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

Organ transplant rules In India: A Significant Step
Central Idea
- The changes to the organ transplant rules announced by the Union health ministry last week, are small, but significant, steps towards giving a new lease of life to many people with failing organs. Despite of performing the third-the greatest number of transplants in the world, only about 0.01 percent of Indians donate their organs after death, according to the World Health Organization.
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What are the changes introduced?
- No age ceiling for organ receivers: With the new changes, patients who are 65 years and older can now register for receiving organs from a deceased donor. Now an individual of any age can register for organ transplant.
- Previously: Previously, the upper age limit for registering patients requiring organs from deceased donors was 65 years, but this ceiling has now been removed.
- No domicile criteria for receivers: Eliminate the domicile criterion for registering to receive organs, so that patients in need can register in any state.
- Previously: Currently, certain states restrict registration for deceased organ donors to only those who are domiciled in the state or give them preference. Organs harvested in one state are first shared with other hospitals within the same state, then in the region and then share nationally on the occasion that no match was found.
- No registration fees: The ministry has also requested that states not impose any fees on patients seeking registration for organ transplantation, as it violates the 2014 Transplantation of Human Organs and Tissues Rules.
- Previously: States such as Maharashtra, Kerala, Gujarat, and Telangana charge between Rs 5,000 and Rs 10,000 to register patients who need an organ replacement. The health ministry has rightly directed these states to stop charging this fee.
Where does India stand?
- Third Highest number of transplants in the world: India conducts the third highest number of transplants in the world every year. Yet barely four per cent of the patients who require a liver, heart or kidney transplant manage to get one.
- Organ transplants has significantly increased over the past decade: According to latest available official data, the number of organ transplants has significantly increased over the past decade. In 2013, there were 4,990 organ transplants, whereas in 2022, there were 15,561 a jump of 211 percent.
- Kidney transplants: Specifically, the number of kidney transplants from living donors increased by approximately 181 percent from 3,495 in 2013 to 9,834 in 2022. The number of kidney transplants from deceased donors increased by approximately 193 percent from 542 in 2013 to 1,589 in 2022.
- Liver transplants: The total number of liver transplants from living donors increased by approximately 350 percent from 658 in 2013 to 2,957 in 2022, and from deceased donors, it increased by approximately 217 percent from 240 in 2013 to 761 in 2022. Deceased donors account for nearly 17 percent of all transplants in India.
- Heart and Lung transplants: The total number of heart transplants increased by approximately 733 percent from 30 in 2013 to 250 in 2022, while lung transplants increased by approximately 500 percent from 23 to 138.
- Government hospitals fall behind: Furthermore, private hospitals lead in organ transplants while numbers in government hospitals remain relatively low, sources said.
Challenges to Organ Donation in India
- Lack of awareness: There is a lack of awareness among the general public about the importance of organ donation, the legal framework governing it, and the procedures involved. This can limit the number of potential donors.
- Cultural beliefs and superstitions: In India, there are several cultural beliefs and superstitions that discourage organ donation. Some people believe that organ donation is against religious beliefs, or that it can impact the soul or afterlife.
- Lack of infrastructure: India faces a shortage of hospitals and medical facilities that are equipped to handle organ transplantation. This can limit the availability of organs for transplantation.
- Regulatory bottlenecks: While the legal framework exists, there is a lack of implementation and enforcement of the law. This can lead to issues such as organ trafficking and black-market activities.
Did you know?
- NOTTO Scientific Dialogue 2023 was organized to bring all the stakeholders under one roof to brainstorm ideas about interventions and best practices in the organ and tissue transplant field that can be taken up for saving lives.
What is National Organ and Tissue Transplant Organization (NOTTO)?
- NOTTO is a national level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.
- It has following two divisions:
- National Human Organ and Tissue Removal and Storage Network: It functions as apex Centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country
- National Biomaterial Centre: The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues. The centre will take care of the Tissue allografts such as Bone and bone products, Skin graft, Cornea and Heart valves and vessel.
Conclusion
- The percentages are very likely to go up once the changes in the rules announced last week take effect. The organ shortage problem is, however, a complex one, that continues to confound planners, even in nations whose healthcare systems are far better equipped than that of India’s. There is a need to expand the number of institutions where surgeries and transplants are undertaken. A uniform policy, will help patients in seeking transplant from deceased donors at any hospital in the country, giving them a lot of flexibility.
Mains Question

Q. Despite of performing the third-the greatest number of transplants in the world, only about 0.01 percent of Indians donate their organs after death. Discuss the recent changes in the rules of transplantation suggested by Union Health Ministry.

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February 20, 2023
The question in the minds of students: How to be future-ready?
Central Idea
- Intelligent Machines are revealing glimpses of a future envisaged long ago in science fiction as they steadily morph from human-assist systems to systems-as-human. The currently indispensable face obsolescence. The question in the minds of students entering college is this: How to be future-ready?
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Learn quickly to swim through these rapidly evolving times
- Work at the edges of disciplines: Now, one not only needs to be competent in a major area but also learn new topics quickly and deeply and be able to work at the edges of disciplines, while innovating constantly.
- Skills are new oil: Capability is judged not only by grades, but also by skills demonstrated in complex situations.
- Rapidly changing times: Worth will also be measured vis-a-vis Artificial Intelligence. Critical and original thinking, quality communication, IQ-EQ balance, and ethics will remain important strengths for swimming through these rapidly evolving times.
- Change is already in the air: Students and institutions are evolving, the former much faster, to assimilate advancements and prepare for the times ahead.
- Colleges must enable students to follow flexible pathways: There are options for dual degrees, minors, specialisations across disciplines in their home institutions as well as certifications from worldwide venues. External experiences like internships in industry, academia, research institutions and start-ups add value to a candidate’s capability repertoire.
What is needed to prepare for entering the world?
1. Move across disciplines
- A combination of core and transdisciplinary professional competence: To be prepared for the future, one needs to learn new things quickly and thoroughly, constantly sharpening one’s cutting edge. This attitude needs to be ingrained at this stage.
- Average performance and shallow knowledge are a recipe for disaster: It is also necessary to demonstrate personal excellence in a few relevant areas. Completing tasks well is really important.
1. Learn to add value to machine intelligence
- Grasp and utilise Automation effectively: Automation is not only relieving us of mundane work but slowly and steadily encroaching upon tasks meant for so-called intelligent humans and doing them better. One must effectively grasp and utilise it rather than fear and shy away.
- For instance, learn from open sources: Many students are building amazingly smart systems using open-source platforms and off-the-shelf components with ambitions to take on giants.
- Using Artificial Intelligence with consciously: Learning to add value to machine intelligence for solving complex problems better is the mantra here. For this, one needs to understand how it works, what are its current limitations and pitfalls, develop deeper insights and innovate. Blind usage of Artificial Intelligence could be dangerous.
1. Learn to collaborate
- Ability to work both alone as well as in a group: The next proficiency to develop is to be able to work both alone as well as in a group, to creatively ideate, lead and collaborate towards success. Often, people who work alone find it difficult working in a team and vice versa. Now both aptitudes are required.
- Entrepreneurial spirit of sprinting is must: One requires a special bonding of steadiness with speed, constant ideation with dogged persistence. Such an entrepreneurial spirit of sprinting a long-distance race steadily, sometimes in a team, sometimes alone will be needed at every stage of a career, whether at the peak of success or in the trenches of failure.
1. Remain human
- Intellectual-emotional balance: Technology has an interesting way of transforming human beings into automatons without the victim being aware. With extensive usage, people begin to think and behave the way machines work. Therefore, a critical aspect to nurture is to remain human.
- Learn to replenish the mind and body regularly: It is vital to nourish a soulful side through sports, arts, culture, philosophy and humanitarian work, not just as part of a curriculum, but as a passion where one can be blissfully immersed, forgetting everything else for some time.
Conclusion
- In the rapidly-evolving world, the key to success is to be future-ready by developing a unique combination of skills that set us apart from machines. Colleges and universities must enable students to follow flexible pathways, combining core and transdisciplinary professional competence, completing tasks well, and developing personal excellence in relevant areas. By embracing these ideas and staying ahead of the curve, we can be confident in our ability to thrive in an increasingly automated and technology-driven world.
Main question

Q. The future of society is not as much dependent on whether machines will become human-like but more on whether humans will become machines. Discuss

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February 18, 2023

Amendments to Organ Transplant Rules

In a major tweak to the organ donation policy, the Union Ministry of Health and Family Welfare said that the clause that people beyond 65 years could not receive cadaver organ transplants had been removed.

What are the changes introduced?

(1) No Age Bar

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

(2) Doing away with domicile compulsion

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

Organ transplant in India: Key statistics

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

Challenges to Organ Donation in India

Lack of awareness: There is a lack of awareness among the general public about the importance of organ donation, the legal framework governing it, and the procedures involved. This can limit the number of potential donors.
Cultural beliefs and superstitions: In India, there are several cultural beliefs and superstitions that discourage organ donation. Some people believe that organ donation is against religious beliefs, or that it can impact the soul or afterlife.
Lack of infrastructure: India faces a shortage of hospitals and medical facilities that are equipped to handle organ transplantation. This can limit the availability of organs for transplantation.
Regulatory bottlenecks: While the legal framework exists, there is a lack of implementation and enforcement of the law. This can lead to issues such as organ trafficking and black market activities.

Way ahead

To address these challenges, the government and other stakeholders are working to raise awareness, improve infrastructure, and strengthen the legal framework governing organ donation.
Campaigns and initiatives are being undertaken to educate the public and healthcare professionals about the importance of organ donation, and to dispel myths and misconceptions.
Efforts are also being made to improve the infrastructure and facilities for organ transplantation, and to enhance the regulatory framework to prevent illegal activities.
These steps are aimed at promoting organ donation and increasing the availability of organs for transplantation, which can save lives and improve the quality of life for many people in India.

About National Organ Transplant Programme (NOTP)

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

Types of Organ Donations

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

(1) Deceased donors:

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

(2) Living donors:

They are permitted to donate the following:

one of their kidneys
portion of pancreas
part of the liver

Features of the NOTP

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

Back2Basics: National Organ and Tissue Transplant Organization (NOTTO)

NOTTO is a national-level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

1. National Human Organ and Tissue Removal and Storage Network

2. National Biomaterial Centre (National Tissue Bank)

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

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

[II] National Biomaterial Centre (National Tissue Bank)

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

The centre will take care of the following Tissue allografts:

1. Bone and bone products

2. Skin graft

3. Cornea

4. Heart valves and vessels

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February 17, 2023

Understanding India’s Mental Healthcare Act, 2017
Central idea: The article discusses the challenges faced in implementing India’s Mental Healthcare Act, 2017 and the need for better mental healthcare services in the country.

Mental Healthcare Act, 2017

The Mental Healthcare Act, 2017 is a comprehensive legislation that provides for the protection and promotion of the rights of people with mental illness. Some of the key features of the Act are:
- Decriminalization of suicide: The Act decriminalizes suicide and prohibits the use of inhuman and degrading treatment towards those who attempt suicide.
- Advance directives: The Act allows individuals to make advance directives, specifying the type of treatment they would like to receive in the event of a mental health issue.
- Informed consent: The Act mandates that patients have the right to give or refuse consent to treatment, and to be informed about the benefits, side effects, and alternatives of the treatment.
- Mental health review boards: The Act establishes Mental Health Review Boards at the national and state levels to oversee the implementation of the Act and protect the rights of people with mental illness.
- Prohibition of inhuman treatment: The Act prohibits the use of inhuman treatment methods, including chaining, electroconvulsive therapy (ECT) without anaesthesia, and solitary confinement.
- Right to access mental healthcare: The Act guarantees the right to access mental healthcare services, and mandates the establishment of mental health services in every district.
- Protection of rights and dignity: The Act aims to protect the rights and dignity of people with mental illness, and prohibits discrimination and stigmatization on the basis of mental illness.
- Establishment of a Central Mental Health Authority: The Act establishes a Central Mental Health Authority to regulate mental health services in the country.
NHRC flags alert
- Pity over healthcare institution: The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.
- Prolonged hospitalization: The report notes that the facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”.
- Need for Assessment: These observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHA).
Major issue: Lack of implementation
- Despite the act’s provisions, mental health institutions in India have been plagued by a lack of adequate infrastructure, staff, and training.
- Patients have reported human rights violations, including abuse, neglect, and violence.
Need for effective implementation
- The Mental Healthcare Act needs effective implementation and oversight to ensure that patients receive the care and treatment they need with dignity and respect.
- This requires increased investment in mental health infrastructure, including facilities, staff, and training.
Way forward
- Ensuring proper implementation of the Act: There is a need for proper implementation of this act across the country, with a focus on ensuring the rights and dignity of patients in mental healthcare institutions.
- Increasing awareness: Awareness needs to be raised about the Act, and the rights of mental healthcare patients among the general public, healthcare professionals, and law enforcement agencies.
- Providing training and capacity building: Healthcare professionals, including doctors, nurses, and caregivers, need to be trained and equipped with the skills and knowledge to provide quality care and support to mental healthcare patients.
- Strengthening mental healthcare infrastructure: There is a need to strengthen the infrastructure and facilities in mental healthcare institutions, including better staffing, improved physical facilities, and access to quality medication.
- Encouraging community-based care: Community-based care for mental health patients can help reduce the burden on mental healthcare institutions and provide a more supportive environment for patients.
- Promoting human rights: There is a need for greater emphasis on the human rights of mental healthcare patients, including the right to dignity, privacy, and freedom from discrimination and abuse.
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February 16, 2023
AI to improve maternal and child health in India
Context
- With the emergence of Artificial Intelligence (AI) and other digital technologies, there is potential for these tools to support maternal and neonatal healthcare in low-resource settings, although their development in this field is still in its early stages. AI has the capability of transforming maternal and child health in low and middle-income countries by supplementing conventional practices with advanced technology, thus improving the accuracy of diagnoses, increasing access to care, and ultimately saving lives.
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The Sustainable Development Goals (SDGs) target
- The SDGs have set a target to eliminate preventable deaths of newborns and children under five years of age by 2030, with a specific aim to lower neonatal mortality (NMR) to a minimum of 12 deaths per 1,000 live births and under-five mortality (U5MR) to a minimum of 25 deaths per 1,000 live births across all nations.
Challenges and the current state of maternal and child health in India
- One of the main challenges is the high maternal and infant mortality rates: According to the latest SRS Bulletin, India’s maternal mortality rate (MMR) was 97 deaths per 100,000 live births in 2018-2020, and the infant mortality rate (IMR) was 35.2 deaths per 1,000 live births in 2019-21.
- Rates are higher than the SDG targets: According to the latest National Family Health Survey (NFHS) data, the NMR and U5MR in India are 24.9 and 41.9 respectively. These rates are higher than the SDG targets and are a cause for concern.
- Lack of access to healthcare for many women and children in India: Many rural and remote areas lack basic healthcare facilities, and even when facilities are available, they may not be staffed with qualified healthcare providers. Additionally, cultural and societal barriers can prevent women and children from accessing healthcare.
- Malnutrition: Malnutrition is a major contributor to high maternal, neonatal, and infant mortality rates in India, with about 68 percent of child deaths being linked to malnutrition.
- Low birth weight: In low- and middle-income countries like India, low birth weight is a leading cause of death in the first month of life. Prematurity and low birth weight account for 45.5 percent of deaths during the first 29 days of a newborn in India. Presently, around 18.2 percent of children reported having low birth weight.
Some positive developments in maternal and child health in India in recent years
- Programs and policies aimed at reducing maternal and infant mortality: The government has implemented several programs and policies aimed at reducing maternal and infant mortality, such as the Janani Suraksha Yojana (JSY) and the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) which provides cash incentives for pregnant women to deliver in health facilities and free health check-up respectively.
- Efforts to increase access and quality health facilities: There have also been efforts to increase the number of healthcare facilities in rural and remote areas and to improve the quality of care provided at these facilities.
- Using technology in Healthcare: In addition, India has also been working on using technology to improve maternal and child health.
- For example: Telemedicine has been implemented in remote areas, and the government has also launched an application, RCH ANMOL, for tracking pregnant women, infants and children for their health, vaccination, and nutrition status. Other digital initiatives include the Draft Health Data Management Policy, Health Data Retention Policy, Unified Health Interface, and Health Facility Registry.
Potential applications of AI
- Predictive modelling of risk factors: By analysing large amounts of medical data, AI algorithms can identify risk factors for maternal and fetal complications and predict the likelihood of certain outcomes. This can help healthcare providers to identify high-risk pregnancies early on and take steps to mitigate the risks.
- Predicting birth weights for effective nutrition programme: Malnutrition is responsible for lowering newborn immunity to infections and diseases. Predicting birth weight for newborns can aid doctors and parents to adopt putative measures such as effective utilisation of Nutrition Rehabilitation Centres (NRCs) pre-emptively.
- AI can make a big impact is in the detection of fetal abnormalities: In LMICs, access to ultrasound technology is often limited, and the quality of images may be poor. By using AI to analyse ultrasound images, healthcare providers can improve the accuracy of diagnoses and detect abnormalities that may otherwise be missed.
- AI can also be used to improve access to care: Virtual care technologies, such as AI-powered chatbots and virtual assistants, can provide expectant mothers in LMICs with information and support. It has been demonstrated that sending personalised, timed voice messages about pregnancy via mobile phone can positively impact maternal healthcare practices and improve maternal health outcomes.
- Manage and analyse large amounts of medical records: By identifying trends and patterns in this data, healthcare providers can make more informed decisions and improve outcomes for mothers and children.
Challenges to using AI to improve maternal and child health in India
- One of the biggest challenges is data availability and quality: AI relies on large amounts of data to train models, however, in India, there is a lack of data on maternal and child health, and the data that is available may be of poor quality. This can make it difficult to develop accurate and reliable AI-based solutions.
- Limited infrastructure: In many parts of India, there is a lack of basic infrastructure such as electricity and internet connectivity, which makes it difficult to implement AI-based solutions. This can be a particular problem in rural areas where access to healthcare is already limited.
- Ethical concerns: AI-based solutions raise a number of ethical concerns, including issues around privacy, bias, and accountability. It is important to address these concerns to ensure that AI-based solutions are used in a responsible and ethical manner.
- Language and dialects: India has a wide variety of languages and dialects, which can make it difficult to develop AI-based solutions that are accessible to everyone. The lack of data in certain languages or dialects can make it difficult to develop accurate and reliable AI-based solutions that are tailored to the specific needs of different linguistic communities.
- Socio-Economic status: As people living in poverty may not have access to the technology and services provided by AI-based solutions.
Conclusion
- AI has the capability of bringing about a substantial difference in maternal and child health in India. Nevertheless, it is crucial to keep in mind that these innovative technologies should not be utilised as a substitute for conventional healthcare practices, but rather as an additional tool. The integration of AI with the already existing healthcare systems would bring about the best results. It is also essential to involve healthcare providers and local communities in the development and implementation process of AI-based solutions. This way, the solutions can be made more relevant, accessible, and in line with the local context, thereby, maximising their positive impact.
February 14, 2023
What is Bhashini Initiative?
Bhashini, a small team at the Ministry of Electronics and IT (MeitY), is currently building a WhatsApp-based chatbot that relies on information generated by ChatGPT to return appropriate responses to queries.

What is Bhashini Initiative?
- ‘Bhashini,’ one of these initiatives, is a local language translation mission that aims to break the barrier between various Indian tongues by using available technology.
- This government platform aims to make Artificial Intelligence (AI) and Natural Language Processing (NLP) resources available in the public domain to be used by – Indian MSMEs, startups and individual innovators.
- This will help developers to offer all Indians easy access to the internet and digital services in their native languages.
How does it work?
- The project is available on this website: https://www.bhashini.gov.in/en/.
- It is aimed to build and develop an ecosystem where various stakeholders can unite to maintain an ‘ever-evolving repository of data, training and benchmark datasets, open models, tools and technologies.’
- This online platform also has a separate ‘Bhashadaan’ section which allows individuals to contribute to multiple crowdsourcing initiatives and it is also accessible via respective Android and iOS apps.
- The contribution can be done in four ways — Suno India, Likho India, Bolo India and Dekho India – where users have to type what they hear or have to validate texts transcribed by others.
Importance of Bhashini
- Bhashini hopes of breaking the massive Indian language barrier and wants developers to offer Indians digital services in their local languages.
- The project not only has a massive size and magnitude but also has several benefits.
- India has a chance to create a roadmap to allow internet access for local languages.
- Moreover, this is important considering the increased availability of smartphones and cheaper data rates are allowing the internet to penetrate the remote and rural areas of the country.
Key initiatives in this regard
- The National Language Translation Mission (NLTM) was announced in the 2021-22 budget by finance minister Nirmala Sitharaman.
- The reason behind introducing this mission was a survey that concluded that 53% of Indians who don’t access the internet have said that they would start using the web if it had content available in their native languages.
- This is where Bhashini comes in with the sole purpose of developing a national digital public platform for languages to provide universal access to content.
- This is expected to improve the delivery of digital content in all Indian languages.
- Finally, it will help in creating a knowledge-based society where information is freely and readily available which will make the ecosystem and citizens “Atmanirbhar.”
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February 13, 2023
Menstrual health hygiene and sexual and reproductive health: The link
Context
- Maternal mortality rates remain high in low- and middle-income countries, where 94 percent of all cases are recorded. In India, maternal mortality ratio stands at 113 per 100,000 live births; the government is aiming to reduce the incidence to below 70 by 2030. Experts agree that the promotion of sexual and reproductive health (SRH) is among the keys to addressing this massive challenge. Achieving global targets on SRH, in turn, greatly depends on a collective commitment to improve menstrual health and hygiene (MHH).
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Challenges for Menstrual hygiene
- Lack adequate access to information and service: The stark reality is that individuals who menstruate lack adequate access to information and services around SRH and are unable to exercise their SRH rights throughout their life cycle. Among the factors for this lack of access are poor economic and educational outcomes.
- For instance: Multiple studies in different developing countries have shown that those with fewer number of schooling years tend to experience early sexual initiation and early marriage, have higher fertility rates, and suffer poor maternal outcomes.
- Multiple barriers hinder the promotion of menstrual health and hygiene: Barriers that include socio-cultural norms that regard menstruation as taboo, and biological and medical issues such as urinary tract infections, and abnormal urinary bleeding that can be caused by fibroids.
- Vicious circle of poor SRH: These issues diminish the agency of menstruating individuals in making decisions related to sex, relationships, family planning, and contraceptive use. This sets them back into the vicious circle of poor SRH.
- Lack of privacy and dignity: Menstruation-related challenges are seen in schools, work places, and communities where menstruating individuals cannot safely manage their needs with privacy and dignity.
- Taboos and myths: In certain communities, restrictive social norms do not allow menstruating individuals to pray, bathe, sleep in the same bed as others, or make food. In India, taboos and myths hinder the optimal use of the more than 8,000 Adolescents-Friendly Health Clinics (AFHCs) set up by the government across the country.
Global Outlook
- Menstrual health is often neglected in SRH agendas: Despite strong evidence that one of the anchors of sexual and reproductive health is menstrual health, governments, policymakers, and NGOs rarely include menstrual health in their SRH agendas.
- Little attention had been paid: Although SRH was the focus of both the World Population Day and Gender Equality Forum in 2021, little attention has been paid, if at all, to menstrual health.
- For example during the vaccination, menstrual health was not taken into account: Early studies also suggest that during the production of COVID-19 vaccines, menstrual health was not taken into account while conducting the pilot studies on understanding the efficacy of the vaccine.
- The education aspect is also lacking: A study of education policy documents across 21 developing countries found little attention to menstrual health. Of those countries that appeared to have MHH in their health and education agenda in the last decade, the focus was on the distribution of disposable sanitary pads, largely for schoolgirls; they tended to ignore the other issues related to menstrual health and hygiene including safety, disposal, right to dignity and providing choices to people who menstruate.
A Framework for mainstreaming menstrual health and hygiene in India
- Promoting Menstrual Health and Hygiene Education: Conversations around menstruation should be started in schools and local communities by including menstrual health and hygiene in sessions on reproductive health.
- For instance: In 2007, the Indian government introduced the Adolescent Education Program to promote discussions around sexual education, but it received backlash from teachers and parents. Sociocultural issues are equally important and should be given attention by stakeholders.
- Knowledge about the products they use: Programmes should be initiated that will focus on distributing disposable sanitary pads to girls and women, and not only those who are in school. As the discourse on menstruation is now shifting toward sustainable menstruation, it is crucial to equip individuals who menstruate with knowledge about the potential harm of the period products they use.
- Sensitizing gatekeepers: Organising sensitisation workshops for gatekeepers such as teachers, healthcare workers, and women in local communities would go a long way in helping young people who menstruate. Recent studies, suggest that mothers, teachers, and healthcare workers are the first sources of information for adolescent girls about menstruation in India.
- Creating supportive space: Adolescent boys, and men, need to be involved in the conversation around MHH to create supportive spaces. These conversations will help them understand the importance of MHH and prompt changes in societal norms, including removing the stigma around menstruation.
- Conversations around menstruation need to include trans and non-binary individuals: Menstruation is a variable concept, such that many women do not menstruate, while some transmen, non-binary individuals, and people with masculine gender identities do. The feminisation of menstruation has led to the exclusion of transgender and non-binary people from the discourse.
- Improving MHH infrastructure and WASH facilities: Workplace policies for individuals who menstruate should be laid out, including the provision of adequate WASH facilities. There need to engage with the multi-sector stakeholders who can work in improving MHH infrastructure and WASH facilities.
Way ahead
- Raising awareness about the menstrual cycle should be among the priorities of communities and policymakers.
- There is a need to make SRH programming gender-transformative, first by recognising the link between MHH and SRH.
- The task is urgent, given the economic case to sexual and reproductive health: i.e., promoting SRH helps improve a country’s economic, educational and development outcomes.
- The UN High-Level Meeting (UNHLM), 2023 Action Plan, which underlines the need to “leave no one behind” in global goals on universal health care, must bring menstrual health and hygiene to the forefront of the SRH agenda.
- As per 2011 Census data, around 0.5 million individuals self-identify as third gender[b] in India. There is a need to engage communities and educate them about the LGBTQIA+ population and enhance their SRH knowledge by looking at the menstrual health discourse with the core principle of inclusivity.
Conclusion
- Global and national agendas on sexual and reproductive health continue to give little attention to its link with menstrual health. Integrated attention to the links between MHH and SRH can advance the mutual goals of both sectors, and improve the health and well-being of individuals who menstruate, throughout their entire life cycle.
Mains question

Q. The link between Menstrual health and hygiene with sexual reproductive health is often neglected in policymaking. Highlight the challenges for promoting menstrual health and give suggestions.

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February 11, 2023
Budget and the Health expenditure
Context
- In her 2023-24 Union Budget speech, the finance minister announced that the total central government budget for health (not including research) will be roughly Rs 86,175 crore ($10 billion) that is, roughly Rs 615 for every citizen. This is a 2.7 per cent increase from the previous fiscal year and lower than the rate of inflation.
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Government’s current Health spending
- Current health spending lower than middle income countries: India currently spends about Rs 8 lakh crore ($100 billion) or about 3.2 per cent of its GDP on health. This is much lower than the average health spending share of the GDP at around 5.2 per cent of the Lower- and Middle-Income Countries (LMIC)
- Health expenditure in India compared to other countries: Of this, the government (Centre and states put together) spends about Rs 2.8 lakh crore (about $35 billion) roughly 1.1 per cent of the GDP. Contrast this with the government health expenditure in countries like China (3 per cent), Thailand (2.7 per cent), Vietnam (2.7 per cent) and Sri Lanka (1.4 per cent).
How health expenditure affects people especially poor?
- Hospitalisation cost for a day: A Day of hospitalisation at a public hospital is estimated at Rs 2,800. At a private hospital, it is Rs 6,800.
- Disproportionate financial impact on poor households: A greater proportion of disposable incomes is taken away from a poor household as compared to a non-poor one, further broadening the gap between the two.
- Impact of Health expenditure on employment and income: If sickness hits a working member of the household, she/he must often withdraw from active employment and their main source of income dries up at the time when they urgently need more money for treatment.
- Sell or mortgage of assets to cover treatment costs: Households have to often sell or mortgage their productive assets, such as land and cattle, to cover the treatment costs.
- Burden of health expenditures on vulnerable populations: The poor, elderly and sick are already at a disadvantage and the burden of health expenditure makes this even worse.
- Falling into poverty due to health expenditures: This further reduces their capacity to bounce back. According to the WHO, 55 million people fall into poverty or deeper poverty every year due to catastrophic expenditures on health.
Areas where greater spending by the government could help in the immediate term
- Focus should be balanced for both communicable and noncommunicable: The National Health Mission allocates less than 3 per cent (Rs 717 crore) to non-communicable diseases (NCDs) compared to communicable diseases and reproductive and child health services, despite NCDs causing more than half of the total burden of disease and this proportion further increases in both rural as well as urban areas.
- Public health and primary health care focus on rural areas: Urban areas have poorly developed infrastructure for primary care even if secondary and tertiary health care services are better. For example, immunisation coverage is now lower in urban India than in rural India. A third of the country now lives in urban areas and greater resources are needed to improve health here.
- Health research has been neglected for too long: The allocation for the Department of Health Research in this year’s budget is Rs 2,980 crore, flat from last year. Spending Rs 20 per Indian is inconsistent with the need for innovations and technologies in the sector. The bulk of the resources provided to the Indian Council of Medical Research goes towards maintaining a large payroll of scientists and the output is poor.
Way forward
- Maximizing India’s potential: India stands on the brink of a massive opportunity. Quality education and health for the 26 million children born each year and the 65 per cent of the population under the age of 35 could help provide a workforce that would propel India forward.
- Harnessing the Demographic Dividend: India has a growing working-age population, but needs urgent action to harness the demographic dividend and potentially become a developed country within a generation.
- Adopting Competitive funding System for health research: India should adopt a competitive grant system for government-funded health research like other successful countries, to encourage top-notch research. The Wellcome Trust/DBT-India Alliance is a successful example of this system.
Conclusion
- The health (and education) of Indians is the most important determinant of what the country can achieve during the next 25 years of Amrit Kaal. We must find ways to both find more money for health, and also more health for the money to ensure that all Indians achieve their true potential.
Mains question

Q. Highlight the present status of Government’s healthcare spending. How out of pocket health expenditure affects people especially poor? Suggest what government must do and areas where it must focus in the immediate term?

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February 4, 2023
Menstrual leave: The topic of debate
Context
- Menstrual leave is a workplace policy that allows female employees to take time off from work during their menstrual cycle due to physical discomfort or pain. This policy has been a topic of debate, with some arguing that it is necessary to accommodate the needs of women during their period, while others argue that it creates discrimination and reinforces gender stereotypes.
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Background
- Recently, Kerala government announced that the state government will grant menstrual leave for female students in all state universities under the Department of Higher Education.
- The declaration occurred shortly after the Cochin University of Science and Technology (CUSAT) announced the decision, in response to a request by the students’ union, to grant menstruation leave to all of its female students.
Menstrual leave and the debate
- Widespread conversation in recent years: The adoption of voluntary menstrual leave policies by some companies in recent years has led to a widespread conversation on periods in India.
- Termed as Special leave for women: When the Bihar government implemented a period leave policy in 1992, it was termed special leave for women due to the stigma attached to the word menstruation.
- Normalising conversation: The recent initiative by employers to provide period leave has been discussed and debated in the public sphere, thereby normalising the conversation around menstruation to an extent.
Who are menstruators?
- Menstruators is an inclusive term refers to individuals who have female reproductive anatomy and experience menstrual periods.
- It includes, women, trans men, and non-binary persons as well.
- This biological process also decouples menstruation from womanhood.
Arguments in favour
- Biological process comes with physical pain: Though menstruation is a biological process, it is accompanied by cramps, nausea, back and muscle pains, headaches, etc.
- Polycystic ovary syndrome (PCOS): Additionally, these can take a debilitating form amongst menstruating people who suffer from polycystic ovary syndrome (PCOS) and endometriosis.
- For instance: In India, 20 per cent of menstruators have PCOS and approximately 25 million suffer from endometriosis. The intensity of pain can vary for individuals for a variety of reasons.
- Acknowledges the reality: For many menstruators, it is a biological process intertwined with medical symptoms. Mandatory period leave is an affirmative action policy that acknowledges this reality.
- Kerala governments announcement is a welcome step: The Kerala government’s announcement to grant menstrual leave to all female students of state universities is a welcome move that takes the discourse a step further into educational institutions.
- It should be replicated across universities and schools in India: This will also help reduce the drop-out rates of female students from government schools in rural India caused by the lack of clean toilets, running water, sanitary pads, etc.
Arguments against
- Fear of bias in hiring: The major opposition to a menstrual leave policy is the fear of bias in hiring due to the financial costs to employers. Discriminatory hiring has been a cause of concern in many countries.
- Probable decline in women labour force participation: It is often equated to the decline in the labour force participation of women following the introduction of mandatory paid maternity leave.
- Medicalising normal biological process: Period leave is often seen as medicalising a normal biological process.
Did you know?

“Female sugarcane cutters surgically remove their uteri to secure work”
- A widely accepted menstrual health framework can also ameliorate the conditions of female workers in the unorganised sector.
- In Maharashtra’s Beed district, contractors in the sugarcane industry do not hire anyone who menstruates.
- More than 10,000 female sugarcane cutters have had to surgically remove their uteri to secure work.
- Most of them are in their twenties and thirties, and now experience various post-surgery health complications. Such exploitation is a human rights violation.
Way ahead
- Need to bridge the gaps: The path to equality does not lie in inaction due to fear of further discrimination. What is needed is a holistic outlook aimed at bridging existing gaps.
- Comprehensive and inclusive approach is must: The implementation of menstrual leave should be based on a comprehensive and inclusive approach that takes into account the needs and rights of all employees, regardless of gender.
- Mandatory self-care leaves as an alternative: Employers should be made to introduce a mandatory self-care leave as an alternative to period leaves for those who cannot avail of the latter. Employees should be able to utilise their self-care leave as they deem fit. This will reduce burnout and increase productivity.
- Self-care leave will also destigmatise menstruation: The names menstrual leave and self-care leave will also destigmatise menstruation and self-care respectively. Further, employers should be made to implement a stringent diversity, equity, and inclusion (DEI) framework.
- Safeguards menstruators in unorganized sector: A formal menstrual leave policy in the organized sector can act as a catalyst in safeguarding menstruators in the unorganized sector too.
Conclusion
- Menstrual health is a public health issue. Considering the sizable population of menstruators in India who face stigma, period leave cannot be dismissed anymore as a foreign concept. It is a pivotal step in ensuring proper reproductive health equity in India.
Mains question.

Q. The topic of Menstrual leave is in the headlines for some time now. Anaalyse the dabate

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February 3, 2023
Its high time to focus on Mental Health
Context
- Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. According to WHO, India’s suicide rate in 2019, at 12.9/1,00,000, was higher than the regional average of 10.2 and the global average of 9.0. Suicide has become the leading cause of death among those aged 15–29 in India.
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Background: Mental Health
- While every precious life lost through suicide is one too many, it represents only the tip of the mental health iceberg in the country, particularly among young adults. Women tend to suffer more.
- Across the world, the prevalence of some mental health disorders is consistently higher among women as compared to men.
Prevalence of Mental ill-health
- The pandemic has further exacerbated the problem: Globally, it might have increased the prevalence of depression by 28 per cent and anxiety by 26 per cent in just one year between 2020 and 2021, according to a study published in Lancet.
- Increased among younger age groups: Again, the large increases have been noted among younger age groups, stemming from uncertainty and fear about the virus, financial and job losses, grief, increased childcare burdens, in addition to school closures and social isolation.
- Use of social media exacerbating the stress: Increased use of certain kinds of social media is also exacerbating stress for young people. Social media detracts from face-to-face relationships, which are healthier, and reduces investment in meaningful activities. More importantly, it erodes self-esteem through unfavourable social comparison.
Socio-economic implications of Mental ill-health
- People living in poverty are at greater risks: Mental ill health is a leading cause of disability globally and is closely linked to poverty in a vicious cycle of disadvantage. People living in poverty are at greater risk of experiencing such conditions.
- People experiencing mental health problems likely to fall in poverty: On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure.
- Stigma and discrimination: Stigma and discrimination often further undermine their social support structures. This reinforces the vicious cycle of poverty and mental ill-health.
- Higher income inequality has high prevalence of ill mental ill health: Not surprisingly, countries with greater income inequalities and social polarization have been found to have a higher prevalence.
Approach to protect, promote and care for the mental health of people?
- Killing the deep stigma surrounding mental health issues: The first step should be killing the deep stigma which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak. Stigma festers in the dark and scatters in the light. We need a mission to cut through this darkness and shine a light.
- Making Mental health an integral part of public health programme: There is need to make mental health an integral part of the public health programme to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen interventions like counselling services. Special emphasis will need to be given to schools.
- Paying attention to highly vulnerable: In addition, we should pay special attention to groups that are highly vulnerable because of the issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
- Creating a strong infrastructure for mental health care and treatment: Lack of effective treatment and stigma feed into each other. Currently, only 20-30 per cent of people with such disorders receive adequate treatment.
- Mental health services should be made affordable for all: Improved coverage without corresponding financial protection will lead to inequitable service uptake and outcomes. All government health assurance schemes, including Ayushman Bharat, should cover the widest possible range.
Why is the wide treatment gap?
- One major reason for a wide treatment gap is the problem of inadequate resources.
- Less than two per cent of the government health budget, which itself is the lowest among all G20 countries, is devoted to mental health issues.
- There is a severe shortage of professionals, with the number of psychiatrists in the country being less than those in New York City, according to one estimate.
- Substantial investments will be needed to address the gaps in the health infrastructure and human resources.
- Currently, most private health insurance covers only a restricted number of mental health conditions. Similarly, the list of essential medicines includes only a limited number of WHO-prescribed medications.
Conclusion
- We need an urgent and well-resourced whole of society approach to protecting, promoting and caring for the mental health of our people, like we did for the Covid pandemic. Brock Chisholm, the first Director General of WHO, famously said, “there is no health without mental health”.
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January 31, 2023