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

  • Iron Fortification: Health Risks of Excessive Iron Intake

    iron

    Central Idea

    • Iron is an essential mineral for bodily functions, but excessive intake can be harmful.
    • Fortification of food with iron is a suggested method for treating iron deficiency anemia.
    • Excess consumption of fortified foods or simultaneous consumption of multiple fortified foods can lead to excessive iron intake.

    What is Iron Fortification?

    • Iron fortification refers to the process of adding iron to food products to increase their iron content.
    • It is done using various forms of iron, such as iron salts or iron powders, which are added to the food during processing.
    • It is a public health strategy employed to address iron deficiency, particularly in populations where inadequate iron intake is prevalent.
    • The goal is to provide a significant portion of the recommended daily iron intake through fortified foods, contributing to the prevention and treatment of iron deficiency anaemia.

    Implications for Iron Overload

    • Comorbidities: Iron overload conditions, such as thalassemia, hemochromatosis, and chronic liver disease, have impaired iron excretion mechanisms.
    • Blooding events: Iron absorption is balanced by steady and minimal excretion, except during bleeding events.
    • Menstrual bleeding: Women can excrete iron through menstrual bleeding, while men are less capable of iron excretion.
    • Oxidative stress: Increased iron intake can lead to oxidative stress, cellular damage, and impaired mitochondrial function.
    • Heart ailments: High serum ferritin levels (a marker of iron storage) are associated with an increased risk of chronic diseases such as high fasting serum glucose, high total cholesterol, high triglycerides, and hypertension.
    • Liver damage: Very high amounts of iron can activate hepatic stellate cells and cause excessive deposition of extracellular matrix in the liver. Prolonged liver iron overload can lead to liver fibrosis and cirrhosis.

    Challenges and consequences

    • Minimal absorption: Only a small percentage of ingested iron from fortified foods is absorbed, with the rest passing through the intestine.
    • Digestive issues: Unabsorbed iron can cause inflammation in the gastrointestinal lining and disrupt the colonic microbiota, leading to abdominal discomfort and gastrointestinal issues.
    • Issues with nutrition absorption: Excessive iron in the gastrointestinal tract can impair the absorption of other essential minerals like zinc and copper and potentially result in other deficiencies.

    Way Forward

    • Implement individualized strategies for iron intake rather than mandatory fortification programs to avoid unsupervised high iron intake across diverse populations.
    • Ensure thorough monitoring and detection of adverse events related to iron intake.
    • Precision in public health approaches is necessary to prevent the risk of iron overload and potential long-term chronic illnesses associated with excess iron.
    • Evaluate the specific dietary iron needs of different population segments to avoid unnecessary excess iron consumption.

     

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  • Highlights of the Joint Malnutrition Estimates (JME)

    Central Idea

    • According to the Joint Malnutrition Estimates (JME) by UNICEF, WHO, and the World Bank, India has shown a reduction in stunting among children under five.

    Such reports (including NFHS) are credible sources of information to substantiate your answers in Mains answer writing ….

    What is Stunting and Wasting?

      Stunting Wasting
    Definition Impaired growth and development due to chronic malnutrition. Rapid weight loss and muscle wasting in a short period.
    Measurement Height-for-age comparison against standardized growth reference. Weight-for-height comparison against standardized growth reference.
    Causes Insufficient intake of essential nutrients, frequent infections, poor maternal health. Inadequate caloric intake, poor feeding practices, infectious diseases.
    Effects Irreversible consequences, reduced cognitive development, increased disease vulnerability. Increased morbidity and mortality, severe malnutrition.
    Time Frame Long-term condition Short-term condition
    Overall Nutritional Status Reflects chronic malnutrition Represents acute malnutrition
    Focus Impacts growth and development Impacts weight and muscle mass

     

    Decline in Child Stunting in India

    • The prevalence of stunting in India dropped from 41.6% in 2012 to 31.7% in 2022, with 1.6 crore fewer stunted children recorded.
    • India’s share of the global burden of stunting declined from 30% to 25% in the past decade.

    Concerns over Wasting

    • Wasting remains a concern in India, with an overall prevalence of 18.7% in 2022.
    • India contributes 49% to the global burden of wasting, reflecting the severity of this malnutrition indicator.
    • Two-thirds of wasting cases in India may be attributed to maternal malnutrition, leading to low birth weight for height.

    Rise in Obesity

    • The prevalence of obesity in India increased marginally from 2.2% in 2012 to 2.8% in 2022.
    • India’s obesity classification remains low compared to the global prevalence of 5.6%.
    • Obesity contributes to 8.8% of the global burden, with 31.8 lakh obese children in India.

    Way Forward

    • The JME report highlights the need for accelerated efforts to achieve global nutrition targets.
    • India’s progress aligns with the National Family Health Survey (NFHS) data, indicating a reduction in stunting.
    • More research is needed to understand the complexities of wasting, particularly its links to maternal malnutrition.
    • Continued focus on addressing malnutrition, access to health services, and maternal nutrition is crucial for further improvement.
    • Learning more about wasting and its determinants will be essential for tailored interventions in India and Asia.

     

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  • Debate over Fortified Rice

    fortified rice

    Central Idea

    • The Union Food Ministry refuted the allegations made by the Opposition regarding the distribution of Fortified Rice through fair price shops.

    What is Fortified Rice?

    • Fortified rice refers to the process of enhancing regular rice with essential nutrients to address nutritional deficiencies in populations that heavily rely on rice as a staple food.
    • These added nutrients aim to improve the nutritional value of rice and combat specific deficiencies prevalent in certain regions or population groups.
    • The fortification process involves coating the rice grains with a nutrient-rich powder or premix.
    • The specific nutrients added to fortified rice can vary, but commonly include:
    1. Iron: Iron is often added to fortified rice to address iron deficiency anaemia, a widespread nutritional problem globally.
    2. Vitamins: Essential vitamins such as vitamin A, vitamin B-complex (including thiamine, riboflavin, niacin, and folic acid), and vitamin D may be included in fortified rice to address specific vitamin deficiencies prevalent in target populations.
    3. Minerals: Other minerals like zinc, calcium, and iodine may be incorporated into fortified rice, depending on the specific nutritional needs and deficiencies of the target population.

    Need for fortification

    • Data from the National Family Health Survey 2019-21 shows that 57 per cent of women in the reproductive age group (15-49) are deficient in iron.
    • Moreover, studies have shown that about a fifth of the children (0-5 years) who do not have access to a nutritious and diversified diet suffer from vitamin-A deficiency.
    • Vitamin D deficiency has been termed a silent epidemic.

    Advantages offered

    • Health: Fortified staple foods will contain natural or near-natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • Taste: It provides nutrition without any change in the characteristics of food or the course of our meals.
    • Nutrition: If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittently supplement.
    • Economy: The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 percent of the total food value.
    • Society: It upholds everyone’s right to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger.

    Issues with fortified food

    • Against nature: Fortification and enrichment upset nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Bioavailability: Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • Immunity issues: They lack immune-boosting substances.
    • Over-nutrition: Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

    Possible health hazard

    • Thalassemia, sickle cell anaemia and malaria are conditions where there is already excess iron in the body, whereas TB patients are unable to absorb iron.
    • Consumption of iron-fortified foods among patients of these diseases can reduce immunity and functionality of organs.

    Ministry’s justification of Fortified Rice

    • The Ministry cited various studies to support the assertion that consumption of fortified rice leads to a significant improvement in haemoglobin levels and a reduction in the prevalence of anaemia.
    • Rice fortification has been adopted by seven countries, including the U.S., since 1958, highlighting its effectiveness as a public health intervention.
    • Ongoing evaluation, conducted by NITI Aayog in collaboration with the Indian Council of Medical Research, is being carried out to assess the impact and effectiveness of fortified rice.
    • Evaluation studies focusing on pilot districts are currently underway to gather comprehensive data and insights.

    Way Forward

    • Collaborative efforts between the Ministry, NITI Aayog, and other relevant institutions should be prioritized to conduct a thorough and independent evaluation of the fortified rice program.
    • Transparent communication of evaluation results and findings is crucial to foster trust and address any potential shortcomings or areas of improvement.
    • Incorporating feedback and recommendations from stakeholders will be valuable in enhancing the implementation and impact of the fortified rice distribution program.
    • Continuous monitoring and assessment of the program’s effectiveness should be a priority, enabling necessary adjustments and improvements to be made in a timely manner.

     

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  • What is PARAKH Program?

    Central Idea

    • The Ministry of Education has organized a workshop in New Delhi to discuss the unification of 60 school examination boards operating across different states and union territories.
    • The key component of this plan is PARAKH, the National Assessment Centre established under the National Council of Educational Research and Training.

    What is PARAKH?

    • PARAKH stands for Performance Assessment, Review, and Analysis of Knowledge for Holistic Development.
    • It is an organization created to bring school boards from various states and union territories onto a unified platform.
    • It has been launched as part of the implementation of the National Education Policy (NEP)-2020.
    • It acts as a constituent unit of the NCERT.
    • It is tasked with holding periodic learning outcome tests like the National Achievement Survey (NAS) and State Achievement Surveys.
    • It will work on three major assessment areas: large-scale assessments, school-based assessment, and examination reforms.

    Key objectives of PARAKH

    • Uniform Norms & Guidelines: Setting comprehensive norms, standards, and guidelines for student assessment and evaluation in all recognized school boards.
    • Enhance Assessment Pattern: Encouraging school boards to adopt assessment patterns aligned with the skill requirements of the 21st century.
    • Reduce Disparity in Evaluation: Establishing uniformity across state and central boards, which currently employ different evaluation standards, resulting in significant score disparities.
    • Benchmark Assessment: Developing a benchmark assessment framework to move away from rote learning and align with the objectives of the NEP 2020.

    Outcomes of the recent workshop

    (1) Establishing Equivalence of Boards

    • The Centre is planning for the equivalence of boards to facilitate seamless transitions for students across different boards or regions.
    • The objective is to align curriculum standards, grading systems, and evaluation methodologies to enhance the credibility and recognition of certificates and grades obtained across boards.

    (2) Moving away from Rote Examination Culture

    • The workshop highlighted the need to reassess the prevailing rote examination culture in the education system.
    • There is a growing realization that holistic assessments, considering various dimensions of a student’s abilities and potential, are equally important.

    (3) Standardization and Fairness in Assessments

    • The discussion emphasized the importance of well-designed and standardized question papers to ensure fairness and consistency across schools and boards.
    • Striking a balance between formative and summative assessments was identified as a means to reduce the burden of high-stakes examinations while effectively measuring student progress.

    Conclusion

    • PARAKH’s significance lies in its potential to bring about transformative change, facilitating collaboration, and benchmarking assessments.
    • It is an important step towards creating a standardized and equitable assessment system, providing students with a fair platform to demonstrate their abilities and skills.

     

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  • Plight of Single-Teacher Schools: A Call for Urgent Action

    Single-Teacher Schools

    Central Idea

    • The presence of single-teacher schools in India, particularly in Jharkhand, continues to persist despite the Right to Education Act mandating a minimum of two teachers in every school. The prevalence of such schools poses significant challenges, hampering the quality of education and depriving children of their right to a proper education. The alarming situation of single-teacher schools, calls attention to recent findings, and emphasizes the need for urgent action to address this issue.

    Single-Teacher Schools

    Plight of Single-Teacher Schools in India

    • Even after 14 years since the implementation of the Right to Education Act, the proportion of single-teacher schools in India remains high at 14.7%.
    • In Jharkhand alone, nearly one-third of primary schools fall under the single-teacher category, significantly impacting the quality of education.
    • While Jharkhand is a poor performer, a few States had a similar or even higher proportion of single-teacher schools such as Andhra Pradesh (34%), Telangana (30%) and Karnataka (29%).
    • In nine of India’s 21 major States, the share of children studying in single-teacher schools was well above 10%, rising to 25% in Jharkhand.
    • A recent report titled Gloom in the Classroom sheds light on the severity of the situation in Jharkhand.
    Did you know?

    ·       The Right to Education Act states that every school must have at least two teachers.

    Reasons attributed to the presence of Single-Teacher Schools in certain states

    • Low Population Density and Scattered Settlements: In states with low population density and scattered settlements, such as Himachal Pradesh, it becomes challenging to establish multiple schools in close proximity. Limited resources and logistical difficulties make it economically unviable to have multiple teachers in such areas. As a result, single-teacher schools are often the only feasible option to provide education to children in remote locations.
    • Low Fertility Rates: States with low fertility rates, such as Himachal Pradesh and Kerala, may have a smaller number of students in schools. In these cases, single-teacher schools serve as a more efficient and cost-effective arrangement to cater to the relatively smaller student population. With fewer students, consolidating them into larger schools may not be practical or necessary.
    • Viability of Mini-Schools: In some states, single-teacher schools are a result of the viability and historical existence of mini-schools. Mini-schools were established in sparsely populated areas before the Right to Education Act came into force. Some states, like Kerala, have successfully managed to merge mini-schools, while others continue to have single-teacher schools as separate entities.
    • Staffing Challenges and Budget Constraints: State governments facing staffing challenges and budget constraints may opt for under-staffing schools in underprivileged areas, leading to the prevalence of single-teacher schools. Limited resources and difficulties in recruiting and retaining teachers, especially in remote or economically disadvantaged regions, contribute to the staffing issues.
    • Resistance to Remote Postings: Remote areas often lack basic amenities and facilities, making it challenging for teachers to adjust to such environments. Reluctance to accept postings in remote locations can lead to a shortage of teachers, resulting in single-teacher schools as a temporary solution.

    Measures to tackle the challenges associated with single-teacher schools

    • Infrastructure and Resources: Adequate investment in infrastructure, including the establishment of additional classrooms, is crucial to accommodate more teachers and reduce the burden on existing staff. Providing schools with sufficient teaching resources, such as textbooks, learning materials, and technological tools, can enhance the teaching-learning process.
    • Recruitment and Retention: State governments must prioritize the recruitment of qualified teachers, ensuring a sufficient number of professionals in underprivileged areas. Encouraging and incentivizing teachers to accept postings in remote areas can help overcome the resistance to such assignments.
    • Policy Reforms: The Right to Education Act needs to be rigorously implemented, emphasizing the requirement for a minimum of two teachers in each school. State governments should allocate adequate funds to address staffing needs and enforce compliance with the act. Policy reforms should focus on promoting equity and inclusivity, targeting marginalized communities and ensuring access to quality education for all children.
    • Community Engagement: Building awareness among parents and communities about the importance of education and the impact of single-teacher schools is crucial. Encouraging community participation in school management committees and fostering collaboration between schools, parents, and local organizations can drive collective efforts to improve the educational environment.

    Way forward: Revitalizing the Education Movement

    • It is imperative to revive the momentum for the right to education that once echoed across the nation.
    • A renewed movement is necessary to advocate for quality education, raise awareness about the persisting challenges, and hold authorities accountable for ensuring children’s right to education.
    • The recent protests in Jharkhand, which highlighted the unmet demand for quality education, serve as a reminder of the urgent need to address the plight of single-teacher schools.

    Conclusion

    • The prevalence of single-teacher schools in Jharkhand and several other states indicates a systemic failure in fulfilling the right to education. Immediate action is required to improve infrastructure, recruit qualified teachers, implement policy reforms, and foster community engagement. By prioritizing education and addressing the challenges associated with single-teacher schools, we can ensure that every child has access to quality education and the opportunity to thrive.

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    Also read:

    [Sansad TV] Reforms in Content and School Text Books

  • Arsenic Contamination in India

    arsenic

    Central Idea: A recent peer-reviewed study suggests that even low levels of arsenic consumption can affect cognitive function in children, adolescents, and young adults.

    Arsenic Contamination

    • Arsenic is a highly toxic element naturally present in the environment.
    • Contaminated water, particularly groundwater, is a major source of arsenic exposure.
    • Long-term arsenic exposure can lead to various health issues, including cancer, skin lesions, cardiovascular disease, and negative impacts on cognitive development.

    Menace in India

    • Arsenic contamination in groundwater is one of the most crippling issues in the drinking water scenario of India.
    • According to the latest report of the Central Ground Water Board (CGWB), 21 states across the country have pockets with arsenic levels higher than the BIS stipulated permissible limit of 0.01 milligram per litre (mg/l).
    • The states along the Ganga-Brahmaputra-Meghna (GBM) river basin — Uttar Pradesh, Bihar, Jharkhand, West Bengal and Assam — are the worst affected by this human-amplified geogenic occurrence.
    • In India, arsenic contamination was first officially confirmed in West Bengal in 1983.
    • Close to four decades after its detection, the scenario has worsened.
    • About 9.6 million people in West Bengal, 1.6 million in Assam, 1.2 million in Bihar, 0.5 million in Uttar Pradesh and 0.013 million in Jharkhand are at immediate risk from arsenic contamination in groundwater.

    Key findings of the recent study

    (1) Arsenic impact on behaviour

    • The study found that individuals exposed to arsenic had reduced grey matter and weaker connections within key regions of the brain associated with cognitive functions.
    • Chronic exposure to arsenic could have significant consequences at a population level, leading to increased school failures, diminished economic productivity, and higher risks of criminal and antisocial behavior.

    (2) Arsenic Exposure and Socioeconomic Factors

    • As previous studies have shown, arsenic exposure is particularly harmful to the poor.
    • The recent study reaffirms that economically and nutritionally disadvantaged individuals experience greater cognitive impairment from arsenic exposure.
    • The impact of arsenic on impairing cognition is more pronounced at a collective level rather than at an individual level.

    Government Initiatives to address Arsenic Contamination

    • Governments in Bihar and West Bengal have taken steps to address arsenic contamination since the 1990s.
    • Strategies include promoting piped water access, installing arsenic removal plants, and encouraging groundwater extraction from deeper aquifers with lower arsenic levels.
    • The goal is to minimize arsenic exposure and mitigate its health impacts in affected regions.

    Possible solutions

    Some of the management options include

    • Uses of surface water sources
    • Exploring and harnessing alternate arsenic-free aquifer
    • Removal of arsenic from groundwater using arsenic treatment plants/filters
    • Adopting rainwater harvesting/ watershed management practices.

     

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  • Exploring the Prospects of Integrated Medicine: A Dialogue on Ayush and Modern Healthcare

    Medicine

    Central idea

    • In a recent development, the Indian Council of Medical Research (ICMR) and the Ministry of Ayush have agreed to enhance cooperation in health research related to integrated medicine. This collaboration aims to establish Ayush departments within prestigious medical institutions like AIIMS. However, this move has sparked a debate regarding the efficacy and viability of an integrated system of medicine.

    What is integrated system of medicine?

    • An integrated system of medicine refers to an approach that combines elements from different healthcare systems or modalities, such as conventional medicine and traditional or complementary/alternative medicine, with the goal of providing comprehensive and patient-centered care.

    Common features of integrated system of medicine

    • Holistic Approach: An integrated system of medicine takes a holistic approach to healthcare, recognizing the interconnectedness of various aspects of health, including physical, mental, emotional, and spiritual well-being. It considers the whole person rather than focusing solely on symptoms or specific diseases.
    • Multiple Healthcare Modalities: It incorporates multiple healthcare modalities and disciplines, such as conventional medicine, traditional medicine systems (e.g., Ayurveda, Traditional Chinese Medicine), complementary and alternative medicine (e.g., acupuncture, herbal medicine), mind-body practices (e.g., yoga, meditation), and other evidence-based therapies.
    • Collaborative and Interdisciplinary Care: An integrated system of medicine encourages collaboration and cooperation among healthcare providers from different disciplines. This interdisciplinary approach allows for a comprehensive assessment of the patient’s needs and the development of personalized treatment plans.
    • Evidence-Based Practice: The integration of different healthcare modalities is based on scientific evidence, research, and clinical guidelines. It emphasizes the use of evidence-based practices, ensuring that treatments and interventions are safe, effective, and supported by reliable data.
    • Individualized Treatment: An integrated system of medicine recognizes that each person is unique and may require personalized treatment approaches. It considers individual circumstances, preferences, and goals when developing treatment plans, allowing for customized care.
    • Emphasis on Prevention and Wellness: It places importance on preventive measures, health promotion, and wellness-oriented approaches. It aims to identify and address underlying factors that contribute to illness, focusing on strategies to prevent disease and promote optimal health.
    • Patient-Centered Care: An integrated system of medicine prioritizes the patient’s needs, preferences, and values. It involves active patient participation in healthcare decision-making, education, and self-care practices. The patient is viewed as a partner in their own healthcare journey.
    • Continuity of Care and Care Coordination: An integrated system of medicine strives for seamless coordination and continuity of care across different healthcare modalities. It emphasizes effective communication, information sharing, and collaborative management to ensure comprehensive and well-coordinated healthcare.

    Ayush inpatient and outpatient departments at Central government hospitals

    • Dedicated AYUSH departments: The Ayush Ministry has decided to open dedicated AYUSH inpatient and outpatient departments at Central government hospitals to provide services related to Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (collectively known as Ayush systems of medicine).
    • Aims to provide wider range of treatment options: This initiative aims to integrate traditional and complementary medicine practices into mainstream healthcare, offering patients a wider range of treatment options and promoting holistic healthcare approaches.
    • Aims to promote and preserve traditional healthcare: The decision to establish these departments reflects the government’s recognition of the growing popularity and acceptance of Ayush systems of medicine in India. It aligns with the ministry’s goal of promoting and preserving traditional healthcare practices, while ensuring their integration within the broader healthcare framework.
    • Facilitate and a boost to research: Opening Ayush departments in Central government hospitals also facilitates research, as it allows for the investigation of the effectiveness and safety of Ayush treatments in conjunction with conventional medical practices. This collaboration between Ayush and modern medicine can lead to the development of standardized protocols, better understanding of the potential benefits, and improved patient outcomes.

    Facts for prelims

    World Ayurveda Congress (WAC), 2022

    • The 9th edition of World Ayurveda Congress (WAC) & Arogya Expo was organized at PANJIM, GOA.
    • Organised by Ministry of AYSUSH on the principle of whole government approach.
    • The event witnessed the active participation of more than 40 countries and all states of India.
    • WAC is a platform established by World Ayurveda Foundation to propagate Ayurveda globally in its true sense.

    World Ayurveda Foundation (WAF)

    • WAF is an initiative by Vijnana Bharati aimed at global propagation of Ayurveda, founded in 2011.
    • The objectives of WAF reflect global scope, propagation and encouragement of all activities scientific and Ayurveda related are the core principles.

    What is mean by complementary and alternative medicine (CAM)?

    • Complementary and alternative medicine CAM refers to medical practices and treatments that are not considered part of conventional mainstream medicine.
    • It encompasses a broad range of practices, systems, and therapies, which may include herbal medicine, traditional healing practices, acupuncture, homeopathy, naturopathy, chiropractic care, Ayurveda, and traditional Chinese medicine, among others.
    • These practices often have their roots in ancient cultural and traditional healing systems.

    Prevalence of complementary and alternative medicine (CAM)

    • Global Acceptance: Alternative medicine practices are popular and widely accepted in many countries worldwide. Traditional healing systems, herbal remedies, and other alternative therapies have been part of various cultures for centuries.
    • Regional Variations: The prevalence of alternative medicine varies across regions and countries. Some regions have a long-standing cultural and historical association with specific traditional healing practices, while others have seen increased adoption due to globalization and growing interest in holistic health approaches.
    • High Usage Rates: Surveys indicate that a significant portion of the population in various countries has used alternative medicine at some point in their lives. The prevalence rates can range from around 30% to over 70%, depending on the country and the specific therapies or practices included in the survey.
    • Specific Modalities: Different alternative medicine modalities may have varying levels of popularity. Practices such as acupuncture, herbal medicine, chiropractic care, and traditional medicine systems like Ayurveda and traditional Chinese medicine are among the commonly used modalities.
    • Complementary Use: Many individuals use alternative medicine alongside conventional medical treatments. This approach, known as complementary medicine, involves integrating alternative therapies with standard medical care to address a broader range of health concerns.
    • Health Conditions: Alternative medicine is sought for various health conditions, including chronic pain, mental health issues, musculoskeletal problems, gastrointestinal disorders, and general well-being. People often turn to alternative medicine when conventional treatments have been unsatisfactory or to explore more holistic and natural approaches.
    • Wellness and Prevention: Alternative medicine is also used for wellness promotion and preventive care. Practices such as yoga, meditation, and dietary supplements are frequently utilized to support overall health and prevent illness.
    • Global Trends: The prevalence of alternative medicine continues to grow globally. Factors such as increased awareness, patient empowerment, access to information, and a desire for more personalized and holistic healthcare contribute to this trend.

    Why do patients gravitate towards complementary/alternative medicine?

    • Holistic Approach: Complementary/alternative medicine often takes a holistic approach to healthcare, considering the physical, mental, emotional, and spiritual aspects of a person’s well-being. It focuses on treating the whole person rather than just the symptoms or specific diseases.
    • Dissatisfaction with Conventional Medicine: Some patients may have had unsatisfactory experiences with conventional medicine, such as ineffective treatments, adverse effects, or limited time with healthcare providers. As a result, they may seek alternative options that offer a different approach and more personalized care.
    • Desire for Natural and Non-Invasive Treatments: Complementary/alternative medicine often emphasizes natural remedies, herbal therapies, nutritional interventions, and non-invasive techniques. Patients who prefer a more natural or gentle approach may be drawn to these methods, especially when conventional treatments involve pharmaceutical drugs or invasive procedures.
    • Empowerment and Active Participation: Complementary/alternative medicine often encourages patients to take an active role in their health and treatment decisions. Patients may feel empowered by being involved in the decision-making process, exploring lifestyle modifications, and engaging in self-care practices.
    • Prevention and Wellness Focus: Many complementary/alternative medicine practices emphasize preventive measures and lifestyle modifications to promote overall health and wellness. Patients who are interested in maintaining good health and preventing future illnesses may be attracted to these approaches.
    • Cultural or Traditional Beliefs: Certain complementary/alternative medicine systems have deep cultural or traditional roots. Patients from specific cultural backgrounds may have a strong belief in the efficacy of these practices and may choose them based on cultural heritage or family traditions.
    • Perception of Individualized Care: Complementary/alternative medicine often places importance on individualized care, taking into account the unique needs and circumstances of each patient. This personalized approach may resonate with patients who value a more tailored and comprehensive treatment plan.
    • Perception of Fewer Side Effects: Some patients perceive complementary/alternative medicine to have fewer side effects compared to conventional medicine. They may be concerned about the potential adverse effects of pharmaceutical drugs and prefer to explore alternative options that are perceived as safer.

    Does the sale of these medicines need to be regulated?

    • Safety and Efficacy: Regulation helps ensure that alternative medicines meet certain safety standards and have demonstrated efficacy. This is important to protect consumers from potential harm or ineffective treatments.
    • Quality Control: Regulation helps maintain consistent quality in the production and distribution of alternative medicines. It can include measures to ensure proper sourcing of ingredients, good manufacturing practices, quality testing, and adherence to labeling requirements.
    • Consumer Protection: Regulation provides a framework for consumer protection by establishing rules and guidelines for marketing, advertising, and claims made by manufacturers and practitioners of alternative medicines. This helps prevent misleading or false information and ensures that consumers can make informed choices.
    • Standardization: Regulation facilitates the standardization of formulations and practices within alternative medicine systems. Standardization helps establish consistency, reliability, and reproducibility of treatments, allowing for better comparisons and research in the field.
    • Adverse Event Reporting: Regulatory oversight enables the monitoring and reporting of adverse events associated with the use of alternative medicines. This helps identify potential risks and allows for timely interventions to protect public health.
    • Integration with Conventional Medicine: Regulation promotes the integration of alternative medicine with conventional healthcare systems. It establishes frameworks for collaboration, communication, and referral between practitioners of different modalities, ensuring coordinated and safe care for patients.
    • Professional Accountability: Regulatory measures can include licensing, certification, and registration requirements for practitioners of alternative medicine. This helps ensure that practitioners meet certain educational and competency standards, promoting professionalism and accountability in the field.
    • Public Confidence: Regulation helps build public trust and confidence in alternative medicine. Clear regulations and oversight mechanisms provide reassurance to consumers, healthcare professionals, and policymakers that alternative medicines are subject to scrutiny and oversight, contributing to the credibility and acceptance of these practices.

    Medicine

    Value addition box from Civilsdaily: Differences between Naturopathy and Allopathy

    Aspect Naturopathy Allopathy (Conventional Medicine)
    Philosophy Emphasizes body’s self-healing capacity, holistic approach, natural remedies, and wellness promotion Focuses on scientific principles, evidence-based practices, disease diagnosis, and symptom management
    Treatment Approach Natural remedies, lifestyle modifications, holistic therapies, herbal medicine, and mind-body practices Pharmaceutical drugs, surgeries, medical procedures, advanced technologies
    Diagnosis Observation, physical examinations, patient history, and traditional diagnostic methods Laboratory tests, imaging techniques, diagnostic tools
    Emphasis Prevention, overall health and wellness, identifying root causes of illness Disease management, symptom relief, targeted treatments
    Individualization Personalized treatment plans based on individual needs and characteristics Standardized treatment protocols based on clinical guidelines
    Pharmaceutical Usage Minimal reliance on pharmaceutical drugs, emphasizes natural therapies Utilizes pharmaceutical drugs as primary treatment methods
    Specialized Fields Naturopaths may have specific areas of focus but often provide general holistic care Various specialized fields (cardiology, neurology, etc.) addressing specific diseases or conditions

    Conclusion

    • The debate on the integration of Ayush practices within mainstream healthcare reflects contrasting perspectives. While there are immense potential benefits of an integrated system it also raises concerns about the scientific validity and safety of alternative medicine. Striking a balance between evidence-based medicine, patient preferences, and regulatory oversight is essential.

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    Also read:

    Strengthening India’s Drug Regulatory Framework for Ensuring Quality Medicines

     

  • Strengthening India’s Drug Regulatory Framework for Ensuring Quality Medicines

    Medicine

    Central Idea

    • The recent incidents of substandard and contaminated medicines in India have raised concerns about the quality and regulatory oversight in the pharmaceutical industry. While India takes pride in being the largest manufacturer of generic medicines globally, it is essential to address the persistent quality concerns to maintain its reputation and protect public health.

    Tragic incidents highlighting quality concerns

    • Digital Vision Contamination: In January 2020, 12 children in Jammu died after consuming contaminated medicine manufactured by Digital Vision, revealing the presence of diethylene glycol. Despite previous red flags from drug laboratories, another incident occurred six months later, leading to the death of a two-year-old consuming Cofset cough syrup from the same manufacturer.
    • Nycup Syrup: In March 2021, Nycup syrup was found to have lower levels of the active ingredient, raising concerns about quality control. However, limited regulatory action hindered effective intervention against the manufacturer.

    An overview of the drug regulation mechanism in India

    • Central Drugs Standard Control Organization (CDSCO): The CDSCO, under the Ministry of Health and Family Welfare, is the central regulatory authority responsible for the approval, regulation, and control of pharmaceutical products in India. It plays a crucial role in granting licenses, conducting inspections, and monitoring drug manufacturing, import, and distribution.
    • Drug Controller General of India (DCGI): The DCGI is the head of the CDSCO and holds the overall responsibility for drug regulation in India. The DCGI oversees the approval of new drugs, clinical trials, and the regulation of imported drugs.
    • National Pharmaceutical Pricing Authority (NPPA): The NPPA regulates the prices of essential drugs in India to ensure affordability and accessibility. It monitors and controls the prices of scheduled medicines and sets guidelines for the pricing of pharmaceutical products.
    • Pharmacovigilance Program of India (PvPI): PvPI is a national program that focuses on monitoring and reporting adverse drug reactions (ADRs) to ensure the safety of medicines. It encourages healthcare professionals and the public to report any suspected ADRs to a centralized database for analysis and evaluation
    • Intellectual Property Rights (IPR) Protection: The regulatory framework includes provisions to protect intellectual property rights related to pharmaceutical inventions and innovations. This promotes research and development in the industry and encourages the introduction of new drugs.
    • Manufacturing Standards: The CDSCO ensures that drug manufacturers in India adhere to good manufacturing practices (GMP) to ensure that drugs are produced under quality standards and are safe for use.
    • Clinical Trials: The CDSCO regulates clinical trials in India to ensure that they are conducted ethically and with the safety of participants in mind. The CDSCO requires that clinical trials follow the guidelines of the International Conference on Harmonization (ICH).

    Challenges in the Indian pharmaceutical industry

    • Fragmented Regulatory Structure: With approximately 36 drug regulators in India, coordination and consistency in regulatory oversight become challenging. A consolidated and centralized regulatory body can mitigate the risk of regulatory capture and ensure common standards across states.
    • Persisting Quality Concerns: Despite being the largest manufacturer of generic medicines globally, India has encountered quality issues. Recent inspections revealed that 48 drugs failed to meet quality standards, jeopardizing patient safety.
    • Global Reputation at Stake: Observations from global regulators, such as the US FDA, indicate compliance issues in Indian pharmaceutical facilities, potentially tarnishing India’s image as a quality drug manufacturing country.
    • Limited Regulatory Action: In some instances, regulatory action has been limited or challenging to implement due to various reasons, making it difficult to effectively address quality issues and hold manufacturers accountable.
    • Insufficient Transparency and Accountability: The lack of transparency in the drug regulatory regime hinders public trust and confidence. Limited public disclosure of drug application reviews, inspection records, and past violations makes it challenging to evaluate the compliance and track record of manufacturers.
    • Inspection and Enforcement Capacity: The sheer number of pharmaceutical manufacturing units in India, coupled with the large-scale inspection load, puts strain on the inspection teams under state drug controllers.

    Way forward

    • Regulatory Reforms: Amend the Drugs and Cosmetics Act (1940) and establish a centralized drugs database for effective surveillance. Consolidate regional regulators into a single regulatory body to minimize state-level patronage and influence networks. Implement common standards across states.
    • Enhanced Transparency and Reporting: Publish comprehensive reports on drug testing laboratories’ findings and establish a public database of past violations, inspection records, and failure history. Introduce a national law on drug recall, empowering victims and imposing penalties on firms exporting spurious drugs.
    • Strengthening the Central Drugs Standard Control Organisation (CDSCO): Provide statutory backing and establish a Central Drugs Authority as an independent body, ensuring effective regulation and enforcement.
    • Industry Accountability: The pharmaceutical industry should focus on producing quality generic and innovative drugs, moving beyond generic manufacturing. Embrace zero-defect principles and prioritize public health.

    Conclusion

    • Addressing the challenges India’s pharmaceutical industry requires comprehensive reforms, including regulatory consolidation, transparency, enhanced inspections, and industry accountability. By prioritizing patient safety and ensuring the delivery of quality medicines, India’s pharmaceutical industry can reclaim its position as a global leader in drug manufacturing.

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    Also read:

    India’s delayed implementation of mandatory Drug Recall Law

     

  • Trend of unnecessary Hysterectomies

    hyster

    Central Idea: The Health Ministry in India is concerned about the high incidence of unnecessary hysterectomies, particularly among poor, less-educated women in rural areas.

    Why in news?

    • The Supreme Court has directed States and Union Territories to implement health guidelines formulated by the Centre to monitor and prevent unnecessary hysterectomies.

    What is Hysterectomy?

    • Hysterectomy is a surgical procedure to remove the uterus, and sometimes surrounding organs and tissues.
    • It can be classified as a partial hysterectomy (removal of the uterus), total hysterectomy (removal of the uterus and cervix), or radical hysterectomy (removal of the uterus, cervix, part of the vagina, and surrounding tissues).
    • The procedure can be performed through the vagina or through an incision in the abdomen.

    Issues with such surgery

    • Overuse and unnecessary procedures: Hysterectomy can be performed without exploring alternative treatments.
    • Psychological and emotional impact: The procedure may lead to feelings of loss and changes in body image.
    • Surgical risks and complications: Hysterectomy carries risks such as infection and damage to surrounding organs.
    • Long-term health effects: Removal of the uterus may have impacts on hormones and bone health.
    • Patient autonomy and informed consent: Patients should be fully informed about the procedure and involved in decision-making.
    • Access and equity: Disparities in access to healthcare may contribute to overuse, particularly among marginalized communities.

    Concerns and Petition

    A public interest litigation (PIL) highlighted the occurrence of unnecessary hysterectomies in the states of Bihar, Chhattisgarh, and Rajasthan under government healthcare schemes.

    • Marginalized women were targeted: Women from marginalized communities, such as Scheduled Castes, Scheduled Tribes, and Other Backward Communities, were disproportionately affected.
    • Misuse and Insurance Fraud: Healthcare institutions were found to be misusing hysterectomies to claim high insurance fees from the government under various health insurance schemes.

    Key issue: Violation of Fundamental Rights

    • The recent judgement acknowledges that rising hysterectomy rates among young women in India deviate from trends observed in developed countries.
    • It recognizes the violation of fundamental rights, stating that unnecessary hysterectomies infringe upon the right to health and the right to life under Article 21 of the Constitution.

    Government action and guidelines

    • The Health Ministry has closely monitored the issue of hysterectomies and requested States to share data on hysterectomy cases before and after the implementation of guidelines.
    • Compulsory audits for all hysterectomies are advised, similar to those conducted for maternal mortality, in both public and private healthcare institutions.
    • In 2022, the Health Ministry issued guidelines to prevent unnecessary hysterectomies and urged States to comply with them.

     

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  • India’s Maternal Healthcare Crisis: A Call for Urgent Action

    Maternal Healthcare

    Central Idea

    • A recent United Nations report revealed a startling reality that India, along with nine other nations, accounted for a staggering 60% of global maternal deaths, stillbirths, and newborn deaths. In 2020 alone, India accounted for over 17% of such fatalities, making it the country with the second-highest number of maternal deaths after Nigeria.

    What is maternal mortality?

    • As per World Health Organization, Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

    Gaps in maternal Healthcare in India

    • Maternal mortality rate: A United Nations report highlighted that India was among the top 10 countries responsible for 60% of global maternal deaths, stillbirths, and new-born deaths. In 2020, India accounted for over 17% of such deaths, making it the second-highest contributor after Nigeria.
    • Antenatal care (ANC):1% of mothers in India did not attend any ANC visit during their recent pregnancy. Furthermore, only 34.1% of mothers attended one, two, or three visits, falling short of the World Health Organization’s (WHO) recommendation of four visits.
    • Postnatal care: 16% of women in India did not receive any postnatal health check-ups, while 22.8% experienced delayed check-ups occurring two days after childbirth. In the poorest 20% of the households, 26.3% women never had a postnatal health check-up, whereas among the richest, only 7.9% did not.
    • Lack of skilled health providers: 8% of Indian women did not receive tetanus shots, which are crucial for preventing infections during and after surgery. In about 11% of cases, no skilled health providers were present at the time of delivery, posing risks in detecting and managing complications.
    • Decline in MMR: The Sample Registration System (SRS) 2016-2018 estimated India’s MMR at 113 per 100,000 live births. This represents a decline from previous years and indicates progress in reducing maternal deaths.

    Facts for prelims

    • India’s maternal mortality ratio (MMR) has improved to 103 in 2017-19, from 113 in 2016-18.
    • Seven Indian states have very high maternal mortality. These are Rajasthan, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Bihar, Odisha and Assam.
    • The MMR is ‘high’ in Punjab, Uttarakhand and West Bengal. This means 100-130 maternal deaths per 100,000 live births.
    • It is ‘low’ in Haryana and Karnataka.
    • The states of Uttar Pradesh, Rajasthan and Bihar have seen the most drop in MMR.
    • West Bengal, Haryana, Uttarakhand and Chhattisgarh have recorded an increase in MMR over the last survey.

    Challenges in achieving further reductions in MMR in India

    • Regional Disparities: States with limited healthcare infrastructure and resources often report higher MMR compared to more developed regions. Bridging these regional gaps in healthcare access and quality is crucial for ensuring equitable maternal healthcare outcomes.
    • Socioeconomic Factors: Socioeconomic factors play a substantial role in maternal health outcomes. Women from marginalized communities, low-income households, and rural areas face higher risks due to limited access to healthcare facilities, education, and economic resources.
    • Quality of Healthcare Services: The availability of skilled healthcare providers, adequate infrastructure, and essential medical supplies is lacking in many parts particularly in remote and ares.
    • Awareness and Education: Limited awareness among women, families, and communities about the importance of antenatal care, skilled birth attendance, and postnatal care hindering timely and appropriate care-seeking behavior.
    • Cultural and Social Factors: Deep-rooted cultural and social factors often influence maternal healthcare-seeking behavior and decision-making. Traditional beliefs, practices, and societal norms directly or indirectly affect women’s access to and utilization of maternal healthcare services.

    Government’s initiatives to improve maternal health

    • National Health Mission (NHM): The NHM is a flagship program of the Government of India aimed at providing accessible and affordable healthcare services, including maternal healthcare. Under the NHM, the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) strategy focuses on improving maternal and child health outcomes through a continuum of care approach.
    • Janani Suraksha Yojana (JSY): The JSY is a conditional cash transfer program that encourages institutional deliveries and postnatal care utilization. It provides financial assistance to pregnant women from low-income households to cover the cost of delivery and associated expenses. The program aims to reduce financial barriers and promote institutional deliveries, ensuring access to skilled birth attendants.
    • Pradhan Mantri Matru Vandana Yojana (PMMVY): The PMMVY is a maternity benefit scheme that provides cash incentives to pregnant and lactating women for their first live birth. It aims to provide partial wage compensation to pregnant women for wage loss during childbirth and to improve maternal and newborn health outcomes.
    • Janani Shishu Suraksha Karyakram (JSSK): The JSSK program ensures free and cashless delivery, including caesarean section, in public health facilities. It covers the costs of essential drugs, diagnostics, blood transfusion, and transportation for pregnant women and sick infants. The program also provides free referral transport services for pregnant women in need of emergency care.
    • Maternal Death Surveillance and Response (MDSR): The MDSR system is an important component of the government’s efforts to reduce maternal deaths. It focuses on identifying, reporting, and analyzing maternal deaths to understand the causes and take appropriate actions for prevention in the future.
    • National Iron Plus Initiative (NIPI): The NIPI focuses on addressing anemia in pregnant women by providing iron and folic acid supplements. Anemia is a significant risk factor for maternal mortality, and the NIPI aims to ensure universal coverage and adherence to iron and folic acid supplementation during pregnancy.
    • Skill Development Initiatives: The government has also emphasized the training and skill development of healthcare professionals, especially in the field of obstetric and neonatal care. This includes the establishment of skilled birth attendant programs, enhancing the capabilities of healthcare providers, and promoting evidence-based practices for safe deliveries and postnatal care.

    Way ahead

    • Strengthening Healthcare Infrastructure: Investing in healthcare infrastructure, especially in underserved areas, is crucial to improve access to quality maternal healthcare services. This includes ensuring the availability of skilled healthcare professionals, adequate facilities, and essential medical supplies in both urban and rural settings.
    • Enhancing Healthcare Workforce: Strengthening the healthcare workforce through training programs and capacity-building initiatives is essential. This involves increasing the number of skilled birth attendants, midwives, and other healthcare professionals who can provide comprehensive maternal care services.
    • Improving Access and Affordability: Addressing financial barriers is crucial to ensure that all women can access and afford maternal healthcare services. Enhancing the coverage and effectiveness of health insurance schemes, such as the Pradhan Mantri Jan Arogya Yojana (PMJAY), can significantly reduce out-of-pocket expenses for maternal healthcare.
    • Community Engagement and Awareness: Promoting community participation and awareness about maternal health is vital. Community-based programs can play a significant role in educating women, families, and community members about the importance of antenatal care, skilled birth attendance, postnatal care, and recognizing pregnancy-related complications.
    • Strengthening Maternal Death Surveillance and Response (MDSR): Enhancing the MDSR system can provide critical insights into the causes of maternal deaths and inform evidence-based interventions. Establishing robust systems for reporting, reviewing, and analyzing maternal deaths can help identify gaps in the healthcare system and facilitate targeted interventions to prevent future deaths.
    • Empowering Women and Gender Equality: Promoting gender equality and empowering women are fundamental to improving maternal health outcomes. This includes increasing access to education, economic opportunities, and decision-making power for women. Empowered women are more likely to seek and demand quality maternal healthcare services.
    • Collaboration and Partnerships: Collaboration between government agencies, healthcare providers, NGOs, civil society organizations, and other stakeholders is crucial. Partnerships can facilitate the sharing of resources, knowledge, and best practices to drive collective efforts toward reducing maternal mortality rates.
    • Monitoring and Evaluation: Establishing robust monitoring and evaluation mechanisms to track progress and identify areas that require further attention is essential. Regular data collection, analysis, and reporting on maternal health indicators can help assess the effectiveness of interventions and inform evidence-based decision-making.

    Conclusion

    • India’s high maternal mortality rates necessitate immediate interventions to address the gaps in ANC, PNC, awareness, and access to skilled healthcare providers. Bridging the disparities based on education, wealth, and caste is crucial for equitable maternal healthcare. It is imperative to prioritize comprehensive maternal healthcare and take urgent action to save lives and ensure the well-being of women and newborns in India.

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    Also Read:

    AI to improve maternal and child health in India