveillance: During the COVID-19 pandemic, India created a formidable network of institutions that can identify new pathogens. This can now be complemented with wider testing of wastewater and samples from incoming ships and aircraft.
    • Coordination between ministries: Several ministries, including health, animal husbandry, forests, and biotechnology, have been brought under the Principal Scientific Advisor to address overlapping mandates and improve coordination.
    • Expansion of research laboratories: India is expanding its network of research laboratories, which primarily focused on influenza, to cover all respiratory viruses of unknown origin.
    • Partnerships between research bodies and manufacturers: Indian manufacturers produced vaccines, test kits, therapeutics, masks and other items at very competitive prices, both for India and other countries. The partnerships between research bodies and manufacturers will need to be sustained and enhanced to make India a global hub in the biopharma sector.
    • Clinical trial network: The clinical trial network set up under the National Biopharma Mission is a positive step toward improving access to affordable new vaccines and drugs in India and around the world.
    • Ayushman Bharat Digital Health Mission: The mission can facilitate the bringing of private hospitals and clinics under a common platform and placing data in the public domain to augment surveillance in vulnerable areas.
    • Municipal corporations mandated to provide early alerts: Municipal corporations have been mandated to identify the most vulnerable areas and provide early alerts. For this to be successful, strong partnerships with communities, dairy cooperatives, and the poultry industry will be needed to identify new infections.

    What are the potential advantages of the One Health approach?

    • Holistic approach: The One Health approach looks at the interconnectedness of human, animal, and environmental health. By taking a holistic approach, it enables a better understanding of the complex interconnections between human, animal, and environmental health, and can lead to more effective interventions and solutions
    • Early disease detection: The One Health approach emphasizes the importance of early disease detection in animals, which can serve as an early warning system for potential human outbreaks. This approach can help prevent the spread of diseases and reduce the risk of pandemics.
    • Better disease surveillance: The One Health approach facilitates better disease surveillance by enabling the sharing of information and resources between different sectors, including human health, animal health, and environmental health.
    • More effective responses: The One Health approach can lead to more effective responses to outbreaks by facilitating collaboration between different sectors and stakeholders, and ensuring a coordinated response.
    • Improved animal health: The One Health approach recognizes the importance of animal health and welfare, and can lead to improved animal health through better disease control and prevention measures.
    • Better environmental management: The One Health approach also recognizes the importance of environmental management and conservation, and can lead to more sustainable environmental practices that benefit both human and animal health.

    One Health

    Conclusion

    • India’s One Health approach is a positive step towards addressing the health of people, animals, and ecosystems together. The country’s efforts to tackle future pandemics are commendable, and the success of these efforts will be critical. The rise of new pathogens, zoonotic diseases, and antibiotic resistance highlights the need for a comprehensive approach to prevent future pandemics. India’s efforts to build stronger health systems, prevent pandemics, and respond to outbreaks will help protect its citizens and set an example for the world.

    Mains Question

    Q. What do you understand by mean One Health? Discuss the advantages of One health approach the efforts of India in this direction.

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  • Latest National Health Account figures on India’s Healthcare Sector

    national health

    Central idea: The National Health Account Estimates 2019-20 report shows an increase in government spending and a decline in out-of-pocket expenditure on healthcare.

    About National Health Account (NHA) estimates

    • The NHA estimates for India 2019-20 is the seventh consecutive report prepared by the National Health Systems Resource Centre (NHSRC).
    • NHSRC was designated as National Health Accounts Technical Secretariat (NHATS) in 2014 by the Union Health Ministry.
    • The NHA estimates use an accounting framework based on the internationally accepted standard of System of Health Accounts, 2011 developed by the WHO.
    • India now has a continuous series of NHA estimates from 2013-14 to 2019-20, making the estimates comparable internationally.
    • The estimates enable policymakers to monitor progress in different health financing indicators of the country.

    health

    Key highlights

    Description
    Government spending as % of GDP
    • Increased from 1.13% (FY 2015) to 1.35% (FY 2020)
    • Per capita health spending of the government has also increased from Rs 1,108 in FY 2015 to Rs 2,014 in FY 2020.
    • Govt share in total healthcare spending has increased from 29% in 2015 to 41.4% in 2020
    Declining out-of-pocket expenditure
    • Proportion of total healthcare spending that comes from people’s pockets has decreased from 62.6% in 2015 to 47.1% in 2020
    • Govt aims to further reduce out-of-pocket expenditure by investing in public health and insurance
    • To reduce the financial burden of healthcare on individuals and increase the utilization of healthcare services
    Government spending on primary healthcare
    • Increased from 51.3% in 2015 to 55.9% in 2020.
    • Govt. invested in creating 1.5 lakh health and wellness centres that can screen people for cancers, diabetes, and eye disease.
    Increase in social security expenditure
    • Increased from 5.7% of total healthcare spending in 2015 to 9.3% in 2020.
    • Suggests that the government is investing more in social welfare programs.
    Increase in spending on insurance
    • Privately purchased health insurance increased from 3.9% of total health expenditure in 2015 to 7.72% in 2020
    • Govt. financed health insurance spending also went up from 3.8% in 2015 to 6.37% in 2020
    Health spending by states
    • Only two big states and three smaller ones have crossed the target of 8% of their budget going towards healthcare as set by the National Health Policy 2017.

     

    Key issues

    • Marginal increase: Activists are concerned about the marginal increase in government spending.
    • Global laggard: This increase in government health expenditure as a percentage of GDP also takes into account capital spending, which puts India in 164th place out of 184 countries in terms of government health spending.
    • No proportional increase: Total spending on health as a proportion of GDP has been going down, from 3.9% in 2015 to 3.3% in 2020, indicating a decline in consumption of healthcare services.

    Conclusion

    • Overall, the report shows that government spending on healthcare has been increasing, while out-of-pocket expenditure has been declining.
    • There is a need to invest in public health and insurance and increase the contribution of states towards healthcare.

     

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  • Malaria soon to be a notifiable disease across India

    malaria

    Malaria is all set to become a notifiable disease across India, which will require cases to be reported to government authorities by law.

    About Malaria

    Description
    Definition A potentially life-threatening disease caused by parasites that are transmitted through the bite of infected female Anopheles mosquitoes
    Causes Four species of plasmodium parasites, namely plasmodium vivax, plasmodium falciparum, plasmodium malariae, and plasmodium ovale
    Spread Bite of infected female Anopheles mosquitoes
    Symptoms Fever, chills, headache, muscle pain, fatigue, nausea, vomiting
    Diagnosis Blood test
    Treatment Antimalarial drugs
    Prevention Insecticide-treated bed nets, indoor residual spraying, wearing protective clothing, using mosquito repellent, avoiding mosquito bites
    Vaccine RTS,S/AS01 (Mosquirix)

     

    Why in news?

    • The move is part of India’s vision to become malaria-free by 2027 and to eliminate the disease by 2030.

    Menace of malaria in India

    • In India, 80% of malaria cases occur among 20% of its population living in the 200 high-risk districts of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, West Bengal and the seven north-eastern states.
    • With only fewer than half of those infected reaching a clinic or hospital, the cases and deaths are much higher than recorded.

    What is Notifiable Disease?

    • A notifiable disease is a disease that is required by law to be reported to government authorities.
    • In India, the Ministry of Health and Family Welfare maintains a list of notifiable diseases under the National Health Mission.
    • This is done to track the spread of the disease and to take necessary measures to control and prevent its spread.
    • Reporting notifiable diseases is important for public health surveillance and response to outbreaks.

    Malaria as a Notifiable Disease

    • Malaria is currently a notifiable disease in 33 states and Union Territories in India.
    • Bihar, Andaman and Nicobar Islands, and Meghalaya are in the process of putting malaria in the notifiable disease category.

    Other measures to curb malaria

    • Malaria Elimination Programme: The government has launched the National Framework for Malaria Elimination in India 2016-2030 to eliminate malaria from the country by 2030.
    • Joint Action Plan: The Health Ministry has initiated a joint action plan with the Ministry of Tribal Affairs for malaria elimination in tribal areas. This plan aims to bring down malaria cases to zero in tribal areas, which are among the most vulnerable to the disease.
    • HIP-Malaria Portal: The Ministry has ensured the availability of near-real-time data monitoring through an integrated health information platform and periodic regional review meetings to keep a check on malaria growth across India.

    Vaccines developed so far

    • The WHO has approved the rollout of two first-generation malaria vaccines, RTS,S and R21, in high-transmission African countries.
    • Bharat Biotech, an Indian company, has been licensed to manufacture the RTS,S vaccine, with adjuvant provided by GSK.
    • The R21 vaccine, developed by scientists at Oxford University, has shown promising results in phase 2 clinical studies and has been approved by regulatory authorities in Ghana and Nigeria.
    • Scientists at the International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi have developed and produced two experimental blood-stage malaria vaccines, with Phase I clinical trials completed for one of them.

     

     

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  • Tuberculosis (TB) Should No Longer Exists in the 21st Century: India can lead the way

    TB

    Central Idea

    • At the One World TB Summit in Varanasi, Uttar Pradesh on March 24, 2023, Prime Minister Narendra Modi called for a fresh approach to the global tuberculosis (TB) elimination response, with innovation and research being central drivers of change. This is a critical step as India and the world look to redefine their TB elimination response. India’s recent progress in TB control efforts and COVID-19 response provides a good reflection point, which offers lessons to address the challenges faced in the fight against TB.

    India’s Progress in TB Control Efforts

    • Expanded reach and improved detection measures: India’s National TB Elimination Programme has introduced several measures to find, notify, and treat TB cases, resulting in expanded reach and improved detection measures. As a result, the number of TB case notifications has significantly increased, rising from 15.6 lakh in 2014 to over 24 lakh in 2022.
    • Innovative approaches: India has adopted innovative approaches to TB management, including engagement with the private sector, launch of social support provisions, and introduction of diagnostic tools and new drug regimens. These measures have improved TB management in the country.
    • Increased investment in health research and development: India has recognized the importance of investing in health research and development, especially in recent years. The Mission COVID Suraksha programme to develop vaccines was a good example of a public-private partnership, with clear goals and outcomes. The country has also established centres of excellence, which will facilitate collaboration between Indian Council of Medical Research laboratories and the private sector.
    • Expansion of diagnostic tools: India has been working on expanding access to diagnostic tools for TB. Innovations such as nasal and tongue swab-based tests for TB can be a game changer by reducing diagnostic delays, and handheld digital x-ray machines with artificial intelligence-based software can now be taken to villages and urban settlements to screen large numbers of high-risk individuals.
    • Introduction of new therapeutic molecules: India has been investing in the development and introduction of new therapeutic molecules for TB treatment. Shorter, safer, and more effective regimens, such as the 1HP regimen for latent TB infections, the four-month regimen (HPZM) for drug-susceptible TB, and the six-month regimen (BPaL/M) for drug-resistant TB, have been developed.

    Why there is a Need for Disruptive Approaches and New Tools in TB elimination response?

    • Lack of widespread awareness: Despite the progress made by India’s National TB Elimination Programme, there is still a lack of widespread awareness about the disease, which has led to delayed diagnosis and treatment.
    • Access to quality care: Many people with TB in India and other developing countries do not have access to quality care, which has led to high rates of morbidity and mortality.
    • Limited diagnostic tools: There is a need to expand access to diagnostic tools for TB, especially in rural and remote areas.
    • Drug-resistant TB: The emergence of drug-resistant TB has made treatment more difficult, requiring the development of new therapeutic molecules and regimens.
    • Need for innovative approaches: Innovative approaches are needed to change the way TB is prevented, diagnosed, and treated.
    • Rapidly evolving technology: Advances in technology, such as point-of-care tests, artificial intelligence-based software, and handheld digital x-ray machines, have made it possible to develop new tools to combat TB.
    • For example: Innovative technologies such as handheld digital x-ray machines with artificial intelligence-based software and nasal and tongue swab-based tests for TB can reduce diagnostic delays and provide rapid, low-cost diagnostics. Similarly, newer and more effective regimens and repurposed existing drugs for TB can play a crucial role in the long run.

    Importance of Prioritizing TB Vaccine Trials

    • Vaccines are key to ending the TB epidemic: Vaccines are one of the most effective ways to prevent infectious diseases. For TB, a vaccine would be a critical tool for ending the epidemic, especially for those who are at the highest risk of developing and spreading TB.
    • BCG vaccine is not effective for all: The current TB vaccine, Bacille Calmette-Guérin (BCG), is not effective for everyone, especially adolescents and adults who are at the highest risk of developing and spreading TB. Therefore, new and effective vaccines are needed to provide adequate protection.
    • Multiple TB vaccine candidates in the pipeline: There are currently over 15 TB vaccine candidates in the pipeline, which have shown promise in pre-clinical and clinical trials. Prioritizing these clinical trials will help identify the most effective vaccine candidates for various community settings and different target groups.
    • Cost-effectiveness: Vaccines are a cost-effective way to prevent diseases, and a TB vaccine would be no different. Investing in TB vaccine trials and development would save resources in the long run by reducing the burden of TB on health systems and economies.
    • Global impact: TB is a global public health issue, affecting millions of people worldwide. The development of a new TB vaccine would have a significant impact not only in India but also in other high-burden countries.

    Facts for prelims: Types of vaccine technologies

    Vaccine Technology

    		 Explanation

    Examples
    Inactivated or killed vaccines Use viruses or bacteria that have been inactivated or killed so that they can no longer cause disease Inactivated polio vaccine, hepatitis A vaccine
    Live attenuated vaccines Use viruses or bacteria that have been weakened so that they can’t cause disease in healthy people Measles, mumps, and rubella (MMR) vaccine, yellow fever vaccine
    Protein subunit vaccines Use pieces of the virus or bacteria, such as proteins or sugar molecules, to stimulate an immune response Human papillomavirus (HPV) vaccine, pertussis (whooping cough) vaccine
    Nucleic acid vaccines Use genetic material from the virus or bacteria, such as DNA or RNA, to stimulate the immune system COVID-19 mRNA vaccines from Pfizer-BioNTech and Moderna
    Viral vector vaccines Use harmless viruses, such as adenoviruses, to deliver genetic material from the target virus or bacteria into the body to stimulate an immune response Johnson & Johnson COVID-19 vaccine, Ebola vaccine developed by Merck

    How Testing and Diagnosis of TB can be improved?

    • Increased access to diagnostic tools: There is a need to increase access to diagnostic tools for TB, especially in rural and remote areas. Innovative approaches such as point-of-care tests (POCTs), including home-based tests, can provide decentralized, rapid, and low-cost diagnostics to provide results within minutes.
    • Introduction of new diagnostic tools: New innovations such as nasal and tongue swab-based tests for TB can be a game changer by reducing diagnostic delays. Further, handheld digital x-ray machines (with artificial intelligence-based software) can now be taken to villages and urban settlements to screen large numbers of high-risk individuals, safely and conveniently.
    • Strengthening the laboratory network: It is essential to strengthen the laboratory network in India to ensure quality diagnostics, especially in the private sector. Accreditation of private laboratories for TB diagnosis and linking them with the public sector is essential.
    • Integration with other healthcare services: TB testing and diagnosis need to be integrated with other healthcare services to improve access and reduce stigma. For example, TB screening can be done in conjunction with diabetes or HIV screening.
    • Empowering patients: Empowering patients with knowledge about TB symptoms and diagnostic tests can help increase awareness and improve early diagnosis. TB awareness campaigns can also help reduce stigma associated with the disease.
    • Collaboration between public and private sectors: Collaboration between the public and private sectors can improve access to diagnostic tools and reduce the time required for TB testing and diagnosis. The private sector can be leveraged to provide affordable and quality TB diagnostics and treatment.

    Need for Appropriate Policy Frameworks

    • Smoothening the rollout of proven tools: Creating regulatory and policy frameworks can smoothen the rollout of proven tools to reach people with as little delay as possible. This requires greater collaboration between policymakers, scientists, product developers, and clinical researchers across the country and even across regions.
    • Harmonization of standards and regulatory processes: Harmonization of standards and regulatory processes between countries can enable mutual recognition of evidence-based standards and licenses and save critical time towards rollout.
    • Addressing the regulatory challenges: Appropriate policy frameworks can address the regulatory challenges of introducing new tools and approaches. This can help reduce the time and cost of clinical trials and shorten the time to market for new tools and products.
    • Encouraging innovation: Policy frameworks that incentivize innovation can encourage the private sector to invest in TB research and development. This can lead to the development of new and effective tools for TB prevention, diagnosis, and treatment.
    • Supporting public-private partnerships: Appropriate policy frameworks can support public-private partnerships that can bring together the strengths of both sectors to develop and scale up innovative solutions for TB control.

    Conclusion

    • India’s scientific ingenuity during the COVID-19 pandemic has cemented its position as pioneers in innovation in the life sciences. India must use its G-20 presidency to build a global health architecture that creates equitable access for all. India must use this opportunity to call for the collaborative development of transformational tools and approaches that cater to not only India’s needs but also those of the under-represented but disproportionately affected developing world. TB should no longer be the leading infectious disease killer globally in the 21st century, and India can lead the way.

    Mains Question

    Q. At the One World TB Summit held at in Varanasi recently, Prime Minister Narendra Modi called for a fresh approach to the global tuberculosis (TB) elimination response. In this light discuss India’s Progress in TB Control Efforts and the need for disruptive approaches and new tools in TB elimination response.

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  • NCERT’s Changes On Mughal History and Sparked Heated Debate

    NCERT

    Central Idea

    • The controversy over the National Council of Educational Research and Training (NCERT) reducing the content on Mughal history in the school curriculum has sparked a heated debate in the country. While some argue that this move is part of a larger agenda to erase the Mughal legacy, others believe that it is a necessary step towards reducing the burden on students and providing a more balanced approach to teaching Indian history.

    NCERT’s changes

    • The NCERT removed overlapping material from grades 6 to 12 to reduce the burden on students.
    • Grade 12 has been designed around themes in Indian history. It is divided into three parts spanning over 2,000 years. One theme out of 12 focuses on Kings and Chronicles. It revolves around the significant policies that redefined the landscape and mindset of the people. Akbar’s policies feature in this theme in the rationalized syllabus as well.
    • This is over and above the extensive coverage they get in the middle school curricula, at the cost of the exclusion of the rest. Mughals have been overrepresented in Indian history books and were an obvious area for right-sizing.

    What NCERT has said on omitting chapters?

    • Part of rationalisation process: According to NCERT director, Chapters on Mughals have not been dropped. There was a rationalisation process last year because due to COVID, there was pressure on students everywhere.
    • Reducing the burden without affecting the knowledge: The expert committees examined the books from standards 6-12. They recommended that if some sections or this chapter is dropped, it won’t affect the knowledge of the children and an unnecessary burden can be removed.
    • Transition towards National Education Policy (NEP): NCERT working as per NEP, 2020. This is a transition phase. NEP 2020 speaks of reducing the content load. NCF (National Curriculum Framework) for school education is being formed, it will be finalised soon. Textbooks will be printed in 2024 as per NEP.

    Need for a balanced approach

    • Purpose of studying Indian history: The purpose of studying Indian history should be to understand who we are and how we got here, by understanding the demography, culture, and practices of the various components of India over the last two-and-a-half millennia.
    • Dive deep into all polities: This requires us to dive deep into all polities that have resided in the subcontinental region for significant periods.
    • Mughal history is just one part: Mughal history is just one part of just one period (medieval) of Indian history, and there is a lot more to our history that needs attention.

    Need for a more comprehensive approach

    • Rich and long history: Indian history is too rich, long, and unwieldy for any curriculum to do justice.
    • Children needs to have broader understanding: In the age of Wikipedia, we need to expose our children to the broad themes and grand sweep of history, create an understanding of their origins, and equip them with the tools and curiosity to read and research further as they grow.
    • Step is in good direction: The current reorganization is a good step in that direction.

    Conclusion

    • The real debate should be how to teach 2,500 years of Indian history to children in an engaging and informative manner. Those quibbling over the current rearrangement lack both a perspective on the scale of Indian history and an understanding of the complexities of teaching it. They would be better served by picking up a few history books themselves.

    Mains Question

    Q. The national education policy speaks of reducing the content load and ensure the understanding in this light discuss the significance of teaching history of India in more rational and comprehensive manner.

  • UGC releases National Credit Framework (NCrF)

    The University Grants Commission (UGC) released the National Credit Framework (NCrF), which will allow students to earn educational credits at all levels, irrespective of the mode of learning i.e. offline, online, or blended.

    What is National Credit Framework (NCrF)?

    • The NCrF is a meta-framework that integrates the credits earned through school education, higher education, and vocational and skill education.
    • It consists of three verticals:
    1. National School Education Qualification Framework (NSEQF)
    2. National Higher Education Qualification Framework (NHEQF) and
    3. National Skills Qualification Framework (NSQF)
    • The NCrF provides a mechanism for the integration of general academic education and vocational and skill education, ensuring equivalence within and between these two education streams.
    • Institutions would be free to notify their detailed implementation guidelines with flexibility for catering to their academic requirements.

    Key features

    (1) Credit System

    • Under the NCrF, one credit corresponds to 30 notional learning hours in a year of two semesters.
    • A student is required to earn a minimum of 20 credits every semester.
    • A student can earn more than 40 credits in a year.
    • Maximum credits a student can earn during schooling period is 160.
    • A three-year bachelor’s degree course will result in a total of 120 credits earned.
    • A Ph.D. degree is at Level 8 and earns 320 credits upon completion.

    (2) Study of Vedas:  Students can obtain credits for their proficiency in diverse areas of the Indian knowledge system, including the Puranas, Vedas, and other related components.

    (3) Indian Knowledge System (IKS): UGC notified the final report, which includes the components of the IKS. The IKS comprises 18 theoretical disciplines called vidyas and 64 practical disciplines, including vocational areas and crafts. These disciplines were the foundation of the 18 sciences in ancient India, as per the report.

    (4) Educational Acceleration: The NCrF supports educational acceleration for students with gifted learning abilities. It provides scope for crediting national/international achievers in any field, including but not limited to sports, Indian knowledge system, music, heritage, traditional skills, performing & fine arts, master artisans, etc.

    (5) International Equivalence: The international equivalence and transfer of credits shall be enabled through various multilateral/bilateral agreements between respective regulators of the countries concerned. NCrF would lend credibility and authenticity to the credits being assigned and earned under various programs in India, making these credits more acceptable and transferable internationally.