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

  • What changes after COVID-19 vaccination?

    As the vaccination drive gains momentum, questions have emerged about appropriate behaviour after being vaccinated.

    What does being vaccinated mean?

    • Being fully vaccinated means a period of two weeks or more following the receipt of the second dose in a two-dose series, or two weeks or more following the receipt of a single-dose vaccine.
    • In India, currently, both vaccines being used — Covishield and Covaxin — follow a two-dose regimen.
    • Typically, the immune response takes a while to build up after a vaccine shot.
    • After the first jab of a two-dose vaccine, a good immune response kicks in within about two weeks. It is the second dose that boosts the immune response.

    Is the COVID threat averted?

    • It is still unclear how long immunity lasts from the vaccines at hand now.
    • Whether or not the immune response is durable, how it performs with the passage of time, and how long it lasts can be found out only by monitoring people who have already been vaccinated over a period.
    • If the vaccinated individual is still carrying the virus, the vaccine may provide immunity from severe disease for him or her, but the individual could still transmit the virus.

    What changes after you get a vaccine shot?

    • After vaccination, one risk of severe disease from COVID-19 goes down dramatically.
    • There is not enough evidence yet of vaccine response for some age groups, and vaccines are in short supply in the community.

  • Intensified Mission Indradhanush (IMI) 3.0

    States and UTs have started the implementation of the Intensified Mission Indradhanush 3.0, a campaign aimed to reach those children and pregnant women who have been missed out or been left out of the routine immunisation.

    Do not get confused with the Mission Indradhanush for Public Sector Banks launched in 2015. It aims at revamping the functioning of the Public Sector Banks to enable them to compete with the Private Sector Banks.

    Intensified Mission Indradhanush (IMI) 3.0

    • IMI 3.0 is aimed to accelerate the full immunization of children and pregnant women through a mission mode intervention.
    • The campaign is scheduled to have two rounds of immunisation lasting 15 days (excluding routine immunisation and holidays).
    • It is being conducted in pre-identified 250 districts/urban areas across 29 States/UTs in the country.
    • Beneficiaries from migration areas and hard to reach areas will be targeted as they may have missed their vaccine doses during the pandemic.

    About the Mission Indradhanush

    • Mission Indradhanush seeks to drive towards 90% full immunisation coverage of India and sustain the same by the year 2020. It was launched in December 2014.

    Aims and objectives

    • It aims to immunize all children under the age of 2 years, as well as all pregnant women, against eight vaccine-preventable diseases.
    • The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.
    • In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus.
    • In 2017, Pneumonia was added to the Mission by incorporating the Pneumococcal conjugate vaccine under Universal Immunisation Programme

    Try this question from CSP 2016:

    Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

    (a) Immunization of children and pregnant women

    (b) Construction of smart cities across the country

    (c) India’s own search for the Earth-like planets in outer space

    (d) New Educational Policy

  • What are Non-Alcoholic Fatty Liver Diseases (NAFLD)?

    The Union Govt has integrated the Non-alcoholic fatty liver disease (NAFLD) in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.

    Try this MCQ:

    Q.A Company marketing food products advertises that its items do not contain trans-fats. What does this campaign signify to the customers?

    1. The food products are not made out of hydrogenated oils.
    2. The food products are not made out of animal fats/oils.
    3. The oils used are not likely to damage the cardiovascular health of the consumers.

    Which of the statements given above is/are correct?

    (a) Only 1

    (b) 2 and 3 only

    (c) 1 and 3 only

    (d) 1, 2 and 3

    NAFLD

    • NAFLD is the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver, such as harmful alcohol use, viral hepatitis, or medications.
    • According to doctors, it is a serious health concern as it encompasses a spectrum of liver abnormalities.
    • It can cause non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer.

    Why such a move?

    • NAFLD is emerging as an important cause of liver disease in India.
    • Epidemiological studies suggest the prevalence of NAFLD is around 9% to 32% of the general population in India with a higher prevalence in those with overweight or obesity and those with diabetes or prediabetes.
    • Researchers have found NAFLD in 40% to 80 % of people who have type 2 diabetes and in 30% to 90% of people who are obese.
    • Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease.
    • Cardiovascular disease is the most common cause of death in NAFLD.

  • Reform lessons for education

    The article deals with state of the education and its relation with employment in India.

    Improving higher education system

    • Improving India’s higher education justice and worker productivity needs the broadening of our education ambition.
    • Our focus on Gross Enrollment Ratio should also be anchored to Employed Learner Ratio -proportion of our 55 crore labour force in formal learning.
    • For enrolling five crore new employed learners, India needs five regulatory changes.

    Reflecting on global and domestic education experience

    • Multi-decade structural changes include  organisations that are less hierarchical, lower longevity, shorter employee tenures, higher competition.
    • There is also change in the form of work: capitalism without capital, soft skills valued more than hard skills, 30 per cent working from home etc.
    • There change in the form of education in which Google knows everything, so tacit knowledge is more valuable than codified or embedded knowledge.
    • These shifts are complicated by a new world of politics, third-party financing viability, and fee inflation.

    India faces financing failure in skill

    • We have 3.8 crore students in 1,000-plus universities and 50,000-plus colleges.
    • We confront a financing failure in skills:
    • Employers are not willing to pay for training of candidates but a premium for trained candidates.
    • Candidates are not willing to pay for training but for jobs.
    • Financiers are unwilling to lend unless a job is guaranteed, and training institutions can’t fill their classrooms.

    Steps need to be taken

    • For many people the income support of learning-while-earning is crucial to raising enrollment.
    • Many students lack employability and workers lack productivity because learning is supply-driven.
    • Learning-by-doing ensures demand-driven learning.
    • The de facto ban on online degree learning with only seven of our 1,000-plus universities licensed for online offerings.
    • That needs to be changed.
    • High regulatory hurdles creates an adverse selection among entrepreneurs running educational institutions.

    Five regulatory changes

    • First, modify Part 3 of the UGC Act 1956 and Part 8 of the UGC Act to include skill universities.
    • Second, remove clauses 3(A), 3(B), and clause 5 of UGC ODL and Online Regulations 2020 and replace them with a blanket and automatic approval for all accredited universities to design, develop and deliver their online programmes.
    • Third, modify clause 4(C)(ii) of UGC online regulations 2020 to allow innovation, flexibility, and relevance in an online curriculum as prescribed in Annex 1-(V)-3-i) that allows universities to work closely with industry on their list of courses.
    • Fourth, modify clauses 13(C)(3), 13(C)(5), 13(C)(7), 18(2) of UGC online regulations 2020 to permit universities to create partner ecosystems for world-class online learning services, platforms, and experience.
    • Fifth, introduce Universities in clause 2 of the Apprentices Act 1961 to enable all accredited universities to introduce, administer and scale all aspects of degree apprenticeship programs.
    • These five changes would enable enrolling five crore incremental employed learner.

    Conclusion

    Reforming education requires thinking horizontally, holistically, and imaginatively. The reforms suggested here should be carried out considering these aspects.

  • vaccine hesitancy

    Reluctance to take the vaccine has several implications. The misinformation around the vaccines needs to be fought through several measures. 

    Understanding vaccine hesitancy

    • According to the World Health Organization, vaccine hesitancy is defined as a reluctance or refusal to vaccinate despite the availability of vaccine services.
    • To date, two vaccines have been approved for inoculation in India: Pune-based Serum Institute’s Covishield and Hyderabad-based Bharat Biotech’s Covaxin.
    • An adequate supply of vaccines is in place at least for the first phase, but the trickier part is to persuade the population for vaccination.
    • Like Western nations, vaccine hesitancy has been a cause of concern in the past in India as well.
    • Social media has seen a rising number of self-proclaimed experts who have been making unsubstantiated claims.
    • The debates around hesitancy for COVID-19 vaccines include concerns over safety, efficacy, and side effects due to the record-breaking timelines of the vaccines, competition among several companies, misinformation, and religious taboos.

    Need to adopt libertarian paternalism

    • It is suggested that we adopt the idea of libertarian paternalism, which says it is possible and legitimate to steer people’s behaviour towards vaccination while still respecting their freedom of choice.
    • Vaccine hesitancy has a different manifestation in India, unlike in the West.
    • According to the World Economic Forum/Ipsos global survey, COVID-19 vaccination intent in India, at 87%, exceeds the global 15-country average of 73%.

    Way forward

    • Instead of anti-vaxxers, the target audience must be the swing population i.e., people who are sceptical but can be persuaded through scientific facts and proper communication.
    • The second measure is to pause before you share any ‘news’ from social media.
    • It becomes crucial to inculcate the habit of inquisitive temper to fact-check any news related to COVID-19 vaccines.
    • The third measure is to use the celebrity effect — the ability of prominent personalities to influence others to take vaccines.
    • Celebrities can add glamour and an element of credibility to mass vaccinations both on the ground and on social media.

    Consider the question “What is vaccine hesitancy? Suggest the measures to deal with it”

    Conclusion

    The infodemic around vaccines can be tackled only by actively debunking myths, misinformation and fake news on COVID-19 vaccines.

  • Sharpening educational divide

    The article highlights the issue of the decrease in allocation for education and two ways in which the government seeks to plug this gap.

    Decrease in allocation to education: Two paradoxical axes

    • The government allocated Rs 6,000 crore less on education in Budget 2021 as compared to last year.
    • It’s strange that this year’s budget makes no reference to the pandemic and the multiple challenges it has thrown up for the poor.
    • Parents who depend on the lowest rung of free government schools are the ones who need maximum state support.
    • More recently, the state’s position with regard to the provision of education in general and budgetary allocations to education in particular hinges on two paradoxical axes.

    1) Supporting community volunteer

    • On one axis, is its appreciation of the commitment and passion of the community volunteers to reach out to children who may not be learning for multiple reasons.
    • Acknowledging the contribution of such people, the NEP proposes ideas of “peer-tutoring and trained volunteers” to support teachers to impart foundational literacy and numeracy skills to children in need of such skills.
    • While such efforts need to be applauded, they cannot be regarded as substitutes of the formal state apparatus.
    • Such a view also de-legitimises the teaching profession-associated qualifications and the training mandated by the state for people to become teachers.
    • Salaries and working conditions of the local community, most of whom are unemployed youth and women, are often compromised.
    • This is exploitation and needless to say, it also impacts the quality of education for the poor.

    2) Public-Private partnership and issues with it

    • On the second axis, is the position advocating partnerships between public and private bodies.
    • Not that the involvement of private individuals/organisations/schools in education is anything new in India.
    • However, in the past, private schools catered to the relatively better-off but now the poor are being targeted for profit.
    • This narrative is based on two sources: Poor learning outcomes of children, particularly those studying in government schools as reported by large scale assessment surveys, and large-scale absenteeism/dereliction of duty on the part of government school teachers.
    • Reasons for these are attributed to government school teachers having no accountability.
    • NEP 2020 also states that the non-governmental philanthropic organisations will be supported to build schools and alternative models of education will be encouraged by making their requirements for schools as mandated in the RTE less restrictive.
    • This is clearly problematic but convenient as the justification underlying this position is that one needs to shift focus from inputs to outputs.
    • This also indicate that schools can do with lesser financial resources, and compromised inputs may not necessarily lead to compromised outputs.
    • The nature of the partnership between public and private has also changed from the private supporting the public to private jostling for space with the public, even replacing them.
    • It’s a win-win situation for both — the state gets to spend less and private players make profit.

    Consider the question “Examine the impact of a covid pandemic on the education of the poor. Suggest the measure need to be taken by the government to mitigate the impact.”

    Conclusion

    While money may not ensure quality education, lack of adequate resources will only deepen the social divide between people.

  • MTP amendment Bill

    The article discusses the provision of the medical board in the MTP (Amendment) Act and issues with it.

    Proposal of medical board

    • The Medical Termination of Pregnancy (Amendment) Bill (‘MTP Bill’) passed in the Lok Sabha is scheduled to be tabled for consideration in Rajya Sabha.
    • The Act prescribes the setting up of medical boards in every state and Union territory (UT), consisting of a gynaecologist, paediatrician, radiologist or sonologist and any other members as proposed by that state or UT.
    • Each board will be responsible for diagnosing substantial foetal abnormalities that necessitate termination of pregnancy after a 24-week gestation period.
    • Medical boards are a form of third-party authorisation and were not envisaged in the MTP Act, 1971.

    Issues with the proposal

    • In the context of the current healthcare budgetary challenges, this proposal to set up infrastructure across the country to regulate medical termination of pregnancies is both financially unsound and practically impossible.
    • India’s healthcare system has neither the financial investment nor the infrastructure to sustain the operation and functioning of medical boards in every state and UT.
    • Due to the weak healthcare infrastructure in the country, it would be practically impossible to constitute these boards with the requisite specialists.
    • Even where they are set up, the accessibility of such boards for pregnant persons, especially those living in rural areas, remains a major challenge.
    • More importantly, subjecting people to multiple invasive examinations is a grave violation of their rights to privacy and dignity.
    • Requiring pregnant persons to navigate a bureaucratic web of authorisation will inevitably lead to delays and thereby impede access to safe and legal abortion services.

    Poor public financing and privatisation of healthcare

    • At 1.6 per cent of GDP in 2019-20 India’s current level of public financing of health is one of the lowest in the world
    • This has meant that most health expenditure in the country is out of pocket (OOP) — borne by patients themselves.
    • OOP expenditure on healthcare is recorded at 58.7 per cent as per the National Health Accounts in 2016-17.
    • The central government has preferred to incentivise private players to set up or offer services, instead of building infrastructural and professional capacity.
    • Privatisation drives up costs of care and the handing over of public facilities to the private sector can have catastrophic consequences.
    • They additionally remain non-accountable to state authorities in terms of affordability or transparency for instance, through Right to Information enquiries, or to uphold fundamental rights like non-discrimination in treatment or employment, or even the fundamental right to health.
    • The National Sample Survey Organisation (NSSO)’s 75th report shows that less than 20 per cent of the population is covered by health insurance in India.
    • According to the National Health Profile 2017, India has only one doctor for roughly 10,200 people in the public sector.

    Consider the question “Discsss the changes made by the Medical Termination of Pregnancy (Amendment) Bill and the challenges its provision could face.”

    Conclusion

    Poor public health infrastructure and absence of specialists across the country have meant that most abortions do not happen in the public sector, but at private centres or at home. With overwhelming shortfalls in specialist availability, especially in rural and scheduled areas, it would be impossible to constitute boards with requisite specialist representation as contemplated under the MTP Bill.

  • What is Immunity Passport?

    In a bid to ease travel restrictions amid the coronavirus pandemic, countries like Denmark, Estonia, Israel, Chile, UK have announced a new ‘immunity passport.’

    Try this question form mains:

    Q.Discuss various ethical issues evolved during the outbreaks of pandemics (of the scale of COVID-19).

    Immunity Passport

    • They are the recovery or release certificate or a document attesting that its bearer is immune to a contagious disease.
    • The concept has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economic recovery.
    • The can be used as a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease.

    Ethical issues involved

    • Issuing ‘immunity certificates’ to people who have recovered can be an ethical minefield.
    • Doctors do not generally prefer immunity to be induced by natural infection compared with vaccines. It seems logical, but there are multiple challenges.
    • There might be long-term health complications in those who had COVID-19, whereas the vaccine will have minimal or no adverse health consequences.
    • There is a danger that similar arguments will be made for other vaccine-preventable diseases for which we have a universal immunisation programme.

    Public health risk

    • People whose livelihood has have been affected would be encouraged to adopt risky behaviour so as to get infected rather than taking precautions to stay protected from the virus.
    • This would lead to a sharp increase in cases across the country with huge numbers requiring hospitalization.
    • Such a situation would lead to testing capabilities getting overwhelmed, crumbling of the health-care systems and increased deaths.

    Threats over malpractices

    • Immunity certification will include a system for identification and monitoring, thus compromising privacy.
    • Other contentious issues would be profiteering by private labs performing tests, and the menace of fake certificates which we have already seen in some Indian states.
    • In the end, an immunity passport will further divide the society with different ‘haves’ and ‘have-nots’.

    Way forward

    • We need to look at COVID-19 with a sense of balance and not hysteria.
    • Terms such as immunity passports may not have relevance as we do not know anything about specific kinds of immune responses and the duration of protection in people.
    • There is currently not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate’.
    • The permission to travel or work should be decided on a case by case basis, according to the principles of ethics while dealing with a pandemic.

  • First steps in India’s journey to universal health care

    The article highlights the issues with India’s approach in achieving universal health care and issues with it.

    Learning from the experience of Thailand

    • About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
    • What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
    • This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
    • This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.

    Budgetary allocations for health

    • The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
    • Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
    • ₹13,192 crore has been allocated as a Finance Commission grant.
    • These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.

    Two important and prominent arms of universal health coverage in India merit discussion here

    1) Insurance route for achieving universal health coverage and issues with it

    • The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
    • Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
    • However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
    • Beyond low allocations, poor budget reliability merits attention.
    • Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
    • Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
    • Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
    • Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
    • Finally, even high actual coverage should not be equated with effective financial protection.
    • For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.

    2) Comprehensive primary care

    • Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
    • Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
    • Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
    • Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
    • This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
    • This offers huge cost projections.
    • The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
    • Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
    • Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
    • Two untoward implications could result from under-investing and spreading funds too thinly.
    • Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
    • Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.

    Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?” 

    Conclusion

    COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.

  • FSSAI caps transfats in foods

    The FSSAI has amended its rules to put a cap on trans fatty acids (TFAs) in food products just weeks after it tightened the norms for oils and fats.

    What are the new rules?

    • Food products in which edible oils and fats are used as an ingredient shall not contain industrial Trans fatty acids more than 2% by mass of the total oils/fats present in the product, on and from 1st January 2022.
    • In December, the FSSAI had capped TFAs in oils and fats to 3% by 2021, and 2% by 2022 from the current levels of 5%.
    • The 2% cap is considered to be the elimination of trans fatty acids, which is to be achieved by 2022.

    What are Trans Fats?

    • Trans fatty acids are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid, increase the shelf life of food items and for use as an adulterant as they are cheap.
    • They are present in baked, fried and processed foods as well as adulterated ghee which becomes solid at room temperature.
    • They are the most harmful form of fats as they clog arteries and cause hypertension, heart attacks and other cardiovascular diseases.

    Why need such regulation?

    • As per the World Health Organisation (WHO), approximately 5.4 lakh deaths take place each year globally because of intake of industrially-produced trans-fatty acids.
    • The WHO has called for the elimination of industrially-produced trans-fatty acids from the global food supply by 2023.
    • The latest FSSAI rules signal the completion of the process of regulating trans fats in India.
    • The move will make a big difference in the health harm caused by this unwanted ingredient.
    • This allows FSSAI and the State-level food safety machinery to focus on implementation and enforcement of the WHO recommendations.