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

  • Operation Pangea XIV

    More than 1.10 lakh web links, including websites and online marketplaces, have been taken down in the operation Pangea XIV.

    Operation Pangea XIV

    • Code-named “Operation Pangea XIV”, the exercise was coordinated by Interpol.
    • It involved the police, customs, and health regulatory authorities of 92 countries against the sale of fake and illicit medicines and medical products.
    • Indian agencies also participated in the operation, said an official of the Central Bureau of Investigation that is the nodal body for the Interpol in the country.
    • It showed that criminals were continuing to cash in on the huge demand for personal protection and hygiene products due to the COVID-19 pandemic.

  • Performance Grading Index 2020 by Education Ministry

    The Education Ministry’s Performance Grading Index for 2019-20 was recently released.

    Performance Grading Index

    • The PGI is a tool to provide insights on the status of school education in States and UTs including key levers that drive their performance and critical areas for improvement.
    • It monitors the progress that States and UTs have made in school education with regard to learning outcomes, access and equity, infrastructure and facilities, and governance and management processes.
    • Grading will allow all States and UTs to occupy the highest level i.e Grade I, at the same time which is a sign of a fully developed nation.

    Its methodology

    • This is the third edition of the index and uses 70 indicators to measure progress.
    • Of these, the 16 indicators related to learning outcomes remain unchanged through all three editions, as they are based on data from the 2017 National Achievement Survey, which tested students in Classes 3, 5, 8, and 10.

    Highlights of the 2019-20 Report

    • Punjab, Tamil Nadu, and Kerala have all scored higher than 90%.
    • Gujarat dropped from second to the eighth rank in the index, while MP and Chhattisgarh are the only States which have seen actual regression in scores over this period.

  • Different types of fungus due to Covid

    Context

    As India is still reeling under the second wave of COVID-19 pandemic, Black, White and Yellow Fungus infections have brought along unending woes, pressuring the already stressed healthcare system. These fungal infections have been attributed to COVID-19 and led to prolonged morbidity and mortality in COVID-19 patients

    Black Fungus

    What is black fungus (Mucormycosis)?

    • Mucormycosis, previously known as zygomycosis and sometimes called black fungus, is a serious fungal infection, generally in people with less ability to fight infection.
    • Mucormycosis is a rare but serious infection that is caused by a group of moulds called mucormycetes.
    • It mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
    • It reduces the ability to fight environmental pathogens.
    • It can also happen on the skin after a burn, cut or other type of skin wound through which the fungus enters the skin. It can also affect the brain
    • People having co-morbities, variconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.

    Types of Mucormycosis

    • Sinuses and brain (rhinocerebral): Most common in people with poorly controlled diabetes and in people who have had a kidney transplant.
    • Lungs (pulmonary): The most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
    • Stomach and intestine (gastrointestinal): More common among young premature and low birth weight infants, who have had antibiotics, surgery, or medications that lower the body’s ability to fight infection.
    • Skin (cutaneous): After a burn, or other skin injury, in people with leukaemia, poorly controlled diabetes, Graft-versus-host disease, HIV and intravenous drug use.
    • Widespread (disseminated): When the infection spreads to other organs via the blood.

    Symptoms of Mucormycosis

    The symptoms of Black Fungus infection are:

    For Brain Mucormycosis

    1- One-sided facial swelling
    2- Headache
    3- Nasal or sinus congestion
    4- Black lesions on nasal bridge or upper inside of the mouth
    5- Fever

    For Pulmonary Mucormycosis

    1- Fever
    2- Cough
    3- Chest pain
    4- Shortness of breath

    For Gastrointestinal Mucormycosis

    1- Abdominal pain
    2- Nausea and vomiting
    3- Gastrointestinal bleeding

    Who are at risk of getting infected with Black Fungus?

    1- Diabetes
    2- Cancer
    3- Organ transplant
    4- Stem cell transplant
    5- Neutropenia 
    6- Long-term corticosteroid use
    7- Hemochromatosis (excess of iron)
    8- Skin injury due to surgery, burns, or wounds
    9- Pre-maturity 
    10- Low birth weight 

    Where are these fungi found?

    • Mucormycosis is caused by a group of molds called mucormycetes. It is naturally found in air, water and even food.
    • It enters the body through fungal spores from the air or can also occur on skin after a cut, burn, or skin injury.

    Mucormycosis affecting COVID-19 patients

    • Patients who have high levels of diabetes are at a higher risk of contracting covid-19. When this occurs, they are treated with steroids which compromises their immunity.
    • According to doctors, steroids can prove to be a trigger for mucormycosis. While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike.
    • Medicines used in treating Covid-19 tend to bring down the count of lymphocytes.
    • Lymphocytes are one of the three types of white blood cells whose job is to defend our body against disease-causing pathogens such as bacteria, viruses, and parasites.
    • The reduced count of lymphocytes leads to a medical condition called lymphopenia, making way for opportunistic fungal infection in Covid-19 patients.

    Treatment

    • While it is treated with antifungals, mucormycosis may eventually require surgery.
    • To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.

    Life after surgery for mucormycosis

    • Mucormycosis can lead to loss of the upper jaw and sometimes even the eye.
    • Be it the eye or upper jaw, these can be replaced with appropriate artificial substitutes or prostheses.

    Yellow Fungus

    • Yellow Fungus, dangerous than white or black fungus, is another fungal infection that has been attributed to COVID-19. Health experts say it is a fatal infection.
    • Yellow Fungus is commonly found in reptiles.
    • Yellow fungus initially develops by the presence of moulds (a type of fungi) in the environment. It may be present with unnecessary fatigue, rashes, burning sensation on skin etc.
    • It may not start from the lungs but it invades internal organs of the body and affects the entire functioning.

    Potential causes of yellow fungus

    • Prolonged use of steroid.
    • Contaminated environment.
    • Uncontrolled diabetes.
    • Unhygienic or dirty surroundings.
    • Unhygienic habits.
    • Lesser immunity.
    • Co-morbidities.

    Symptoms of Yellow Fungus

    • Weight loss
    • Reduced appetite
    • Lethargy
    • Pus leakage
    • Sunken eyes
    • Organ failure

    Treatment

    • Like mucormycosis, the treatment for yellow fungus is Amphoteracin-B injection

    Prevention

    • Keep your room, home and surroundings as clean as possible
    • Remove stale food and fecal matter immediately to check bacterial and fungal growth.
    • Keep the humidity of the room and home under check as excessive humidity promotes bacteria growth. Just like for Covid patients maintaining clean air flow inside the room and homes is necessary.
    • Coronavirus positive patients must immediately start treatment so complications like yellow fungus do not develop.

    White Fungus

    • White Fungus or Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida.
    • Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems.
    • Candida can cause infections if it grows out of control or if it enters deep into the body (for example, the bloodstream or internal organs like the kidney, heart, or brain).
    • The most common species that causes infection is Candida albicans.
    • Patients of white fungus show Covid-like symptoms but test negative; the infection can be diagnosed through CT-Scan or X-ray.

    Cause

    • This infection can be caused due to low immunity, or if people come in contact with things that contain these moulds like water, etc.
    • Children and women are more at risk of contracting the fungal infection.
    • Like the black fungus, white fungus is also more likely to afflict people with compromised immune systems, pre-existing medical conditions, AIDS, a recent kidney transplant or diabetes.

    Symptoms

    • People experience symptoms similar to Covid if it reaches the lungs such as chest infection, despite testing negative for the virus.
    • White fungus affects the lungs as well as other parts of the body including the nails, skin, stomach, kidney, brain, private parts and mouth.

    Diagnosis/Treatment

    • CT scans or X-Rays can reveal the condition.
    • Patients with the white fungus are currently being treated with known anti-fungal medication.

    Prevention

    • Special caution is required of moulds in water that can lead to infection.
    • Proper sanitation is very important.

    Way Forward

    • Use of Steroids must be curbed down in the treatment of Covid to prevent low immunity in patients.
    • The fungus must be dealt as a pandemic and not just a regular post Covid complication.
    • All necessary medicines needed for the treatment of above mentioned Fungus must be made available in the hospital.
    • Government should run awareness campaigns about these funguses as a preventive measure.

  • What are Neglected Tropical Diseases (NTD)?

    The ongoing World Health Assembly has declared January 30 as ‘World Neglected Tropical Diseases (NTD) Day’.

    Neglected Tropical Diseases

    • NTDs are a group of infections that are most common among marginalized communities in the developing regions of Africa, Asia, and the Americas.
    • They are caused by a variety of pathogens such as viruses, bacteria, protozoa, and parasitic worms.
    • These diseases generally receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
    • Some examples of NTDs include snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease.

    Significance of global recognition

    • NTDs affect more than a billion people globally, according to the WHO. They are preventable and treatable.
    • However, these diseases and their intricate interrelationships with poverty and ecological systems — continue to cause devastating health, social and economic consequences.
    • A major milestone in the movement to recognize the global burden of these diseases was the London Declaration on NTDs that was adopted January 30, 2012.
    • The first World NTD Day was celebrated informally in 2020. This year, the new NTD road map was launched.

  • Addressing vaccine hesitancy

    The article deals with the issue of vaccine hesitancy and its consequences.

    Why vaccinate?

    • The primary purpose of vaccination is to protect individuals against severe infection.
    • Vaccination also protects populations by providing ‘herd immunity’, if done on a large scale.
    • Globally, vaccinations against polio, small pox, meningitis and so on have seen huge success.

    Need to address the vaccine hesitancy

    • The results of a 2020 Gallup poll, conducted before the vaccine roll-out reveals that 18% of the Indian said that they won’t take the vaccine.
    • But vaccine hesitancy has gone up in India since then, due in part to largely overblown reports of complications or even deaths.
    • The consequences of vaccine hesitancy are disastrous.
    • If herd immunity does not develop, disease outbreaks and pandemics will prevail.
    • The slower the vaccination rate, the wider the spread of infection and the greater the chances of mutations and the emergence of new variants.

    Factors driving vaccine hesitancy

    • The influencing factors include a lack of awareness of the extent of benefits.
    • Fears based on inaccurate information.
    • Lack of access to vaccine.
    • Disinformation, especially on social media.
    • Other factors include civil liberty concepts, cost, cultural issues, and various layers of confidence deficit.

    Way forward

    • To allay vaccine fears, our messaging needs to focus on simple facts.
    • Before attempting to persuade people, we need to understand the basis of their fear, hesitancy and the anti-vax attitude.
    •  By challenging untruths, we inadvertently feed the perception that we are actively suppressing the “real” truth.
    • The objective now should be to reach more people faster with a message that doesn’t just provide more science but includes guidance.
    • Providing practical information through social media, alternatives to apps for those lacking easy access to vaccines, and taking the help of well-informed frontline workers will all help.

    Conclusion

    The possibility of a significant number of people not getting vaccinated thwarts our collective ability to reach the herd immunity threshold against Covid-19. Therefore the issue of vaccine hesitancy needs to be urgently addressed.

  • WHO BioHub: Global Facility for Pathogen Storage

    The World Health Organization (WHO) and Switzerland have signed an MoU to launch a BioHub facility that will allow rapid sharing of pathogens between laboratories and partners to facilitate better analysis and preparedness against them.

    WHO BioHub

    • The BioHub will enable member states to share biological materials with and via the BioHub under pre-agreed conditions, including biosafety, biosecurity, and other applicable regulations.
    • The facility will help in the safe reception, sequencing, storage, and preparation of biological materials for distribution to other laboratories, so as to facilitate global preparedness against these pathogens.
    • It would be based in Spiez, Switzerland.
    • Pathogens are presently shared bilaterally between countries: A process that can be sluggish and deny the benefits to some.

    Its significance

    • This will ensure timeliness and predictability in response activities.
    • The move is significant in the view of the novel coronavirus disease (COVID-19) pandemic and the need to underline the importance of sharing pathogen information to assess risks and launch countermeasures.
    • The move will help contribute to the establishment of an international exchange system for novel coronavirus SARS-CoV-2 and other emerging pathogens.

  • What is Vaccine Tourism?

    A couple of days ago, reports emerged of a Dubai-based tour operator offering a 24-day package tour from Delhi to Moscow that has included two shots of the Russian Sputnik-V vaccine.

    What is vaccine tourism?

    • In India, the term “vaccine tourism” became popular late last year when reports emerged of several tour operators offering packages to the US with the additional benefit of a vaccine shot.
    • Meanwhile, South Africans are said to be flying to Zimbabwe, Canadians and South Americans are traveling to the US for jabs, while tour operators in Europe are offering trips to Russia for Sputnik V shots.
    • It is said that Russia and the Maldives are already working on programs to offer people abroad the chance to get vaccinated during a visit; similar offerings are sprouting in the US as well.

    Why is it gaining popularity?

    • In fact, vaccine tourism is an emerging trend in countries where vaccines are in short supply, or where certain groups are still restricted from being inoculated.
    • Still, there are only a few countries in the world (parts of the US, Russia, Slovakia, Zimbabwe, etc) that don’t restrict their vaccination policy to local residents.
    • Currently, it is not illegal to travel to a foreign country to get vaccinated if air travel is allowed.
    • Recently, Seychelles announced that only vaccinated visitors from India, Pakistan, and Bangladesh who have completed two weeks after their second dose are permitted to travel to and enter the island nation, with proof.

    Can Indians go abroad to get vaccinated for Covid-19?

    • There may be no need for anyone from India to go abroad for vaccination since all eligible Indians will be vaccinated in the country by the end of this year – that too, at the most reasonable rates possible.
    • However, the idea of vaccine tourism is gaining momentum in India.
    • Many Indians, who fled to Dubai just before the international flight ban came into effect last month, are said to be availing of the Chinese vaccine Sinopharm shots in the UAE.

    Not to be confused with Vaccine Passport

    • Sometimes, vaccine tourism is confused with vaccine passports, which is a more regulated practice gaining currency around the world.

  • The fault line of poor health infrastructure

    The poor public health infrastructure in India hits the poor hard. The article examines the factors responsible for poor public health infrastructure and suggests the measures to deal with it.

    Poor state of health infrastructure

    • World Bank data reveal the poor state of India’s health infrastructure.
    • It reveals that India had 85.7 physicians per 1,00,000 people in 2017.
    • In contrast, it is 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan.
    • India had 53 beds per 1,00,000 people.
    • It is 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan.
    • India had172.7 nurses and midwives per 1,00,000 people in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan.

    What are the factors responsible for poor health infrastructure?

    • Stagnant expenditure: Analysis by the Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that health expenditure has been stagnant for years.
    • Lack of expertise with states: Despite health being a state subject, the main bodies with technical expertise are under central control.
    • The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
    • Inter-State variation: States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.
    • Kerala and Delhi have been close to top in years from 2011 to 2019-20.
    • Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in the same years.

    Out-of-pocket expenditure and its impact on the poor

    • Due to low levels of public health provision, the World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
    • Some of the poorest States, Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha, have a high ratio of OOP expenditures in total health expenditure.
    • Impact on the poor: High ratio of OOP means that the poor in the poorest States, the most vulnerable sections, are the worst victims of a health emergency.

    Way forward

    1) Coordinated national plan

    • The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
    • The Centre already tightly controls major decisions, including additional resources raised specifically for pandemic relief, e.g. the PM CARES Fund.
    • The need for a coordinated strategy on essential supplies of oxygen and vaccines is acute.
    • The Centre can bargain for a good price from vaccine manufacturers in its capacity as a single large buyer like the European Union did for its member states.
    • Centre will also benefit from the economies of scale in transportation of vaccines into the country.
    • Once the vaccines arrive in India, these could be distributed across States equitably in a needs-based and transparent manner.
    • Another benefit of central coordination is that distribution of constrained resources like medical supplies, financial resources can internalise the existing disparities in health infrastructure across States.

    2) Form Pandemic Preparedness Unit

    • There is a need for the creation of a “Pandemic Preparedness Unit” (PPU) by the central government.
    • PPU would streamline disease surveillance and reporting systems; coordinate public health management and policy responses across all levels of government.
    • It will also formulate policies to mitigate economic and social costs, and communicate effectively about the health crisis.

    Consider the question “India has among the highest out-of-pocket expenditure in the world, which is the result of poor public health infrastructure. Examine the factors responsible for poor public health infrastructure and suggest the ways to deal with it.”

    Conclusion

    As and when we emerge on the other side of the pandemic, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States.

  • Issues in Social Security Code 2020

    Provisions in Social Security Code 2020

    • India’s Parliament in September 2020 passed a Social Security Code (SS Code 2020).
    • The SS Code 2020 merges existing social security laws and attempts to include informal workers within the ambit of social security administration.
    • The SS Code 2020 amalgamates and rationalises the provisions of eight existing central labour laws.
    • Of these acts, employees provident fund, employees state insurance (ESI), maternity benefit, gratuity are entirely for organised sector workers. 
    • Employee threshold removed: For employees’ state insurance, the existing employee threshold has been withdrawn.
    • Now the central government can extend ESI benefits to any organisation irrespective of the number of workers employed.

    Key benefits not available to informal workers in Social Security Code 2020

    • Maternity benefit: Under the SS Code, the provision of maternity benefit has not been made universal.
    • Maternity benefit is presently applicable for establishments employing 10 workers or more.
    • The definition of ‘Establishment’ in the proposed code did not include the unorganised sector.
    • Hence, women engaged in the unorganised sector would remain outside the purview of maternity benefit.
    • Employees Provident Fund: The SS Code maintains that the Employees’ Provident Fund Scheme will remain applicable, as before, to every establishment in which 20 or more employees are employed.
    • Thus, for informal sector workers, access to employees’ provident fund remains unfulfilled too in the new code.
    • Payment of gratuity: Gratuity shall be payable to eligible employees by every shop or establishment in which 10 or more employees are employed, or were employed, on any day of the preceding 12 months.
    • But although payment of gratuity was expanded in the new Code, it still remains inaccessible for a vast majority of informal workers.

    Challenges faced by informal workers in availing social security

    • Registration barrier: To avail social security, an informal worker must register herself on the specified online portal to be developed by the central government.
    • Absence of definition: The absence of definite and unambiguous provisions in the present code would further complicate achievement of universal registration.
    • Lack of awareness: Experience shows that there is an awful lack of awareness among informal workers regarding social security schemes.
    • Lack of digital literacy: Online registration places a further challenge as most informal workers lack digital literacy and connectivity.
    • Lack of documents: Informal workers also find it difficult to furnish all documentary papers required as part of the registration process.
    • Furnishing proof of livelihood and income details in the absence of tangible employer-employee relations is very difficult.
    • Such requirements deter informal workers from completing the registration and they continue to remain outside the social security ambit.

    Way forward

    The provision of social security could be used to formalise the workforce to a certain extent. Employers could have been made to own up to the responsibility of providing social security to their workers.

    1) Inter-State cooperation

    • As unorganised workers are spread across the length and breadth of India, inter-State arrangement and cooperation becomes imperative.
    • The central government should conceptualise a basic structure, which if successful, should be adopted by States after necessary customisation.

    2) Universal coverage

    • The unorganised workforce is all encompassing, minus the minuscule regular workers of organised sectors.
    • This identity should be primal and all unorganised workers should have basic social security coverage, irrespective of labour market classifications.
    • The code fails to undertake such inclusion in a meaningful way.

    Conclusion

    The Social Security Code fails to provide adequate protection to informal workers, who constitute 91% of the workforce. The pandemic and misery brought by it on these informal workers highligths the need for universal social security.

  • Brain drain of India’s health worker

    The article highlights the issue of shortage of healthcare workers in India even as it exports its healthcare workers to other countries.

    India as an exporter of healthcare workers

    • For several decades, India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council countries, Europe and other English-speaking countries.
    • As per OECD data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017.
    • In these four countries, 56,000 Indian-trained nurses were working in the same year.
    • There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.
    • There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.

    Shortage of nurses and doctors

    • The migration of healthcare workers is part of the reason for the shortage in nurses and doctors.
    • If we look at the figures for countries where we export our healthcare workers, we see just how big the difference is between the sending and the receiving countries.
    • As per government reports, India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1,404.
    • This is well below the WHO norm of 3 nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
    • But, this does not convey the entire problem.
    • The distribution of doctors and nurses is heavily skewed against some regions.
    • Moreover, there is high concentration in some urban pockets.

    Factors driving migration

    • There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries.
    • However, there are strong push factors that often drive these workers to migrate abroad.
    • The low wages in private sector outfits along with reduced opportunities in the public sector plays a big role in them seeking employment opportunities outside the country.
    • The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration.

    Measures to check brain drain and issues with it

    • Over the years, the government has taken measures to check the brain drain of healthcare workers with little or no success.
    • In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US.
    • The NORI certificate is a US government requirement for doctors who migrate to America on a J1 visa and seek to extend their stay beyond three years.
    • The non-issuance of the NORI would ensure that the doctors will have to return to India at the end of the three-year period.
    • The government has included nurses in the Emigration Check Required (ECR) category.
    • This move was taken to bring about transparency in nursing recruitment and reduce the exploitation of nurses in the destination countries.
    • The government’s policies to check brain drain are restrictive in nature and do not give us a real long-term solution to the problem.

    Way forward

    • We require systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to workers and building an overall environment to motivate them to stay in the country.
    • The government should focus on framing policies that promote circular migration and return migration — policies that incentivise healthcare workers to return home after the completion of their training or studies.
    •  It could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.
    • The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world.
    • Increased investment in healthcare, especially in the public sector, is thus the need of the hour.
    • This would, in turn, increase employment opportunities for health workers.

    Consider the question “What are the factors driving the migration of healthcare workers from India? Suggest the measure to stem their migration.”

    Conclusion

    India needs systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to health workers and building an overall environment that could prove to be beneficial for them and motivate them to stay in the country.