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

  • India needs to rethink its nutrition agenda

    Poor nutritional outcomes in NFHS-5 show that a piecemeal approach does not work.

    Nutrition-related data released by NFHS-5

    • The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).
    • The 22 States/ UTs don’t include some major States such as Tamil Nadu, Rajasthan, Punjab, Uttar Pradesh, Jharkhand, Odisha and Madhya Pradesh.

    Practice Question: The latest findings from the National Family Health Survey data shows a sign of worry. Suggest the policy measures required to tackle the health and nutrition-related issues in India.

    Worrying findings

    • There is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16). Kerala and Karnataka are the only two big states where there is some decline.
    • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
    • Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
    • There is also an increase in the prevalence of other indicators such as adult malnutrition in many States/ UTs.
    • Most States/UTs also see an increase in overweight/obesity prevalence among children and adults shows the inadequacy of diets in India both in terms of quality and quantity.
    • The data report an increase in childhood stunting (an indicator of chronic under-nutrition and considered a sensitive indicator of overall well-being) in 13 of the 22 States/UTs.
    • Poshan Abhiyaan, one of the flagship programmes of the PM, launched in 2017, aimed at achieving a 2% reduction in childhood stunting per year.

    Economic growth vs health indicators

    • There is an increase in the prevalence of childhood stunting in the country during the period 2015-16 to 2019-20.
    • This calls for serious introspection on not just the direct programmes in place to address the problem of child malnutrition but also the overall model of economic growth that the country has embarked upon.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
    • Over the last three decades, India has experienced high rates of economic growth. But this period has also seen increasing inequality, greater informalisation of the labour force, and reducing employment elasticities of growth.
    • Currently, India is witnessing a slowdown in economic growth, stagnant rural wages and highest levels of unemployment. This is reflected in the rising number of reported starvation deaths from different parts of the country.
    • The situation has become even worse due to the pandemic and lockdown-induced economic distress.
    • Field surveys such as the recent ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
    • All of this calls for urgent action with commitment towards addressing the issue of malnutrition.

    Social protection schemes and their impact on nutrition indicators

    • Social protection schemes and public programmes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to a reduction in absolute poverty as well as previous improvements in nutrition indicators.
    • However, there are continuous attempts to weaken these mechanisms through underfunding and general neglect.
    • Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilized.
    • There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.

    A piecemeal approach

    • The overall poor nutritional outcomes show that a piecemeal approach addressing some aspects does not work.
    • Direct interventions such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
    • Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognizing women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
    • The linkages between agriculture and nutrition both through what foods are produced and available as well as what kinds of livelihoods are generated in farming are also important.

    Conclusion

    • The basic determinants of malnutrition – household food security, access to basic health services and equitable gender relations – cannot be ignored any longer.
    • An employment-centred growth strategy which includes the universal provision of basic services for education, health, food and social security is imperative.
    • There have been many indications in our country that business as usual is not sustainable anymore.
    • It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for a serious rethinking of issues related to nutrition and accord these issues priority.

  • National Family Health Survey- 5 Part: I

    • Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all.
    • The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.

    The first phase of the fifth National Family Health Survey (NFHS-5) has been released.

    Do you think that India is still the sick man of Asia?

    What is the National Family Health Survey?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
    • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

    Part I of the Survey

    • The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five UTs (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic.
    • Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.

    Highlights of the NHFS-5

    • The NFHS-5 contains detailed information on population, health, and nutrition for India and its States and Union Territories.
    • This is a globally important data source as it is comparable to Demographic Health Surveys (DHS) Programme of 90 other countries on several key indicators.
    • It can be used for cross country comparisons and development indices.

    Good news

    • Several of the 22 states and UTs, for which findings have been released, showed an increase in childhood immunisation.
    • There has been a drop in neonatal mortality in 15 states, a decline in infant mortality rates in 18 states and an increase in the female population (per 1,000 males) in 17 states.
    • Fertility rate decline and increase in contraceptive use were registered in almost all the states surveyed showing trends of population stabilization.

    Some bad news

    • There has been an increase in stunting and wasting among children in several states, a rise in obesity in women and children, and an increase in spousal violence.
    • In several other development indicators, the needle has hardly moved since the last NFHS-4.

    (1) Hunger Alarm

    • The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades.
    • Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
    • The share of underweight and wasted children has also gone up in the majority of the states.

    (2) Fertility Rate

    The total fertility rate (TFR) is defined as the average number of children that would be born to a woman by the time she ends childbearing.

    • The TFR across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest NFHS-5.
    • Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
    • In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.
    • India’s population is stabilizing, as the total fertility rate (TFR) has decreased across majority of the states.

    (3) Under-5 and infant mortality rate (IMR)

    • The Under 5 and infant mortality rate (IMR) has come down but in parallel recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed.
    • These states are Goa, Gujarat, Himachal Pradesh, Kerala, Maharashtra, Meghalaya, Mizoram, Nagaland, Telangana, Tripura, West Bengal, Lakshadweep and Dadra & Nagar Haveli and Daman and Diu.

    For the first time: Gaps in internet use

    • In 2019, for the first time, the NFHS-5, which collects data on key indicators on population health, family planning and nutrition, sought details on two specific indicators: Percentage of women and men who have ever used the Internet.
    • On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet, according to the survey.
    1. First, only an average of 42.6 per cent of women ever used the Internet as against an average of 62.16 per cent among the men.
    2. Second, in urban India, average 56.81 per cent women ever used the Internet compared to an average of 73.76 per cent among the men.
    3. Third, dismal 33.94 per cent women in rural India ever used the Internet as against 55.6 per cent among men.
    • In urban India, 10 states and three union territories reported more than 50 per cent women who had ever used the Internet: Goa (78.1%), Himachal Pradesh (78.9%), Kerala (64.9%), and Maharashtra (54.3%).
    • The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).

  • Issues related to Nursing Sector in India

    The year 2020 has been designated as “International Year of the Nurse and the Midwife”.

    But the nursing education in India displays a grim situation. It suffers poor quality of training, inequitable distribution, and non-standardized practices.

    Nursing sector in India

    • Nurses and midwives will be central to achieving universal health coverage in India.
    • India’s nursing workforce is about two-thirds of its health workforce. Its ratio of 7 nurses per 1,000 population is 43% less than the World Health Organization norm; it needs 2.4 million nurses to meet the norm.
    • The sector is dogged by structural challenges that lead to poor quality of training, inequitable distribution, and non-standardized practices.

    Uneven regulation

    Nursing education in India has a wide array of certificate, diploma, and degree programmes for clinical and non-clinical nursing roles.

    • The Indian Nursing Council regulates nursing education through prescription, inspection, examination, and certification. 91% of the nursing education institutions are private and weakly regulated. The quality of training of nurses is diminished by the uneven and weak regulation.
    • The current nursing education is outdated and fails to cater to the practice needs. The education, including re-training, is not linked to the roles and their career progression in the nursing practice.
    • There are insufficient postgraduate courses to develop skills in specialities and address critical faculty shortages both in terms of quality and quantity.
    • These factors have led to gaps in skills and competencies, with no clear career trajectory for nurses.
    • Multiple entries point to the nursing courses and lack of integration of the diploma and degree courses diminish the quality of training.
    • A common entrance exam, a national licence exit exam for entry into practice, and periodic renewal of licence linked with continuing nursing education would significantly streamline and strengthen nursing education.
    • Transparent accreditation, benchmarking, and ranking of nursing institutions too would improve the quality.
    • The number of nursing education institutions has been increasing steadily but there are vast inequities in their distribution. Around 62% of them are situated in southern India.
    • There is little demand for postgraduate courses. Recognizing the need for speciality courses in clinical nursing 12 PG diploma courses were rolled out but the higher education qualification is not recognized by the recruiters.
    • The faculty positions vacant in nursing college and schools are around 86% and 80%, respectively.

    Gaps in education, services

    • There is a lack of job differentiation between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion.
    • The higher qualifications are underutilized, leading to low demand for postgraduate courses.
    • Those with advanced degrees seek employment in educational institutions or migrate abroad which has led to an acute dearth of qualified nurses in the country.
    • Small private institutions with less than 50 beds recruit candidates without formal nursing education. They are offered courses of three to six months for non-clinical ancillary nursing roles and are paid very little.
    • The Indian Nursing Act primarily revolves around nursing education and does not provide any policy guidance about the roles and responsibilities of nurses in various cadres.
    • Nurses in India have no guidelines on the scope of their practice and have no prescribed standards of care and is a major reason for the low legitimacy of the nursing practice and the profession. This may endanger patient safety.
    • The Consumer Protection Act holds only the doctor and the hospital liable for medico-legal issues; nurses are out of the purview of the Act. This is contrary to the practices in developed countries where nurses are legally liable for errors in their work.

    Institutional reforms required

    1. The governance of nursing education and practice must be clarified and made current.
    2. The Indian Nursing Council Act of 1947must be amended to explicitly state clear norms for service and patient care, fix the nurse to patient ratio, staffing norms and salaries.
    3. The jurisdictions of the Indian Nursing Council and the State nursing councils must be explained and coordinated so that they are synergistic.
    4. Incentives to pursue advanced degrees to match their qualification, clear career paths, the opportunity for leadership roles, and improvements in the status of nursing as a profession should be done.
    5. A live registry of nurses, positions, and opportunities should be a top priority to tackle the demand-supply gap in this sector.
    6. The public-private partnership between private nursing schools/colleges and public health facilities is another strategy to enhance nursing education. NITI Aayog has recently formulated a framework to develop a model agreement for nursing education.
    7. The Government has also announced supporting such projects through a Viability Gap Funding.

    Practice Question:

    Q. Discuss the various issues related to nursing sector in India and measures to be taken to address them.

    A Bill that could spell hope

    • The disabling environment prevalent in the system has led to the low status of nurses in the hierarchy of health-care professionals. In fact, nursing has lost the appeal as a career option.
    • The National Nursing and Midwifery Commission Bill currently under consideration should hopefully address some of the issues highlighted.
    • These disruptions are more relevant than ever in the face of the COVID-19 pandemic.

  • Matru Sahyogini Samitis Scheme

    The MP government has issued an order for the appointment of committees led by mothers to ensure better monitoring of services delivered at Anganwadi or day-care centres across the State.

    Try this PYQ:

    Q.Which of the following are the objectives of ‘National Nutrition Mission’?

    1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
    2. To reduce the incidence of anaemia among young children, adolescent girls and women.
    3. To promote the consumption of millets, coarse cereals and unpolished rice.
    4. To promote the consumption of poultry eggs.

    Select the correct answer using the code given below:

    (a) 1 and 2 only

    (b) 1, 2 and 3 only

    (c) 1, 2 and 4 only

    (d) 3 and 4 only

    Matru Sahyogini Samitis

    • Called ‘Matru Sahyogini Samiti’ or Mothers’ Cooperation Committees, these will comprise 10 mothers at each Anganwadi centres.
    • They would be representing the concerns of different sets of beneficiaries under the Integrated Child Development Services, or National Nutrition Mission.
    • Beneficiaries’ would include children between six months to three years, children between three years and six years, adolescent girls and pregnant women and lactating mothers.
    • These mothers will keep a watch on weekly ration distribution to them as well as suggest nutritious and tasteful recipes for meals served to children at the centres.
    • The move is being taken as per the mandate of the National Food Security Act, 2013 (NFSA).

    Its’ functioning

    • The committees will include mothers of beneficiary children as well as be represented by pregnant women and lactating mothers who are enrolled under the scheme.
    • The Anganwadi scheme includes a package of six services delivered at the centres, including supplementary nutrition, health services including vaccination, early education, among others.
    • The Committees will also include a woman panch, women active in the community and eager to volunteer their support to the scheme, teachers from the local school, and women heads of self-help groups (SHG).

    Why such a move?

    • This is in a move that is aimed at strengthening community response to the problem of hunger and malnutrition in the State.
    • With the help of mothers, we will be able to turn anganwadis into a community health system, a nutrition management centre, and spread awareness against social evils.
    • These will turn into a model for local governance as well as allow for greater engagement between communities and the State government.

    Back2Basics: Integrated Child Development Services (ICDS)

    • The ICDS aims to provide food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.
    • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.
    • The tenth FYP also linked ICDS to Anganwadi centres established mainly in rural areas and staffed with frontline workers.
    • The ICDS provide for anganwadis or day-care centres which deliver a package of six services including:
    1. Immunization
    2. Supplementary nutrition
    3. Health checkup
    4. Referral services
    5. Pre-school education (Non-Formal)
    6. Nutrition and Health information

    Implementation

    • For nutritional purposes, ICDS provides 500 kilocalories (with 12-15 grams of protein) every day to every child below 6 years of age.
    • For adolescent girls, it is up to 500-kilo calories with up to 25 grams of protein every day.
    • The services of Immunisation, Health Check-up and Referral Services delivered through Public Health Infrastructure under the Ministry of Health and Family Welfare.

  • Threat of malnutrition to promise of India

    POSHAN Abhiyan has completed 1000 days. The article analyses the challenges country face on the nutrition front which has been exacerbated by the Covid-19 induced disruptions.

    Severity and impact of malnutrition

    • Malnourished children tend to fall short of their real potential — physically as well as mentally.
    • That is because malnutrition leaves their bodies weaker and more susceptible to illnesses.
    • In 2017, a staggering 68% of 1.04 million deaths of children under five years in India was attributable to malnutrition, reckoned a Lancet study in 2019.
    • Without necessary nutrients, their brains do not develop to the fullest.
    • Malnutrition places a burden heavy enough for India, to make it a top national priority.
    • About half of all children under five years in the country were found to be stunted (too short) or wasted (too thin) for their height, estimated the Comprehensive National Nutrition Survey, carried out by the Ministry of Health and Family Welfare with support of UNICEF three years ago.

    POSHAN Abhiyan against the background Covid-19 disruption

    • The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan in 2018, led to a holistic approach to tackle malnutrition.
    • Under it, the government strengthened the delivery of essential nutrition interventions.
    • COVID-19 is pushing millions into poverty making them vulnerable to malnutrition and food insecurities.
    • Pandemic-prompted lockdowns disrupted essential services — such as supplementary feeding under anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which can exacerbate malnutrition.
    •  Leaders from academia, civil society, development partners, community advocates and the private sector have come together as part of ‘commitment to action’.
    • The ‘commitment to action’ includes commitments around sustained leadership, dedicated finances, multi-sectoral approach and increased uninterrupted coverage of a vulnerable population under programmes enhancing nutrition.

    Financial commitments

    • India already has some of the world’s biggest early childhood public intervention schemes such as the Integrated Child Development Scheme, the mid-day meal programme, and Public Distribution System.
    • India needs to ensure coverage of every single child and mother.
    • To ensure this, the country needs to retain its financial commitments for nutrition schemes.
    • Economic insecurities often force girls into early marriage, early motherhood, discontinue their schooling, and reduce institutional deliveries, cut access to micronutrient supplements, and nutritious food.
    •  Accelerating efforts to address these will be needed to stop the regression into the deeper recesses of malnutrition.

    Conclusion

    It takes time for nutrition interventions to yield dividends, but once those accrue, they can bring transformative generational shifts. Filling in the nutrition gaps will guarantee a level-playing field for all children and strengthen the foundations for the making of a future super-power.

  • Anganwadi centres

    The article highlights the role of Anganwadi’s in the effective implementation and service delivery under the ICDS.

    Gaps in the utilisation of services by ICDS

    • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
    • The Integrated Child Development Services (ICDS) programme is one such scheme.
    • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.  
    • However, recent reports have shown gaps in the utilisation of services.

    Recasting the Anganwadi centres

    • Anganwadi centres (AWCs) could become agents of improved delivery of ICDS’s services.
    • According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).
    • These centres have expanded their reach, but they need to play a much larger role in anchoring community development.
    • Nearly a fourth of the operational AWCs lack drinking water facilities and 36 per cent do not have toilets.
    • In 2015, the NITI Aayog recommended better sanitation and drinking water facilities, improved power supply and basic medicines for the AWCs.
    • NITI Aayog also suggested that these centres be provided with the required number of workers, whose skills should be upgraded through regular training.
    •  It has acknowledged the need to improve anganwadi centres.
    • The Central government’s Saksham Anganwadi Scheme aims to upgrade 2.5 lakh such centres across the country. It is up to the state governments to take up the baton
    • Only a limited number of AWCs have facilities like creche, and good quality recreational and learning facilities for pre-school education.
    • An approach that combines an effective supplementary nutrition programme with pedagogic processes that make learning interesting is the need of the hour.

    Steps taken for effective implementation of ICDS

    • Effective implementation of the ICDS programme rests heavily on the combined efforts of the anganwadi workers (AWWs), ASHAs and ANMs.
    • The Centre’s POSHAN Abhiyaan has taken important steps towards building capacities of AWWs.
    • Technology can also be used for augmenting the programme’s quality.
    • AWWs have been provided with smartphones and their supervisors with tablets, under the government schemes.
    • Apps on these devices track the distribution of take-home rations and supplementary nutrition services.
    • The data generated should inform decisions to improve the programme.
    • In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.
    • Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

    Conclusion

    Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled. Second, states have much to learn from each other’s experiences. Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

  • Healthcare in India & Pandemic

    Pandemic has been ravaging the world in a way few could have imagined. It highlighted the flaws in our healthcare system. However, it also offers several important lessons for tackling future pandemics and healthcare emergencies.

    Where we stand after 1 year of pandemic

    • About a year after the first cases were reported, we are in a different position than at the start.
    • Doctors, public health specialists and policymakers have a better sense of the interventions that are required.
    • Many treatments initially proposed, based on expert experience, have been tested and removed from management strategies even as modified protocols have improved survival rates.
    • Vaccines have moved even faster than drugs with  nearly 40 of them undergoing clinical trials, a dozen of which are at the phase three stage, and at least one has been licensed post-phase three trials under conditional emergency use authorisation (EUA).
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.
    • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.

    Takeaways from our response to pandemic

    1) Increase investment on health services

    • The countries which handled the pandemic best (Thailand and Vietnam) have well-functioning health systems designed to deliver primary healthcare services.
    • These countries also have strong preventive and promotive health services as well as a dedicated public health workforce.
    • Their governments had made sustained investments in health over decades.
    • In contrast, countries which focused mainly on hospital centric medical systems struggled.

    2) Important role played by health workers

    • The role of community health workers in recognising, referring and motivating individuals for therapy was remarkable.
    • Healthcare workers, particularly those at the frontline, such as the accredited social health activists (ASHA) who visited hundreds of households repeatedly during the pandemic.
    •  If we are to build back better, we need to give them better recognition, salaries and career progression.

    3) Increase community participation

    • Third, community trust and participation is essential for implementation of non-pharmacological interventions.
    • Dharavi in Mumbai is an example of the difference community participation can make.

    4) Importance of data

    • Outside of the immediate response, the need for timely and quality data in a health information system was recognised again during the pandemic.
    • Without real time data on testing, disease surveillance and other outcomes, tailored responses are near impossible.
    • The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments.

    Conclusion

    Future readiness needs to start now, and we have the resources and knowledge to do this — all we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.

  • [pib] Digital platform ‘CO-WIN’

    A New Digital platform ‘CO-WIN’ is being used for COVID-19 Vaccine Delivery.

    Q.India’s first mass adult vaccination drive against COVID-19 is a difficult task. Explain.

    CO-WIN

    • This user friendly mobile app for recording vaccine data is working as a beneficiary management platform having various modules.
    • The platform will be used for recording vaccine data and will form a database of healthcare workers too.
    • The app will have separate modules for administrator, registration, vaccination, beneficiary acknowledgement and reports.
    • Once people start to register for the app, the platform will upload bulk data on co-morbidity provided by local authorities.
    • In the process of forming database of Healthcare Workers, which is in an advanced stage across all States/UTs, data is presently being uploaded on the Co-WIN platform.

    Prioritized group

    Prioritized Population Groups include:

    1. Healthcare Workers in both Government and Private Healthcare facilities
    2. Frontline Workers including personnel from state and central police department, armed forces, home guard, civil defence organizations, disaster management volunteers and municipal workers and
    3. Prioritized Age Group, which includes those aged above 50 years & those with co-morbidities

    (Note: This is not the sequence, but categorization.)

  • Investing in India’s youth

    Significant progress has been made in India on the skill development front. However, there are many challenges that are needed to be tackled through policy measures and their effective implementation. The article deals with the issue.

    Progress in skill development in India

    • Evidence shows that many people develop 21st-century skills on the job, or from courses that focus on practical application of skills, rather than in schools.
    • India has laid the foundation for delivering on the vision of making quality skills development programmes available to the youth.
    • Vocational education can be a route for many to gain specific skillsets, such education formats are referred to as Technical and Vocational Education and Training (TVET).
    • The National Skill Development Policy was launched in 2009 and revamped in 2015, recognising the challenge of skilling with speed and high standards.
    • The Skill India Mission was launched soon after, with the vision for making India the “skill capital” of the world.

    Key finding and recommendations of the UNESCO’s State of the Education Report for India

    • The report focuses on vocational education and training and showcases the growth of the skills development sector.
    • It also provides practical recommendations to ensure that policy is effectively implemented.
    • One of the biggest challenges for expanding the reach of TVET-related courses has been the lack of aspiration and stigma attached to jobs such as carpentry and tailoring.
    • Considerable effort, including information campaigns involving youth role models, would help in improving the image of vocational education.
    • At the same time, common myths around TVET need to be debunked.
    • Research is now proving that TVET graduates for entry level jobs can get paid as much as university graduates.
    • Moreover, students from vocational streams typically take less time to find jobs as compared to university graduates.
    • The report emphasises the need for expanding evidence-based research.
    • High-quality research based on careful data-gathering and analytics can add value to all aspects of TVET planning and delivery.

    Emphasis on vocational education in NEP

    • The new National Education Policy (NEP) aims to provide vocational education to 50% of all learners by 2025.
    • Schools are encouraged to provide students access to vocational education from Grade 6 onwards and to offer courses that are aligned to the local economies and can benefit local communities.
    • For the vision of the NEP to be fulfilled, a robust coordination mechanism for inter-ministerial cooperation is necessary for bringing the skills development and vocational education systems together.

    Conclusion

    Effective implementation of the policies for skill development is essential for capitalising on the country’s demographic dividend.

  • Surgery as part of Ayurveda

    Last month, a government notification listed out specific surgical procedures that a postgraduate medical student of Ayurveda must be “practically trained to acquaint with, as well as to independently perform”.

    Q.Allowing modern surgeries to Ayurveda professionals is a mixopathy and an encroachment into the jurisdiction and competencies of modern medicine. Critically analyse.

    What is the notification?

    • The notification mentions 58 surgical procedures that postgraduate students must train themselves in and acquires skills to perform independently.
    • These include procedures in general surgery, urology, surgical gastroenterology, and ophthalmology.

    The issue

    • The notification has invited sharp criticism from the Indian Medical Association, which questioned the competence of Ayurveda practitioners to carry out these procedures.
    • They have called the notification as an attempt at “mixopathy”.
    • The IMA has planned nationwide protests against this notification and has threatened to withdraw all non-essential and non-Covid services.

    Surgery as a part of Ayurveda

    • It is not that Ayurveda practitioners are not trained in surgeries, or do not perform them.
    • In fact, they take pride in the fact that their methods and practices trace their origins to Sushruta, an ancient Indian sage and physician.
    • The comprehensive medical treatise Sushruta Samhita has, apart from descriptions of illnesses and cures, detailed accounts of surgical procedures and instruments.
    • There are two branches of surgery in Ayurveda — Shalya Tantra, which refers to general surgery, and Shalakya Tantra which pertains to surgeries related to the eyes, ears, nose, throat and teeth.
    • All postgraduate students of Ayurveda have to study these courses, and some go on to specialize in these and become Ayurveda surgeons.

    Distinctions in surgical procedures

    • For several surgeries Ayurvedic procedures almost exactly match those of modern medicine about how or where to make a cut or incision, and how to perform the operation.
    • There are significant divergences in post-operative care, however.
    • The only thing that Ayurveda does not do is super-speciality surgeries, like neurosurgery or open-heart surgeries.
    • For most other needs, there are surgical procedures in Ayurveda. It is not very different from allopathic medicine.

    Ayurvedic surgeries before the notification

    • PG education in Ayurveda is guided by the Indian Medical Central Council (Post Graduate Education) Regulations framed from time to time.
    • Currently, the regulations formulated in 2016 are in force. The latest notification of last month is an amendment to the 2016 regulations.
    • The 2016 regulations allow postgraduate students to specialise in Shalya Tantra, Shalakya Tantra, and Prasuti evam Stree Roga (Obstetrics and Gynecology), the three disciplines involving major surgical interventions.
    • Students of these three disciplines are granted MS (Master in Surgery in Ayurveda) degrees.

    Arguments in favour

    • Ayurveda practitioners point out that students enrolling in Ayurveda courses have to pass the same NEET (National Eligibility-cum-Entrance Test).
    • Ayurveda institutions prescribe textbooks from modern medicine, or that they carry out surgeries with the help of practitioners of modern medicine.
    • Their course, internship and practice also run parallel to the MBBS courses.
    • Postgraduate courses require another three years of study. They also have to undergo clinical postings in the outpatient and In-patient departments at hospitals apart from getting hands-on training.
    • Medico-legal issues, surgical ethics and informed consent is also part of the course apart from teaching Sushruta’s surgical principles and practices.

    So, what is new?

    • Ayurveda practitioners say the latest notification just brings clarity to the skills that an Ayurveda practitioner possesses.
    • The surgeries that have been mentioned in the notification are all that are already part of the Ayurveda course. But there is little awareness about these.
    • A patient is usually not clear whether an Ayurvedic practitioner has the necessary skill to perform one of these operations.
    • Now, they know exactly what an Ayurveda doctor is capable of. The skill sets have been defined. This will remove question marks on the ability of an Ayurveda practitioner.

    What are the IMA’s objections?

    • IMA doctors insist that they are not opposed to the practitioners of the ancient system of medicine.
    • But they say the new notification somehow gives the impression that the skills or training of the Ayurveda doctor in performing modern surgeries are the same as those practising modern medicine.
    • This, they say, is misleading, and an “encroachment into the jurisdiction and competencies of modern medicine”.
    • The IMA has condemned the move calling it predatory poaching on modern medicine and its surgical disciplines.
    • The IMA has demanded that the notification, as well as the NITI Aayog, move towards ‘One Nation One System’ (of AYUSH) be withdrawn.