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

  • Preparing for outbreaks

    Context

    Prime Minister Narendra Modi launched the Ayushman Bharat Health Infrastructure Mission, one of the largest pan-India schemes for strengthening healthcare infrastructure, in his parliamentary constituency Varanasi in Uttar Pradesh.

    Aims of Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) and how it seeks to achieve it

    • This was launched with an outlay of â‚č64,180 crore over a period of five years.
    •  In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment, including critical care services.
    • The latter goal would be met with the establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts.
    • Laboratories and their preparedness: The government will be establishing integrated district public health labs in 730 districts to provide comprehensive laboratory services.
    • Research: ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
    • One health approach: The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
    • Surveillance labs: A network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.
    • Local capacities in urban areas: A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
    • The services from the existing urban primary health centres will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres and polyclinics or specialist clinics.

    Conclusion

    The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) is another addition to the arsenal we have to prepare for such oubreaks in the future.

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  • Ayushman Bharat Health Infrastructure Mission

    PM has launched the Ayushman Bharat Health Infrastructure Mission (AB-HIM), one of the largest pan-India schemes for strengthening healthcare infrastructure.

    AB- Health Infrastructure Mission

    • AB-HIM is being rolled out as India’s largest scheme to scale up health infrastructure.
    • It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.

    Key features

    • Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
    • Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
    • Integrated public health labs: will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
    • Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
    • Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.

    Why is the scheme significant?

    • India has long been in need of a ubiquitous healthcare system.
    • A 2019 study has highlighted how access to public health care remained elusive to those living on the margins.
    • The study found that 70 per cent of the locations have public healthcare services.
    • However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
    • In 45 per cent of the surveyed locations, people could access healthcare services by walking, whereas in 43 per cent of the locations they needed to use transport.

     

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  • What the low rank on the Global Hunger Index means for India

    Context

    This year’s Global Hunger Index (GHI) ranks India 101 out of 116 countries for which reliable and comparable data exist.

    Government’s stand

    • Is India’s performance on hunger as dismal as denoted by the index or is it partly a statistical artefact?
    • This question assumes immediacy, especially since the government has questioned the methodology and claimed that the ranking does not represent the ground reality.
    • This calls for careful scrutiny of the methodology, especially of the GHI’s components.

    Understanding the GHI methodology

    • The GHI has four components.
    • The first — insufficient calorie intake — is applicable for all age groups.
    • The data on deficiency in calorie intake, accorded 33% weight, is sourced from the Food and Agriculture Organization’s Suite of Food Security Indicators (2021).
    • The remaining three — wasting (low weight for height), stunting (low height for age) and mortality — are confined to children under five years.
    • The data on child wasting and stunting (2016-2020), each accounting for 16.6% of weight, are from the World Health Organization, UNICEF and World Bank, complemented with the latest data from the Demographic and Health Surveys.
    • Under-five mortality data are for 2019 from the UN Inter-Agency Group for Child Mortality Estimation.

    Issues with GHI

    • The GHI is largely children-oriented with a higher emphasis on undernutrition than on hunger and its hidden forms, including micronutrient deficiencies.
    • The first component — calorie insufficiency — is problematic for many reasons.
    • The lower calorie intake, which does not necessarily mean deficiency, may also stem from reduced physical activity, better social infrastructure (road, transport and healthcare) and access to energy-saving appliances at home, among others.
    • For a vast and diverse country like India, using a uniform calorie norm to arrive at deficiency prevalence means failing to recognise the huge regional imbalances in factors that may lead to differentiated calorie requirements at the State level.

    Understanding the connection between stunting and wasting and ways to tackling them

    • India’s wasting prevalence (17.3%) is one among the highest in the world.
    •  Its performance in stunting, when compared to wasting, is not that dismal, though.
    • Child stunting in India declined from 54.2% in 1998–2002 to 34.7% in 2016-2020, whereas child wasting remains around 17% throughout the two decades of the 21st century.
    • Stunting is a chronic, long-term measure of undernutrition, while wasting is an acute, short-term measure.
    • Quite possibly, several episodes of wasting without much time to recoup can translate into stunting.
    • Effectively countering episodes of wasting resulting from such sporadic adversities is key to making sustained and quick progress in child nutrition.
    • Way forward: If India can tackle wasting by effectively monitoring regions that are more vulnerable to socioeconomic and environmental crises, it can possibly improve wasting and stunting simultaneously.

    Low child mortality

    • India’s relatively better performance in the other component of GHI — child mortality — merits a mention.
    • Studies suggest that child undernutrition and mortality are usually closely related, as child undernutrition plays an important facilitating role in child mortality.
    • However, India appears to be an exception in this regard.
    • This implies that though India was not able to ensure better nutritional security for all children under five years, it was able to save many lives due to the availability of and access to better health facilities.

    Conclusion

    The low ranking does not mean that India fares uniformly poor in every aspect. This ranking should prompt us to look at our policy focus and interventions and ensure that they can effectively address the concerns raised by the GHI, especially against pandemic-induced nutrition insecurity.

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  • NEET hasn’t created the equality of opportunity

    Context

    The Tamil Nadu government has passed an Act seeking an exemption from treating NEET as the sole and mandatory requirement for medical admission in the state. The Act, which is yet to get approval from the President.

    NEET issue in Tamil Nadu

    • The Justice A K Rajan committee was appointed by the state government of Tamil Nadu to examine whether NEET is an equitable method of selection.
    • Its report lends credence to the belief that NEET tends to give an advantage to students from privileged backgrounds.
    • It also observed that NEET, in terms of orientation, is biased towards the Central Board of Secondary Education (CBSE).
    • In the section titled ‘Size of coaching market’, the report brings out two poignant facts.
    • One, by inadvertently creating a “market for coaching”, NEET has helped to create an “extractive industry of coaching” as an essential condition for clearing it.
    • Two, the coaching fees are not only high, but are beyond the reach of many, especially the poor and marginalised.
    • Acting upon the committee’s recommendation, the Tamil Nadu government has passed an Act seeking an exemption from treating NEET.
    • The Act, which is yet to get approval from the President.
    •  An educational intervention which was introduced as a solution to foster equality of opportunity has turned out to be the primary cause of deepening inequality of participation and opportunity.

    Important questions

    • There are at least two important questions.
    • Equality of opportunity: First, does NEET help foster equality of opportunity for everyone without unduly advantaging or disadvantaging anyone?
    • Second, is NEET’s bias towards CBSE justifiable in an immensely diverse country like ours, where varied school curricula coexist with a highly unequal access to financial and educational resources and opportunities?
    • The question here is: How can NEET promote parity of participation when aspiring first-generation students from marginalised and poor households participate from a highly unequal position in the first place?
    • NEET disregards the fact that the terms and conditions of participation are highly unequal and biased.

    Way forward

    • The National Education Policy (NEP 2020) envisions a curriculum and pedagogy which will promote holistic learning, social responsibility and multilingualism, among other things.
    • It is important, therefore, to significantly restructure the focus of NEET keeping in mind the spirit of NEP and varied school curricula in regional languages.

    Conclusion

    A restructured NEET, which does not require intensive and repeated coaching as a prerequisite and is not biased towards any board, can go a long way in promoting the parity of participation and nourishing the capacity to aspire, especially of the poor and marginalised.

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  • India ranked 101 in Global Hunger Index (GHI)

    The Global Hunger Index 2021 has ranked India at 101 positions out of a total 116 countries.

    Note the parameters over which the GHI is based and their weightage composition.

    Global Hunger Index (GHI)

    • The Global Hunger Index is a peer-reviewed annual report, jointly published by Concern Worldwide and Welthungerhilfe.
    • It determines hunger on a 100-point scale, where 0 is the best possible score (no hunger) and 100 is the worst.
    • It is designed to comprehensively measure and track hunger at the global, regional, and country levels.
    • The aim of the GHI is to trigger action to reduce hunger around the world.

    For each country in the list, the GHI looks at four indicators:

    1. Undernourishment (which reflects inadequate food availability): calculated by the share of the population that is undernourished (that is, whose caloric intake is insufficient)
    2. Child Wasting (which reflects acute undernutrition): calculated by the share of children under the age of five who are wasted (that is, those who have low weight for their height)
    3. Child Stunting (which reflects chronic undernutrition): calculated by the share of children under the age of five who are stunted (that is, those who have low height for their age)
    4. Child Mortality (which reflects both inadequate nutrition and unhealthy environment): calculated by the mortality rate of children under the age of five

    India’s (poor) performance

    • India is among the 31 countries where hunger has been identified as serious.
    • Only 15 countries fare worse than India.
    • Some of these include Afghanistan (103), Nigeria (103), Congo (105), Mozambique (106), Sierra Leone (106), Timor-Leste (108), Haiti (109), Liberia (110), Madagascar (111) and Somalia (116).
    • India was also behind most of the neighbouring countries.
    • Pakistan was placed at 92 rank, Nepal at 76 and Bangladesh also at 76.

    Reasons for such poor performance

    • Poor maternal health: Mothers are too young, too short, too thin and too undernourished themselves, before they get pregnant, during pregnancy, and then after giving birth, during breast-feeding.
    • Poor sanitation: Poor sanitation, leading to diarrhoea, is another major cause of child wasting and stunting.
    • Food insecurity: Low dietary diversity in India is also a key factor in child malnutrition.
    • Poverty: Almost 50 million households in India are dependent on these small and marginal holdings.
    • Livelihood loss: The rural livelihoods loss after COVID and lack of income opportunities other than the farm sector have contributed heavily to the growing joblessness in rural areas.

    Issues over credibility of GHI

    • India has ranked among many African countries while it is among the top 10 food-producing countries in the world.

     

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  • On Digital Health ID, proceed with caution

    Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.

    Explained: Digital Health ID

    Good intents of the DHID

    • The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
    • The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.

    Why need DHID?

    (a) Record maintenance

    • The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
    • A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
    • It met with limited success, despite the strong positives.
    • With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.

    (b) Better tracking of medical history

    • The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
    • As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
    • That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.

    (c) Better Diagnosis

    • DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
    • Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
    • The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.

    (d) Promoting medical research

    • Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
    • Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
    • This storehouse of patient data can be valuable for clinical and operational research.

    Given our population, would this be an idealistic expectation?

    • We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
    • While technology helps smoothen processes and enhance patient experience, there is a cost attached.
    • Investments have to be made upfront and results should not be expected overnight.

    Issues with DHID

    (a) A costly affair

    • In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
    • Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
    • Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.

    (b) Privacy concerns

    • Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
    • The possibility of privacy being violated increases with the centralisation of all information.
    • Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
    • How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
    • So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.

    Ground situation in India

    • Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
    • Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
    • Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
    • Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
    • Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
    • Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
    • Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.

    Plugging the existing gaps

    • Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
    • Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
    • But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
    • Continuity of care is central to good outcomes in inpatient management of chronic diseases.
    • The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
    • Technology can be of little use in the absence of doctors and basic infrastructure.

    Way forward

    • What is needed is building very robust firewalls and trust.
    • Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
    • For this reason, instead of a big bang approach, it is better to go slow and steady.
    • That’s the only way to ensure that a good policy does not die along the way due to poor implementation.

     

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  • [pib] DigiSaksham Initiative

    The Ministry of Labour and Employment has launched DigiSaksham Initiative.

    DigiSaksham

    • It is joint initiative with Microsoft India is an extension of the Government’s ongoing programs to support the youth from rural and semi-urban areas.
    • Through DigiSaksham initiative, free of cost training in digital skills including basic skills as well as advance computing, will be provided to more than 3 lakh youths in the first year.
    • The Jobseekers can access the training through National Career Service (NCS) Portal.
    • DigiSaksham will be implemented in the field by Aga Khan Rural Support Programme India (AKRSP-I).

    Training offered

    • Under the initiative, there will be basically three types of training viz. Digital Skills – Self paced learning, VILT mode training (Virtual Instructor led) and ILT mode training (Instructor led).
    • The ILT training which is in person training would be conducted at the Model Career Centres (MCCs) and National Career Service Centres (NCSC) for SCs/STs across the country.
    • Students will be able to access training in areas like Java Script, Data Visualisation, Advance Excel, Power Bi, HTML, Programming languages, software development fundamentals, Introduction to coding etc.

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  • Explained: Digital Health ID

    The PM has recently launched the flagship Ayushman Bharat Digital Mission (ABDM) which involves the creation not just a unique digital health ID for every citizen.

    Ayushman Bharat Digital Mission

    What is the unique health ID?

    • If a person wants to be part of the ABDM, she must create a health ID, which is a randomly generated 14-digit number.
    • The ID will be broadly used for three purposes: unique identification, authentication, and threading of the beneficiary’s health records, only with their informed consent, across multiple systems and stakeholders.

    Why is this initiative significant?

    • The initiative has the potential to “increase the ease of living” along with “simplifying the procedures in hospitals”.
    • At present, the use of digital health ID in hospitals is currently limited to only one hospital or to a single group, and mostly concentrated in large private chains.
    • The new initiative will bring the entire ecosystem on a single platform.
    • The system also makes it easier to find doctors and specialists nearest to you.
    • Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest.
    • Also, labs and drug stores will be easily identified for better tests using the new platform.

    How can one get it?

    • One can get a health ID by self-registration on the portal or by downloading the ABMD Health Records app on one’s mobile.
    • Additionally, one can also request the creation of a health ID at a participating health facility.
    • Health facilities may include government or private hospitals, community health centres, and wellness centres of the government across India.
    • The beneficiary will also have to set up a Personal Health Records (PHR) address for consent management, and for future sharing of health records.

    What is a PHR address?

    • It is a simple self-declared username, which the beneficiary is required to sign into a Health Information Exchange and Consent Manager (HIE-CM).
    • Each health ID will require linkage to a consent manager to enable sharing of health records data.
    • An HIE-CM is an application that enables sharing and linking of personal health records for a user.
    • At present, one can use the health ID to sign up on the HIE-CM; the National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from in the near future.

    What does one need to register for a health ID?

    • Currently, ABDM supports health ID creation via mobile or Aadhaar.
    • The official website states that ABDM will soon roll out features that will support health ID creation with a PAN card or a driving licence.
    • For health ID creation through mobile or Aadhaar, the beneficiary will be asked to share details on name, year of birth, gender, address, mobile number/Aadhaar.

    Is Aadhaar mandatory?

    Ans. No, it is voluntary.

    • One can use one’s mobile number for registration, without Aadhaar.
    • If the beneficiary chooses the option of using her Aadhaar number, an OTP will be sent to the mobile number linked to the Aadhaar.
    • However, if she has not linked it to her mobile, the beneficiary has to visit the nearest facility and opt for biometric authentication using Aadhaar number.
    • After successful authentication, she will get her health ID at the participating facility.

    Are personal health records secure?

    • The NHA says ABDM does not store any of the beneficiary health records.
    • The records are stored with healthcare information providers as per their “retention policies”.
    • They are “shared” over the ABDM network “with encryption mechanisms” only after the beneficiary express consent.

    Can one delete my health ID and exit the platform?

    Ans. Yes, the NHA says ABDM, supports such a feature.  Two options are available: a user can permanently delete or temporarily deactivate her health ID.

    • On deletion, the unique health ID will be permanently deleted, along with all demographic details.
    • The beneficiary will not be able to retrieve any information tagged to that health ID in the future, and will never be able to access ABDM applications or any health records over the ABDM network with the deleted ID.
    • On deactivation, the beneficiary will lose access to all ABDM applications only for the period of deactivation.
    • Until she reactivates her health ID, she will not be able to share the ID at any health facility or share health records over the ABDM network.

    What facilities are available to beneficiaries?

    • Users can access personal digital health records right from admission through treatment and discharge.
    • One can access and link his/her personal health records with your health ID to create a longitudinal health history.

    What other features will be rolled out?

    • Upcoming new features will enable access to verified doctors across the country.
    • The beneficiary can create a health ID for her child, and digital health records right from birth.
    • Third, she can add a nominee to access her health ID and view or help manage the personal health records.
    • Also, there will be much inclusive access, with the health ID available to people who don’t have phones, using assisted methods.

    How do private players get associated with a government digital ID?

    • The NHA has launched the NDHM Sandbox: a digital architecture that allows helps private players to be part of the National Digital Health Ecosystem as health information providers or health information users.
    • The private player sends a request to NHA to test its system with the Sandbox environment.
    • The NHA then gives the private player a key to access the Sandbox environment and the health ID application programming interface (API).
    • The private player then has to create a Sandbox health ID, integrate its software with the API; and register the software to test link records and process health data consent requests.
    • Once the system is tested, the system will ask for a demo to the NHA to move forward. After a successful demo, the NHA certifies and empanels the private hospital.

    Now try this PYQ:

    Consider the following statements:

    1. Aadhaar metadata cannot be stored for more than three months.
    2. State cannot enter into any contract with private corporations for sharing of Aadhaar data.
    3. Aadhaar is mandatory for obtaining insurance products.
    4. Aadhaar is mandatory for getting benefits funded out of the Consolidated Fund of India.

    Which of the statements given above is/are correct?

    (a) 1 and 4 only

    (b) 2 and 4 only

    (c) 3 only

    (d) 1, 2 and 3 only

     

    [wpdiscuz-feedback id=”3o1iiih1nf” question=”Please leave a feedback on this” opened=”1″]Post your answers here.[/wpdiscuz-feedback]

     

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  • Right to Govt. Aid is not a Fundamental Right: SC

    The right of an institution, whether run by a majority or minority community, to get government aid is not a fundamental right.  Both have to equally follow the rules and conditions of the aid, the Supreme Court held in a judgment.

    What is the case about?

    • The judgment came in an appeal filed by Uttar Pradesh against a decision of the Allahabad High Court to declare a provision of the Intermediate Education Act of 1921 unconstitutional.

    Key takeaways from the Judgment

    • The SC has clarified that if the government made a policy call to withdraw aid, an institution cannot question the decision as a “matter of right”.
    • Whether it is an institution run by the majority or the minority, all conditions that have relevance to the proper utilisation of the grant-in-aid by an educational institution can be imposed.
    • All that Article 30(2) states is that on the ground that an institution is under the management of a minority, whether based on religion or language.
    • The grant of aid to that educational institution cannot be discriminated against, if other educational institutions are entitled to receive aid.

    Basis of the Judgment

    • A grant of government aid comes with accompanying conditions.
    • An institution is free to choose to accept the grant with the conditions or go its own way.
    • If an institution does not want to accept and comply with the conditions accompanying such aid, it is well open to it to decline the grant and move in its own way.
    • On the contrary, an institution can never be allowed to say that the grant of aid should be on its own terms, the Bench observed.

    Various grounds discussed

    The court explained why institutions cannot view government aid as a “matter of right”.

    • Government aid is a policy decision: It depends on various factors including the interests of the institution itself and the ability of the government to understand the exercise. Therefore, even in a case where a policy decision is made to withdraw the aid, an institution cannot question it as a matter of right.
    • Financial constraints and deficiencies: These are the factors which are considered relevant in taking any decision qua aid, including both the decision to grant aid and the manner of disbursement of an aid.
    • Not arbitrary decision: The bench said that a policy decision is presumed to be in public interest, and such a decision once made is not amenable to challenge, until and unless there is manifest or extreme arbitrariness, a Constitutional court is expected to keep its hands off.

     

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    Back2Basics: Minority Rights in India

    • Article 15: prohibits discrimination on grounds of religion race cast sex or place of birth
    • Article 17: prohibits untouchability
    • Article 25 provides the right to practice any religion.
    • Article 26 allows religious institutions to be opened.
    • Article 27 provides that no person shall be forced to pay any taxes which is not mandatory.
    • Article 28 provides that there shall be no religious instruction to be followed in any particular educational institutions.
    • Article 29 provides that no citizen shall be denied admission in any educational institution on grounds of religion race caste.
    • Article 30 provides that minority shall not be prohibited from any educational institutions.

     

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  • Disease surveillance system

    Context

    A well-functioning system can reduce the impact of diseases and outbreaks.

    Importance of disease surveillance system

    • Successful tackling of cholera in 1854 in London by use of the health statistics and death registration data from the General Registrar Office (GRO) started the beginning of a new era in epidemiology.
    • Importance of data: The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
    • This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
    • Subsequently, the high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
    • Then, in the second half of the Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
    • These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

    Surveillance in India

    • The Government of India launched the National Surveillance Programme for Communicable Diseases in 1997.
    • However, this initiative remained rudimentary.
    • In wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
    • The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

    Issues with surveillance: Interstate variation

    • Variation among states: The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
    • In the fourth round of serosurvey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected.
    • This points towards a weak disease surveillance system.
    • In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.
    • While Kerala is picking the maximum COVID-19 cases; it could pick the first case of the Nipah virus in early September 2021. 
    • On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.

    Way forward

    • A review of the IDSP in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems.
    • These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
    • Increase allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
    • Trained workforce: The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
    • The vacancies of surveillance staff at all levels need to be urgently filled in.
    • Capacity increase: The laboratory capacity for COVID-19 needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
    • The interconnectedness of human and animal health: The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.
    • The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
    • Strengthening registration system: There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of death (MCCD).
    • Coordination: It is also time to ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
    • The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

    Consider the question “Examine the measure for disease surveillance in India? How it can help reduce the impact of the diseases?”

    Conclusion

    We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with the application of principles of epidemiology, we can reduce their impact.

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