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

  • FSSAI slashes limit for Trans Fats level in food

    The Food Safety and Standards Authority of India (FSSAI) has capped the amount of trans fatty acids (TFA) in oils and fats to 3% for 2021 and 2% by 2022 from the current permissible limit of 5%.

    New FSSAI norms

    • FSSAI has acted in response to the amendment to the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations.
    • The country’s food regulatory body notified the amendment on December 29, more than a year after it issued a draft on the subject for consultation with stakeholders.
    • The revised regulation applies to edible refined oils, vanaspati (partially hydrogenated oils), margarine, bakery shortenings, and other mediums of cooking such as vegetable fat spreads and mixed fat spreads.
    • It was in 2011 that India first passed a regulation that set a TFA limit of 10% in oils and fats, which was further reduced to 5% in 2015.

    What are Trans Fats?

    • Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
    • Since they are easy to use, inexpensive to produce and last a long time, and give foods a desirable taste and texture, they are still widely used despite their harmful effects being well-known.

    Why such a regulation?

    • Trans fats are associated with increased risk of heart attacks and death from coronary heart disease.
    • As per the WHO, approximately 5.4 lakh deaths take place each year globally because of intake of industrially-produced trans-fatty acids.
    • The WHO has also called for global elimination of trans fats by 2023.

  • Issues with NEP’s regulatory architecture

    The article deals with the idea of single regulator for higher education in the country and the challenges it could fece.

    Recommendations for regulation of higher education

    • Regulatory bodies came up in response to the rapid growth of private participation since the 1980s.
    • Due to multiplicity of regulatory bodies in higher education, nearly all advisory panels appointed since 2005 have been asked for a single regulator.
    • National Knowledge Commission (NKC) concluded in 2007 that the plethora of agencies attempting to control entry, operation, intake, price, size, output and exit had rendered the regulation of higher education ineffectual.
    • The NKC recommended the setting up of an overarching Independent Regulatory Authority in Higher Education (IRAHE).
    • A major concern of the Yash Pal Committee constituted in 2009 was compartmentalisation of academia.
    • To promote such a dialogue, the Yash Pal committee recommended the creation of an apex body called the National Commission for Higher Education and Research (NCHER).
    • TSR Subramanian committee in 2016 proposed an Act for setting up an Indian Regulatory Authority for Higher Education (IRAHE) to subsume all existing regulatory bodies in higher education.
    • The draft national policy presented by the Kasturirangan Committee in 2019 proposed a National Higher Education Regulatory Authority (NHERA) as a common regulatory regime for entire higher education sector.
    • The draft NEP 2020 proposed a Rashtriya Shiksha Aayog (RSA) to coordinate, direct and address inter-institutional overlaps and conflicts.

    The regulatory regime under NEP 2020

    • NEP 2020 has now a single regulator for all higher education barring medical and law education.
    • It envisages an overarching Higher Education Commission of India (HECI), with four independent verticals comprising the National Higher Education Regulatory Council (NHERC), the National Accreditation Council (NAC), the Higher Education Grants Council (HEGC) and the General Education Council (GEC).
    •  The University Grants Commission (UGC) is to become HEGC while the other regulatory bodies will become professional standard setters.

    Fragmented regulation of medical education to continue

    • NEP-2020 provides for separate regulation for medical education.
    • But it envisions healthcare education as an inter-disciplinary system.[Allopathic student to have a basic understanding of Ayurveda, Yoga etc and vice-versa]
    • Multiple regulators in health education include the National Commission for Homoeopathy (NCH) and the National Commission for Indian System of Medicine (NCISM) and continuation of the Dental Council of India (DCI), Pharmacy Council of India (PCI) and the Indian Nursing Council (INC),
    • Thus, making medical education inter-disciplinary would be difficult due to multiple regulators.

    Lessons from the governance of medical education

    • The above example demonstrate the difficulty in designing a single regulatory framework to take care of the domain-specific needs of even within healthcare education.
    • But if accepted as a principle, it has the potential to delay, if not derail, the idea of a single regulator.
    • And should that actually happen, the idea of reining in the regulators might mean abandoning the idea of regulation of regulators.

    Issues with the single regulator proposed in NEP 2020

    • The regulatory architecture proposed in the NEP is far too monolithic for a system of higher education serving a geographically, culturally and politically diverse country like ours.
    • Even in the matter of privatisation, there is enormous diversity of players and practices.
    • Historically too, private participation in the running of colleges has not followed a single pattern.
    • To imagine that a uniform structure called Board of Governors can serve all different kinds of institutions across the country is flawed.
    • Such a vision calls for better appreciation of what exists, no matter how worrisome a condition it is in.

    Consider the question “What are the challenges in the regulation of higher education in the country? What are the concerns with the idea of single regulator for the regualtion of higher education in country?”

    Conclusion

    Before proceeding with the single regulator, the government need to pay attention to the issue of diversity in various aspects in the country.

  • Burden of Anaemia in India

    Indian women and children are overwhelmingly anaemic, according to the National Family Health Survey (NFHS) 2019-20 released this month, and the condition is the most prevalent in the Himalayan cold desert.

    Anaemia is the condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. How widespread is it in India?

    What is Anaemia?

    • The condition of having a lower-than-normal number of red blood cells or a quantity of haemoglobin. It can make one feel tired, cold, dizzy, and irritable, and short of breath, among other symptoms.
    • A diet that does not contain enough iron, folic acid, or vitamin B12 is a common cause of anaemia.
    • Some other conditions that may lead to anaemia include pregnancy, heavy periods, blood disorders or cancer, inherited disorders, and infectious diseases.

    How widespread is anaemia in our country?

    • In Phase I of the NHFS, result factsheets have been released for 22 states and UTs.
    • In a majority of these states and UTs, more than half the children and women were found to be anaemic.
    • In 15 of these 22 states and UTs, more than half the children are anaemic. Similarly, more than 50 percent of women are anaemic in 14 of these states and UTs.
    • The proportion of anaemic children and women is comparatively lower in Lakshadweep, Kerala, Meghalaya, Manipur, Mizoram, and Nagaland.
    • However, it is higher in Ladakh, Gujarat, J&K, and West Bengal, among others.
    • Anaemia among men was less than 30 percent in a majority of these states and UTs.

    What was the methodology used?

    • NFHS used the capillary blood of the respondents for the estimation of anaemia. For children, haemoglobin of fewer than 11 grams per decilitre (g/dl) indicated anaemia.
    • For non-pregnant and pregnant women, it was less than 12 g/dl and 11g/dl respectively, and for men, it was less than 13 g/dl.
    • Among children, the prevalence was adjusted for altitude and among adults, it was adjusted for altitude and smoking status.

    Why is anaemia so high in the country?

    • Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
    • Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
    • Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.

    What about the cold desert region of the western Himalaya?

    • In the union territory of Ladakh, a whopping 92.5 per cent children, 92.8 per cent women, and around 76 per cent men are anaemic in the given age groups, as per the survey.
    • The high prevalence in this region could be due to the short supply of fresh vegetables and fruits during the long winter each year.
    • Crops here are generally only grown in summer and during winter; residents fail to get a regular supply of green vegetables and fresh produce from outside, due to restricted connectivity in harsh weather.
    • However, there could be other factors as well and the causes of anaemia here are yet to be scientifically ascertained.

  • [pib] PM-JAY SEHAT

    The Prime Minister has launched Ayushman Bharat PM-JAY SEHAT to extend coverage to all residents of Jammu & Kashmir.

    Q.Discuss various challenges in ensuring Universal Healthcare in India. (150W)

    PM-JAY SEHAT

    • The full form of SEHAT is social, endeavor for health, and telemedicine. Under this scheme, the SEHAT card will be distributed to all the eligible beneficiaries.
    • All the eligible beneficiaries of Jammu and Kashmir can apply for the Scheme through common service center operators
    • Around 1 crore beneficiaries will cover under this scheme. All the eligible citizens of Jammu and Kashmir will get cashless treatment up to Rs 5 lakh under the Scheme.

  • Governance reforms in central universities

    Central Universities need reforms in their Governing Councils to make them realise their potential.

    Central Universities in the need of reforms

    • There are 55 central universities.
    • These are endowed with prime land, extensive funding from the central government and there is a long line of students waiting to get in.
    • However, they are in turmoil. In recent years, six vice-chancellors (VCs) of central universities have been sacked.
    • Some of these institutions have seen their glory days, yet increasingly, the energy is going out of the system.
    • However, not a single new private university has so far been able to create a true broad-based Vishwa Vidyalaya with the full range of humanities, social and natural sciences, and professional disciplines.
    • Therefore, to save academia in India, central universities must be saved.

    Organizational structure

    • Each of the 55 central universities is governed by a separate Act. but the broad structure is as follows.
    • The Visitor of the university is the President of India.
    • On his behalf, the Ministry of Education recommends an eminent citizen as the chancellor, whose role is mostly ceremonial.
    • The Ministry also constitutes a search committee for the post of VC, which comes up with a list of 3 candidates.
    • From this list, the government picks a VC.
    • Separately, and through a different process, the governing council (GC) is chosen.
    • The governing council (GC) of the university usually have nominees from various stakeholders, including the government, faculty, students, and citizens.
    • The university’s work is carried out by the executive council chaired by the VC, who also appoints the registrar.
    • A separate finance committee is constituted, headed by a chief finance officer, who is often a civil servant on secondment to the university.
    • This arrangement is designed to maintain financial checks and balances.

    Issues with the governance

    • The GC has no say in the selection of the VC.
    • The GC typically meets only once a year and its size is usually very large.[Delhi University has 475 members]
    • In theory, the VC presents and gets approval for the annual plan of the university from the GC.
    • In practice, after much grandstanding on both sides, the plan is rubberstamped.
    • After that, throughout the year, there is the minimal direction or monitoring from the GC, which may or may not meet again.
    • There are typically no quarterly updates, and there is little oversight.
    • Under the circumstances, the high number of failures should not come as a surprise, since effectively, there is minimal governance.

    Comparing with provisions in IIM Bill

    • The new IIM Bill very sensibly limits the GC to at most 19 members.
    • They are expected to be eminent citizens, with broad social representation and an emphasis on alumni.
    • This GC chooses the director, provides overall strategic direction, raises resources, and continuously monitors his or her performance.
    • Within the guidelines provided by the GC, the director has full autonomy but also full accountability.

    Way forward

    • The governing councils of all central universities, IITs, and all other central institutions, need to be restructured by an Act of Parliament.
    • The most eminent alumni of these institutions must be brought on their boards.
    • The dynamism and exposure that these alumni bring to the table will promptly lead to world-class innovations.

    Conclusion

    To allow central universities, the IITs and other public institutions to truly blossom, we need to reform their Governance. There is no time to waste.

  • Scheduled Castes Post-matric Scholarship Plan

    The Cabinet Committee on Economic Affairs has approved changes to the post-matric scholarship scheme for students from the Scheduled Castes (SCs), including a new funding pattern of 60-40 for the Centre and States.

    Note:

    Equality enshrined in the Constitution is not mathematical equality and does not mean all citizens will be treated alike without any distinction.

    To this effect, the Constitution underlines two distinct aspects which together form the essence of equality law:

    1) Non-discrimination among equals, and

    2) Affirmative action to equalize the unequal

    About the Scholarship

    • It is a Centrally Sponsored Scheme and implemented through State Government and UT administration.
    • Under the scheme, the government provides financial assistance to students from SCs for higher education at post-matriculation and post-senior-secondary stages, which means Class XI onwards.
    • It can be availed by those, whose household incomes are less than Rs 2.5 lakh annually.

    What are the new changes?

    • States would carry out verification of the students’ eligibility and caste status and collect their Aadhaar and bank account details.
    • Transfer of financial assistance to the students under the scheme shall be on DBT [direct benefit transfer] mode, and preferably using the Aadhaar Enabled Payment System.
    • Starting from 2021-22, the Central share [60%] in the scheme would be released on DBT mode directly into the bank accounts of the students as per a fixed time schedule.

    Why such changes now?

    • The changes were aimed at enabling four crore students to access higher education over the next five years.
    • Switching from the existing “committed liability” formula, the new funding pattern would increase the Centre’s involvement in the scheme.

    Benefits of the scheme

    • The changes approved by the Cabinet were aimed at enrolling the poorest students, ensuring timely payments, and maintaining accountability.
    • An estimated 1.36 crore students who would otherwise drop out after Class 10 would be brought into the higher education system under the scheme in five years.

  • Dominance of Private healthcare in India & Related issues

    • Lack of resources such as 1:1,700, doctor: citizen ratio, well below the minimum ratio of 1:1,000 stipulated by WHO.

    • Rural areas and smaller towns of India are the worst sufferers, where even basic health services remain inaccessible, many cases were reported where ward boys and alone found running the primary healthcare center.

    • Inadequate government spending on healthcare and lack of access to health insurance to a large section of society.

    • The quality of public health services in India continues to remain below expectations which hamper the economic growth of the country.

    • Government’s inability to build sufficient capacity and infrastructure, difficulty in reaching out to poor and vulnerable groups.

    • An undersized skilled workforce and the absence of upgraded technology is a major challenge in the health sector.

  • [pib] PM Special Scholarship Scheme (PMSSS)

    The Prime Minister’s Special Scholarship Scheme (PMSSS) instalment has been released to support J&K and Ladakh students.

    Tap to read more about: Reorganization of J&K

    About PMSSS

    • The PMSSS aims to build the capacities of the youths of J&K and Ladakh by educating, enabling and empowering them to compete in the normal course.
    • Under the Scheme, the youths of J&K and Ladakh are supported by way of scholarship in two parts namely the academic fee & maintenance allowance.
    • The academic fee is paid to the institution where the student is provided admission after on-line counselling process conducted by the AICTE (All India Council for Technical Education).
    • The academic fee covers tuition fee and other components as per the ceiling fixed for various professional, medical and other under-graduate courses.
    • In order to meet the expenditure towards hostel accommodation, mess expenses, books & stationery etc., a fixed amount of Rs.1.00 Lakh is provided to the beneficiary and is paid in instalments of Rs. 10,000/- pm directly into students account.

  • [pib] Vision 2035: Public Health Surveillance in India

    NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

    Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

    Vision 2035 for PHS

    • It is a continuation of the work on health systems strengthening.
    • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
    • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

    Let’s have a look at the executive summary of the vision document:

    PHS in India

    • Surveillance is an important Public Health function.
    • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

    Why need PHS?

    • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
    • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
    • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
    • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
    • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
    • This ensured that there was a comprehensive tracking of the pandemic.

    Highlights of the vision document

    • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
    • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
    • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
    • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
    • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

    Gap areas in India’s PHS that could be addressed

    • India can create a skilled and strong health workforce dedicated to surveillance activities.
    • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
    • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
    • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
    • PHS could be integrated within India’s three-tiered health system.
    • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
    • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

    Moving ahead

    • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Identify broad disease categories that will be included under PHS.
    • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
    • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
    • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
    • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
    • Encourage innovations at every step-in surveillance activity.

  • Standards must not be lowered to certify Ayurveda postgraduates surgeons

    This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

    Practice Question: There is a need to rethink on the recent notification of AYUSH Ministry allowing Ayurveda postgraduates to conduct surgeries keeping the safety of the patient at the centre. Discuss.

    The current clash

    • The clash between the allopathic and AYUSH fraternities is about the AYUSH practitioners’ “right” to conduct surgeries.
    • The Ayurvedic fraternity maintains postgraduates in Shalya and Shalakya (two surgical streams among 14 post-graduate courses) are taught procedures listed in the curriculum.
    • The oldest-known surgical specialist was, in fact, an Ayurvedic surgeon/sage Sushrut (600 BC) who wrote the Sushrut Samhita — a profound exposition on conducting human surgery which continues to receive worldwide acclaim.
    • Surgery was practised by Ayurvedic surgeons long before the advent of western medicine.
    • Allopaths question the logic of Sushrut’s millennia-old pre-eminence bestowing the right to practise modern surgery. Ayurvedic surgeons may not know the hidden risks of every surgical procedure and how to surmount sudden mishaps.
    • The Ministry of AYUSH justifies its notification on the ground that not all vaidyas but only postgraduates qualifying from two surgical streams have been authorized to perform selected surgeries.

    The contentious issue

    • The moot point is about who decides whether Ayurvedic surgeons possess sufficient proficiency to conduct these surgeries safely and by what standard their skills are judged.
    • Surgical proficiency cannot be judged by different standards in one country — particularly when less-educated patients would rather save money than question a surgeon’s qualifications.
    • The statutory regulatory body for AYUSH education is the Central Council of Indian Medicine (CCIM). CCIM has only promoted what private college managements demand, propelled, in turn, by students’ need to earn a stable income as medical professionals.
    • In this misplaced zeal to give better earnings to the Ayurvedic vaidyas, CCIM has sidelined many skills that Ayurveda could have included, which are relevant even today.
    • This has subjugated the curriculum to nurture more and more replicas of doctors of modern medicine.
    • This has killed the knowledge, purity and goodness of classical Ayurveda, which ironically is the Ayurveda in high demand in Europe, Russia and America.

    Nothing can replace practise and training to perform surgery

    • When it comes to surgery, it is not knowledge but rigorous training and continuous practice which makes for perfection. Both require clinical material and most Ayurvedic hospitals do not have a fraction of the surgical patients found in allopathic general hospitals.
    • Allopathic students of surgery learn first by watching and then performing scores of surgeries under supervision.
    • Surgical skills are by no means impossible to learn but they become difficult to master without continuous training and supervision.
    • Due to the paucity of patients, limited scope for training and access to gaining hands-on practice, it is hazardous to allow all Shalya and Shalakya postgraduates to undertake surgical procedures.
    • In the last three decades, specialization has excluded general surgeons from performing what was once considered routine. For example, only an ENT surgeon can perform a tonsillectomy.
    • Therefore, to notify that Ayurvedic postgraduates in surgery can perform omnibus operations runs counter to the norm in India and in other countries.

    Way forward

    • In performing surgery, the only benchmark should be the duration of hands-on training received — counted by surgeries under supervision, and being judged through external evaluation.
    • Every surgeon’s skills and competence must be tested by applying exactly the same standards before she/he can operate.
    • This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.