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

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

    Central Idea

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

    Overcoming past challenges

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

    Current Health Challenges

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

    Current state of healthcare in India

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

    Conclusion

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

    diabetes

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

    What is Diabetes?

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

    Types of Diabetes

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

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

    Menace of diabetes in India

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

    Measures to mitigate TID impact on students

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

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

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

     

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  • Healthcare: Public Health and The Insurance Funding

    Central Idea

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

    The key features of the Tamil Nadu public health model

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

    Benefits of Decentralization

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

    Insurance Funding in healthcare

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

    Drawbacks of Insurance Funding

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

    Facts for prelims

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

    Conclusion

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

    Mains Question

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

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  • Tuberculosis (TB): India’s Renewed Commitment

    TB

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

    Central Idea

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

    Back to basics: TB

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

    India’s Battle Against TB

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

    Challenges in Implementation

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

    Way Ahead: Opportunities for Collaboration

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

    Facts for Prelims: CB-NAAT

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

    TB

    Conclusion

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

    Mains Question

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

     

     

  • ICMR releases Ethical Guidelines for AI usage in Healthcare

    health

    The Indian Council of Medical Research (ICMR) has recently released the first-ever set of ethical guidelines for the application of artificial intelligence (AI) in biomedical research and healthcare.

    Ethical Guidelines for AI usage in Healthcare

    • The guidelines aim to create “an ethics framework which can assist in the development, deployment, and adoption of AI-based solutions” in specific fields.
    • Through this initiative, the ICMR aims to make “AI-assisted platforms available for the benefit of the largest section of common people with safety and highest precision possible”.
    • It seeks to address emerging ethical challenges when it comes to AI in biomedical research and healthcare delivery.

    Key features

    • Effective and safe development, deployment, and adoption of AI-based technologies: The guidelines provide an ethical framework that can assist in the development, deployment, and adoption of AI-based solutions in healthcare and biomedical research.
    • Accountability in case of errors: As AI technologies are further developed and applied in clinical decision making, the guidelines call for processes that discuss accountability in case of errors for safeguarding and protection.
    • Patient-centric ethical principles: The guidelines outline 10 key patient-centric ethical principles for AI application in the health sector, including accountability and liability, autonomy, data privacy, collaboration, risk minimisation and safety, accessibility and equity, optimisation of data quality, non-discrimination and fairness, validity and trustworthiness.
    • Human oversight: The autonomy principle ensures human oversight of the functioning and performance of the AI system.
    • Consent and informed decision making: The guidelines call for the attainment of consent of the patient who must also be informed of the physical, psychological and social risks involved before initiating any process.
    • Safety and risk minimisation: The safety and risk minimisation principle is aimed at preventing “unintended or deliberate misuse”, anonymised data delinked from global technology to avoid cyber attacks, and a favourable benefit-risk assessment by an ethical committee among a host of other areas.
    • Accessibility, equity and inclusiveness: The guidelines acknowledge that the deployment of AI technology assumes widespread availability of appropriate infrastructure and thus aims to bridge the digital divide.
    • Relevant stakeholder involvement: The guidelines outline a brief for relevant stakeholders including researchers, clinicians/hospitals/public health system, patients, ethics committee, government regulators, and the industry.
    • Standard practices: The guidelines call for each step of the development process to follow standard practices to make the AI-based solutions technically sound, ethically justified, and applicable to a large number of individuals with equity and fairness.
    • Ethical review process: The ethical review process for AI in health comes under the domain of the ethics committee which assesses several factors including data source, quality, safety, anonymization, and/or data piracy, data selection biases, participant protection, payment of compensation, possibility of stigmatisation among others.

    Policy moves for streamlining AI in Healthcare

    • India already offers streamlining of AI technologies in various sectors, including healthcare, through the National Health Policy (2017), National Digital Health Blueprint (NDHB 2019), and Digital Information Security in Healthcare Act (2018) proposed by the Health Ministry.
    • These initiatives pave the way for the establishment of the National Data Health Authority and other health information exchanges.

    Potential applications of AI in healthcare

    Artificial Intelligence (AI) has revolutionized the healthcare industry by enabling various applications. These applications include:

    • Diagnosis and screening: AI can be used to identify diseases from medical images like X-rays, CT scans, and MRIs.
    • Therapeutics: AI can assist in the development of personalised medicines by analyzing a patient’s genetic makeup.
    • Preventive treatments: AI can predict the risk of developing a disease, helping healthcare professionals to take preventive measures.
    • Clinical decision-making: AI can analyze large amounts of data to assist healthcare professionals in making treatment decisions.
    • Public health surveillance: AI can be used to monitor disease outbreaks and inform public health policies.
    • Complex data analysis: AI can analyze large amounts of data from multiple sources to identify patterns and inform healthcare decision-making.
    • Predicting disease outcomes: AI can predict disease outcomes based on patient data, enabling early
    • Behavioural and mental healthcare: AI can help diagnose and treat mental health conditions.
    • Health management systems: AI can assist in managing patient records, appointment scheduling and reminders, and medication management.

    Various challenges for imbibing

    • Data privacy and security: With the use of AI in healthcare, there is a significant amount of personal and sensitive data is collected. This data needs to be kept secure and protected from potential cyber-attacks.
    • Regulatory and ethical issues: AI technology is still in its early stages of development and there are no clear guidelines or regulations in place for its use in healthcare. There are also ethical considerations, such as accountability, transparency, and bias that need to be addressed.
    • High cost involved: The implementation of AI in healthcare requires significant investment in terms of infrastructure, software, and training. This cost can be a major challenge for healthcare organizations, especially in developing countries.
    • Integration with existing systems: AI systems need to be integrated with existing healthcare systems and processes. This can be challenging, especially in cases where the existing systems are outdated or incompatible with AI technology.
    • Lack of trust and acceptance: AI technology is still relatively new in healthcare and there is a lack of trust and acceptance among healthcare professionals and patients. This can be a major hurdle in the widespread adoption of AI in healthcare.

    Threats posed by AI to healthcare

    • Data privacy and security: The use of AI in healthcare requires the collection and analysis of vast amounts of personal health data, which could be at risk of being stolen or misused.
    • Bias and discrimination: There is a risk that AI algorithms could perpetuate existing biases and inequalities in healthcare, such as racial or gender bias.
    • Lack of transparency: Some AI models are complex and difficult to understand, which can make it difficult to explain the reasoning behind a particular decision.
    • Medical errors: AI systems can make errors if they are trained on biased or incomplete data, or if they are used inappropriately.
    • Ethical concerns: There are several ethical concerns associated with the use of AI in healthcare, including the potential for AI to replace human doctors, the impact on patient autonomy, and the implications for informed consent.

    Way forward

    • Develop a national AI strategy for healthcare: This strategy should include policies for data sharing, privacy, and security, as well as guidelines for the ethical and responsible use of AI.
    • Invest in AI research and development: The government should invest in research and development of AI technologies that can help address the challenges in healthcare.
    • Promote collaboration between stakeholders: Collaboration between stakeholders such as healthcare providers, researchers, government agencies, and industry can help accelerate the development and adoption of AI technologies in healthcare.
    • Train healthcare professionals in AI: The government can work with academic institutions and the industry to create training programs and certifications for healthcare professionals.
    • Address regulatory challenges: The government should work to address regulatory challenges related to the use of AI in healthcare.
    • Focus on affordability and accessibility: This can be achieved by promoting innovation, encouraging competition, and ensuring that AI technologies are integrated into existing healthcare infrastructure.

     

  • Strengthening the Fight Against Tuberculosis (TB)

    Tuberculosis

    Central Idea

    • The fight against tuberculosis (TB) has been going on for over 30 years since it was declared a global health emergency, yet the goal of ending TB by 2030 is still uncertain. The fight against TB needs a renewed focus on three key areas i.e., vaccine development, newer therapeutic agents, and improved diagnostics to meet the goal of ending TB by 2030.

    Background

    • In 1993, the World Health Organization declared TB a global health emergency and the 1993 World Development Report stated that TB treatment for adults was the best buy among all developmental interventions.
    • Since then, the global response to TB has been slow and lacks urgency.

    Global Fund

    • The Global Fund to Fight AIDS, TB, and Malaria was created in response to the call for action against TB at the G7 summit in Okinawa, Japan, in 2001.
    • The Global Fund has become the single largest channel of additional funding for global TB control.
    • However, it faces constraints due to zero-sum games from donor constituents and competition between the three diseases it finances.

    Tuberculosis

    StopTB Partnership

    • The StopTB Partnership was constituted to mobilize and marshal a disparate set of actors towards the goal of ending TB.
    • It has been adapting to changes, such as using molecular diagnostic tools developed to respond to bioterrorism to diagnose TB and using social safety programs to address the poverty drivers of the TB epidemic.

    Facts for prelims: Basics of TB

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

    Tuberculosis

    Three key areas that need attention

    1. Vaccine development:
    • The development of an adult TB vaccine is the first area that needs urgent attention.
    • The current vaccine is 100 years old, and the development and wide use of an adult TB vaccine are essential to ending TB.
    • COVID-19 vaccine development process provides insights into accelerating the process.
    • India’s capabilities can play a significant role in vaccine development and equitable distribution.
    1. Newer therapeutic agents for TB:
    • A few new anti-TB drugs are available but face cost and production constraints.
    • Shorter, injection-free regimens are needed to improve compliance and reduce patient fatigue.
    • A continuous pipeline of new drugs is essential to combat drug resistance.
    1. Improved diagnostics:
    • AI-assisted handheld radiology and passive surveillance of cough sounds can revolutionize TB diagnostics.
    • Incentivize biotech startups to disrupt the complexity and price barriers of molecular testing.

    Tuberculosis

    Conclusion

    • India’s leadership role in the G20 and the upcoming StopTB Partnership board meeting in Varanasi provide the perfect opportunity for India to lead the way in ending TB. With the collective will and action of leaders, it is possible to end TB sooner rather than later.
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  • Rajasthan becomes first state to guarantee Right to Health

    health

    The Rajasthan Assembly passed the Right to Health (RTH), even as doctors continued their protest against the Bill, demanding its complete withdrawal.

    Right to Health (RTH): A conceptual insight

    • RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
    • It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.

    Scope of RTH

    • RTH covers various health-related issues, including-
    1. Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
    2. Accessible, affordable, and quality healthcare services,
    3. Eliminating barriers to healthcare access
    4. Informed consent to medical treatment and accessing information about their health.

    What is the Rajasthan Right to Health Bill?

    • Free treatment: RTH gives every resident of the state the right to avail free Out Patient Department (OPD) services and In Patient Department (IPD) services at all public health facilities and select private facilities.
    • Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
    • Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
    • No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
    • State reimbursement of charges: After emergency care and stabilisation, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.

    Existing schemes in Rajasthan

    • The flagship Chiranjeevi Health Insurance Scheme provides free treatment up to Rs 10 lakh, which has been increased to Rs 25 lakh in the latest budget.
    • The Rajasthan Government Health Scheme covers government employees, ministers, current and former MLAs, etc.
    • The Nishulk Nirogi Rajasthan scheme provides free OPD and IPD services in government hospitals and covers about 1,600 medicines, 928 surgicals, and 185 sutures.
    • The Free Test scheme provides up to 90 free tests in government hospitals and has benefited 2.93 crore persons between March-December 2022.

    Need for the RTH Scheme

    • The state prioritizes healthcare and wants Rajasthan to be a great example of good health.
    • The Health Minister has received many complaints about private hospitals asking for money from patients who have the Chiranjeevi card.
    • So, they are bringing in a new law to stop this.
    • The new law will make sure that future governments follow it and provide free healthcare to everyone.

    Controversy with the RTH Law: Emergency Care Provisions

    • Emergency care was a contentious issue in the RTH.
    • The clause states that people have the right to emergency treatment and care for accidental emergency, emergency due to snake bite/animal bite and any other emergency decided by the State Health Authority under prescribed emergency circumstances.
    • Emergency treatment and care can be availed without prepayment of requisite fee or charges.
    • Public or private health institutions qualified to provide such care or treatment according to their level of health care can offer emergency care.

    Issues raised by healthcare professionals

    • Existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
    • Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
    • Unnecessary obligations: The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.

    Way forward

    • Given the contentious nature of the Bill, it is important for all stakeholders to come to the table and engage in constructive dialogue to resolve the issues at hand.
    • It should involve liaison between government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
    • This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
    • Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.

     

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  • Rising Cancer Cases in India And Economic Burden

    Central Idea

    • Cancer cases in India are predicted to cross the 15 lakh mark by 2025, highlighting concerns about the economic burden of expensive cancer treatments and the accessibility of affordable healthcare for patients.

    Cancer

    • Cancer is a group of diseases that arise when cells in the body begin to grow and divide uncontrollably, leading to the formation of tumors.
    • Normally, cells in the body grow, divide, and die in an orderly fashion, but in cancer, this process goes awry, leading to the accumulation of abnormal cells that can form a mass or tumor.
    • There are many different types of cancer, which can affect any part of the body. Some cancers, such as leukemia, do not form tumors but still involve the uncontrolled growth of abnormal cells.
    • Symptoms of cancer can vary depending on the type and location of the cancer, but common signs include unexplained weight loss, fatigue, pain, and changes in the skin or the appearance of a lump or mass.

    Economic Burden of Cancer Treatment

    1. Inaccessible and Increasing Costs:
    • The average medical expenditure per hospitalization case for cancer treatment was ₹68,259 in urban areas, according to the NSS 2017-18 report.
    • A Parliamentary Standing Committee report expressed concern about the inaccessible and increasing cost of cancer treatment.
    1. Regulatory Challenges:
    • While anti-cancer medicine costs can be regulated, the cost of radiotherapy cannot, as it has not been declared an essential service.
    • Insurance Coverage and Out-of-Pocket Expenses.
    1. Impact on Patients:
    • Cancer often strikes around the retirement age, leading to mounting debt burdens.
    • The average hospital stay for 14.1% of cancer patients is more than 30 days, further increasing bills.

    Insurance Coverage and Out-of-Pocket Expenses

    1. Poor Insurance Penetration: More than 80% of hospital bills are paid out of pocket, as per the NSS 2017-18 report.
    2. Ayushman Bharat Limitations: The Committee observed that the Ayushman Bharat insurance scheme launched in 2018 does not cover entire prescriptions, latest cancer therapies, or many diagnostic tests.
    3. State-Specific Insurance Schemes: The Committee suggested a convergence of State and Central schemes, as some State-specific insurance schemes have been highly beneficial.

    State-wise Variation in Cancer Treatment Expenditure

    • State-wise average medical expenditure per hospitalization case for cancer treatment in government hospitals varies, with the lowest in Tamil Nadu and Telangana, and the highest in northern and north-eastern India.

    Facts for Prelims: CAR T-cell therapy

    • Unlike chemotherapy or immunotherapy, which require mass-produced injectable or oral medication, CAR T-cell therapies use a patient’s own cells.
    • The treatment involves modifying a patient’s own T-cells, which are a type of immune cell, in a laboratory to target and attack cancer cells.
    • CAR stands for chimeric antigen receptor, which refers to the genetically engineered receptor that is added to the patient’s T-cells.
    • The patient’s T-cells are collected and genetically modified in a laboratory to express the CAR.
    • The modified T-cells are then infused back into the patient’s body, where they can seek out and destroy cancer cells that express the antigen targeted by the CAR.
    • The cells are even more specific than targeted agents and directly activate the patient’s immune system against cancer, making the treatment more clinically effective.
    • This is why they’re called living drugs.
    • CAR T-cell therapy has shown promising results in treating certain types of blood cancers, including leukemia and lymphoma.

    Conclusion

    • The rising number of cancer cases in India underscores the need to address the economic burden of expensive cancer treatments and improve the accessibility of affordable healthcare for patients. Converging State and Central insurance schemes, expanding insurance coverage, and exploring ways to regulate treatment costs are essential steps to ensure that patients can access life-saving treatments without facing insurmountable financial challenges.
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  • Universal Health Coverage (UHC) Must be Affordable to All

    Central Idea

    • The Universal Health Coverage (UHC) and its implementation in India raises the question of whether we believe in health as a basic human right, which India’s Constitution guarantees under the right to life. The UHC should encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.

    The Definition of Health

    • The definition of health according to the World Health Organization (WHO), which includes mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
    • We cannot achieve health in its wider definition without addressing health determinants, which necessitates an intersectoral convergence beyond medical and health departments.

    Difference between Primary health care (PHC) and Universal health care (UHC)

    • The main difference between PHC and UHC is that PHC is a level of care within the health care system, while UHC is a broader goal of ensuring access to health care for all individuals.
    • PHC is typically provided at the primary care level, while UHC includes all levels of care, from primary to secondary and tertiary care.
    • PHC is focused on basic health care services and health promotion, while UHC aims to provide comprehensive health care services to all individuals.

    Health for All by 2000

    • The slogan Health for All by 2000 proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977. It argues that universal health care/coverage (UHC) was implied as early as 1977.
    • India committed itself to the ‘Health for All’ goal by 2000 through its National Health Policy 1983.

    International Conference on PHC

    • The International Conference on Primary Health Care, at Alma Ata, 1978, which listed eight components of minimum care for all citizens.
    • Components included: It mandated all health promotion activities and the prevention of diseases, including vaccinations and treatment of minor illnesses and accidents, to be free for all using government resources, especially for the poor.
    • Components excluded: Chronic diseases, including mental illnesses, and their investigations and treatment were almost excluded from primary health care. When it came to secondary and tertiary care, it was left to the individual to seek it from a limited number of public hospitals or from the private sector by paying from their own pockets.

    Concerns around The Astana Declaration

    • The Astana declaration of 2018, which calls for partnership with the private sector. However the commercial private sector, which contributes to alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution, is well established.
    • The Astana declaration never addressed poverty, unemployment, and poor livelihood, but eulogizes quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.

    Conclusion

    • Every individual has a right to be healed and not have complications, disability, and death. That right is guaranteed only by individualism in public health, the new global approach to UHC, where nobody is left uncounted and uncared for. The Alma Ata declaration of primary health care can be left behind as a beautiful edifice of past concepts, and we should move forward with a newer concept of UHC.
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  • Tamil Nadu’s TN-KET initiative results in reduced TB deaths

    tb

    Tamil Nadu has pioneered an initiative across the State to reduce the mortality rate among people with tuberculosis named: TN-KET (Tamil Nadu Kasanoi Erappila Thittam) meaning TB death-free project.

    What is TN-KET?

    • TN-KET aims to reduce the mortality rate among people with tuberculosis.
    • This initiative, which began in April 2022, has already achieved significant reduction in the number of early TB deaths.

    Unique features

    • Differentiated TB Care: This is at the heart of the initiative, which aims at assessing whether people with TB need ambulatory care or admission in a health facility to manage severe illness at the time of diagnosis.
    • Radiological assessment: The guidelines require comprehensive assessment of 16 clinical, laboratory and radiological parameters.
    • Triage of assessment: The preliminary assessment of patients based on just three conditions — very severe undernutrition, respiratory insufficiency, and inability to stand without support — was found to be feasible for quick identification at diagnosis.

    Outcome: Significant reduction in early TB deaths

    • Above features vastly cut down the delay and increasing the chances of saving lives.
    • The initiative has achieved the initial target of 80% triaging of patients, 80% referral, comprehensive assessment and confirmation of severe illness, and 80% admission among confirmed.
    • The State’s target is to achieve 90%-90%-90% at each district.

    Key challenges

    • The challenge is to increase the duration of admission, especially for people with very severe undernutrition, which comprises 50% of the admitted patients.

     

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