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

Mental Health Problem and effective policy
Context
- The fifth Global Mental Health Summit, co-sponsored by over half a dozen organisations engaged with mental health, was held in Chennai to discuss mental health in the context of human rights, ethics and justice. Highlighting the importance of mental health, it gave a call for action against the continued neglect by society at large and the governments at central and state levels, in particular.
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Findings of national mental health survey
- The National Mental Health Survey (NMHS): The latest National Mental Health Survey (NMHS) conducted by National Institute of Mental Health and Neuro Sciences (NIMHANS) in collaboration with the Ministry of Health and Family Welfare and WHO, was published in 2016.
- Prevalence of mental disorder: According to the survey, the prevalence of mental disorders among adults in India is around 10.6%. The most common disorders were anxiety disorders (7.3%) and mood disorders (4.5%).
- Higher among women than men: The survey also found that the prevalence of mental disorders was higher among women than men, and that the majority of people with mental disorders did not receive any treatment.
- Prevalence of mental disorders is higher in urban areas: It also found that the prevalence of mental disorders was higher in urban areas than in rural areas, and that there was a higher prevalence of mental disorders among people with lower levels of education and income.
- Gap in treatment coverage for people with mental disorder : The survey highlighted that there is a significant gap in treatment coverage for people with mental disorders, and that the majority of people with mental disorders do not receive any treatment.
- Plan for mental health: The survey has provided an important information for Indian government and mental health professional to plan and implement mental health programs and policies in the country.
What constitutes good policy making on mental health?
- Policy should be based on research and findings: Policies should be based on sound research and evidence from scientific studies. This helps to ensure that policies are effective in addressing mental health issues and are not based on assumptions or stereotypes.
- Active engagement of stakeholders: Policy making should involve a wide range of stakeholders, including people with lived experience of mental health issues, mental health professionals, and representatives from relevant government departments and non-governmental organizations.
- A comprehensive and integrated approach: Mental health policies should be comprehensive and address a wide range of issues, including prevention, early intervention, treatment, and recovery. They should also be integrated with other policies, such as those related to education, housing, and employment.
- Ensure easy access to mental health care: policies should ensure that people have access to appropriate and affordable mental health care, including both medication and psychosocial therapies.
- Public awareness and Sensitization : policies should ensure that people with mental health issues are treated with dignity and respect, and that their human rights are protected.
Case study: How India tackled HIV/AIDS?
- Active surveillance system: The need for crafting strategic interventions based on epidemiological evidence from an active surveillance system.
- Modelling different options: The importance of modelling different options of addressing the wide array of interventions required in different geographies, among different target groups, to provide the data related to cost effectiveness as well as efficacy of the interventions required for scaling up.
- Proactive advocacy of systemic issues among all influencers: The proactive advocacy of systemic issues among all influencers the media, judiciary, politicians, police and other intersectoral departments whose programmes and activities have had a direct bearing on the key populations being worked on.
- Community engagement: The use of peer leaders and civil society that was allocated over 25 per cent of the budget. Though a central sector programme was fully funded by the central government, every intervention was formulated with active participation and dialogue among the states and constituencies of local leaders.
Strategy for better implementation of mental health policy
- Clear goals and objectives: Having clear and measurable goals and objectives can help to ensure that policies are implemented effectively and that progress can be tracked.
- Training and capacity building: Providing training and capacity building for mental health professionals, as well as for other relevant stakeholders such as community leaders, can help to ensure that policies are implemented effectively.
- Community engagement: Involving communities in the planning and implementation of mental health policies can help to ensure that policies are responsive to the specific needs and priorities of local populations.
- Monitoring and evaluation: Regularly monitoring and evaluating the implementation of policies can help to identify any barriers or challenges, and make adjustments as necessary.
- Multi-sectoral approach: Adopting a multi-sectoral approach that involves collaboration between different sectors, such as health, education, social welfare, housing, and employment can help to ensure that policies are implemented in a coordinated and effective manner.
- Policy flexibility: Policies should be flexible enough to adapt to changing circumstances, and be responsive to feedback and suggestions from the community and stakeholders.
latest research in mental health domain
- The growing recognition of the importance of early intervention in mental health: Research has shown that early intervention can prevent mental health issues from becoming more severe, and can help individuals to recover more quickly.
- The use of technology in mental health: There has been an increase in the use of technology, such as mobile apps, virtual reality, and teletherapy, to deliver mental health care. Studies have shown that these technologies can be effective in improving mental health outcomes.
- The impact of the COVID-19 pandemic on mental health: The pandemic has had a significant impact on mental health, and research has been conducted to understand the extent of the impact and to develop strategies to mitigate it.
- Advancements in brain imaging and genetics: Researchers are using brain imaging techniques and genetic studies to gain a better understanding of the underlying causes of mental disorders and to develop more effective treatments.
- The use of personalized medicine in mental health: There is growing interest in the use of personalized medicine, which involves using genetic and other information to tailor treatment to the individual patient, to improve mental health outcomes.
- The benefits of nature-based interventions for mental health: Studies have shown that spending time in nature can have a positive impact on mental health, including reducing symptoms of stress, anxiety, and depression.
- The importance of social determinants of mental health: Research has highlighted the importance of social determinants such as poverty, education, and social support in mental health.
- The importance of addressing mental health in the workplace: Studies have highlighted the impact of workplace stress and burnout on mental health and the importance of workplace interventions to promote mental well-being.
Do you know Neuralink?
- Neuralink is a gadget that will be surgically inserted into the brain using robotics. In this procedure, a chipset called the link is implanted in the skull.
- Neuralink can be used to operate encephalopathy. It can also be used as a connection between the human brain and technology which means people with paralysis can easily operate their phones and computer directly with their brain.
Conclusion
- Mental health problems and not related to age of persons. From children to old age all can suffer from this menace. Government of the must formulated, implement the effective, resulted oriented mental health policy as earliest as possible
Mains Question

Q. What factors need to be taken care while drafting sound mental health policy? Suggest a strategy for better implementation of metal health policy.

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January 16, 2023
Malnutrition in the North-eastern states of India
Context
- Between the National Family Health Survey (N
  
  FHS)-4 (2015–16) and the fifth round (2019–2020), there has been a considerable increase in the number of malnourished children in India, and the progress made during the first half of the decade appears to have been undone. Malnutrition in the North-eastern states of India is worse than the country average.
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What is malnutrition?
- Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
- For a child’s motor, sensory, cognitive, social, and emotional development, malnutrition has substantial long-term effects. It impedes productivity and academic progress.
The term malnutrition covers two broad groups of conditions
- Undernutrition: Undernutrition includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
- Overnutition: The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).
Did you know?
- Stunting, or low height for age, is a recognized risk factor for children’s delayed development.
- According to a study, a 1% reduction in adult height as a result of childhood stunting is linked to a 1.4% reduction in economic productivity.
- Children who are stunted, earn 20% less as adults.
Malnutrition in North East India
- Upsurge in stunting: Four states in the Northeast Meghalaya, Mizoram, Nagaland and Tripura have seen an upsurge in stunting among children under the age of five. Stunting is highest in Meghalaya at 46.8 %, followed by Nagaland (32.7%), Tripura (32.3 %), and Mizoram (28.9%). In Mizoram, Nagaland, and Tripura, the percentage of kids who are stunted, wasting, underweight, or overweight has increased
- Levels of stunting decreased in Assam: The NFHS-5 shows Assam, Manipur and Sikkim have shown a drop in stunting levels. In Assam, stunting has decreased by almost one percentage point, although rates of overweight (2.3% to 4.9%), underweight (29.8% to 32.8%), and stunting (17% to 21.7%) have all increased, whereas that of wasting and underweight have decreased by more than 2% in each instance.
- Sikkim performs better than other NE states: As the number of stunted, wasting, and underweight children has dropped, Sikkim has done considerably better than other NE states so has Manipur, with a decrease in wasting from 6.8% to 9.9% in under-five children.
- Increase in no of overweight people in every NE state: Every state in the Northeast saw an increase in the number of overweight people, which amplifies the growing double burden of malnutrition in the states.
Appropriate foods and feeding practices show Higher immunity
- Feeding practices adequate only in Meghalaya and Tripura: The percentages of breastfeeding children receiving adequate complementary foods have improved only in Meghalaya and Tripura. Early initiation of breastfeeding is on the decline in six out of the eight northeastern states, with highest levels in Sikkim (33.5%) and Assam (15.3%).
- Reduction in exclusive breastfeeding rates (EBF): Sikkim, Tripura, and Manipur all exhibit a notable reduction in exclusive breastfeeding (EBF) rates. EBF in Sikkim is the lowest at 28.3 percent, far lower than the national average of 63.7 percent. Tripura demonstrated a gain of 39.5 percentage points in the practice of timely introduction of semi-solid food, whereas Meghalaya, Mizoram, Nagaland, Sikkim, and Arunachal Pradesh showed a slight fall.
- All NE states except Assam performed well on diet adequacy: Minimum Adequate Diet (or diet adequacy) is a combined indicator of feeding frequency and diet variety. From 8% to 29.8%, there is a significant range throughout the northeastern states. All states, with the exception of Assam, have performed better on this measure than the nation as a whole.
- The situation with obesity is more complicated: Only Meghalaya and Nagaland have seen decreases, while the other six states have seen increases. It is heartening to see a declining trend in underweight women (BMI < 18.5) in all eight northeastern states.
- Anaemia is increased: In six of the eight northeastern states, anaemia among women of reproductive age has increased, with Tripura worst at 67.2%, and Assam at 65.9%.
How malnutrition can be tackled in NE?
- Finding out the causes: Stunting among children in the Northeast is caused by a number of factors, including poor maternal health, a lack of antenatal care, inadequate infrastructure and healthcare facilities, inadequate feeding and nutrition for women, and limited access to education, clean drinking water, and sanitary facilities.
- For instance: Lack of toilets, drinking water and cooking fuels in the home environment have an impact on child malnutrition, according to a 2015 study on indigenous peoples in the Northeast.
- Improving the maternal nutrition: Manipur, Mizoram, and Sikkim fare better than the national average in most measures. Newborns’ chances of being stunted are decreased by better maternal nutrition prior to conception, throughout pregnancy, and after delivery. According to data for Sikkim, Manipur, and Mizoram, the risk of stunting decreases as the number of underweight mothers decreases.
- Upgrading the service availability: In the northeastern states, the use of supplementary food at the anganwadi centres (ANC) varies greatly, from about 35% in Arunachal Pradesh to 70% in Tripura. A low of 20.7% in Nagaland and a high of 79.4% in Manipur is the ANC coverage across the Northeast.
- Improving the required intake of Iron and Folic acid: All states have lower percentages of iron and folic acid (IFA) intake than the national average of 26%, with the exception of Manipur where 30.3% of pregnant women completed the full 180-day course of IFA tablets. Nagaland has the lowest rate, at just 4.1%. Overall, the NE states show a wide variation in service availability and uptake.
Note it down: The innovative programmes to enhance mother and child health
- Nutrition gardens: For example, the Assam government encouraged women in rural communities to develop “nutrition gardens” where they could grow vegetables.
- My school my Farm: “Kan Sikul, Kan Huan (My School, My Farm)” programme in the most impoverished and disaster-prone area in Mizoram-Lawngtlai.
- Lunchbox exchange: The “dibbi adaan pradaan (lunchbox exchange)” initiative in Hailakandi district of Assam for promoting better nutrition and variety in menu.
Conclusion
- Malnutrition in the Northeast has to be addressed holistically through the scaling up of direct nutrition interventions and the coupling of them with nutrition-sensitive measures to close the nutrition gap. In the long run, it could be beneficial to improve the monitoring and evaluation of current interventions by building on the POSHAN Abhiyaan and health projects.
Mains question

Q. What is Malnutrition? Malnutrition in the North-eastern states of India is worse than the country average. Discuss.

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January 11, 2023
Vishwaguru aspirations and the internationalization of Indian higher education
Context
- The 2020 National Education Policy (NEP) was a pathbreaking moment in the annals of Indian higher education. The policy envisions a complete overhaul and re-energising of the higher education system. The just announced University Grants Commission (Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India) Regulations, 2023, have re-ignited debates on the internationalization of Indian higher education.
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Major factors that influence Internationalization of higher education
- Prohibitive costs of higher education, especially in developed countries: Indian students must pay approximately Rs 70 lakh per annum to study at Harvard, Yale or Stanford and over Rs 55 lakh per annum to study at Oxford or Cambridge. Tuition fees alone would be about 15 times more expensive than Indian private universities. The new proposal vitiates the NEP’s vision of equity and inclusion as it envisages higher education only for the super-rich.
- The establishment costs of top university campuses make the project unviable: The vision of uniform academic standards in both the parent university and its international campus is a noble aspiration. However, the reality is international campuses have become a second-rate option, primarily accessible to those unable to get admission to the main campus. The quality and excellence in teaching and research on overseas campuses cannot match those in their primary location.
- The landscape of global higher education has dramatically changed post-Covid: The idea of brick-and-mortar international campuses has given way to building solid partnerships, student and faculty mobility, exchange and immersion programmes, joint teaching and research opportunities, collaborative conferences and publications and the development of online and blended degree programmes. The global thinking around international collaborations has changed.
Steps to become a global leader in international education
- Greater autonomy to Indian universities as well as Institutions of Eminence (IoE): Indian universities, both public and private, are generally highly regulated and poorly governed. The ingrained institutional habit of regulatory bodies instructing universities on what they should be doing must stop. The government must pay greater attention to the IoEs and expand their scope and scale so that they become natural destinations for international students.
- Establishing universities more of global orientation and outlook: Establish global universities in India led by the public and the private sector to cater to the needs and aspirations of international students. India’s Gross Enrolment Ratio (GER) is lopsided. The national GER is approximately 22 per cent but there are states, such as Tamil Nadu, with a GER of 52 per cent. We must build more public and private universities across the country, with greater autonomy, resources and better governance structures, minimising the role of the regulatory bodies.
- Provide more resources to all the Indian universities: Indian universities face acute resource scarcity. The NEP has envisaged a six per cent annual investment in higher education and a National Research Foundation to allocate additional resources. Government must encourage CSR and philanthropic initiatives with more tax incentives to enable private sector contributions to public and private universities.
- Breaking the barriers, bias and prejudices and hierarchy: The NEP envisages breaking the long-standing barriers between public and private institutions. But many biases and prejudices persist. An institutionalised hierarchy in the Indian higher education system replicates the caste system. First, the IITs and the IIMs are placed high in the pecking order, followed by the central universities. Next come the IISERs, NITs and much lower down are the state public universities.
- Establish a liberal and progressive regulatory ecosystem for Indian universities to attract international students: Much more than reforms in the education sector will be needed if India is to become a sought-after international destination for students from developing countries. Government must reform its visa processes and the FRRO registration procedures. There must be a significant improvement in the quality of infrastructure and hostels on university campuses. The safety, security and well-being of the students, especially women, must be ensured. Other forms of university towns and education cities can create a comprehensive ecosystem that will enable students and faculty to study, work and live in these communities.
What should be the India’s approach?
- Focus on becoming global higher education destination in our own right: Instead of enabling the creation of international campuses of universities from developed countries, we need to focus on becoming a global higher education destination in our own right.
- Assume leadership role to realise Vishwaguru aspiration: We will not realise the Vishwaguru aspiration by inviting prestigious foreign universities to locate campuses. We must assume the leadership role we had over 2,000 years ago when Nalanda, Takshashila, Vallabhi and Vikramshila attracted faculty and students from around the world.
- High quality education in affordable cost: We can be truly global leaders in providing high-quality education at an affordable cost. Likewise, we can produce high-quality research at a relatively lower cost.
- For instance: Indian scientists made a successful mission to Mars with a modest budget of $74 million, less than the production cost of $108 million for Gravity, a Hollywood film.
Conclusion
- The vision of India becoming a Vishwaguru cannot be achieved by outsourcing Indian higher education to international universities. Instead of enabling the creation of international campuses of universities from developed countries, it must focus on becoming a global higher education destination in its own right.
Mains question

Q. India strives to become a global leader in international education. Discuss what steps need to take and what should be the India’s approach?

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January 10, 2023
UGC norms to setup Foreign Universities in India
The University Grants Commission (UGC) has unveiled draft regulations for ‘Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India’.

Quest for Foreign Universities in India: A quick recap
- The government had in 1995 drafted the Foreign Education Bill which had to be shelved.
- Another attempt was made in 2006, but the draft law could not cross the Cabinet stage.
- Then in 2010, the UPA-2 government brought the Foreign Educational Institutions Bill, which failed to get enough support in the Parliament.
- The bill lapsed in 2014 as UPA lost power.
- The New Education Policy, 2020 allows for establishment of foreign university campuses in India.
Procedure for Universities coming to India
- The process for getting approval for setting up a campus in India will be strictly online in the beginning. Interested institutions have to apply at the UGC portal with a non-refundable fee, and then submit some documents.
- After the applications are received, a committee formed by the Commission will examine these applications on these factors:
1. Credibility of the institution
2. Programmes to be offered by the institution
3. Their potential to strengthen academic opportunities in India
4. Proposed infrastructure
UGC (Setting up and Operation of Campuses of Foreign Higher Educational Institutions in India) Regulations 2023: Key questions answered
- UGC approval compulsory: All foreign universities that wish to set up their campus in India will be allowed to do so only after getting approval from the UGC.
- Reputed institutions: To set up a campus in Indian foreign universities will either have to be in the top 500 to apply or will have to be “highly reputed” in their respective countries (if the varsity does not participate in global rankings). If their ranking is between 500 and 100, but the subject-wise ranking is higher than overall, then in such cases, the institutions will be permitted to set up their campuses only for those ranked subjects.
- Quality assurance: Additionally, the UGC will reserve the right to inspect these Indian campuses of foreign HEIs at any time, and they will not be outside the purview of anti-ragging and other criminal laws.
- Offline classes only: All the foreign universities that open their branches in India will be allowed to conduct offline classes only, i.e. foreign universities can offer only full-time programmes in physical mode.
- Freedom to choose admission process, fee, and faculty: All foreign varsities will have the freedom to come up with their own admission process. However, the universities will have to ensure “quality of education imparted at their Indian campuses is on par with their main campus.”
- Admissions to all: Foreign higher educational institutes will have the freedom to enroll Indian as well as international students on their Indian campuses.
- International funds transfer: To ensure that there is no chaos in funds transfer, all matters related to funding will be as per the Foreign Exchange Management Act 1999.
- Safeguarding of students’ interest: FHEI shall not discontinue any course or programme or close the campus without the commission’s prior approval. In the case of a course or programme disruption or discontinuation, the parent entity shall be responsible for providing an alternative to the affected students.
- Equivalence with degrees awarded by Indian HEIs: The qualifications awarded to the students in the Indian campus shall be recognised and treated as equivalent to the corresponding qualifications awarded by the FEHI in the main campus located in the country of origin.
- Securing India’s national interest: FEHIs shall not offer any such programme or course which jeopardises the national interest of India or the standards of higher education in India. The operation of FEHIs shall not be contrary to the sovereignty and integrity of India, the security of the state, friendly relations with foreign states, public order, decency, or morality.
Why such move?
- Increase in domestic enrolment: India has more than 1000 universities and 42,000 colleges. Despite having one of the largest higher education systems in the world, India’s Gross Enrolment Ratio (GER) in higher education is just 27.1%, among the worlds’ lowest.
- Education quality improvement: The lack of quality in Indian education is reflected in the QS World University Rankings 2022. IIT Bombay was the top-ranking Indian institute in the list with a ranking of 177. Only eight Indian universities made it to the top 400.
- Paving the way: London Business School, King’s College in London, the University of Cambridge, and New York University have started preliminary discussion with the GIFT City authorities and the regulator to establish facilities at the GIFT International Financial Services Centre.
Benefits of the move
- Human capital generation: This move would complement efforts to provide high quality human capital to India’s financial services industry.
- Decreased overseas spending: Indian students’ overseas spending is set to grow from current annual $28 billion to $80 billion annually by 2024.
- Reduce FOREX spending: Apart from fostering a competition in quality, International branch campuses can also help in reducing the foreign exchange outflow.
- Prevents brain-drain: Education attracts opportunities. Atmanirbhar Bharat push will retain the domestic talent. More than eight lakh Indians gave up their citizenship in the last seven years.
- Increase India’s soft power: Opening the door for foreign universities can improve India’s soft power as it will provide further impetus to the government’s Study in India programme that seeks to attract foreign students.
Challenges
- Regulatory challenges: The following factors may deter foreign higher educational institutions from investing in India-
1. Multi-layer regulatory framework governing different aspects of higher education
2. Lack of a single regulatory body overlooking the collaborations/ investments and
3. Multiple approvals required to operate in India
- Implementation issues: While NEP has taken the right steps to boost the education sector and pave the way for a globally-compatible education system, its implementation has been slow and requires clarity.
- Higher possibility of Brain Drain: A policy challenge that stands before the GoI is to facilitate such tie-ups in a way that the Indian talent chooses to and is incentivised to remain in India and the Indian educational infrastructure is developed to match global standards.
Conclusion
- The intent of the GoI, with respect to international universities setting up campuses in India, is clear from the provisions in the NEP.
- However, much clarity is awaited for the proper implementation.
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January 6, 2023
Digital healthcare Services
Context
- India leveraged information and communications technologies (ICTs) during the pandemic. Digital health solutions played a crucial role in bridging the gap in healthcare delivery as systems moved online to accommodate contactless care.
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India’s spectacular demonstration of digital public good (DPG) so far
- Aadhar and UPI are like the building blocks of DPG: India has demonstrated its digital prowess by building digital public goods the digital identity system Aadhaar, the DPGs built on top of Aadhaar and the Unified Payments Interface.
- Aadhar for PDS and UPI for payments: While Aadhaar has become central to India’s public service delivery architecture, UPI has transformed how payments are made.
- One of the largest internet users: Our digital public infrastructure has reached the last mile, enabled by 1.2 billion wireless connections and 800 million internet users.
- Some examples of DPGs developed during the pandemic: For instance, the Covid Vaccine Intelligence Network (CoWIN) and the Aarogya Setu application. CoWIN propelled India to adopt a completely digital approach to its vaccination strategy. Aarogya Setu provided real-time data on active cases and containment zones to help citizens assess risk in their areas.
- Increasing use of Telemedicine platforms: Telemedicine platforms saw a steep increase in user acquisitions, as 85 per cent of physicians used teleconsultations during the pandemic, underscoring the need to better incorporate cutting-edge digital technologies into healthcare services.
Acknowledging the current need?
- Although the impact of the pandemic on health services put the spotlight on the benefits of digital innovation and technology-enabled solutions, private entities, health technology players, and the public sector have been driving digitisation in the sector for some time now.
- It has become clear that a comprehensive digital healthcare ecosystem is necessary to bring together existing siloed efforts and move toward proactive, holistic, and citizen-centric healthcare.
Government efforts in this direction?
- Shared public goods for healthcare: Recognising this need, the government has created shared public goods for healthcare and developed a framework for a nationwide digital health system. This brought healthcare to a turning point in India.
- Ayushman Bharat Digital Mission (ABDM): The PM launched the Ayushman Bharat Digital Mission on September 27, 2021, under the aegis of the National Health Authority. Within a year of its launch, ABDM has established a robust framework to provide accessible, affordable, and equitable healthcare through digital highways. The ABDM has implemented vital building blocks to unite all stakeholders in the digital healthcare ecosystem.
- The Ayushman Bharat Health Account (ABHA): ABHA creates a standard identifier for patients across healthcare providers. With the ABHA and its associated Personal Health Record (PHR) app, citizens can link, store, and share their health records to access healthcare services with autonomy and consent. With more than 300 million ABHAs and 50 million health records linked, the mission is growing at a massive rate.
- The Health Facility Registry (HFR) and the Health Professional Registries (HPR) for central digital health information: HFR and HPR accounts provide verified digital identities to large and small public and private health facilities and professionals. This enables them to connect to a central digital ecosystem while serving as a single source for verified healthcare provider-related information. HFR and HPR improve the discovery of healthcare facilities and help health professionals build an online presence and offer services more effectively. The
- Drug registry for centralised repository of approved drugs: It is a crucial building block designed to create a single, up-to-date, centralised repository of all approved drugs across all systems of medicine.
- Unified Health Interface (UHI) enables a connect between healthcare providers with end users: It aims to strengthen the health sector by enabling all healthcare service providers and end-user applications to interact with each other on its network. This will provide a seamless experience for service discovery, appointment booking, teleconsultations, ambulance access, and more. The UHI is based on open network protocols and can address the current challenge of different digital solutions being unable to communicate with each other.
What the government is planning next in this domain?
- To give UHI the necessary push, the government is repurposing Aarogya Setu and CoWIN: Aarogya Setu is being transformed into a general health and wellness application. At the same time, CoWIN will be plugged with a lite Hospital Management Information System (HMIS) for small clinics, to bring digitisation to the masses.
- Addressing well the patient registration process at the hospital counters: Another use-case of ABDM is scan and share, which uses a QR code-based token system to manage queues at hospital counters. It uses the foundational elements of ABHA and PHR to streamline the outpatient registration process in large hospitals
- Expanding healthcare digital initiative worldwide: The government is also planning to expand its digital initiatives in the healthcare sector with Heal by India, making India’s healthcare professionals’ services available worldwide.
- Platform for organ donation: Additionally, a platform is being developed to automate the allocation of deceased organ and tissue donations, making the process faster and more transparent.
Way ahead
- Digitise insurance claim settlement process: With the implementation of digital solutions, the next step is to digitise and automate the insurance claim settlement process through the Health Claim Exchange platform.
- Making claim settlement process inexpensive and transparent: There is need to make claim-related information verifiable, auditable, traceable and interoperable among various entities, enabling claim processing to become inexpensive, transparent and carried out in real time.
- Bringing together global efforts for digital health: India assumes the G20 presidency this year. The G20 Global Initiative on Digital Health calls for the creation of an institutional framework for a connected health ecosystem to bring together global efforts for digital health.
- Accelerating UHC by scaling up the technologies: It also calls for the scaling-up of technologies such as global DPGs to accelerate Universal Health Coverage.
Conclusion
- The ABDM has proven to be a valuable asset and its adoption across states has been accelerated by the National Health Authority. It aims to build the foundation for a sustainable digital public infrastructure for health, enabling India to achieve universal health coverage. The mission embodies G20’s theme of “Vasudhaiva Kutumbakam” or “One Earth. One Family. One Future”
Mains question

Q. India has demonstrated spectacular success in digital public goods, specifically in Digital health. Discuss how the government efforts are taking shape in this direction and suggest a way ahead in short.

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January 5, 2023
Contamination of medicine: India; The Pharmacy of the world needs a relook in drug regulations
Context
- Merely two months after the World Health Organisation (WHO) sounded an alert over deadly contamination in four brands of cough syrup manufactured by a Sonepat-based pharmaceutical company that were subsequently linked to the deaths of 72 children in Gambia, another Indian pharmaceutical company stands accused of a similar crime. This time, it is Uzbekistan which has accused a Noida-based pharmaceutical company of selling contaminated cough syrup that has allegedly killed 18 children in that country.
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Thorough analysis
- Unacceptable levels of Ethylene/ Diethylene glycol: In both cases, lab tests reportedly found unacceptable levels of diethylene glycol (DEG) or ethylene glycol (EG) or both in the cough syrups.
- Ideally these chemicals should not be found in any medicine: Both DEG and EG are deadly chemicals that should not be found in any medicine.
- Then how these chemicals end up in medicines: The typical reason these chemicals end up in medicine is because pharmaceutical manufacturers do not adequately test industrial solvents purchased from chemical traders and used to manufacture cough syrups despite the fact that the law mandates such testing for contamination.
- Proximity in two cases: Given the physical proximity of the manufacturers implicated in the Gambian and Uzbekistan cases, there is a very high possibility that the same batch of contaminated industrial solvent was used by both companies.
Contamination of medicines in India
- India has a tumultuous history of DEG contamination in medicines: Between 1972 and 2020, India has seen at least five mass DEG poisonings in Chennai, Mumbai, Bihar, Gurgaon and Jammu. The incident in Gurgaon led to the death of 33 children and the incident in Jammu of at least 11 children.
- Difficult to diagnose deaths due to adulterated medicine: The final reported toll in such cases is definitely an undercount because it is notoriously difficult for doctors to diagnose such deaths and attribute them to adulterated medicine.
- Lethargy and denial is a pattern with drug regulators in India: In August 2020, about eight months after the DEG-related deaths of the children in Jammu were first reported by PGIMER, Chandigarh, the same hospital reported that another two-year-old child from Baddi had died in its facility after consuming a different brand of cough syrup manufactured by the same company that was responsible for the deaths earlier in Jammu. This was a death that could have been easily avoided if the regulators had conducted and published a thorough root cause analysis after the Jammu incident and followed it up by a nationwide recall of all cough syrups manufactured at the same facility. This never happened.
Critique: Whether the Ministry of Health and the Central Drugs Standard Control Organization have learnt their lessons from these previous incidents?
- Government will handle the issue just as any other public relation crisis: The present government is likely to handle this crisis as yet another public relations crisis instead of a public health crisis. Assumption is based on the observation of the official response from the government to the tragedy in Gambia.
- Instead of condoling, accused them for not testing before prescribing: Far from condoling the deaths of 72 Gambians, the initial press release from the Ministry of Health gaslit the Gambians by accusing them of not testing the cough syrups before prescribing them to patients.
- False presumption that the drug regulator is doing its job well: This was an absurd allegation because nobody tests drugs that are purchased before releasing them for patient use, even in India. The presumption is that the drug regulator is doing its job to ensure quality control.
- Government’s information czars accusing WHO: The first step of this PR strategy was to keep leaking to journalists that the WHO was not co-operating with the information requests made by an expert committee set up by the Government of India to investigate the deaths in Gambia. This despite the government fully knowing that the responsibility of investigating the deaths lay not with the WHO but with the sovereign authorities in Gambia.
- Rare mention of sympathy: The common thread running through these events is a communications strategy aimed at denial and intimidation. There is rarely a mention of sympathy for lives lost or a commitment to protect public health.
- Even China does better than India: An iron fist in a titanium glove is the best way to describe the government’s response to any allegations of quality issues afflicting the Indian pharmaceutical industry. In 2007, when a Chinese chemicals manufacturer was implicated in the deaths of 365 people in Panama who consumed cough syrup manufactured with an adulterated industrial solvent, the Chinese arrested the manufacturer and publicly promised to punish him.
What should be done immediately?
- The immediate public health response in these cases of DEG contamination should be aimed at limiting further deaths.
- This means tracing the origins of the contaminated industrial solvent used to manufacture the syrups.
Conclusion
- What India needs right at the moment is to accept the fact that there is a major quality problem with the Indian pharmaceutical industry. Allegations cannot be morphed from one to another. Perhaps the need of the hour is to have meaningful and comprehensive conversation on actual regulatory reform.
Mains question

Q. It is said that India has a tumultuous history of DEG contamination in medicines. The recent deaths in Gambia and Uzbekistan supports this statement. What the critique has to say over India’s response in such cases.

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December 31, 2022
Indian biotech investigated following deaths of Uzbek children
The Central Drugs Standards Control Organisation (CDSCO) are investigating Noida-based firm after the deaths of 18 children in Uzbekistan by drinking health syrup contaminated with Diethylene Glycol (DEG).

India’s response to these deaths
- It is certainly the responsibility of the importing country to test medicines before releasing them in their market.
- After being informed about the incident, India’s apex regulatory body, Central Drugs Standard Control Organisation (CDSCO) opened investigations and lifted control samples.
Issue: India’s credibility at stake
- India is one of the leading exporters of medicines.
- PM Modi recently stressed that Indian drugs had earned the world’s trust and that India could be called the ‘pharmacy to the world’.
- However, such negative reports on the quality and safety of our medicines will be a massive blow to the country’s image as a source of cheap generic drugs to the world.
Issues highlighted by the incident
- Smuggling of cheap drugs: Inquiry reveals that these were imported from an Indian manufacturer, not under public tender but privately.
- Ignorance by authorities: The drug which is banned for domestic consumption has got exported and led to fatalities. This is a huge blissful mistake by Indian Authorities.
- Lack of inspection: There are not enough drug inspectors in the country to conduct as many inspections as is ideally required in such as vast set-up.
- Inadequacies in quality-check: Despite huge production units, there are not an adequate number of laboratories to test the samples in time if all the samples that should be lifted for testing are picked up.
- Blot on credibility: The matter, if not properly handled, can damage the perception that Indian medicines are trustworthy for many countries and the global South.
Possible factors behind this tragedy
- There are rackets of counterfeit Indian medicines turning up in many countries.
- Some of these were coming from unregistered producers in India, who would produce medicine depending on what cost was paid to them without concern for quality.
- In some cases, competitors from other countries were known to make counterfeit medicines with Indian markings and dump them in markets where Indian pharmaceuticals were well regarded.
Way forward
- The pharmaceutical trade is vital and must be protected from predatory practices and violations of regulatory norms.
- Regulatory mechanism on both sides should be strengthened.
- Importers should be given lists of recognised Indian manufacturers.
- Training should be provided to drug controllers to curtail the menace of counterfeit and poor-quality medicine entering from India.
Back2Basics: Diethylene Glycol (DEG)
- A/c to WHO, Diethylene Glycol (DEG) or ethylene glycol is toxic to humans when consumed and can prove fatal.
- It can cause kidney and neurological toxicity and has been associated with several cases of mass poisoning when consumed via drugs.
- The chemical tastes sweet and is water-insoluble.
- The toxic effects of the chemical include abdominal pain, vomiting, diarrhea, inability to pass urine, headache, altered mental state, and acute kidney injury.
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December 30, 2022
India’s G20 Presidency: Healthcare should be a central agenda
Context
- Health needs to be a central agenda for the G20 2023. It has been one of the priority areas for G20 deliberations since 2017, when the first meet of health ministers of G20 countries was organised by the German presidency. The G20 now has health finance in its financial stream and health systems development in the Sherpa stream.
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Background: Prioritizing Health
- An annual G20 meeting of health ministers and a joint health and finance task force reflects the seriousness the subject has gained.
- The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance.
- The Covid-19 pandemic gave added urgency to pandemic preparedness and the Indonesian presidency in 2022 made it the major focus. The Indian presidency needs to advance these agendas.
Global community engagement to strengthen Health systems
- Universal Health Coverage (UHC): The concept of UHC was born in the 2000s to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalizing health insurance coverage.
- UHC as a strategy to ensure healthcare for all: The UHC has been the big global approach for health systems strengthening since 2010, also adopted in 2015 as the strategy for Sustainable Development Goal-3 on ensuring healthcare for all at all ages.
- Limited impact of UHC: However, the limited impact of this narrow strategy was soon evident, with expenditures on outdoor services becoming catastrophic for poor households and preventing access to necessary healthcare and medicines, while many unnecessary/irrational medical interventions were being undertaken.
What are the new approaches developed to strengthen healthcare system?
- Highlighted the need to prioritise primary healthcare (PHC): In 2018, the Astana Conference organised by WHO and UNICEF put out a declaration stating that primary healthcare (PHC) is essential for fulfilling the UHC objectives.
- Combined UHC- PHC approach: In 2019, the UN General Assembly adopted the combined UHC-PHC approach as a political declaration.
- World bank report on benefits of PHC services during pandemic: The World Bank published a report in 2021, “Walking the Talk: Reimagining Primary Health Care After COVID-19”. The dominant hospital-centred medical system is becoming unaffordable even for the high-income countries, as apparent during the 2008 recession and subsequently.
What is PHC-with-UHC approach?
- It means strengthening primary level care linked to non-medical preventive action (food security and safety, safe water and air, healthy workspaces, and so on)
- It works through whole-of-society and whole-of-government approaches, and extending the “PHC principles” to secondary and tertiary care services.
- This could be the most cost-effective systems design the comprehensive game changer that global health care requires.
What is to be strengthened, what initiatives can be applied and how?
- Making health central to development in all sectors: Health in all policies, one health (linking animal and human health for tackling antimicrobial resistance and zoonotic diseases), planetary health, pandemic preparedness.
- Health systems strengthening: Designing PHC-with-UHC for diverse contexts. Conceptualised as a continuum of care from self-care in households to community services, to primary level para-medical services and first contact with a doctor, services provided as close to homes as possible, affordable and easily deliverable.
- Appropriate technologies to be adopted as a norm: By strengthening health technology assessment, ethics of healthcare, equitable access to pharmaceutical products and vaccines, integrative health systems using plural knowledge systems rationally.
- Health and healthcare from the perspective of the marginalised: Gendered health care needs, Health care of indigenous peoples globally, occupational health, mental health and wellbeing, healthy ageing.
- Easy access to health knowledge for all: decolonization and democratization of health knowledge, with interests and perspectives of low-middle-income countries (LMICs), prevention and patient-centred healthcare.
India’s G20 Presidency: An opportunity to contribute and make inclusive healthcare system
- India has several pioneering initiatives that can contribute to the PHC-with-UHC discussion:
- National Health mission and dedicated health facilities: Lessons from the National Health Mission for strengthening public health delivery; the HIV-control programme’s successful involvement of affected persons/communities and a complex well-managed service structure.
- Democratized health knowledge: Pluralism of health knowledge systems, each independently supported within the national health system.
- Certified Health personnel: Health personnel such as the ASHAs, mid-level health providers and wellness centres, traditional community healthcare providers with voluntary quality certification;
- R&D and widely acknowledged pharmaceutical capacity: Research designed for validation of traditional systems; pharmaceutical and vaccines production capacity;
- Digital health as an example: Developments in digital health; social insurance schemes and people’s hospital models by civil society.
Conclusion
- What is required is the drafting of PHC-with-UHC (a PHC 2.0) with a broad global consensus and commitment to a more sustainable and people-empowering health system. Pursuing such an agenda would involve much dialogue within countries, regions and globally. India should use its presidency to draft a model policy focusing on primary healthcare that commits to a universal, affordable, inclusive and just healthcare system
Mains Question

Q. What is Primary HealthCare and Universal healthcare integrated approach? What steps are necessary to further strengthen sustainable healthcare system? Discuss how India can contribute to it under its G20 presidency?

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December 26, 2022
[pib] The Urban Learning Internship Programme (TULIP)
More than 25,000 internship opportunities have been advertised under the TULIP programme so far.

TULIP Program
- TULIP is a portal jointly developed by the Ministry of HRD, Ministry of Housing & Urban Affairs, and All India Council for Technical Education (AICTE).
- It helps reap the benefits of India’s demographic dividend as it is poised to have the largest working-age population in the world in the coming years.
- It helps enhance the value-to-market of India’s graduates and help create a potential talent pool in diverse fields like urban planning, transport engineering, environment, municipal finance etc.
- It furthers the Government’s endeavors to boost community partnership and government-academia-industry-civil society linkages.
Why need such a program?
- India has a substantial pool of technical graduates for whom exposure to real-world project implementation and planning is essential for professional development.
- General education may not reflect the depth of productive knowledge present in society.
- Instead of approaching education as ‘doing by learning,’ our societies need to reimagine education as ‘learning by doing.’
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December 24, 2022
World Ayurveda Congress: Aligning traditional medicine with modern medicines
Context
- Prime Minister Narendra Modi commended the recent growth of traditional medicine (TM), and Ayurveda in particular, while addressing the World Ayurveda Congress 2022 (WAC) earlier this month. Noting the lag in evidence despite considerable research, he gave a clarion call “to bring together medical data, research, and journals and verify claims (benefit) using modern science parameters”.
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All you need to know about World Ayurveda Congress (WAC)
- Platform by World Ayurveda foundation: The World Ayurveda Congress (WAC) is a platform established by World Ayurveda Foundation to propagate Ayurveda globally in its true sense.
- Platform to connect various stakeholders in medicine: World Ayurveda Congress (WAC) is a platform to connect Ayurveda practitioners, medicine manufacturers, enthusiasts and academicians.
- What is the mandate: World Ayurveda Congress (WAC) & Arogya Expo monitors progress and initiate missions and collect feedbacks.
World Ayurveda Congress (WAC), 2022
- 9th edition of WAC held at Panjim, Goa: 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 (WGA): The WAC organised by the Ministry of AYUSH on the ‘Whole Government Approach’ (WGA) to foster and strengthen the research ecosystem for AYUSH systems.
- What is Whole System Approach (WSA): The concept of WGA is in consonance with the “Whole System Approach” (WSA). WSA encompasses integrated and network participation of several stakeholders (including patients and the community) for better solutions (treatment outcomes) in a challenging and complex situation. IM is an important component of WSA in the current context.
- Active Participation: The event witnessed the active participation of more than 40 countries and all states of India.
- PM’s vision: To transform the healthcare system of the country and to develop a healthy society, there is a need to think holistically and integrate the Traditional medicine (TM) and modern medicine system (MM).
World Ayurveda Foundation (WAF)
- Aim of WAF: WAF is an initiative by Vijnana Bharati aimed at global propagation of Ayurveda, founded in 2011.
- Objective and core principle: The objectives of WAF reflect global scope, propagation and encouragement of all activities scientific and Ayurveda related are the core principles.
- Focus Areas: Support to research, health-care programmes through camps, clinics and sanatoriums, documentation, organization of study groups, seminars, exhibitions and knowledge initiatives to popularize Ayurveda in the far corners of the world are the broad latitudes of focus at WAF.
What is Traditional Medicine?
- According to WHO: The WHO describes traditional medicine as the total sum of the “knowledge, skills and practices indigenous and different cultures have used over time to maintain health and prevent, diagnose and treat physical and mental illness”.
- Culmination of multiple ancient practices: Its reach encompasses ancient practices such as acupuncture, ayurvedic medicine and herbal mixtures as well as modern medicines.
- Percentage of people use traditional medicine: of According to WHO estimates, 80% of the world’s population uses traditional medicine.
Traditional medicine in India
- It is often defined as including practices and therapies such as Yoga, Ayurveda, Siddha that have been part of Indian tradition historically, as well as others such as homeopathy that became part of Indian tradition over the years.
- Ayurveda and yoga are practised widely across the country.
- The Siddha system is followed predominantly in Tamil Nadu and Kerala.
- The Sowa-Rigpa System is practised mainly in Leh-Ladakh and Himalayan regions such as Sikkim, Arunachal Pradesh, Darjeeling, Lahaul & Spiti.
How TM modalities (such as Ayurveda or homoeopathy) can scientifically align with MM for a better outcome?
- Remarkable success in treating neurological diseases: A recently established Department of IM in NIMHANS continued to show remarkable success in treating difficult neurological diseases with a team of Ayurvedic and MM physicians and carefully planned and monitored IM strategy.
- CRD projects: Modern rheumatology practice in the Centre for Rheumatic Diseases (CRD) model includes critical elements of TM and Ayurveda, which have shown unequivocal evidence in CRD research projects
- Evaluation based on other protocols: Several controlled protocols-based evaluations of standardised Ayurvedic drugs and other TM modalities (such as diet, exercise, yoga, and counselling), often in conjunction with MM, in arthritis patients, were completed.
- Sustained clinical improvement in patients suffering from active Rheumatoid arthritis (RA): RA is a severely painful crippling lifelong autoimmune condition, mostly seen in women, and universally acknowledged as difficult to treat. Supervised and monitored IM intervention (including Ayurvedic drugs) over several years showed a consistently superior and sustained clinical improvement in patients suffering from active RA.
Relationship between AYUSH and Modern medicines
- AYUSH systems include Ayurveda, Homeopathy, Unani, Siddha, and other TM.
- AYUSH systems and MM differ radically in several ways or so it seems.
- Modern scientific research in Ayurveda is often at variance with classical Ayurveda.
- Unlike MM, TM has at its core a personalised approach. MM is dominantly reductionist.
- The ambitious futuristic programme of TM and IM by AYUSH is well-intended and in the right direction.
Conclusion
- TM and Ayurveda need to respond to the new world order, which has changed substantially recently. It is reasonably certain that MM and TM in the current format will continue to treat several medical disorders and altered health states. But evidence-based medicine will become the new mantra. Also, informed and empowered patients and people will continue to make the right choices.
Mains question

Q. What is World Ayurveda congress? What is tradition medicines? How Traditional medicines can align with modern medicines to treat several serious medical disorders.

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December 22, 2022