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

  • The unmet health challenge

    The article analyses the allocation for the health sector in the Budget and highlights the need for more allocations.

    Need to increase spending on health

    • The Economic Survey argues for the need to increase public spending on healthcare to 2.5-3 per cent of the GDP — it’s about 1.5 per cent currently.
    • The Survey points out that there is not much difference in terms of outcomes and quality between healthcare services in the private sector and such services in public centres.
    • The Economic Survey, therefore, calls for strengthening the National Health Mission (NHM) along with Ayushman Bharat.
    • NHM was initiated in 2005-06 to strengthen public health services.
    • The Ayushman Bharat provide social insurance, thereby financing private sector services with public funds. 
    • The Economic Survey makes a strong pitch for greater regulation of health services in the private sector.

    Break-up of allocation in Budget on health (and well being)

    • The finance minister described “health and well-being” as one of the pillars of the budget in her budget speech and announcing a 137 per cent increase in allocations for it.
    • She placed healthcare, water and sanitation and nutrition as the key components of this pillar.
    • However, the figures in the budget documents reveal a different story.
    • There is an absolute increase of 9.6 per cent in allocations for the Department of Health and Family Welfare that includes NHM and Ayushman Bharat.
    • A 26.8 per cent increase for the Department of Health Research and 40 per cent increase for the AYUSH Ministry do not add up to much since each of them are only 3-4 per cent of the total health budget.
    • A Finance Commission grant of Rs 13,000-crore and Rs 35,000-crore for COVID-19 vaccination are one-time allocations and, therefore, do not strengthen the overall system.
    • The core health service and research ministries (H&FW and AYUSH) have together received only an 11 per cent increase.
    • Even in COVID times, the health services get only 2.21 per cent of the total central budget — down from 2.27 per cent in the 2020-21 budget.
    • Computing for inflation, the increase in allocation for health services alone disappears and actually becomes negative.
    • Water and sanitation received a 179 per cent increase from Rs 21,518 crore to Rs 60,030 crore already earmarked for the flagship schemes, Swachh Bharat and Jal Jeevan Mission.
    • But allocation for nutrition decreased by 27 per cent, with the “new” Poshan 2.0 merely combining the poorly performing Supplementary Nutrition Programme and Poshan project.
    • Added together, health, water and sanitation and nutrition make up the claimed 137 per cent increase in allocation to “health” services — with a real decline in healthcare and nutrition.

    Pradhan Mantri Atma Nirbhar Swasthya Yojana (PMANSY)

    • Finance Minister also announced a new scheme, the Pradhan Mantri Atma Nirbhar Swasthya Yojana, to support the almost 29,000 health and wellness centres in the country.
    • The scheme also envisages the creation of public health laboratories and critical care hospital blocks and virology institutes.

    Concerns with PMANSY

    • PMANSY has an announced allocation of Rs 64,180 crore over six years, but it does not find a place in the present budget documents.
    • But these additional activities could have been slotted in the NHM.
    • Since 2014, the allocation for NHM has been on the wane.
    • Therefore, even the marginal 1.33 per cent increase (from Rs 27,039 crore to Rs 30,100 crore) is a demonstration of the government’s realisation that public services do matter.
    • The allocations of about Rs 10,000-Rs 11,000 crore each year for the PMANSY is not enough for making the public services capable of “universal health coverage”.
    • The High-Level Expert Group on Universal Health Coverage had estimated that by 2020, we need a 114 per cent increase in sub-centres and primary health centres, 179 per cent increase in community health centres and a 230 per cent increase in sub-district and district hospitals.
    • Getting anywhere close to this requires doubling of real allocations every year over a five-year period to reach something like 10 per cent of the budget.
    • In the present budget, it declines to a mere 2.21 per cent.

    Way forward

    • If such public provisioning for universal health coverage can’t be done, then effective low-cost rationalised service system options have to be designed.
    • Insurance schemes only create the mirage of affordability of health services while adding to peoples’ expenses.
    • Community and public services are indisputably the most cost-effective for any society.

    Consider the question “Examine the benefits of the idea of health and well being under which health, water and sanitation and nutrition are clubbed together.”

    Conclusion

    Water and sanitation are meaningful for health, but not if it only inflates the allocation to “Health and Wellbeing”. What we need is the real increase in spending on health.

  • Building a robust healthcare system

    The article focuses on the wide variation across the state in terms of the important health parameters and suggests prioritising health.

    Variation across the states

    • The efficacy of the public health system varies widely across the country since it is a State subject.
    • Public health system can be judged just by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate.
    • In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala. In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63.
    • The northern States are performing very poorly in these vital health parameters.
    • The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
    • Since health is a State subject, the primary onus lies with the State governments.
    • Each State government must focus on public health and aim to improve the health indicators mentioned above.
    • Unless all the States perform well, there will be no dramatic improvement in the health system.

    Steps needed to be taken

    • The governments — both at the Centre and the Empowered Action Group States — should realise that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.
    • The Government of India has a vital role to play.
    • Public and preventive health should be his focus by holding the Empowered Action Group States accountable to the SDGs.
    • They must be asked to reach the levels of the southern States within three to five years.
    • An important measure that can make a difference is a public health set-up in these States that addresses primary and preventive health.

    Conclusion

    Unless we invest in human capital, FDI will not help.  Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.

  • What is Herd Immunity?

    The initial findings of the fifth round of serological survey conducted in Delhi suggest that over 56 percent of the people have developed antibodies against Covid-19 implying achievement of herd immunity.

    Herd Immunity

    • Herd immunity is when a large number of people are vaccinated against a disease, lowering the chances of others being infected by it.
    • When a sufficient percentage of a population is vaccinated, it slows the spread of disease.
    • It is also referred to as community immunity or herd protection.
    • The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission.
    • The approach requires those exposed to the virus to build natural immunity and stop the human-to-human transmission. This will subsequently halt its spread.

    Sero-surveys in Delhi

    • The results of the latest serosurvey in Delhi have led researchers and experts to surmise that a large section of the city’s population has already developed antibodies against Covid-19.
    • The presence of antibodies among a large percentage of the population could be a reason for the decline in the daily number of Covid-19 cases.
    • As more people are able to resist infection, it will help to break the chain of transmission of the virus.
    • Five serological surveys have been carried out in Delhi so far, including the present one, which was conducted in January.
    • The survey conducted by NCDC in July last year suggested the presence of antibodies in 23 percent of those surveyed.
    • In August, the survey conducted by the Delhi government showed 29.1 percent had antibodies.

    The relevance of such surveys

    • Carrying out repeated serological surveillance on the same population gives an idea of how the disease is behaving.
    • It is always good to have surveillance regularly to understand the trends.
    • Having robust surveillance is always beneficial, it may not be too close, but it may help us in giving an idea, even of the natural history of the disease.

    What do the data suggest about herd immunity?

    • Many researchers believe that if 60 percent or more of the population has developed antibodies against Covid-19, there is a possibility of acquiring herd immunity.
    • In Delhi, it is quite indicative, as the number of cases is also going down. This shows that we are moving closer towards acquiring herd immunity.

  • Ayushman Bharat for CAPFs

    Union Home Minister has rolled out the ‘Ayushman CAPF’ scheme, extending the benefit of the central health insurance programme to the personnel of all Central Armed Police Forces (CAPFs) in the country.

    Who are the CAPFs?

    • The CAPFs refers to uniform nomenclature of five security forces in India under the authority of the Ministry of Home Affairs.
    • Their role is to defend the national interest mainly against the internal threats.
    • They are the Border Security Force (BSF), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), Indo-Tibetan Border Police (ITBP), Sashastra Seema Bal (SSB)

    Ayushman CAPF

    • Under this scheme, around 28 lakh personnel of CAPF, Assam Rifles and National Security Guard (NSG) and their families will be covered by ‘Ayushman Bharat: PM Jan Arogya Yojana’ (AB PM-JAY).
    • For the CAPF, the existing health coverage was not comprehensive as compared to other military forces.

    Do you know?

    The goal of universal health coverage (UHC) as stated in the UN Sustainable Development Goals (SDGs no. 3) is one of the most significant commitments to equitable quality healthcare for all.

    About Ayushman Bharat

    • PM-JAY aims to provide free access to healthcare for 40% of people in the country.
    • It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
    • It was launched in September 2018 by the Ministry of Health and Family Welfare.
    • The ministry has later established the National Health Authority as an organization to administer the program.

    Key features:

    • Providing health coverage for 10 crores households or 50 crores Indians.
    • It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
    • Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
    • Using criteria from the Socio-Economic and Caste Census 2011 to determine eligibility for benefits.
    • There is no restriction on family size, age or gender.
    • All previous medical conditions are covered under the scheme.
    • It covers 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostic care and expenses on medicines.
    • The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.

    Note these features. They cannot be memorized all of sudden but can be recognized if a tricky MCQ comes in the prelims.

    Must read:

    [Burning Issue] Ayushmaan Bharat

  • Problem of control and governance of knowledge in a globalised world

    The article highlights the issues with the criteria applied by the UGC to evaluate the faculty research.

    Impact of UGC standardisation on social sciences and humanities research

    • UGC has been the regulatory body responsible for maintaining standards in higher education, while addressing challenges of globalisation.
    • Processes of UGC mandated standardisation have in particular impacted social sciences and humanities research in Indian universities.
    • Over the years, UGC has linked institutional funding to ranking and accreditation systems like NAAC and NIRF.
    • In order to evaluate institutions, these bodies have evolved  criteria, which rank universities based on faculty research measured by citations in global journal databases like SCOPUS.
    • In comparison, importance granted to research outputs like books or other forms is declining.

    Issues with the criteria

    • The insistence of publication in journals fails to distinguish between the varied trajectory of disciplines.
    • While in STEM (Science, Technology, Engineering, Management) disciplines, research is often highly objective and quantified.
    • In social sciences and humanities research is subjective, analytical and argumentative.
    • In disciplines like history, sociology, politics, philosophy, psychology and literature, researchers spend years writing books that engage with ideas in complex ways.
    • In devaluing books as authentic forms of research, UGC does major disservice to scholars of social sciences and humanities.
    • Due to emphasis on publication, teachers spend most of their productive time writing articles and getting them published, thereby missing out on quality engagement with pedagogy and research.

    Issues with the process of peer review

    • The process of peer review itself is subjective, and depends upon the knowledge, inclination and availability of time of the particular reviewer.
    • It is often quite challenging for scholars to meet peer-review standards of A-listed journals.
    • This has actually required the UGC to expand its own list, ending up including and subsequently deleting a large number of locally published journals.

    Issue of inaccessibility

    • Publication of research in paywalled journal databases makes research inaccessible for students as universities continue to cut down library budgets.
    • Students and teachers, access articles through pirated sites like Libgen and Scihub, prone to be shut down at any point of time as evident from the litigations.
    • Clearly, access to knowledge is structurally made inequitable in favour of the elite and/or moneyed institutions and their constituents.

    Way forward

    • The above arguments maintain for the possible multiplicity that can emerge as the end-result of research.
    • Interdisciplinary and practice-based research can throw up social and ecological experiments, artworks and performances, and numerous new outcomes yet to be conceived as research outputs.
    • While the UGC hopes to raise the standards to global levels, precarity of employment, longer teaching hours, a dismal student-teacher ratio, lack of sabbaticals, research and travel grants, access to research facilities and office space, adversely impact the research potential of teachers.
    • Regulating research needs to be replaced with facilitating research, allowing minds to think and gestate.
    • Regulations without facilitation will merely bureaucratise the governance of knowledge without generating any pathbreaking insights.

    Conclusion

    The UGC needs to widen its criteria which values publication of a book as much as a research paper in the mandated journal to widen the research in social sciences and humanities.

  • Covid-19 vaccine policy

    The article explains the challenge in the vaccination program for the Covid-19 vaccine.

    Issue of lack of data about the vaccine

    • In the COVID vaccine roll out, there is no clear data for either of the two vaccines proposed for use in the programme.
    • We do not know if they provide protection for life, for a year or six months, its efficacy among the elderly or the very sick or in stopping new infections.
    • Getting such data requires at least three years and cannot be obtained in a few months.

    Guidelines for implementing vaccine programme

    • Given these limitations, the government has drawn up strategic guidelines for implementing an vaccine programme covering 30 crore people by July.
    • The guidelines draw upon the knowledge of running national campaigns acquired over three decades of implementing the Universal Immunisation Programme.
    • These guidelines detail the skills, roles and responsibilities of the required human resources, logistics for delivering vaccines at point of use, physical infrastructure, monitoring systems based on digital platforms and feedback systems for reporting adverse events.
    • The approach involves 19 departments, donor organisations and NGOs at the national, state, district and block level.
    • The guidelines also mention the priority criteria — caregivers, front line workers of the departments of health, defence, municipalities and transportation; persons above the age of 50 and those below 50 having diabetes, hypertension, cancers and lung diseases.

    Issues with the guidelines

    • Of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat.
    • Combined with poor human resources — doctors, nurses, pharmacists — a weak private sector, poor safety and hygiene standards, frequent power outages, poor infrastructure, the capacity to implement with the expected speed, quality and accuracy is daunting.
    • The immunisation can disrupt routine health service delivery — antenatal care, national programmes like those pertaining to TB or other immunisation drives.
    • While data for the above-50-year-olds is available in the electoral rolls, line listing of the under 50s with comorbidities can be challenging.
    • Not only are urban-rural variations substantial, but urban areas have weak public health infrastructure and a multiple number of private providers due to the poor implementation of the Clinical Establishment Act, 2010.
    • Patient tracking can be problematic.
    • The non-availability of efficacy data could also impact the procurement and supply of vaccines, result in huge wastage, and can introduce scope for errors and duplication.

    Way forward

    • Central to the success of the roll out will be the confidence of the people in the vaccines.
    • Coming out of this messy situation is necessary and one option — as adopted for the polio eradication programme — is to establish an independent team of experts under the aegis of the WHO to ensure the safety of the vaccine.
    • This will create confidence in the community and international authorities as well.

    Conclusion

    it is important to understand that vaccination is an incomplete solution to ending the epidemic, since the virus is mutating. Adopting safe behaviour is.

  • India’s burden of heart diseases

    According to the Global Burden of Disease, nearly a quarter (24.8 per cent) of all deaths in India is due to cardiovascular diseases (CVDs).

    The fastest-growing economy has some perils. In this newscard, you will get to see how CVDs are a legacy of economic growth.

    Global Burden of Disease (GBD) Report

    • The GBD is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors.
    • GBD is a collaboration of over 3600 researchers from 145 countries.
    • It is based out of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and funded by the Bill and Melinda Gates Foundation.

    Indian burden of CVDs

    • About a third of the senior citizens have been diagnosed with hypertension, 5.2% with chronic heart disease and 2.7% with stroke
    • Even an analysis of the medical certification of cause of death (MCCD) reports points to an increase in the proportion of deaths due to CVD. It went from 20.4 per cent in 1990 to 27.1 per cent in 2004.
    • According to MCCD report, 2018, CVDs accounted for more than half (57%) of the total deaths in the age group of 25–69 years.
    • Case fatality due to CVD in low-income countries, including India, appears to be much higher than in middle and high-income countries.
    • In India, for example, the mean age at which people get the first myocardial infarction is 53 years, which is about 10 years earlier than their counterparts in developed countries.
    • About a third (32 per cent) of the senior citizens have been diagnosed with hypertension, 5.2 per cent were diagnosed with chronic heart disease and 2.7 per cent with stroke.

    Women are more vulnerable

    • Numerous studies have also pointed out that CVD remains the number-one threat to women’s health as more women than men die annually due to these diseases.
    • A Harvard study shows low high-density lipoproteins and high triglycerides appear are the main factors that increase the chances of death from cardiovascular disease in women over age 65.
    • As per the LASI report, gender differences were evident in cross-state variations.
    • CVD among men was higher in Kerala (45 per cent), Goa (44 per cent), Andaman and Nicobar (41 per cent) and lower in Chhattisgarh (15 per cent), Meghalaya (16 per cent), Nagaland (17 per cent).

    Why CVDs are prevalent in India?

    • Epidemiological evidence suggests that CVD is associated with behavioural factors such as smoking, alcohol use, low physical activity, and insufficient vegetable and fruit intake.
    • In the Indian context, poverty, maternal malnutrition, and early life changes enhance an individual’s risk of CVDs.
    • Rural to urban migration that happens in distress leads to over-crowded and unclean environments in urban slums.
    • Problems of inadequate housing, indoor pollution, infectious diseases, inappropriate diet, stress and smoking crop up as a result.

    Need of the hour

    • CVD-risk prevention is one of the important priorities among India’s sustainable development goals.
    • In an earlier estimate, WHO had said with India’s present CVD burden, the country would lose $237 billion from the loss of productivity and spending on healthcare over 10 years (2005–2015).
    • This is because the diseases affect the country’s working population.

    Way ahead

    • The government should devise an approach that can improve the efficiency of care and health system preparedness to curb the CVD epidemic currently sweeping India.
    • Attempts in direction to preserve the traditional lifestyle are also necessary.

  • [pib] Longitudinal Ageing Study of India (LASI)

    The Union Minister for Health & Family Welfare has released INDIA REPORT on Longitudinal Ageing Study of India (LASI) Wave-1.

    Discuss various issues pertaining to old-age care in India.

    Longitudinal Ageing Study of India (LASI)

    • LASI is a full–scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India.
    • The LASI, Wave 1 covered a baseline sample of 72,250 individuals aged 45 and above till the oldest-old persons aged 75 and above from all States and UTs of India (excluding Sikkim).
    • It is India’s first and the world’s largest ever survey that provides a longitudinal database for designing policies and programmes for the older population in the broad domains of social, health, and economic well-being.
    • The evidence from LASI will be used to further strengthen and broaden the scope of National Programme for Health Care of the Elderly.
    • It would also help in establishing a range of preventive and health care programmes for older population and most vulnerable among them.

    Why need such survey?

    • In 2011 census, the 60+ population accounted for 8.6% of India’s population, accounting for 103 million elderly people.
    • Growing at around 3% annually, the number of elderly age population will rise to 319 million in 2050.
    • 75% of the elderly people suffer from one or the other chronic disease.
    • 40% of the elderly people have one or the other disability and 20% have issues related to mental health.
    • This report will provide base for national and state level programmes and policies for elderly population.

  • Need to focus on the well-being of the child from womb to first five years

    The article analyses the data of NHFS-5 and try to factors responsible for the outcomes.

    Analysing health and nutrition of child through NHFS-5

    • The recently released fifth round of the National Family Health Survey (NFHS-5) provide insights into some dimensions of micro-development performance before COVID struck.
    • The latest round only has data for 17 states and five Union territories.
    • Madhya Pradesh, Uttar Pradesh, Punjab, Rajasthan and Tamil Nadu are notable exclusions.
    • Many of the child-related outcomes are also determined by state-level implementation, therefore neither success nor failure can be attributed to state or the centre alone.

    Let’s understand the data

    • The NFHS has 42 indicators related to child’s health and nutrition.
    • Indicators fall into nine categories and each of these can be divided into outcomes and inputs.
    • For example, neonatal, infant and under-5 mortality rates can be thought of as outcomes.
    • Similarly, all the nutrition indicators —stunting, wastage, excess wastage, underweight and overweight can also be classified as outcomes.
    • In contrast, the post-natal care indicators relating to visits made by health workers and the extent and nature of feeding for the child can be classified as inputs.

    Outcomes of the survey

    • On the front of wasting (weight for height of children) these is an improvement because even though the gains were marginal, they reversed a negative trend between 2005 and 2015. 
    • India continues to be successful in preventing child deaths, but the health and nutrition of the surviving, living child has deteriorated, somewhat worryingly.
    • India continued to make progress in preventing child-related deaths (neonatal, infants and under-5).
    • The pace of improvement in child mortality slowed down relative to the previous 10 years (Fig.1).
    • Figure 2 shows the six indicators where outcomes have deteriorated. These all relate to what happens after survival:
    • The health (anaemia, diarrhoea, and acute respiratory illness (ARI)) and nutrition (stunting, and overweight) of the child deteriorated between 2015 and 2019.
    • The absolute deterioration in health and nutrition indicators must be seen against the fact that they reversed the historic trends of steady improvements.

    What explains the outcomes

    • Implementation capacity of individual states probably played an important role.
    • Sector-specific factors such as changing diets are also implicated.
    • A broader deterioration in outcomes hints at the likelihood of a common factor, namely the macro-economic growth environment, which determines employment, incomes and opportunities.
    • At the least, it is safe to conjecture that some of these outcomes are inconsistent with the narrative of a rapidly growing economy.

    Conclusion

    As discussed in Chapter 5 of the Economic Survey of 2015-16, perhaps the next big welfare initiative of the government should be a mission-mode focus on the well-being of the early child (and of course the mother), from the womb to the first five years, which research shows is critical for realising its long run potential as an individual.

  • School Bag Policy, 2020

    The Directorate of Education has issued a circular asking school to follow the new ‘School Bag Policy, 2020’ released by the National Council of Educational Research and Training (NCERT).

    Q.What are the features of the School Bag Policy, 2020? Discuss how heavy school bags are a serious threat to the health and learning capability of students.

    School Bag Policy, 2020

    • According to the circular, schoolteachers should inform the students in advance about the books and notebooks to be brought to school on a particular day.
    • They frequently need to check their bags to ensure that they are not carrying unnecessary material.
    • It adds that the teachers should take the responsibility of checking the weight of school bags of the students every three months on a day selected for the whole class.
    • It also holds that any information about heavy bags should be communicated to the parents.
    • The circular also says that it is the duty and the responsibility of the school management to provide quality potable water in sufficient quantity.
    • It adds that files and thin/light exercise books should be preferred to thick/heavy ones.

    Prescribed weights

    The weight of the school bags, as per the policy, should be

    • 6 to 2.2 kg for students of Classes I and II
    • 7 to 2.5 kg for Classes III, IV and V
    • 2 to 3 kg for Classes VI and VII
    • 5 to 4 kg for Class VIII
    • 5 to 4.5 kg for Classes IX and X
    • 5 to 5 kg for Classes XI and XII

    Why heavy school bags are a curse?

    • Heavy school bags are a serious threat to the health and well-being of students.
    • A heavy backpack can pull on the neck muscles contributing to headache, shoulder pain, lower back pain and neck and arm pain.
    • Not just this, carrying backpacks over one shoulder is a wrong practice as it makes muscles strain.
    • The spine leans to the opposite side, stressing the middle back, ribs, and lower back more on one side than the other and this muscle imbalance can cause muscle strain, muscle spasm, and back pain.
    • Heavy school bags are also one of the major reasons for cervical and lumbar pains.
    • The posture of the body also gets affected to a great extent which in the long term develops imbalances in the body and affects the health of the nervous system.