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

  • Delhi’s ‘Happiness Class’

     

    On the upcoming visit to India, US President Trump will visit a Delhi government school, where they will attend a happiness curriculum class.

    What is Delhi’s ‘happiness curriculum’?

    • The curriculum calls for schools in India to promote development in cognition, language, literacy, numeracy and the arts along with addressing the well-being and happiness of students.
    • It further says that future citizens need to be “mindful, aware, awakened, empathetic, firmly rooted in their identity…” based on the premise that education has a larger purpose, which cannot be in isolation from the “dire needs” of today’s society.
    • For the evaluation, no examinations are conducted, neither will marks be awarded.
    • The assessment under this curriculum is qualitative, focusing on the “process rather than the outcome” and noting that each student’s journey is unique and different.

    Objectives of the curriculum

    The objectives of this curriculum include:

    • developing self-awareness and mindfulness,
    • inculcating skills of critical thinking and inquiry,
    • enabling learners to communicate effectively and
    • helping learners to apply life skills to deal with stressful and conflicting situations around them

    Learning outcomes of this curriculum

    The learning outcomes of this curriculum are spread across four categories:

    • becoming mindful and attentive (developing increased levels of self-awareness, developing active listening, remaining in the present);
    • developing critical thinking and reflection (developing strong abilities to reflect on one’s own thoughts and behaviours, thinking beyond stereotypes and assumptions);
    • developing social-emotional skills (demonstrating empathy, coping with anxiety and stress, developing better communication skills) and
    • developing a confident and pleasant personality (developing a balanced outlook on daily life reflecting self-confidence, becoming responsible and reflecting awareness towards cleanliness, health and hygiene).

    How is the curriculum implemented?

    • The curriculum is designed for students of classes nursery through the eighth standard.
    • Group 1 consists of students in nursery and KG, who have bi-weekly classes (45 minutes each for one session, which is supervised by a teacher) involving mindfulness activities and exercise.
    • Children between classes 1-2 attend classes on weekdays, which involves mindfulness activities and exercises along with taking up reflective questions.
    • The second group comprises students from classes 3-5 and the third group is comprised of students from classes 6-8 who apart from the aforementioned activities, take part in self-expression and reflect on their behavioural changes.

  • Worldwide Educating for the Future Index (WEFFI) 2019

     

     

    India has jumped five ranks in the Worldwide Educating for the Future Index (WEFFI) 2019.

    About WEFFI

    • The report is published by The Economist Intelligence Unit. The report and index were commissioned by the Yidan Prize Foundation.
    • The index ranks countries based on their abilities to equip students with skill-based education.
    • The report analyses the education system from the perspective of skill-based education “in areas such as critical thinking, problem-solving, leadership, collaboration, creativity and entrepreneurship, as well as digital and technical skills.”

    Global scenario

    • Among the world’s largest economies, the US, UK, France and Russia all fell back in the index, while China, India and Indonesia took steps forward.
    • Finland was at the apex of the index, with strengths across each category followed by Sweden.

    India’s performance

    • India ranked 35th on the overall index in 2019 with a total score of 53, based on three categories – policy environment, teaching environment and overall socio-economic environment.
    • India scored 56.3 in policy environment falling from a 61.5 score in 2018.
    • India’s score of 52.2 in the teaching environment category and 50.1 in the socio-economic environment category increased significantly from 32.2 and 33.3 in 2018 respectively.
    • Earlier, India ranked 40th with an overall score of 41.2 across categories in 2018.

    What made India progress?

    • The report attributed India’s growth to the new education policy introduced by the government.
    • India’s Finance Minister Nirmala Sitharaman, in the Union Budget 2020, had highlighted a
    • The New Education Policy announced in this year budget under ‘Aspirational India’ will focus on “greater inflow of finance to attract talented teachers, innovate and build better labs.
    • The policy will focus further on skill-based education.

    Various shortcomings highlighted

    • The 2018 WEFFI report had highlighted the shortcomings in India’s education system emphasizing upon its inability to utilise the opportunity of internationalizing its higher education system.
    • A decentralized education system is another shortcoming of India’s education policy according to the 2019 report.
    • Well-intentioned policy goals relating to future skills development often do not get filtered downward, a hazard in economies such as the US and India that have large, decentralized education systems, the report said.

  • Gearing up to fight the next big viral outbreak

    Context

    India is ill-prepared to deal with the new strain of coronavirus (SARS-CoV-2) that is causing worldwide panic. Policymakers must take forceful action to prevent the spread of the new virus and heed the urgent warnings of global public health professionals about new pathogens.

    No country is adequately prepared

    • Finding of the Global Health Security Index: The World Health Organization (WHO)’s Global Health Security Index finds that no country is adequately prepared.
    • It assesses 195 countries across six categories–
      • Prevention
      • Early detection.
      • Rapid response.
      • Health system quality.
      • Standards.
      • Risk environment.
    • India’s dismal rank: India is ranked 57th.
      • That the country scores around the global average is no comfort, because the global average is a low 40.2 out of 100, and India’s score is 46.5. (For the record, the U.S. is ranked first and China 51st).

    Four-point health agenda

    • The prospect of new outbreaks puts four items on the health agenda in the spotlight that require both immediate and longer-term action:
      • Early detection and prevention.
      • Better collaboration across health service providers.
      • More investment in health systems; outcomes, and education; and-
      • Better care of the environment and biodiversity, which directly affects people’s health safety.

    Thailand’s outstanding example

    • Sixth rank on Health Security Index: That Thailand is ranked sixth in the Health Security Index- the highest ranking for an Asian country.
      • The rank says a great deal about the country’s track record in disease prevention, early detection, and rapid response linked to investments in its public health system.
      • When the deadly Middle East Respiratory Syndrome (MERS), also caused by a coronavirus, broke out in 2015, Thailand quickly notified the WHO of its first confirmed case and acted transparently to arrest the spread.
      • This is in stark contrast to delayed notification by China’s officials of the recent outbreak.

    India’s record in past outbreaks

    • Underscoring inadequacies: The influenza A (H1N1) outbreaks since 2009 in Rajasthan, Maharashtra, Tamil Nadu and other States have acutely underscored the need for better detection, awareness of symptoms and quarantining.
    • Protocols for surveillance: Clearer protocols for all three types of surveillance are needed in all States.
      • And these protocols need to be communicated to health professionals at all levels and the public in local languages.

    Conducting stress tests on health system

    • Countries need to do the stress tests for their preparedness to deal with health emergencies.
    • Exposing the crucial gap: Each State in India should do this to expose crucial gaps in areas such as-
      • Adequacy and supply of diagnostic equipment.
      • Health facilities.
      • Hygienic practices, and-
      • Prevention and treatment protocols.
    • Ensuring strong supply chains: Queues of desperate shoppers trying to buy hand sanitizer, face masks and other protective products in Hong Kong and China highlight the need for strong supply chains for products that people need during health emergencies.

    The partnership between countries and with the private sector

    • Partnership to ensure supply chains: Partnerships between private and public sectors, and between countries– that can sustain supply chains and bolster the medical capacity of countries struggling to cope.
      • Collaborative approach in Asia: In Asia, collaborative approaches exist, for example, for combating tuberculosis, AIDS and malaria.
    • Need to do more: More is needed to tackle health emergencies on the scale of recent outbreak, particularly on funding.
      • Emergency loan option: There could be an emergency loan facility, with a “deferred drawdown option” as the World Bank uses for disasters, natural or health.
      • The loan option can help augment own resources in times of a public health catastrophe.
    • Investment is the best defence: But the best defence of all is to invest more, and more efficiently, in health and education to prepare populations and strengthen health services.
      • Low health expenditure: Health expenditure by the government in India is less than 5% of Gross Domestic Product, which is low for a middle-income country.
      • Spending at that level limits, among other things, the availability of health professionals during crises.
      • According to WHO, India has only 80 doctors per 1,00,000 people.

    Investment in health, education

    • Kerala’s experience: Kerala’s experience in 2018 with the deadly Nipah virus showed the value of investing in education and health over the long term.
    • What measures were taken in Kerala? The availability of equipment for-
      • Quick diagnosis.
      • Measures to prevent diseases from spreading and-
      • Public information campaigns- all helped to keep the mortality rate from the Nipah virus relatively low.
      • Having capable public health professionals helped in the information exchange with WHO and other international bodies.

    The relation between environmental degradation and health

    • A new dimension of new pathogens: One of the many dimensions of new pathogens that is getting increased attention is the link with environmental degradation.
    • The relation between pollution and viral respiratory infection: The interaction between particulate matter from pollution and viral respiratory tract infections, especially in the young and the elderly, as well as the malnourished, has been increasingly noted in epidemiological studies.
      • Many of the highest air pollution readings are being recorded in Indian cities.
    • Most vulnerable country: An HSBC study of 67 countries ranks India as the most climate-vulnerable one because of the impact of severe temperature increases and declines in rainfalls.
      • Reasons for vulnerability: The effects of such occurrences are magnified by the high density of the country’s population, the sheer number of people in harm’s way, and the high incidence of poverty.
      • Research is increasingly connecting global warming to vector-borne viruses.

    Conclusion

    The dangerous trend for disease spillovers from animals to humans can be traced to increased human encroachment on wildlife territory; land-use changes that increase the rate of human-wildlife and wildlife-livestock interactions; and climate change. Protecting the precious biodiversity should be a priority.

     

     

     

     

     

     

     

  • Powering the health-care engine with innovation

    Context

    India needs to tap the potential of the health-care start-ups in India and make the necessary provision to deal with the problems in the adoption of innovations in health-care.

    Expanding the supply side

    • Need to increase the hospital empanelled: As the scale of this scheme grows, a key area of focus is-
      • To expand the secondary and tertiary hospitals empanelled under PM-JAY and
      • To ensure their quality and capacity while keeping the costs down.
    • The ratio of doctors and beds: At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
    • 3% hospitalisation under the scheme: In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
      • This means physical and human infrastructure capacity would need to be augmented vastly.
    • Need for more beds: Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
    • Long-term strategy: While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
    • Mainstreaming innovation: A strong, yet under-tapped lever for accelerating health system efficiency and bridging these gaps is mainstreaming innovation in the Indian health system.

    Transformative solutions

    • India’s burgeoning entrepreneurial spirit combined with a systematic push for the development of a start-up ecosystem has led to a plethora of innovations in health care.
    • It is estimated that there are more than 4,000 health-care technology start-ups in India.
    • How do start-ups help? Today, start-ups are working to bring-
      • Innovative technologies and business models that leapfrog infrastructure.
      • Human resources.
      • Cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
    • How other innovations could help?
      • Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings.
      • Tele-ICU platforms to bridge the gap in high-skilled critical care personnel.
      • Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
    • Time to implement transformative solutions: It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

    Challenges in mainstreaming healthcare innovations

    • Lack of uniform regulatory standards: One challenge is non-uniform regulatory and validation standards.
      • Regulations evolving in India: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
      • As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
      • Government to overhaul standards: The government is now pushing ahead to overhaul Indian med-tech regulatory standards and product standards which will help bridge this trust-deficit.
    • Difficulty in the promotion of start-ups: Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
      • Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
      • Long gestation period: The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
    • Lack of framework to adopt innovation: Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
      • Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
      • This leads to limited traction for start-ups promoting innovative solutions.
    • Procurement challenges: Start-ups also face procurement challenges in both public and private procurement.
      • They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
      • Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

    Way forward

    • Identify promising market-ready products: To accelerate the process of mainstreaming innovations within the hospital system in India-
      • We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
    • Facilitate standard operational validation studies: There is a need to-
      • Facilitate standardised operational validation studies that are required for market adoption.
      • To help ease out the start-up procurement process such that these solutions can be adopted with confidence.
      • This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
    • Need to develop an interface between hospital and start-ups: A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
      • Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where-
      • Hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
      • Start-ups as collaborators: Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals.

    Conclusion

    The dream of an accessible, affordable and high-quality health-care system for all, will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.

  • Battling the bug

    Context

    With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected. This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.

    Cause of worry turned into a reality

    • Public health experts have worried most about an animal virus-
      • That gets into humans.
      • Causes human-to-human transmission.
      • Has high infectivity and a range of clinical severity.
      • With no human immunity, no diagnostic tests, drugs or vaccines.
    • An emerging virus, called the 2019 novel coronavirus (2019-nCoV), appears to be just that.
    • With the World Health Organisation declaring it a Public Health Emergency of International Concern (PHEIC), this outbreak is now a pandemic.

    What is coronavirus

    • Group of animal virus: Coronaviruses are a group of animal viruses identified by their crown-like (corona) appearance under a microscope.
    • SAARS connection: The 2019-nCoV belongs to this group of viruses, six of which, including the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS) viruses, were earlier known to cause disease in humans.
      • Genetic similarity with other viruses: Genetic sequencing of the virus from five patients showed it to be 5 per cent identical to the SARS virus.
    • Bats as hosts: Since the SARS outbreak in 2003, scientists have discovered a large number of SARS-related coronaviruses from their natural hosts-bats.
      • Previous studies have shown some of these bat coronaviruses to have the potential to infect humans.
      • Genetic sequencing showed it to human coronavirus to be over 96 per cent identical to a bat coronavirus.
      • Thus, 2019-nCoV clearly originated from bats, jumped into humans either directly or through an intermediate host, and adapted itself to human-to-human transmission.
      • Bats are a particularly rich reservoir for viruses with the potential to infect humans.
      • Examples of these include viruses such as Hanta, Rabies, Nipah, Ebola and Marburg viruses, and others that have caused high levels of mortality and morbidity in humans.
      • India has 117 species and 100 sub-species of bats, but we know little about the viruses they harbour and their disease potential.

    India’s response

    • India’s response includes-
      • Surveillance of arriving passengers at airports.
      • Awareness drives in the border states.
      • Designation of hospitals with isolation wards and the availability of protective gear (e.g. masks) to health workers.
      • SOP: There are clear operating procedures for sample collection and its transport to the National Institute of Virology, Pune, which is the nodal testing centre.
      • A self-declaration mechanism is in place and a 24×7 telephone helpline has been set up.
    • Two areas of concern
      • 1. Promotion of untested medicines: There is mixed messaging promoting AYUSH products that are untested and of questionable efficacy.
      • 2. India- a hot zone of zoonotic pathogens: India has been a “hot zone” for the emergence of new zoonotic (animal-derived) pathogens for over a decade.
      • But we continue to lack the capacity to quickly identify, isolate and characterise a novel pathogen.
      • Example of China: China is a good example of how investments in research and public health will allow it to take a lead on developing diagnostic tests, vaccines and drugs for this new virus. We must do the same and prepare for the future.
    • Disruption in global supply chains and concerns for India
      • With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected.
      • This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.
      • Disruption in medicine supply: The Indian pharmaceuticals industry imports about 85 per cent of its active pharmaceutical ingredients from China.
      • Any disruption in this supply chain would adversely affect the availability of medicines in India, which would be required in an outbreak situation.
      • Need to support local pharma. industry: India must, therefore, take steps to correct this imbalance and support the local pharmaceuticals industry in reducing its dependence on China

    Possible scenarios

    • Public health experts estimate that the epidemic will peak in three months.
    • From here on, there are a few possible scenarios, but which of these would play out is hard to guess.
    • 1st possibility: There could be very large numbers of cases and global spread of the virus with a low CFR of 0.1-0.5 per cent, like the bad flu. Or the same with increased CFR, which would lead to significant mortality.
    • 2nd possibility: It is also possible that the outbreak spiralled in China due to a combination of factors not present elsewhere, such as population density, food habits and the Chinese New Year, which sees large population movements.
      • It is also possible that the pandemic may not sustain outside China and die out like the 2003 SARS outbreak.
    • Whatever be the case, surveillance and sensible public health measures will be needed over the next few months.

    Conclusion

    India escaped the 2003 SARS and 2012 MERS outbreaks largely unscathed. This may still be the case with 2019-nCoV, but the laws of probability are likely to catch up soon. It would help to invest, build capacity and be ready.

     

     

     

     

  • Medical Devices (Amendment) Rules, 2020

    The Ministry of Health and Family Welfare has notified changes in the Medical Devices Rules, 2017 to regulate medical devices on the same lines as drugs under the Drugs and Cosmetics Act, 1940.

    Medical Devices (Amendment) Rules, 2020

    • These rules are applicable to devices intended for internal or external use in the diagnosis, treatment, mitigation or prevention of disease or disorder in human beings or animals” (as notified by the ministry).
    • It requires online registration of these devices “with the Central Licensing Authority through an identified online portal established by the Central Drugs Standard Control Organisation for this purpose.
    • Among the information that the manufacturer has to upload are “name & address of the company or firm or any other entity manufacturing the medical device along with name and address of manufacturing site.
    • It also need to upload certificate of compliance with respect to ISO 13485 standard accredited by National Accreditation Board for Certification Bodies or International Accreditation Forum.
    • This would mean that every medical device, either manufactured in India or imported, will have to have quality assurance before they can be sold anywhere in the country.
    • After furnishing of the above information a registration number will be generated. Manufacturer shall mention the registration number on the label of the medical device.

    What are the items covered under the new Rules?

    • A large number of commonly used items including hypodermic syringes and needles, cardiac stents, perfusion sets, catheters, orthopaedic implants, bone cements, lenses, sutures, internal prosthetic replacements etc are covered under the new rules.
    • For some items such as sphygmomanometers (used to monitor blood pressure), glucometers (to check blood sugar), thermometers, CT scan and MRI equipment, dialysis and X-ray machines, implants etc, different deadlines for compliance have been set.
    • For example for the first three, it is January 2021, for the others it is April next year. For ultrasound equipment, it is November 2020.

    Is this a sudden move?

    • This has been in the offing for some time now.
    • In October last year, the ministry had circulated copies of the then proposed notification for public comments following recommendations of the Drugs Technical Advisory Board (DTAB), which is the highest technical body for these decisions and has experts among its members.
    • In April last year, the DTAB had recommended that all medical devices should be notified as “drugs” under the drug regulation law to ensure they maintain safety and quality standards.
    • The notification makes it clear that the government has issued it in consultation with the DTAB.

    Why was the move required?

    • For much of the last one year, the health sector has been at the centre of attention following revelations about faulty hip implants marketed by pharma major Johnson & Johnson.
    • This has caused major embarrassment to the government, too, as it exposed the lack of regulatory teeth when it came to medical devices.
    • The matter dragged on, exposing the regulatory loopholes until finally the company agreed in court to pay Rs 25 lakh each to the 67 people who had had to undergo revision surgeries because the implants were defective.
    • That is really where the discussion started about regulation of medical devices.

    What are the penal provisions under Indian law?

    • There are various penal provisions under the Drugs and Cosmetics Act, 1940 for various kinds of offences. Manufacture or sale of substandard items is punishable with imprisonment of at least 10 years, which may extend to imprisonment for life.
    • There is also a provision for fine that will “not be less than Rs 10 lakh rupees or three times value of the confiscated items”.

  • Novel Coronavirus renamed as COVID-19 by WHO

    The World Health Organization (WHO) gave an official name to the disease caused by the novel coronavirus. The death toll from the virus has now crossed 1,000 and the disease has infected tens of thousands of people, the majority of them in China.

    COVID-19

    • The disease will be called “COVID-19”; the “CO” stands for coronavirus, “VI” for virus and “D” for disease.
    • The coronavirus itself is called “nCoV-2019”.

    WHO nomenclature

    • The WHO, in consultation with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), has identified best practices for naming new human diseases.
    1. These best practices apply to a new disease:
    2. That is an infection, syndrome, or disease of humans;
    3. That has never been recognised before in humans;
    4. That has potential public health impact; and
    5. Where no disease name is yet established in common usage
    • Names that are assigned by the WHO may or may not be approved by the International Classification of Diseases (ICD) at a later stage.
    • The ICD, which is also managed by the WHO, provides a final standard name for each human disease according to standard guidelines that are aimed at reducing the negative impact from names while balancing science, communication and policy.

    Terms to avoid

    • The agreed best practices include advice on what the disease names should not include, such as geographic location (Middle East Respiratory Syndrome, Spanish Flu, Japanese encephalitis).
    • Disease names should not include people’s names (Creutzfeldt-Jakob disease, Chagas disease), the species or class of animal or food (swine flu, monkeypox etc.), cultural or occupational references (miners, butchers, cooks, nurses etc.) and terms that incite “undue fear” such as death, fatal and epidemic.
    • The use of names such as “swine flu” and “Middle East Respiratory Syndrome” has had “unintended negative impacts” by stigmatising certain communities and economic sectors.

    Terms to include

    • The best practices include using generic descriptive terms such as respiratory diseases, hepatitis, neurologic syndrome, watery diarrhoea.
    • They include using specific descriptive terms that may indicate the age group of the patients and the time course of the disease, such as progressive, juvenile or severe.
    • If the causative pathogen is known, it should be used as part of the disease name with additional descriptors such as the year when the disease was first reported or detected.
    • The names should also be short (rabies, malaria, polio) and should be consistent with the guidelines under the International Classification of Diseases (ICD) Content Model Reference Guide.
    • As per the WHO, “severe” should be used only for those diseases that have a very high initial case fatality rate. “Novel” can be used to indicate a new pathogen of a previously known type
    • In the case of the novel coronavirus, “recognizing that this term will become obsolete if other new pathogens of that type are identified”, the WHO has now changed its name.

  • Arsenic Contamination

    As the geography of arsenic contamination spreads, there is an urgent need for governments to reorient mitigation measures. That’s because the focus till now has only been on drinking water, but new research says arsenic has contaminated our food chain.

    Arsenic contamination of water

    • Arsenic contamination in groundwater is one of the most crippling issues in the drinking water scenario of India.
    • According to the latest report of the Central Ground Water Board (CGWB), 21 states across the country have pockets with arsenic levels higher than the BIS stipulated permissible limit of 0.01 milligram per litre (mg/l).
    • The states along the Ganga-Brahmaputra-Meghna (GBM) river basin — Uttar Pradesh, Bihar, Jharkhand, West Bengal and Assam — are the worst affected by this human-amplified geogenic occurrence.
    • In India, arsenic contamination was first officially confirmed in West Bengal in 1983.
    • Close to four decades after its detection, the scenario has worsened.
    • About 9.6 million people in West Bengal, 1.6 million in Assam, 1.2 million in Bihar, 0.5 million in Uttar Pradesh and 0.013 million in Jharkhand are at immediate risk from arsenic contamination in groundwater.

    Effects of arsenic poisoning

    • Long-term exposure to arsenic in drinking water can cause cancer in the skin, lungs, bladder and kidney. It can also cause other skin changes such as thickening and pigmentation.
    • The likelihood of effects is related to the level of exposure to arsenic and in areas where drinking water is heavily contaminated, these effects can be seen in many individuals in the population.
    • Increased risks of lung and bladder cancer and skin changes have been reported in people ingesting arsenic in drinking water at concentrations of 50 µg/litre, or even lower.

    Affecting food

    • Recent research says arsenic contamination in groundwater has penetrated the food chain.
    • It eventually causes photo-accumulation of arsenic in the food crops, especially in the leaves, can emanate from contaminated water sprayed on them.
    • Yet the focus remained on drinking water, and the affected regions became the primary stake-holder in the mitigation approach.

    Way forward

    • Mitigation measures — that are currently focused on drinking water — must have a more comprehensive approach to ensure arsenic-free water for drinking and agricultural products.
    • That means that the government must check for arsenic in water used for agricultural produce.
    • Both the Union and state governments must work toward facilitating research that can investigate the accumulation of arsenic in crops and addressing the agricultural concerns of the affected regions.
    • They must watch out for arsenic percolation in the food chain and the possibilities of biomagnification.
    • The government needs to also conduct a larger study on the arsenic contamination of our food chain and its health impacts to understand its spatial spread through the agricultural supply chain.

  • A mix Indian health care can do without

    Context

    In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system which is one of the most prodigal health systems, and it is a well-known reality that it is infamously poor-performing.

    Emulating the U.S. health system in India and problems in this approach

    • Implicit intent to emulate the U.S. system: In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system like-
      • Enhance private initiative.
      • And uphold the insurance route as the way to go for health care.
    • AB-NHPS scheme: These are being largely envisaged while riding on the back of the Ayushman Bharat-National Health Protection Scheme (AB-NHPS).
      • AB-NHPS aims to provide insurance cover to nearly 50 crores poor Indians.
      • The mechanism to check insurance frauds: The AB-NHPS affirmed strong mechanisms to check insurance fraud which was commonplace in its precursor programme, the Rashtriya Swasthya Bima Yojana (RSBY).
      • New of fraud in AB-NHPS: Recently, 171 hospitals were reported to have been de-empanelled from the AB-NHPS on charges of fraud.
    • How are the frauds in AB-NHPS sought to be tackled? The response to these has been envisaged through an unprecedented bolstering of administratively-heavy and technology-driven mechanisms.
      • Anti-fraud units: National- and state anti-fraud units have been established and partnerships with fraud control companies conceived.
      • One would ask this question: what is wrong in all of this?
    • What is wrong with this approach? Let us return to the U.S. once again.
      • Administrative intensive: Multiple layers of complex arrangements and concomitant complex regulatory provisions have made the U.S. system one of the most administratively and technologically intensive systems in the world.
      • 50% spending going for the wages: More than 50% of health-care spending in the U.S. in 2010 went into health worker’s wages, with a large chunk of the growth in health-care labour taking place in the form of non-clinical workers.
      • Very little going into improving health: What this entails is that for every penny spent on health care, very little goes into actually improving health.

    What are the concerns in emulating the U.S. system?

    • Sub-satisfactory operations at the large cost: The new system necessitates-
      • A battery of new structures.
      • Personnel cadres.
      • Data systems.
      • And working arrangements only in order to sub-satisfactorily operate an insurance scheme that would cover less than half the population.
      • Disregarding the death spiral that policy-driven over-reliance on private health care could lead to considerable costs which would not primarily contribute to improving health outcomes.
      • Ethical concerns over unnecessary spending: While a besottedness with cutting-edge technology and state-of-the-art systems can help garner eyes and promote businesses, each unnecessary penny incurred this way raises significant ethical concerns.
    • Problems of inadequate funding
      • Funding sufficient only for a quarter of beneficiary: Gupta and Roy have shown how the allocation for the AB-NHPS for 2019-20 would have covered less than a quarter of the targeted beneficiaries.
      • Paltry increase in allocations: For 2020-21, there has been a paltry increase in health-care sector allocation (5.7% above 2019-20 RE), while the allocation for the AB-NHPS is unchanged.
      • It is very possible that the AB-NHPS continues to remain insufficiently funded and incapable of extending considerable financial risk protection to the poor.
    • Diversion of limited funds to wasteful areas
      • Attractive on face: Embracing the complexities associated with robust regulation of the insurance programme and making the requisite technological and administrative investments appear attractive and commendable on the face.
      • Diversion of limited fund: However, these complexities entail diverting highly limited resources towards wasteful and dispensable high-end areas.
      • These funds could have been set aside for much more pressing and productive domains, such as public hospitals and health centres.
      • Improvements in these areas would have strongly reflected in terms of tangibly better health outcomes.
      • AB-NHPS reinforcing contradictions: Rather, the AB-NHPS appears attuned to reinforcing a stark contradiction wherein trailblazing but unproductive high-end structures thrive alongside decrepit but potentially fructuos basic structures.

    Conclusion

    The fanfare with which AB-NHPS was launched, can hide the pressing concerns which lie underneath. The government must ensure that every penny spent on improving healthcare is used in the most optimal way and ensure that India’s AB-NHPS won’t end up the US healthcare way.

  • Fine-tuning the Surrogacy Bill

    Context

    • In a recent report, a Select Committee of Parliament has recommended that the contentious clause limiting surrogacy only to “close relatives” to be removed from the Surrogacy (Regulation) Bill, 2019.
    • These recommendations aim to make the benefits of modern technology more easily available to infertile couples.
    • A look at the genesis of the Bill, its provisions and why the current report could signal some progressive amendments in the Bill:

    What are the provisions of the Surrogacy (Regulation) Bill?

    • The Surrogacy Bill proposes to allow altruistic ethical surrogacy to intend infertile Indian married couples in the age groups 23-50 years (women) and 26-55 years (men).
    • It was first mooted in 2016 in the wake of repeated reports of exploitation of women who were confined to hostels, not provided adequate post-pregnancy medical care and paid a pittance.
    • The couple should have been legally married for at least five years and should be Indian citizens.
    • They cannot have a surviving child, either biological or adopted, except when they have a child who is mentally or physically challenged or suffers from a life-threatening disorder with no permanent cure.
    • It requires surrogacy clinics to be registered, and national and state surrogacy boards to be formed.
    • It makes commercial surrogacy, and abandoning or disowning a surrogate child punishable by imprisonment up to 10 years and a fine up to Rs 10 lakh.

    What changes has the Select Committee suggested?

    • The Select Committee recommended that the “close relatives” clause should be removed, and any “willing” woman should be allowed to become a surrogate mothe.
    • It has strongly backed the ban on commercial surrogacy.
    • It has also recommended that divorced and widowed women aged between 35 and 45 years should be able to be a single commissioning parent.
    • It has emphasised the need for a five-year waiting period for childless married couples could be waived if there is a medical certificate that shows that they cannot possibly conceive.
    • It has recommended that persons of Indian origin should be allowed to avail surrogacy services.
    • It has not, however, recommended expanding the definition of commissioning parent to include singles, either men or women.
    • It also recommended that the ART Bill (which deals with assisted reproductive technologies) should be brought before the Surrogacy bill so that all the highly technical and medical aspects could be properly addressed.

    What is the ART Bill?

    • The Assisted Reproductive Technology (Regulation) Bill has been in the making since 2008.
    • It aims to regulate the field through registration of all IVF clinics and sperm banks, segregation of ART clinics and gamete banks etc.
    • It also requires national and state boards to be established for the purpose of regulation of the fertility market.
    • The Select Committee report says: “Surrogacy is a part and parcel of ART and hence the Surrogacy Bill should come into force only after the enactment of ART Bill.
    • Bringing Surrogacy Bill before the ART will be irrelevant and also create duplication of Boards.
    • The Standing Committee on Health and Family Welfare, too has “strongly recommended” to the government that the two Bills should be brought together and not in isolation.

    How big is India’s surrogacy market?

    • Estimations by the ICMR put it around 2,000-odd babies per year through commercial surrogacy — when a woman is paid an agreed sum for renting her womb.
    • CII figures say surrogacy is a $2.3-billion industry fed by a lack of regulations and poverty.

    What happened the last time the Bill was scrutinized by a parliamentary panel?

    • The Bill was earlier scrutinized by the Parliamentary Standing Committee on Health and Family Welfare.
    • That committee had recommended that compensation should be the norm and the word “altruistic” should be replaced with “compensated”.
    • Couples — including those in live-in relationships — should be allowed to choose surrogates from both within and outside the family. Altruistic surrogacy, it observed, is tantamount to exploitation.
    • The “close relative” condition is open to misuse in a patriarchal setup, the committee had observed.
    • Given the patriarchal familial structure and power equations within families, not every member of a family has the ability to resist a demand that she be a surrogate for another family member.
    • A close relative of the intending couple may be forced to become a surrogate which might become even more exploitative than commercial surrogacy.
    • These recommendations were not accepted by the government.