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

  • [pib] E-Sanjeevani Telemedicine Service

    In a landmark achievement, eSanjeevani, Health Ministry’s national telemedicine initiative today completed 9 lakh consultations.

    Although telemedicine brings with it many benefits, there are some downsides to it as well. Discuss.

    What is E-Sanjeevani?

    • Ministry of Health & Family Welfare has launched two variants of eSanjeevani namely – doctor to doctor (eSanjeevani AB-HWC) in the hub and spoke model and patient to doctor (eSanjeevaniOPD).
    • E-Sanjeevani OPD (out-patient department) is a telemedicine variant for the public to seek health services remotely; it was rolled out on 13th of April 2020 during the first lockdown in the country.
    • It enables virtual meetings between the patients and doctors & specialists from geographically dispersed locations, through video conferencing that occurs in real-time.
    • At the end of these remote consultations, eSanjeevani generates electronic prescriptions which can be used for sourcing medicines.
    • Andhra Pradesh was the first state to roll out eSanjeevani AB-HWC services in November 2019.

    Benefits of telemedicine

    Telemedicine benefits patients in the following ways:

    • Transportation: Patients can avoid spending gas money or wasting time in traffic with video consultations.
    • No missing work: Today, individuals can schedule a consultation during a work break or even after work hours.
    • Childcare/Eldercare Challenges: Those who struggle to find care options can use telemedicine solutions.

  • What is the Emergency Use Authorization (EUA) for Drugmakers?

    The US drugmaker Moderna said it was applying for emergency use authorisation for its vaccine in India.

    Practice question for Mains:

    Q. What is Vaccine Nationalism? Discuss various ethical issues involved and its impact on vulnerable populations across the globe.

    Emergency Use Authorisation (EUA)

    • Vaccines and medicines, and even diagnostic tests and medical devices, require the approval of a regulatory authority before they can be administered.
    • In India, the regulatory authority is the Central Drugs Standard Control Organisation (CDSCO).
    • The approval is granted after an assessment of their safety and effectiveness, based on data from trials. In fact, approval from the regulator is required at every stage of these trials.
    • This is a long process, designed to ensure that medicine or vaccine is absolutely safe and effective.
    • The fastest approval for any vaccine until now — the mumps vaccine in the 1960s — took about four-and-a-half years after it was developed.

    Exceptions for emergency

    • In emergency situations, like the current one, regulatory authorities around the world have developed mechanisms to grant interim approvals.
    • However, there should sufficient evidence to suggest a medical product is safe and effective.
    • Final approval is granted only after completion of the trials and analysis of full data; until then, EUA allows the medicine or the vaccine to be used on the public.

    What is the process of getting a EUA in India?

    • India’s drug regulations do not have provisions for a EUA, and the process for receiving one is not clearly defined or consistent.
    • Despite this, CDSCO has been granting emergency or restricted emergency approvals to Covid-19 drugs during this pandemic — for remdesivir and favipiravir in June, and itolizumab in July.

    Associated risks

    • The public has to be informed that a product has only been granted a EUA and not full approval.
    • In the case of a Covid-19 vaccine, for example, people have to be informed about the known and potential benefits and risks.

    Not a compulsion

    • There has been an ongoing debate over whether people have the option of refusing to take the vaccine.
    • Incidentally, no country has made vaccination compulsory for its people.
    • Initially, all vaccines are likely to be deployed on emergency use authorizations only. Final approval from may take several months, or years.

  • Swasthya Sathi Health Insurance Scheme

    West Bengal CM has recently extended the Swasthya Sathi health insurance scheme to cover the entire population of the state.

    Do you know?

    Delhi, Telangana, Odisha and West Bengal have not implemented the Ayushman Bharat Scheme.

    Swasthya Sathi

    • The scheme was launched in West Bengal in 2016.
    • It is a basic health cover for secondary and tertiary care up to Rs five lakh per annum per family.
    • It is quite popular among rural and economically deprived sections of the state’s population.

    Highlights of the expanded scheme

    • Every family, every citizen irrespective of the age group will be included in this scheme
    • This is a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family
    • The scheme is completely funded by the state government
    • To cover the entire population of the state, each and every family will be given one smart card to avail the benefits under this scheme, where they will get cashless treatment
    • All state-run and private hospitals are going to come under the Swasthya Sathi
    • The card will be issued to the female guardians of families

  • Is allowing Ayurvedic doctors to perform surgery legally and medically tenable?

    The Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry has allowed postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.

    Debate over Ayurvedic surgeries

    • The Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.
    • The debate revolves Ayurveda doctors allowing  ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.
    • The AYUSH Ministry has clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum.

    Broader issue

    • The broader issue is the feasiblity of short-term training equip them to conduct surgeries and if this dilutes the medicine standards in India.
    •  As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.
    • Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.

    Why such a move?

    • The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue.
    • The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats.
    • However, it would probably still continue to fall short of enough trained specialists in rural areas.

    Are there any restrictions on Ayurveda practitioners?

    •  As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas.
    • They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.

    Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?

    • The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine.
    • They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda.
    • There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy.

    Various risks associated

    • An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone.
    • It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine.
    • Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.

    Can this lead to substandard care?

    • Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving.
    • For invasive procedures, like surgery, the risk element can be high.

    A matter of rights

    • Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training.
    • There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.

    Way forward

    • We need to explore creative ways of addressing this gap by evidence-based approaches, such as task-sharing, supported by efficient and quality referral mechanisms.
    • The advent of mid-level healthcare providers, such as Community Health Providers in many States, is also an opportunity to shift some elements of healthcare (preventive, promotive, and limited curative) to these providers, while ensuring clarity of role and career progression.

  • Electronic Vaccine Intelligence Network

    The government is using eVIN – Electronic Vaccine Intelligence Network in association with the United Nations Development Program (UNDP) to identify primary beneficiaries and vaccine distribution networks.

    Try this question from CSP 2016:

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

    (a) Immunization of children and pregnant women

    (b) Construction of smart cities across the country

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

    (d) New Educational Policy

    What is eVIN?

    • E-VIN is an indigenously developed technology that digitizes vaccine stocks and monitors the temperature of the cold chain through a smartphone application.
    • It was first launched across 12 states in 2015 to support better vaccine logistics management at cold chain points.
    • It supports the central government’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points across states and UTs.

    Components of eVIN

    • eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
    • At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.

    Benefits of eVIN

    • It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
    • It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
    • While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
    • This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.

  • National Digital Health Mission

    The National Digital Health Mission will soon be ready for a nationwide roll-out, confirmed the Chairman of National Health Authority and CEO of Ayushman Bharat.

    Must read:

    [Burning Issue] Rolling-out of National Digital Health Mission

    National Digital Health Mission

    • Our PM has launched the National Digital Health Mission on 15th August 2020.
    • The mission aims to create an integrated healthcare system linking practitioners with the patients digitally by giving them access to real-time health records.
    • It is a complete digital health ecosystem. The digital platform will be launched with four key features — health ID, personal health records, Digi Doctor and health facility registry.
    • At a later stage, it will also include e-pharmacy and telemedicine services, regulatory guidelines for which are being framed.

    Its implementation

    • The NDHM is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare.
    • The National Health Authority (NHA), is also the implementing agency for Ayushman Bharat.

  • ‘Myths of Online Education’ Report

    The Azim Premji University has published the report titled “Myths of Online Education”, on the efficacy and accessibility of e-learning.

    We have studied the Impacts of COVID-19 on Education. https://www.civilsdaily.com/burning-issue-education-in-times-of-covid-19/
    This report provides decent data about the woes of online education and is easy to remember.

    About the study

    • The study was undertaken in five States across 26 districts and covered 1,522 schools. More than 80,000 students study in these government schools.
    • It examined the experience of children and teachers with online education.

    Highlights of the study

    • More than 60% of the respondents who are enrolled in government schools could not access online education.
    • Children with disabilities in fact found it more difficult to participate in online sessions.
    • 90% of the teachers who work with children with disabilities found their students unable to participate online.
    • Almost 70% of the parents surveyed were of the opinion that online classes were not effective and did not help in their child’s learnings.
    • 90% of parents of government school students surveyed were willing to send their children back to school.
    • The survey also revealed that around 75% of the teachers spent, on an average, less than an hour a day on online classes for any grade.

    Online classes are less effective

    • Teachers as well as students their expressed frustration with online classes.
    • More than 80% surveyed said they were unable to maintain emotional connect with students during online classes, while 90% of teachers felt that no meaningful assessment of children’s learning was possible.
    • Another hurdle that teachers found during the online classes was the one-way communication, which made it difficult for them to gauge whether students understood what was being taught.
    • Teachers also reported that they were ill-prepared for online learning platforms.

  • 2025 nutrition targets call for a multi-dimensional focus

    The article highlights the issue of nutrition and suggest the ways to achieve nutrition security in the country to drive sustainable growth for India.

    Nutrition in India

    • A recent United Nations report-  The State of Food Security and Nutrition in the World, 2020 highlighted that there are 189.2 million undernourished people in India.
    • Even though this number has declined by 60 million over the past decade, the progress is far too slow.
    • While we recorded a drop in undernourishment, obesity amongst Indian adults grew from 25.2 million in 2012 to 34.3 million in 2016.
    • India is likely to miss the 2025 global nutrition targets according to the Global Nutrition Report 2020, unless more is done, soon.

    Impact of POSHAN Abhiyan

    • With the launch of POSHAN Abhiyan in 2018, the government mainstreamed nutrition, with this multi-ministerial and multi-sectoral approach.
    • It converges all existing programs to improve the nutritional status of pregnant women, mothers and children.
    • It brings together several programs such as National Rural Health Mission, Mid-Day meals, Integrated Child Development Scheme, Sarva Shiksha Abhiyan, and others to improve nutrition intake in India.
    • The success lies in following an outcome based approach to ensure all the benefits under these interventions are delivered to mothers and children within the first 1000 days, setting the base for healthier lives.

    Micronutrients through food fortification

    • Food fortification is another effective way to deliver micronutrients to Indian masses, through existing food delivery systems such as mid-day meals and the public distribution system.
    • Regulators have already been promoting fortification in food products like salt, edible oil, milk, rice and wheat flour to improve nutritional content.
    • Going forward, we will see more and more food products and crops getting covered.

    Need for innovation

    • It is crucial for the food and beverage industry to make nutrition an integral part of their strategy.
    • Healthier ingredients, fortification, reformulation to reduce saturated and trans-fat content and optimize sugar and sodium content, immunity boosting product is already commonplace across urban markets.
    • This will soon permeate to rural markets.
    • Factors such as product taste, convenience, shelf life, and price – all of which determine consumption – are also important elements that ensure higher intake of nutritious products by consumers everywhere.
    • This calls for more innovation. Innovation in product, pricing, technology, digitalization, and research and development by food companies.

    Rising nutrition awareness

    • Solving the problem of malnourishment has to start with awareness.
    • In rural areas, general nutritional awareness has historically been lower.
    • In urban areas even though people are generally more aware a large percentage still consumes excess sugar and salt, leads sedentary lifestyles coupled with lack of exercise, resulting in lifestyle diseases like diabetes, obesity, high blood pressure
    • Consumers everywhere need to be better educated about nutritional benefits of common food items and the importance of including them in regular diet.
    • This can be done effectively through government led awareness campaigns and healthy public food distribution initiatives, industry acting responsibly.

    Conclusion

    Good nutrition is the best investment we can make in human capital. It has the power to drive sustainable economic growth for India.

  • Equity in education matters

    Fairness and inclusiveness are two important aspects of education system. Growing shift toward digital education in India has implications for these two aspects. The article suggests ways to make the education system fair and inclusive.

    Knowledge economy in India

    • The new National Education Policy (NEP) as well as other factors have lately brightened up education landscape in India..
    • The rise of education technology (ed-tech) incorporating VR, AR, ‘gamification’, 3D immersive learning, etc, is contributing to the knowledge economy’s potential for large market size, calling for requisite policy support.

    Barriers to equity in education

    • The Organization for Economic Co-Operation and Development (OECD) defines two dimensions of equity in education.
    • First is “fairness”, which means ensuring that personal and social circumstances do not prevent students from achieving their academic potential.
    • The second is “inclusion”, which means setting a basic minimum standard for education that is shared by all students regardless of their background.
    • The barriers that make equity difficult to foster in India are varied and complex.

    Loss of learning during Covid pandemic

    • The latest Annual State of Education Report (ASER) reveals that 20% of rural students lacked textbooks.
    • Only one in ten students had access to online classes during the Covid-19 pandemic.
    • The Survey provides a glimpse into the levels of learning loss that students in rural India, particularly in states like Bihar, West Bengal, UP, and Rajasthan, are suffering, resulting in sharp digital divides in education.
    • Unless remedied with urgency, the digital split may disrupt learning, and jeopardise our hard-won gains resulting in large scale school drop-outs, particularly of adolescent girls.

    How to remove barriers to equity?

    • To remove these barriers we need to look at several aspects like monetary resources, academic standards, academic content and support.
    • Apart from inequality in internet access and access to devices, even the quality of connection and related services and subscription fees exacerbate the digital divide.
    • For education to be availed as a social good, access at an affordable cost and reasonable quality is a precondition.
    • The availability of content in vernacular languages is yet another issue.
    • In digital education along with demand-side issues, supply-side issues need fixing, such as training of teachers in ICT, new learning devices and handling the evolved curriculum.
    • Teachers and academic institutions need to ensure that the content they are using is lucid, appropriate, fact-based and relevant.
    • Access to education loans from banks and financial institutions are a great support in the cause of education, particularly higher education.
    • Education is on the Concurrent List. A cooperative and collaborative spirit will thus be critical to realise the goals.
    • The Centre has a task well cut for building consensus on NEP2020.

    Consider the question “Fainess and inclusiveness are two important dimensions of equity that should be pursued by any education system. However, push towards digital educations threatens these two dimensions of the education system in India. Comment” 

    Conclusion

    With strong corporate commitment, states’ support, backed by strong policy push and intent by the Centre, and value addition by other stakeholders, the roadblocks on the path of equity and inclusiveness in education, though daunting, could be addressed.

    Source-

    https://www.financialexpress.com/opinion/equity-in-education-matters/2121998/

  • Annual State of Education Report (ASER) Wave 1, 2020

    The ASER Wave 1 Survey was recently released since the COVID-19 crisis interrupted this years’ trajectory.

    Practice question for mains:

    Q.Discuss the efficacy of the One-Nation- One-Board System and its limitations.

    About ASER Survey

    • This is an annual survey (published by education non-profit Pratham ) that aims to provide reliable estimates of children’s enrolment and basic learning levels for each district and state in India.
    • ASER has been conducted every year since 2005 in all rural districts of India. It is the largest citizen-led survey in India.
    • It is also the only annual source of information on children’s learning outcomes available in India.

    How is the survey conducted?

    • ASER tools and procedures are designed by ASER Centre, the research and assessment arm of Pratham.
    • The survey itself is coordinated by ASER Centre and facilitated by the Pratham network. It is conducted by close to 30,000 volunteers from partner organisations in each district.
    • All kinds of institutions partner with ASER: colleges, universities, NGOs, youth groups, women’s organisations, self-help groups and others.
    • The ASER model has been adapted for use in several countries around the world: Kenya, Uganda, Tanzania, Pakistan, Mali and Senegal.

    Assessment parameters

    • Unlike most other large-scale learning assessments, ASER is a household-based rather than school-based survey.
    • This design enables all children to be included – those who have never been to school or have dropped out, as well as those who are in government schools, private schools, religious schools or anywhere else.
    • In each rural district, 30 villages are sampled. In each village, 20 randomly selected households are surveyed.
    • Information on schooling status is collected for all children living in sampled households who are in the age group 3-16.
    • Children in the age group 5-16 are tested in basic reading and basic arithmetic. The same test is administered to all children.
    • The highest level of reading tested corresponds to what is expected in Std 2; in 2012 this test was administered in 16 regional languages.
    • In recent years, this has included household size, parental education, and some information on household assets.

    Key Findings

    1.Enrollments:

    • 5.5% of rural children are not currently enrolled for the 2020school year, up from 4% in 2018.
    • This difference is the sharpest among the youngest children (6 to 10) where 5.3% of rural children had not yet enrolled in school in 2020, in comparison to just 1.8% in 2018.
    • Due to the disruptions caused by the pandemic, families are waiting for the physical opening of schools to enrol their youngest children, with about 10% of six-year-olds not in school.
    • Among 15-16 year-olds, however, enrollment levels are slightly higher than in 2018.
    • The proportion of boys enrolled in government schools has risen from 62.8% in 2018 to 66.4% in 2020, while for girls, that number has gone up from 70% to 73% in the corresponding period.
    • Patterns show a slight shift toward government schools, with private schools seeing a drop in enrolment in all age groups.
    • The Centre has now permitted States to start reopening schools if they can follow Covid-19 safety protocols but the majority of the country’s 25 crore students are still at home.

    2.Availability of Smartphones:

    • Among enrolled children, 61.8% live in families that own at least one smartphone which was merely 36.5% in 2018.
    • About 11% of families bought a new phone after the lockdown, of which 80% were smartphones.
    • WhatsApp is by far the most popular mode of transmitting learning materialsto students, with 75% of students receiving input via this app.

    3.Availability of Learning Material:

    • Overall more than 80% of children said they had textbooks for their current grade.
    • This proportion was higher among students enrolled in government schools (84.1%) than in private ones (72.2%).
    • In Bihar, less than 8% got such materials from their schools, along with 20% in West Bengal, Rajasthan and Uttar Pradesh.
    • More than 80% of rural children in Himachal Pradesh, Punjab, Kerala and Gujarat received such input.

    4.Learning Activities:

    • Most children (70.2%) did some form of a learning activity through material shared by tutors or family members themselves, with or without regular input.
    • 11% had access to live online classes, and 21% had videos or recorded classes, with much higher levels in private schools.
    • About 60% studied from their textbooks and 20% watched classes broadcast on TV.

    Suggestions

    • Fluid Situation: When schools reopen, it will be important to continue to monitor who goes back to school as well as to understand whether there is learning lossas compared to previous years.
    • Building on and Strengthening Family Support: Parents’ increasing levels of education can be integrated into planning for learning improvement, as advocated by National Education Policy, 2020. Reaching parents at the right level is essential to understand how they can help their children and older siblings also play an important role.
    • Hybrid Learning: As children do a variety of different activities at home, effective ways of hybrid learning need to be developed which combine traditional teaching-learning with newer ways of “reaching-learning”.
    • Assessment of Digital Modes and Content: In order to improve digital content and delivery for the future, an in-depth assessment of what works, how well it works, who it reaches, and who it excludes is needed.
    • Mediating the Digital Divide: Children from families who had low education and also did not have resources like smartphones had less access to learning opportunities. However, even among such households, there is evidence of effort with family members trying to help and schools trying to reach them. These children will need even more help than others when schools reopen.

    Way Forward

    • Covid-19 has left the nation with deep economic distress and uncertainty over school-reopenings and thrown open new challenges in every sector.
    • The nationally representative sample highlighted the role played by the families where everyone in the family supported children regardless of their education levels.
    • This strength needs to be leveraged by reaching out to more students and reducing the distance between schools and homes.