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

  • Healthcare: Need For Compassionate Leadership

    Central Idea

    • India’s rapid strides in health and healthcare with the help of a digital boom and the Ayushman Bharat Digital Mission, and the need for compassionate leadership to ensure respectful healthcare.

    India’s healthcare sector

    • India’s healthcare sector has shown improvement in multiple metrics due to the push for healthcare digitization, infrastructure, coverage, and other inputs.
    • However, healthcare is not just about the treatment of diseases or the availability of infrastructure but also about the overall wellness of the person.
    • Respectful healthcare that is available, affordable, accessible, and compassionate is a determinant of the quality of care.

    Importance of Compassionate leadership

    • Respectful and compassionate healthcare is essential: Healthcare is a perpetually evolving, stressful, and high-risk industry that puts a vast burden on healthcare providers. It is essential to navigate and manage the situation compassionately to deliver respectful care.
    • Compassion is a beating heart if healthcare: Compassionate leadership is required to build this type of healthcare system, as it is the quiet, beating heart of the entire healthcare system.

    Curriculum for compassionate healthcare

    • Compassionate curriculum is very necessary: To integrate compassion into the healthcare system at every stage, it is necessary to build a curriculum and deliver it to those responsible for administering healthcare respectfully.
    • Curriculum with Dalai Lama’s vision rolled out in Bihar: An eight-stage curriculum, developed by Emory University, that furthers the Dalai Lama’s vision of educating both heart and mind for the greater good of humanity is being rolled out in Bihar.
    • Impact: To date, 1,200 healthcare providers across 20 districts have been impacted by the vital components of the cognitive-based compassion training, creating compassionate leaders at every level.

    Institutionalizing compassionate healthcare

    • Institutionalizing will bring in real change: While the curriculum is a quantum leap towards building compassionate leadership, institutionalizing it will bring in real change.
    • Adopting at each level: Every academic institution and every department mandated with the responsibility to deliver health-related learning should develop and adopt compassion-based curricula.
    • Building capacity: State and regional health institutions must also be built with the capacity to deliver compassionate leadership. Partnerships with established academia and development sector organizations can enable the organizing of master coaches and master facilitators, thereby creating public goods that can be delivered by all.

    Strengthening internal systems

    • Making compassion intrinsic to the ethos: All healthcare providers are expected to carry out a wide range of tasks within the system, which often leads to burnout and impacts patient experience adversely. It is vital to strengthen systems internally to make respect and compassion intrinsic to the ethos.
    • Building a network: Building a network of compassionate practitioners in every state, district and block hospital is crucial to fan the winds of change by starting with self-compassion first and then moving to compassion for others.
    • Valuing and measuring organizational culture: Valuing and measuring organizational culture is just as critical as patient outcomes. Developing sound metrics to measure culture and employee satisfaction, self-compassion, and compassion for the team assumes greater significance to building an institution whose foundation is compassion.

    Conclusion

    • Respectful healthcare is already mentioned in the National Health Mission (NHM) guidelines, and such guidelines need to be the warp and weft of every policy and every guideline developed by public health authorities to improve patient experience. Compassionate leadership can truly realize India’s historically known values of compassion and bring alive the words of Hippocrates, the father of medicine, “Wherever the art of medicine is loved, there is also a love of humanity”.

  • Govt releases pre-draft of National Curriculum Framework

    curriculum

    The Ministry of Education has released a pre-draft version of National Curriculum Framework (NCF) for School Education.

    National Curriculum Framework (NCF)

    Features

    Details
    What is it? A comprehensive framework for school education in India

    Provides guidelines for the development of curricula and syllabi, textbooks, and teaching practices for schools in India
    Developed by National Council of Educational Research and Training (NCERT), an autonomous organization under the Ministry of Education
    Aim To promote a child-centred, activity-based approach to learning that focuses on the development of knowledge, skills, and values
    Development The first NCF was developed in 1986 and subsequently revised in 2000 and 2005.

    The latest pre-draft version of NCF for School Education was released by the Ministry of Education in April 2023.
    Coverage For age groups 3 to 18 years

    Seeks feedback from various stakeholders
    National Steering Committee Set up by the Ministry to undertake and develop NCFs under the chairmanship of K. Kasturirangan.

     

    Salient features of NCF

    (1) Values and Roots

    • A key part of the document is the inclusion of values and its “rootedness” in India.
    • The pre-draft says that the framework is deeply rooted in India in content and learning of languages, in the pedagogical approaches including tools and resources, and in philosophical basis — in the aims and in the epistemic approach.
    • The document further says that it leans towards making students acquainted with true sources of knowledge, which have been a philosophical preoccupation of ancient Indians.
    • These sources focus on six pramanas: pratyaksa, anumana, upamana, arthapatti, anupalabdhi, and sabda.

     

    Six Pramanas

    1.      Pratyaksha: Interpreted as perception through the five senses

    2.      Anumana: Uses inferences to come to new conclusions

    3.      Upamana: Knowing through analogy and comparison

    4.      Arthapatti: Involves knowing through circumstantial implication

    5.      Anupalabdhi: Includes perception of non-existence

    6.      Sabda: Something an individual can only directly know a fraction of all reality through direct experience and inference but must rely on other experts was acknowledged thousands of years ago

     

    (2) Moral Development

    • A part of the document focuses on the moral development of a child through panchakosha vikas or five-fold development.
    • The pre-draft recommends developing moral values for the child through a balanced diet, traditional games, yoga asanas, as well as a wide variety of stories, songs, lullabies, poems, and prayers to develop a love for cultural context.

    (3) Curriculum revamp

    • The pre-draft says that for Grade 10 certification, students will have to take two essential courses from humanities, maths and computing, vocational education, physical education, arts education, social science, science, and interdisciplinary areas.
    • In Grade 11 and 12, students will be offered choice-based courses in the same disciplines for more rigorous engagement.
    • Arts education will include music, dance, theatre, sculpture, painting, set design, scriptwriting, while interdisciplinary areas will include knowledge of India, traditions, and practices of Indian knowledge systems.
    • For Class 11 and 12, the document states that “Modular Board Exams will be offered as opposed to a single exam at the end of the year, and the final result will be based on the cumulative result of each exam.”
    • The framework of the social science curriculum emphasizes understanding and appreciating the feeling of Indianess, ‘bhartiyata,’ by valuing the rich cultural heritage and tradition of the country.
    • It also stresses on identifying and explaining important phases of the Indian national movement against British rule, with special reference to Gandhian and other subaltern movements.

    (4) Social Science Curriculum

    • The pre-draft emphasizes understanding and appreciating the feeling of Indianess, “bhartiyata,” by valuing the rich cultural heritage and tradition of the country.
    • The pre-draft also stresses on identifying and explaining important phases of the Indian national movement against British rule, with special reference to Gandhian and other subaltern movements.
    • It also recommends teaching concepts of Buddhism, Jainism, and Vedic and Confucian philosophies.

    (5) Follow-up processes

    • As a follow-up to the National Education Policy 2020, development of four National Curriculum Frameworks — NCF for School Education, NCF for Early Childhood Care and Education, NCF for Teacher Education, and NCF for Adult Education — have been initiated.
    • The National Steering Committee under the chairmanship of K. Kasturirangan was set up by the Ministry to undertake and develop NCFs.

    Controversy over curriculum revamp

    • The latest round of textbook rationalisation has resulted in some of the most sweeping changes in the curriculum since the NDA government came to power.
    • These changes include removing all references to the 2002 Gujarat riots, reducing content related to the Mughal era and the caste system, and dropping chapters on protests and social movements.
    • Many of these changes are seen as ‘political’, however, their earlier introduction into curriculum was also a political move.

    The furore over Mughal History

    • While some of the content on the Delhi Sultanate and the Mughal Empire has indeed been removed from the history textbook for Class 7, the Mughals have not entirely disappeared.
    • For instance, the chapter ‘The Mughal Empire’ in the Class 7 history textbook, Our Pasts – II, has undergone deletions — including a two-page table on the milestones and achievements of the reigns of the emperors Babur, Humayun, Akbar, Jahangir, Shah Jahan, and Aurangzeb.
    • However, the chapter itself has not been removed.
    • Students of Class 7 will continue to learn about the Mughals, though in lesser detail.

    Significance

    • School textbooks have always been seen as playing a crucial role in shaping national narratives, and as a tool for cultivating a desired national identity.
    • NCERT textbooks are read by more than 5 crore students in 18 states around the country, who are seen by political parties as a large captive audience with impressionable minds.
    • It’s not just school students either — candidates preparing for competitive exams such as the Civil Services Examination, SSC, JEE, and NEET, also rely on these textbooks.

  • Sodium Intake Target: Challenge of Cardiovascular Disease and Hypertension

    Sodium

    Central Idea

    • The WHO recently published the ‘Global Report on Sodium Intake Reduction’ which sheds light on the progress of its 194 member states towards reducing population sodium intake by 30% by 2025. Regrettably, progress has been lethargic, with only a few countries making considerable headway towards the objective. Consequently, there is a proposal to extend the deadline to 2030.

    The target of reducing population sodium intake

    • The target of reducing population sodium intake by 30% by 2025 was set by the World Health Organization (WHO) in its Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2013.
    • The plan aims to reduce premature deaths from non-communicable diseases, including cardiovascular diseases, by 25% by 2025, and to achieve a 30% reduction in the mean population intake of salt/sodium.
    • The target of reducing population sodium intake is aimed at reducing the burden of hypertension, which is a major risk factor for cardiovascular disease.

    Why reducing sodium intake is essential for India?

    • Reduced sodium intake and decreased blood pressure: There is a strong correlation between reduced sodium intake and decreased blood pressure, leading to a decrease in stroke and myocardial infarction incidence. Lowering sodium intake by 1 gram per day leads to a 5 mm Hg reduction in systolic blood pressure, as per a study in The BMJ.
    • Cardiovascular disease: Elevated BP is a critical risk factor for cardiovascular disease, which is the leading cause of mortality worldwide. It contributed to 54% of strokes and 47% of coronary heart diseases globally in 2001.
    • Economic impact of cardiovascular disease on LMICs: Cardiovascular disease has a staggering economic impact on LMICs, estimated at $3.7 trillion between 2011 and 2025 due to premature mortality and disability. This represents 2% of the GDP of LMICs. The Indian economy alone faces losses surpassing $2 trillion between 2012 and 2030 due to cardiovascular disease, highlighting the need for effective interventions to mitigate the economic and health consequences of the disease in LMICs.

    Sodium

    How cardiovascular disease and hypertension pose significant challenges in India?

    1. Cardiovascular diseases as primary cause of mortality and morbidity:
    • As per data from the Registrar General of India, WHO, and the Global Burden of Disease Study, cardiovascular diseases have emerged as the primary cause of mortality and morbidity. Data from the Registrar General of India, WHO, and the Global Burden of Disease Study
    • Age-adjusted cardiovascular disease mortality rate increased by 31% in the last 25 years
    • Hypertension as leading risk factor for such diseases in India
    1. Prevalence of hypertension in India:
    • More prevalent among men aged 15 and above compared to women
    • More common in southern states, particularly Kerala, while Punjab and Uttarakhand in the north also report high incidence rates
    1. Pre-hypertensive population in India
    • Defined by systolic blood pressure levels of 120-139 mmHg or diastolic blood pressure levels of 80-89 mmHg
    • 5% of women and 49.2% of men at the national level
    • Significant risks of cardiovascular disease, stroke, and premature mortality for Indians with BP readings between 130 and 139/80-89 mmHg
    • Many Indians classified as pre-hypertensive are now included in the newly defined stage-I hypertension by the American guidelines.
    1. Circulatory system diseases: The 2020 Report on Medical Certification of the Cause of Death shows that circulatory system diseases account for 32.1% of all documented deaths, with hypertension being a major risk factor.

    Global Efforts to Reduce Sodium Intake

    • The WHO aims to reduce population sodium intake by 30% by 2025
    • Only a few countries have made considerable progress towards the objective
    • India’s score of 2 on the WHO sodium score signifies the need for more rigorous efforts to address the health concern

    Sodium

    Government Initiatives

    • Voluntary programmes: The Union government has initiated several voluntary programmes aimed at encouraging Indians to decrease their sodium consumption
    • Eat Right India: The FSSAI has implemented the Eat Right India movement, which strives to transform the nation’s food system to ensure secure, healthy, and sustainable nutrition for all citizens
    • Aaj Se Thoda Kam: FSSAI launched a social media campaign called Aaj Se Thoda Kam.

    Urgent Need for a Comprehensive National Strategy

    • Despite of awareness efforts, the average Indian’s sodium intake remains alarmingly high. Evidence shows an average daily consumption of approximately 11 grams.
    • India needs a comprehensive national strategy to curb salt consumption
    • Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake

    Conclusion

    • The excessive consumption of salt can lead to severe health consequences, and India has a pressing need to reduce its sodium intake. While the government has initiated several voluntary programs, these have fallen short of the goal. India needs a comprehensive national strategy, engaging consumers, industry, and the government, to curb salt consumption. Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake.

    Mains Question

    Q. Reducing population sodium intake is a critical step towards preventing and controlling non- cardiovascular diseases and hypertension. Comment.

  • Autism Spectrum Disorders: Prevalence in India and Way Ahead

    Central Idea

    • In India, the prevalence of autism spectrum disorders (ASD) is a widely debated issue due to a lack of systematic estimates. Most estimates have been derived from studies based on school children, revealing that over one crore Indians may be on the autism spectrum. However, there are notable cultural differences in diagnosing autism between countries, which highlights the need to assess the prevalence of autism spectrum disorders specifically in the Indian context.

    What is Autism?

    • Spectrum disorder: Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects communication, social interaction, and behaviour. It is called a spectrum disorder because the symptoms and severity can vary widely between individuals.
    • Common symptoms: Some common symptoms of autism include difficulty with social interactions, such as maintaining eye contact or understanding nonverbal cues, delayed speech and language development, repetitive behaviors, and sensory sensitivities.
    • Cause: Autism is believed to be caused by a combination of genetic and environmental factors, but the exact cause is not yet fully understood.
    • Cure: There is currently no cure for autism, but early interventions and therapies can help individuals with autism lead fulfilling and independent lives.

    Prevalence of Autism in India

    • Lack of systematic estimates: Autism is a global issue and affects individuals of all cultures, ethnicities, and socioeconomic backgrounds. However, there is a lack of systematic estimates of autism prevalence in India.
    • Methos failed: Researchers have attempted to estimate prevalence through government hospitals, but this method failed due to the absence of central medical registries.
    • Conservative estimates: As a result, prevalence was estimated through school-based assessments. According to conservative estimates, well over one crore Indians are on the autism spectrum. This highlights the need for further research and attention to address the prevalence of ASD in India.
    • Cultural Differences and Diagnosis of Autism:
    • Notable cultural differences exist in the diagnosis of autism spectrum disorder. In the US and UK, the majority of children with autism spectrum diagnosis are verbal, with average or higher IQ, and attending mainstream schools.
    • However, in India, a significant majority of children with a clinical diagnosis of autism also have intellectual disability and limited verbal ability. This difference is driven by sociological factors, such as access to appropriate clinical expertise, provisions for inclusion in mainstream schools, and availability of medical insurance coverage.

    Challenges in Assessing Autism

    • Assessment tools: Assessment of autism spectrum disorder is primarily behavioral, and most widely used autism assessment tools are not available in Indian languages.
    • Indigenous autism assessment tools challenges: There has been a rise in the development of indigenous autism assessment tools. Despite the development of these tools, it can be challenging to compare across different assessment measures.

    Demand and Supply in India

    • Shortage of mental health professionals: Most autism assessment tools need to be administered by specialist mental health professionals. However, there is a significant shortage of mental health professionals in India, with less than 10,000 psychiatrists, a majority of whom are concentrated in big cities.
    • Delay is costly: Delay in interventions can be costly for neurodevelopmental conditions such as autism.
    • Demand and supply gap need to be met: This gap between demand and supply cannot be met directly by specialists alone, and parallel efforts to widen the reach of diagnostic and intervention services through involving non-specialists is required. Emerging evidence suggests the feasibility of involving non-specialists in autism identification and intervention through digital technology and training programs.

    Way ahead: Need for an All-India Program

    • National program on autism: The need of the hour is to develop a national program on autism in India that links researchers, clinicians, service providers to the end-users in the autism community.
    • Essential components: This program needs to have three essential components that are joined up: assessment, intervention, and awareness.
    • Assessment: Research is needed to develop appropriate assessments and design efficient implementation pathways.
    • Intervention: Clinical and support service workforce needs to be expanded by training non-specialists such that a stepped-care model can be rolled out effectively across the nation.
    • Awareness: Large-scale initiatives need to be launched to build public awareness that can reduce the stigma associated with autism and related conditions.

    Conclusion

    • There are challenges in diagnosing and assessing autism in India which highlights the need for a comprehensive and coordinated effort to address them. By expanding the clinical and support service workforce, training non-specialists, and developing appropriate assessments and interventions, India can improve outcomes for those on the autism spectrum and reduce the stigma associated with the condition. This national program needs to be informed by consultation with different stakeholders, with a primary focus on end-users within the Indian autism community.

  • Duty exemption for drugs for Rare Diseases

    rare

    Central idea: The Centre has exempted all drugs and food for special medical purposes, imported for personal use, for the treatment of rare diseases listed under the National Policy for Rare Diseases 2021 from basic customs duty.

    What are Rare Diseases?

    • Rare diseases are those medical conditions that affect a small percentage of the population.
    • In India, a disease is considered rare if it affects less than 1 in 2,000 people.
    • These diseases are often genetic and are chronic, degenerative, and life-threatening.
    • There are over 7,000 known rare diseases, and it is estimated that about 70 million people in India are affected by them.
    • Many of these diseases do not have a cure, and the treatment can be expensive and difficult to access.

    Need for duty exemption

    • This decision has been taken to help reduce the burden of the cost of treatment for patients and families.
    • The drugs and food required for the treatment of these rare diseases are often expensive and need to be imported.
    • This exemption will result in substantial cost savings and provide much-needed relief to patients with rare diseases.

    Key medicines under this exemption

    • The central government has fully exempted Pembrolizumab (Keytruda), a drug used in the treatment of various types of cancer, from basic customs duty.
    • Previously, the GST rate for Keytruda was cut to 5 per cent from 12 per cent in a meeting held in September 2021 by the GST Council.
    • Life-saving drugs Zolgensma and Viltepso used in the treatment of spinal muscular atrophy were exempted from GST when imported for personal use.

    How the new duty exemption works?

    • The exemption has been granted by the Central Board of Indirect Taxes and Customs (CBIC) by substituting “Drugs, Medicines or Food for Special Medical Purposes (FSMP)” instead of “drugs or medicines”.
    • To avail of this exemption, the individual importer has to produce a certificate from the central or state director health services or district medical officer/civil surgeon of the district.

    How are life-saving medicines taxed?

    • Drugs/medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs/vaccines attract a concessional rate of 5 per cent or nil.
    • In its meeting in September 2021, the GST Council had reduced tax rates for several life-saving drugs.

     

  • Public Policy Education: Essential For Developing Effective Policies

    Central Idea

    • Government policies play a crucial role in determining the future of a country. They not only impact economic growth and public welfare but also improve the ease of living for citizens. Unfortunately, there is a lack of interest in public policy education in India, with only a small percentage of policymakers having formal education in public policy and administration.

    Public policy education

    • Public policy education refers to the study and teaching of the principles, theories, and methods involved in the development, implementation, and evaluation of policies that address societal issues.
    • This field of education aims to equip students with the knowledge and skills necessary to analyze, create, and manage public policies effectively.

    How the government policies, economic growth, and public welfare are closely interconnected?

    • Government policies: Governments create and implement policies to guide economic activities, maintain social order, and promote the welfare of their citizens. These policies cover a wide range of areas, such as fiscal and monetary policy, trade policy, education, healthcare, social security, and infrastructure development. The effectiveness of these policies can have a direct impact on economic growth and public welfare.
    • Economic growth: Economic growth is the increase in a country’s output of goods and services over time, usually measured by the growth rate of gross domestic product (GDP). A growing economy typically leads to higher employment, increased income, and improved living standards for citizens. Government policies play a crucial role in stimulating or hindering economic growth by influencing factors such as investment, consumption, trade, and innovation.
    • Public welfare: Public welfare refers to the overall well-being of a society, encompassing aspects such as income distribution, access to essential services, health, education, and environmental quality. Government policies can significantly impact public welfare by determining the allocation of resources, setting priorities, and providing social safety nets.

    Paucity of Programs

    • As per the All-India Council for Technical Education, there are 3,182 institutions with an approved intake of 4.22 lakh in business management programs, but only about 130 universities that offer public administration programs and only 29 institutes that offer public policy programs.
    • The batch size of public policy courses is 20-60, and there are few jobs available for people pursuing such courses, which disincentivizes educational institutions and students from choosing public management courses.

    Lack of Exposure to Public Management

    • Most civil servants undergo departmental induction training programs that focus on the role they play in their department and not much on how to make good public policies.
    • Consequently, very few civil servants have exposure to public management before joining service, which is critical for developing effective policies.

    Suggestions to boost public policy education in India

    1. Public Management as a Compulsory Subject in UPSC:
    • Public management should be a compulsory subject for the UPSC civil service examination, either as a substitute for one optional subject or an additional paper. This will incentivize universities and private institutions to offer public policy education, research, and case studies at the graduate or post-graduate level, leading to a major boost in public policy education.
    • Additionally, civil servants who join government would have formal education in public management before they enter service, and even those who do not make it to government jobs would develop better understanding and sensitivity towards complexities involved in public management, making them better citizens and effective private sector managers.
    1. Larger Component of Public Policy in Induction Training: Existing training institutions of the government should have a larger component of public policy as part of their induction training. Moreover, a case study bank for training should also be established.
    2. Specialized Positions of Public Policy Analysts: The government can create certain specialized positions of public policy analysts to be picked up from the market directly, thereby creating new job avenues for the graduates of public policy programs.

    Conclusion

    • The lack of formal education in public management has led to governance lagging behind private sector management in terms of efficiency and effectiveness. Public policy education is essential for developing effective policies that spur economic growth, public welfare, and improve ease of living for citizens.

    Mains Question

    Q. What is public policy education, and why is it important for policymakers in India to have formal education in public policy and administration? Suggest measures to boost public policy education in India.

  • Healthcare: Remarkable Progress But The Gaps Needs to be Addressed

    Central Idea

    • The Indian healthcare system has overcome many challenges and has made significant progress, but there are still many tough health challenges that need to be addressed. There is need to bridge the gap between the services available in metropolitan and Tier-II and Tier-III cities, provide healthcare insurance to the unorganised middle class, and use Artificial Intelligence and digital technology to improve healthcare services.

    Overcoming past challenges

    • The Indian healthcare system has overcome seemingly insurmountable problems, including high maternal and infant mortality rates, and low hospital delivery rates.
    • The National Family Health Survey (NFHS-5) results show that even in the so-called BIMARU states, hospital deliveries have soared to 89 per cent.

    Current Health Challenges

    • Five interrelated challenges: The current macro picture shows at least five interrelated challenges that are pervading the population, including non-communicable diseases (NCDs), obesity, and chronic respiratory diseases.
    • NCDs: The proportion of deaths due to NCDs has increased from around 38 per cent in 1990 to 62 per cent in 2016.
    • Obesity: Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5. Awareness about leading healthy lives will save millions from illness and decelerate premature death.

    Current state of healthcare in India

    1. Infrastructure:
    • The state of infrastructure matters. Since 2018, governments at the Centre as well as the state have been trying to bolster primary healthcare by establishing health and wellness centres.
    • But there are still huge variations between states, and some states have better arrangements than others. States must step up efforts to improve infrastructure in the healthcare sector.
    1. Bridging the gap in hospital services:
    • In urban areas, the challenge is to bridge the gap in hospital services between large urban agglomerations and Tier-II and Tier-III cities.
    • Large hospital chains provide only 4-5 per cent of the beds in the private sector.
    • Standalone hospitals and nursing homes provide 95 per cent of private hospital beds but are unable to provide multi-specialty, leave alone tertiary and quaternary care.
    • The gaps between services available in the metros and big cities and in districts must be bridged.
    1. Health Insurance Coverage:
    • Low health insurance penetration and the very high personal outgo on healthcare remain a challenge.
    • But over the past three years, more than four crore Indians have bought health insurance.
    • From 2018, the Ayushman Bharat insurance scheme for 10 crore poor families has been undertaken to provide insurance against hospitalisation for up to Rs 5 lakh per year per family.
    • Nearly 74 per cent of Indians are either covered or eligible for health insurance coverage.
    1. Use of Artificial Intelligence and digital technology:
    • An emerging concern is the use of Artificial Intelligence (AI) and digital technology to improve healthcare services.
    • Surgery assisted by robots, the use of genetic codes, clinical decision support systems, and telemedicine can help in making healthcare more accessible and efficient.

    Conclusion

    • India has shown how the impossible can be achieved, but the healthcare system needs to overcome various challenges to fully redeem its advantage of having the youngest population. The government needs to step up efforts in improving infrastructure, bridging the gap in hospital services, and providing health insurance coverage for the unorganized middle class. It is also essential to regulate the use of AI and digital technology in the healthcare sector to ensure accountability and prevent malpractice.
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  • Type 1 and Type 2 Diabetes among Children

    diabetes

    The National Commission for Protection of Child Rights (NCPCR) has written to Education Boards of all States/UTs, stating schools must ensure proper care/facilities for children with Type 1 diabetes (T1D).

    What is Diabetes?

    • Diabetes is a chronic medical condition that occurs when the body cannot regulate blood sugar levels properly.
    • Blood sugar, also known as blood glucose, is the main source of energy for the body’s cells.
    • Insulin, a hormone produced by the pancreas, helps the body use and store glucose from food.
    • In diabetes, the body either does not produce enough insulin or cannot use the insulin it produces effectively, resulting in high blood sugar levels.
    • Over time, high blood sugar levels can cause serious health problems, such as damage to the heart, blood vessels, eyes, kidneys, and nerves.

    Types of Diabetes

    There are two main types of diabetes: Type 1 and Type 2.

    • Type 1 diabetes: It is an autoimmune disease in which the immune system attacks and destroys insulin-producing cells in the pancreas, resulting in a lack of insulin. This type of diabetes is typically diagnosed in children and young adults, although it can occur at any age. It requires insulin injections or pump therapy for survival.
    • Type 2 diabetes: It is a metabolic disorder in which the body becomes resistant to the effects of insulin or doesn’t produce enough insulin to maintain normal glucose levels. This type of diabetes is often associated with lifestyle factors such as obesity, physical inactivity, and poor diet. It is typically diagnosed in adults, but it is becoming increasingly common in children and adolescents as well. Treatment for Type 2 diabetes may include lifestyle changes, oral medications, or insulin therapy.

    Menace of diabetes in India

    • According to data from the International Diabetes Federation Atlas 2021, India has the world’s highest number of children and adolescents living with Type I Diabetes Mellitus (TIDM).
    • There are over 2.4 lakh TID patients in the Southeast Asia region.

    Measures to mitigate TID impact on students

    • CBSE circular in 2017 allowed students with T1D in Classes X and XII to carry certain eatables to board exam hall to avoid low sugar episodes.
    • They are permitted to carry medicines, snacks, water, a glucometer, and testing strips.
    • NCPCR suggests states allow students to use smartphones to monitor sugar levels.
    • Tamil Nadu has been providing free insulin to children with T1D since 1988.

    Back2Basics: National Commission for Protection of Child Rights (NCPCR)

    • NCPCR is a statutory body established in India under the Commissions for Protection of Child Rights Act, 2005.
    • Its objective is to protect, promote and defend the rights of children in India.
    • It functions as a watchdog to prevent child rights violations, as well as to take action against those responsible for such violations.
    • The NCPCR also advocates for the implementation of laws, policies and programs aimed at promoting child welfare and development.

     

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  • Healthcare: Public Health and The Insurance Funding

    Central Idea

    • The Tamil Nadu public health model has achieved success in improving healthcare outcomes and maintaining equity in healthcare delivery. However, the shift in healthcare funding to insurance companies has brought both benefits and drawbacks to the public healthcare system.

    The key features of the Tamil Nadu public health model

    • Primary Healthcare: The Tamil Nadu public health model is based on a strong emphasis on primary healthcare, which is the first point of contact for patients seeking medical attention. Primary healthcare centres provide basic healthcare services and preventive care, which are critical to reducing the burden of disease.
    • Public Health Infrastructure: The state has a well-established public health infrastructure, including a network of primary healthcare centres, secondary and tertiary care hospitals, and medical colleges. The state government has also invested in health infrastructure, including sanitation facilities, water supply, and waste management.
    • Health Insurance: The Tamil Nadu government has implemented a comprehensive health insurance scheme, the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which provides free healthcare services to families living below the poverty line and low-income groups.
    • Human Resource Development: The state government has also focused on developing human resources in healthcare. It has set up a large number of nursing and paramedical institutions to train healthcare professionals.
    • Health Awareness: The Tamil Nadu government has launched various health awareness campaigns to educate people about health issues, including communicable and non-communicable diseases. The government has also launched campaigns to promote healthy lifestyle choices, such as a balanced diet and regular exercise.
    • Partnership with NGOs: The government has partnered with non-governmental organizations (NGOs) to implement various health programs. These partnerships have helped in the effective delivery of healthcare services in remote and rural areas of the state.
    • Innovations: Tamil Nadu has implemented several innovative approaches in healthcare, such as telemedicine, which enables patients to receive medical consultation and treatment remotely using technology. The state has also established mobile clinics to provide healthcare services to people living in remote areas.

    Benefits of Decentralization

    • Improved access to healthcare: Decentralization can help to improve access to healthcare services, particularly in rural or remote areas. By empowering local communities and healthcare providers to make decisions about healthcare delivery, services can be tailored to meet the specific needs of the population.
    • Better quality of care: Decentralization can lead to better quality of care by enabling healthcare providers to respond more quickly and effectively to the needs of their patients. It can also promote innovation and experimentation in healthcare delivery, leading to new and improved approaches to patient care.
    • Increased accountability: Decentralization can increase accountability in healthcare delivery by empowering local communities and healthcare providers to monitor and evaluate the quality of care. This can help to identify and address problems in healthcare delivery, leading to improved outcomes for patients.
    • Cost savings: Decentralization can lead to cost savings in healthcare delivery by reducing the administrative costs associated with centralized decision-making and management. It can also promote greater efficiency in healthcare delivery, leading to reduced waste and duplication of services.

    Insurance Funding in healthcare

    • Insurance funding in healthcare refers to the use of insurance mechanisms to finance healthcare services. This involves pooling financial resources from individuals or groups through insurance schemes, which are then used to pay for healthcare services.
    • Insurance funding can help to mitigate the financial risks associated with healthcare, and ensure that individuals have access to the care they need without incurring excessive costs.

    Drawbacks of Insurance Funding

    • Shifted focus: The focus on indemnity and negotiations with insurance companies has shifted the focus of hospitals from patient care to claiming money.
    • Compromised quality of service: The appointment of contractual employees with meager pay has created a divide between permanent high-paid staff and temporary low-salaried staff, leading to a compromise in the quality of service.

    Facts for prelims

    Type of Insurance Funding Description
    Private health insurance Purchased by individuals or employers to cover healthcare costs. Coverage, cost, and benefits vary widely and may be offered by commercial insurers, nonprofit organizations, or government programs
    Public health insurance Provided by government-run programs, typically funded through taxes or other government revenues. Coverage is provided to eligible individuals based on criteria such as age, income, or medical need. Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government-funded health insurance program that provides free health coverage to economically disadvantaged families across India.
    Social health insurance A hybrid model that combines elements of private and public insurance. Individuals and employers contribute to a national insurance fund that is used to pay for healthcare services, typically managed by a government agency but delivered by private providers
    Employer-sponsored insurance Private insurance provided by employers to their employees, often mandatory in many countries. Employers are required to provide a certain level of coverage to their employees.

    Conclusion

    • While insurance funding has brought benefits, it has also created challenges, including the erosion of compassion among health professionals and a diversion of funds from public to private hospitals. It is necessary to strike a balance between decentralization, insurance funding, and preserving the fundamental principles of equity, compassion, and excellence in care to maintain the success of Tamil Nadu’s public healthcare system.

    Mains Question

    Q. Highlight the benefits of decentralization in healthcare delivery. Analyse the benefits and drawbacks of insurance funding in India?

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  • Tuberculosis (TB): India’s Renewed Commitment

    TB

    “The theme of World TB Day 2023 — “Yes, we can end TB!”

    Central Idea

    • India’s National TB Elimination Programme has set a goal to eliminate TB by 2025. However, with India contributing 28% of the global TB burden and spending only 2.1% of its total budget on healthcare, the pace of program implementation has slowed down, especially during COVID-19. Increased investments and multi-sector collaboration are required to meet the target. 24 th March is marked as World TB day.

    Back to basics: TB

    • Tuberculosis is an infectious disease caused by bacteria called Mycobacterium tuberculosis.
    • It mainly affects the lungs, but can also affect other parts of the body such as the kidneys, spine, and brain.
    • TB spreads through the air when a person with active TB disease in the lungs or throat coughs, sneezes, or speaks.
    • Symptoms of TB include coughing that lasts for three or more weeks, chest pain, coughing up blood, fatigue, fever, and weight loss.
    • TB can be treated with antibiotics, but drug-resistant forms of TB are a growing concern.

    India’s Battle Against TB

    • International Union Against TB: India’s fight against TB began in 1929, when it joined the International Union Against Tuberculosis.
    • TB division: After independence, the Union government established a TB division under the Directorate General of Health Services with the Ministry of Health to oversee the plan.
    • National TB Control Programme: The National TB Institute was established in Bengaluru in 1959, and the National Tuberculosis Control Programme (NTP) was formulated in 1962. The Revised National TB Control Programme was developed in 1963.
    • National TB Elimination Programme: India’s National TB Elimination Programme now leads the effort to eliminate TB by 2025, five years ahead of the Sustainable Development Goals.
    • TB Harega Desh Jeetega: TB Harega Desh Jeetega (TB will lose, the nation will win) campaign to raise awareness about the disease and encourage people to get tested and treated.

    Challenges in Implementation

    • Lower budgetary allocation: India contributes 28% of the global TB burden, and as of 2022-23, it spends only 2.1% of its total budget on healthcare, the lowest among BRICS countries, and comparable to Bangladesh (2.5%) and Pakistan (3.4%).
    • Slow release of funds: The Joint Monitoring Mission Report 2019 by the Ministry of Health mentions that the slow release of funds has had a significant impact on the program’s effectiveness.
    • Low fund utilization: The low fund utilization has resulted in a lack of resources for critical TB control interventions such as early detection, diagnosis, and treatment.
    • COVID-19 slowed down implementation: Implementation of the TB program has slowed down with COVID-19 and requires further policy development, planning, and additional financing.

    Way Ahead: Opportunities for Collaboration

    • Different actors need to join hands to support the government’s inter-sectoral, multi-centric program approach for TB elimination and empower community response at the grass roots level.
    • Investing in strategic areas like diagnostics and access that have been barriers in the past is critical for reshaping the national TB strategy.
    • The theme of World TB Day 2023, “Yes, we can end TB!” conveys a message of hope that getting back on track to turn the tide against the TB epidemic is possible.

    Facts for Prelims: CB-NAAT

    • CB-NAAT stands for Cartridge-Based Nucleic Acid Amplification Test, which is a diagnostic test used to detect the presence of genetic material of certain types of bacteria, including Mycobacterium tuberculosis.
    • CB-NAAT is a highly sensitive and specific test that can detect MTB and drug-resistant strains of MTB in a short amount of time.
    • The test uses a small cartridge that contains all the necessary reagents and probes to detect MTB nucleic acid. The sample (usually sputum or other respiratory specimen) is mixed with the reagents and the cartridge is placed into a machine that performs the amplification and detection of the nucleic acid.
    • CB-NAAT has been endorsed by the World Health Organization (WHO) as a preferred test for the diagnosis of TB and drug-resistant TB.
    • The Government of India has launched a national program called Revised National TB Control Programme (RNTCP) to provide free diagnosis and treatment of TB, and CB-NAAT is a key component of this program.
    • However, the cost of the test remains a challenge, and efforts are underway to make the test more affordable and accessible to all.

    TB

    Conclusion

    • To successfully eliminate TB by 2025, India must prioritize sustainability through strategic investments, focusing on areas with the greatest need and adequately resourcing TB initiatives. With collaborative efforts and commitment, India can overcome its TB burden and achieve its ambitious target. Together, we can make it happen.

    Mains Question

    Q. Highlight the major initiatives taken by India to combat Tuberculosis and enumerate the challenges and way ahead towards achieving the goal of TB elimination by 2025.