Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Explained: Why is the litchi toxin causing deaths?


From UPSC perspective, the following things are important :

Prelims level : AES, Litchi toxin

Mains level : Preventing child mortality



  • Acute encephalitis syndrome (AES) in few districts of Bihar has so far claimed the lives of over 100 children.
  • Most of the deaths have been attributed to low blood sugar level (hypoglycaemia).

What is acute encephalitis syndrome (AES)?

  • AES in short, it is a basket term used for referring to hospital, children with clinical neurological manifestations which include mental confusion, disorientation, convulsion, delirium or coma.
  • Meningitis caused by virus or bacteria, encephalitis (mostly Japanese encephalitis) caused by virus, encephalopathy, cerebral malaria, and scrub typhus caused by bacteria are collectively called acute encephalitis syndrome.
  • While microbes cause all the other conditions, encephalopathy is biochemical in origin, and hence very different from the rest.
  • There are different types of encephalopathy. In the present case, the encephalopathy is associated with hypoglycemia and hence called hypoglycemic encephalopathy.

Is encephalitis different from hypoglycaemic encephalopathy?

  • The two conditions show very different symptoms and clinical manifestations.
  • Fever on the first day is one of the symptoms of encephalitis before the brain dysfunction begins.
  • While fever is seen in children in the case of hypoglycaemic encephalopathy, fever is always after the onset of brain dysfunction (actually due to the brain dysfunction).
  • And not all children exhibit fever. Some children have no fever, while others may have mild or very high fever.
  • The blood sugar level is usually normal in children with encephalitis but is low in children with hypoglycaemic encephalopathy.

What happens in hypoglycaemic encephalopathy?

  • However, in hypoglycaemic encephalopathy, children go to bed without any illness but manifest symptoms such as vomiting, convulsion and semi-consciousness early next morning (between 4 a.m. to 7 a.m.).
  • At that time, the blood sugar level is low, hence the name hypoglycaemic encephalopathy.

What killed so many children in Bihar?

  • In a majority of cases, children died due to hypoglycaemic encephalopathy.
  • According to a PIB release hypoglycaemia (low blood sugar level) was reported in a “high percentage” of children who died.
  • Unlike hypoglycaemic encephalopathy, encephalitis does not cause low blood sugar level so death in a high percentage of children couldn’t have been due to encephalitis.

Why has it affected only young children in Bihar?

  • It is an observed fact that malnourished children between two to 10 years fall ill and die due to hypoglycaemic encephalopathy.
  • It is not known why older children or adults do not suffer the same way.
  • This clear discrimination by age is also a reason why the underlying cause of the illness cannot be a virus.
  • A virus does not discriminate by age, and children younger than two years too are affected by Japanese encephalitis.
  • It has also been documented that most of the children falling ill are from families camping in orchards to harvest the fruits. These children tend to collect and eat the fruits that have fallen on the ground.
  • Hypoglycaemic encephalopathy outbreaks are restricted to April-July, with a peak seen in June. This is because litchi is harvested during this period.

Role of Litchi

  • In 2012-2013, a research shown that a toxin found in litchi fruit that was responsible for causing hypoglycaemic encephalopathy.
  • In 2017, an India-U.S. team confirmed the role of the toxin called methylene cyclopropyl glycine (MCPG).
  • Early morning, it is normal for blood sugar to dip after several hours of no food intake.
  • Undernourished children who had gone to sleep without a meal at night develop hypoglycaemia.
  • The brain needs normal levels of glucose in the blood. The liver is unable to supply the need.
  • So the alternate pathway of glucose synthesis, called fatty acid oxidation, is turned on. That pathway is blocked by MCPG.
  • Litchi does not cause any harm in well-nourished children, but only in undernourished children who had eaten litchi fruit the previous day and gone to bed on an empty stomach.

How is MCPG hazardous?

  • The toxin acts in two ways to harm the brain and even cause death.
  • Because of the toxin, the body’s natural mechanism to correct low blood glucose level is prevented thus leading to a drop in fuel supply to the brain.
  • This leads to drowsiness, disorientation and even unconsciousness.
  • When the toxin stops the fatty acid conversion into glucose midway, amino acids are released which are toxic to brain cells.
  • The amino acids cause brain cells to swell resulting in brain oedema. As a result, children may suffer from convulsions, deepening coma and even death.

What can be done to prevent this?

  • By making sure that undernourished children do not eat plenty of litchi fruit.
  • Ensuring that they eat some food and not go to bed on an empty stomach.

Can hypoglycemic encephalopathy be treated?

  • Yes, hypoglycaemic encephalopathy can be easily treated with infusing dextrose (a simple sugar that is made from corn and is chemically identical to glucose).
  • Infusing 10% dextrose not only restores blood sugar to a safe level but also stops the production of amino acid that is toxic to brain cells by shutting down the body’s attempt to convert fatty acid into glucose.
  • Together with dextrose infusion, infusing 3% saline solution helps in reducing oedema of the brain cells.
  • The concentration of ions in the fluid outside the brain cells becomes more than what is inside the cell; this causes the fluid from the cells to come out thus reducing oedema and damage to brain cells.
  • If dextrose infusion is not started within four hours after the onset of symptoms, the brain cells may not recover but will die.
  • As a result, even if they survive, children suffer from various aspects of brain damage — speech getting affected, mental retardation, muscle stiffness/weakness and so forth.
Wildlife Conservation Efforts

Normalized Difference Vegetation Index (NDVI)


From UPSC perspective, the following things are important :

Prelims level : NDVI

Mains level : Utility of NDVI


  • A field study by researchers from Bengaluru shows that a popularly used index that remotely estimates density of vegetation does not yield a reliable estimate of food abundance for elephants in tropical forests.
  • In fact, researchers show that this index has a negative correlation with graminoids (grassy food – grasses, sedges and rushes – preferentially consumed by elephants) in tropical forests.

Normalized Difference Vegetation Index (NDVI)

  • For both academic and practical purposes, there is the practice of remotely monitoring vegetation in an area and representing it in terms of maps and parameters.
  • One such parameter used is the normalized difference vegetation index (NDVI) which is measured remotely from satellite data.
  • The NDVI is a simple indicator which tells how much of the ground is covered with vegetation.
  • It basically calculates the difference between the red and near infrared (NIR) components of light reflected by objects, from, say, a satellite.
  • Since healthy vegetation strongly absorbs red and reflects near infrared light, this difference can indicate the presence of healthy vegetation and map it into a colour code.

Using NDVI

  • NDVI always ranges from -1 to +1. But there isn’t a distinct boundary for each type of land cover.
  • For example, when you have negative values, it’s highly likely that it’s water. On the other hand, if you have a NDVI value close to +1, there’s a high possibility that it’s dense green leaves.
  • But when NDVI is close to zero, there aren’t green leaves and it could even be an urbanized area.

Why NDVI isn’t a good measure of vegetation cover?

  • NDVI was negatively correlated to grasses. This means grass abundance tends to be low in locations where NDVI is high and vice-versa.
  • While canopy cover and shrub abundance contribute positively to NDVI, they negatively affect grass abundance.
  • Because of the poor correlation, NDVI cannot be reliably used as a measure of forage abundance in a multi-storeyed forest with a low proportional abundance of food species.
  • Grasses form a large component of food of elephants and also ungulates (hoofed animals) like deer, sambar and gaur.

Misleading Elephants data

  • This has been used to estimate the amount of food abundance available to herbivorous animals, for example, elephants.
  • The NDVI is used, for instance, in attempts to track the presence of elephants using the vegetation they consume.
  • However, this work clearly establishes that this can be misleading, and field-based studies are the ones which can yield definitive results.
  • Researchers in India have found that the abundance of food plants is not correlated with NDVI.
Foreign Policy Watch: India-United States

India out of GSP programme


From UPSC perspective, the following things are important :

Prelims level : GSP

Mains level : Implications of GSP status removal on India


  • The US has announced its intention to “terminate” India’s designation as a beneficiary of its Generalized System of Preferences (GSP) duty concession programme.

Why such move?

  • Under the programme, certain products can enter the US duty-free if beneficiary developing countries meet the eligibility criteria established by its Congress.
  • US said that India had failed to provide assurances to the US for “equitable and reasonable” access to its markets in numerous sectors.
  • US’s refers to India as a “very-high tariff nation” and demands for a “reciprocal tax” on goods from India.

What is GSP?

  • The GSP is a US trade preference programme designed to promote economic development by allowing duty-free entry for thousands of products from designated beneficiary countries.
  • The concept of GSP is very different from the concept of MFN as it provides equal treatment in the case of tariff being imposed by a nation.
  • But in case of GSP, differential tariff could be imposed by a nation on various country whether it is a developed country or a developing country.
  • Both the rules comes under the purview of WTO.
  • GSP provides tariff reduction for least developed countries but MFN is only for not discriminating among WTO members.

India and GSP

  • India has been the biggest beneficiary of the GSP regime and accounted for over a quarter of the goods that got duty-free access into the US in 2017.
  • Exports to the US from India under GSP — at $5.58 billion — were over 12 per cent of India’s total goods exports of $45.2 billion to the US that year.
  • The US goods trade deficit with India was $22.9 billion in 2017.
  • With India exporting $6.3 billion worth of goods to the US under GSP in 2018 and availing duty concession to the tune of only $240 million last year.

Impact of GSP withdrawal

  • Even after US withdrawal of GSP, India continues to enjoy tariff preference from many countries including Australia, Russia and Japan, as well as the European Union (EU), among others.
  • Indian exports to these countries was nearly five times the total exports to the US in 2018.
  • Within the group of countries that provided GSP benefit to India, exports to EU nations were highest, followed by the US, Japan, Russia and Australia, respectively.
  • As exports under GSP accounted for over 11 per cent of India’s total goods exports of $54.4 billion to the US last calendar year, the withdrawal could affect India’s competitiveness in exports.
  • Indian exports from US included organic chemicals, raw materials, iron, steel, furniture, aluminium and electrical machinery.
Disasters and Disaster Management – Sendai Framework, Floods, Cyclones, etc.

Flood Hazard Zonation Atlas for Odisha


From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Flood control and management


  • Odisha has come out with a unique flood hazard atlas on the basis of historic flood inundation captured through satellite imagery over the period from 2001 to 2018.
  • It is expected to help the State manage floods more efficiently.

Flood Hazard Zonation Atlas

  • The National Remote Sensing Centre (NRSC) of the ISRO had taken the study on flood hazard Zonation for Odisha.
  • A large number of satellite images acquired over 18 years (2001-2018) were used. All satellite data sets were analysed and flood layers were extracted.
  • All the flood layers corresponding to a year are combined as one inundation layer, so that this layer represents the maximum flooded area in one year.
  • The NRSC analysis says about 8.96% (13.96 lakh hectares) of land in Odisha was affected by floods during 2001-2018. Out of total flood-affected area (13.96 lakh hectares), about 2.81 lakh hectares of land falls under high (inundated seven-nine times) to very high (inundated 10-14 times) flood hazard categories.
  • Eight out of 30 districts such as Bhadrak, Kendrapara, Jagatsinghapur, Balasore, Puri, Jajpur, Khordha and Cuttack districts are more flood-affected districts.
  • As high as 77% of Bhadrak and 70% of the Kendrapara district have been categorised as flood hazard.

Why Odisha?

  • Vast areas of the State are inundated when there is flooding every year in major rivers, namely, the Mahanadi, Brahmani, Baitarani, Subarnarekha and Rushikulya.
  • Some of the rivers like, the Vamsadhara and Budhabalanga, also cause flash floods due to instant run-off from their hilly catchments.
  • Damages due to floods are caused mainly by the Mahanadi, the Brahmani and the Baitarani, which have a common delta where floodwaters intermingle, and, when in spate simultaneously, wreak considerable havoc.
  • The entire coastal belt is prone to storm surges, which is usually accompanied by heavy rainfall, thus making the estuary region vulnerable to both storm surges and river flooding.

A useful resource

  • All such combined flood layers for 18 years were integrated into flood hazard layer representing the observed flood-inundated areas with different frequencies.
  • This layer was integrated with the digital database layers of Odisha.
  • The atlas would serve as a useful resource of information for policy makers, planners and civil society groups.

Species in news: Miracle Plant ‘Arogyapacha’


From UPSC perspective, the following things are important :

Prelims level : Arogyapacha

Mains level : Not Much



  • Scientists from the University of Kerala have decoded the genetic make-up of Arogyapacha (Trichopus zeylanicus), a highly potent medicinal plant endemic to the Agasthya hills.
  • This ‘miracle plant’ is known for its traditional use by the Kani tribal community to combat fatigue.
  • Studies have also proved its varied spectrum of pharmacological properties such as anti-oxidant, aphrodisiac, anti-microbial, anti-inflammatory, immunomodulatory, anti-tumour, anti-ulcer, anti-hyperlipidemic, hepatoprotective and anti-diabetic.
Water Management – Institutional Reforms, Conservation Efforts, etc.

[op-ed snap] Running dry


From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Water Crisis in urban areas

After a dry spell of almost 200 days, Chennai received monsoon showers last week. But this has not mitigated the water crisis in Tamil Nadu’s capital.


  • Clashes over water have been reported from different parts of the city and firms in Chennai’s Information Technology Park have asked employees to either work from home or bring their own water.
  • The state government and the city’s municipality have blamed the crisis on the deficient Northeast Monsoon in October-November last year.
  • They are not completely wrong.
  • However, the fact also is that in the past five years, Chennai’s water supply has consistently fallen short of the city’s requirement.
  • The Chennai Metropolitan Water Supply and Sewerage Board has been able to supply only 830 million litres a day (mld) as against the demand of about 1,200 mld. This year, the agency’s water supply dipped to 550 mld.
  • Chennai is a rain-shadow city.
  • It gets more than 80 per cent of its water from the Northeast Monsoon.
  • In the past, this water was stored in ponds, canals and lakes which would minimise the run-off — that a coastal city is susceptible to — and recharge groundwater.
  • Besides, according to a study by researchers at the geology department of Chennai’s Anna University, the city had more than 60 large water bodies at the turn of the 20th century.
  • Three major waterways — the Buckingham canal and the rivers, Adyar and Cooum — crisscrossed Chennai.
  • But Tamil Nadu’s capital today has only 28 water bodies, large or small, notes the Anna University study.
  • The Pallikaranai marshland which used to sprawl over more than 6,000 hectares has shrunk to about 650 hectares.
  • A growing body of literature has shown that urban planners gave short shrift to the imperatives of Chennai’s hydrology to meet the city’s infrastructural demands.
  • A parliamentary panel that enquired into the causes of the Chennai floods in 2015, for example, reported that that real estate business had “usurped” the city’s water bodies.
  • Today, Chennai gets its water from four reservoirs, which have gone dry after the retreating monsoon failed last year. Chennai’s desalination plants can barely supply a fifth of the city’s water requirements.


  • Chennai is amongst the 21 Indian cities which the Niti Aayog fears will run out of groundwater by 2020.
  • The city’s water crisis bares a critical challenge for the new Jal Shakti ministry.
  • It has to play a leading role in resolving the tension in India’s current urban planning paradigm between the developmental needs of people and water security imperatives.
  • The new ministry should start by coordinating with local authorities in Chennai to rejuvenate the city’s aquifers.
NITI Aayog’s Assessment

[op-ed snap] Reimagining the NITI Aayog


From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : New vision for Niti Ayog


India’s Constitution-makers thought of India as a union of States with a centripetal bias, done, advisedly, to preserve the unity and integrity of a newly fledged nation.

Change in situation

  • Since then, the Indian economy, polity, demography and society have undergone many changes. The new aspirational India is now firmly on a growth turnpike. It is in this context that we revisit India’s fiscal federalism and propose redesigning it around its four pillars.
  • Challenges before federations
  • Typically, federations (including the Indian one) face vertical and horizontal imbalances.

Vertical imbalance

A vertical imbalance arises because the tax systems are designed in a manner that yields much greater tax revenues to the Central government when compared to the State or provincial governments; the Constitution mandates relatively greater responsibilities to the State governments. For example, in India, post the advent of Goods and Services Tax (GST), the share of States in the public expenditure is 60% while it is 40% for the Centre to perform their constitutionally mandated duties.

Horizontal imbalances

  • The horizontal imbalances arise because of differing levels of attainment by the States due to differential growth rates and their developmental status in terms of the state of social or infrastructure capital.
  • Traditionally, Finance Commissions have dealt with these imbalances in a stellar manner, and they should continue to be the first pillar of the new fiscal federal structure of India.

Understanding the imbalance

  • However, in India, the phenomenon of horizontal imbalance needs to be understood in a more nuanced fashion.
  • It involves two types of imbalances. Type I is to do with the adequate provision of basic public goods and services, while the second, Type II, is due to growth accelerating infrastructure or the transformational capital deficits.
  • It is here that we believe that NITI Aayog 2.0 must create a niche, assume the role of another policy instrument and become the second pillar of the new fiscal federal structure.
  • It is best that the Union Finance Commission be confined to focussing on the removal of the horizontal imbalance across States of the Type I: i.e. the basic public goods imbalance.
  • We need another institution to tackle the horizontal imbalance of the Type II; for this the NITI Aayog is the most appropriate institution.

Tasks for Niti Ayog

  •  NITI Aayog 2.0 should receive significant resources (say 1% to 2% of the GDP) to promote accelerated growth in States that are lagging, and overcome their historically conditioned infrastructure deficit, thus reducing the developmental imbalance.
  • NITI Aayog 2.0 should also be mandated to create an independent evaluation office which will monitor and evaluate the efficacy of the utilisation of such grants. 

Ushering in decentralisation

  • The same perspective will have to be translated below the States to the third tier of government.
  • This is crucial because intra-State regional imbalances are likely to be of even greater import than inter-State ones.
  • Decentralisation, in letter and spirit, has to be the third pillar of the new fiscal federal architecture.
  • De jure and de facto seriousness has to be accorded to the 73rd and 74th constitutional amendments.
  • One of the ways for this is through the creation of an urban local body/panchayati raj institutions consolidated fund.
  • This would mean that Articles 266/268/243H/243X of our Constitution will need to be amended to ensure that relevant monies directly flow into this consolidated fund of the third tier.
  • Further, the State Finance Commissions should be accorded the same status as the Finance Commission and the 3Fs of democratic decentralisation (funds, functions and functionaries) vigorously implemented. This will strengthen and deepen our foundational democratic framework.

Fine-tuning the GST

  • The fourth pillar — and in a sense what is central and binding — is the “flawless” or model GST.
  • We need to quickly achieve the goal of a single rate GST with suitable surcharges on “sin goods,” zero rating of exports and reforming the Integrated Goods and Services Tax (IGST) and the e-way bill.
  • The GST Council should adopt transparency in its working, and create its own secretariat with independent experts also as its staff.
  • This will enable it to undertake further reforms in an informed and transparent manner. Thus, India will be able to truly actualise the “grand bargain” and see the GST as an enduring glue holding the four pillars together by creating the new fiscal federal architecture and strengthening India’s unique cooperative federalism.
US policy wise : Visa, Free Trade and WTO

[op-ed snap] Clouds of war


From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Iran Us on brink of war


U.S. President Donald Trump’s decision to pull back from air strikes on Iran, after the latter shot down an American drone near the Strait of Hormuz, was a rare moment of restraint amid otherwise escalating tensions between the two countries.


  • The rationale behind the pull-back, according to Mr. Trump, was that he did not want to cause any loss of Iranian lives as no American lives were hurt by the Iranians.
  • Avoiding open conflict – Clearly, Mr. Trump, who had campaigned against the costly wars of the U.S. overseas, does not seem to be in favour of launching an open conflict with Iran.
  • Iran’s Strengths – A war with Iran could be prolonged and disastrous. Iran has ballistic missiles, proxy militias and a relatively vibrant navy.
  • And the Strait of Hormuz, through which one-third of the world’s seaborne oil shipments move, is within its range.
  • Mr. Trump does not want to take a risk unless there are provocations from Iran targeting American lives.
  • Maximum pressure – While this approach is better than that of Mr. Trump’s National Security Adviser, John Bolton, who has threatened Iran with war several times, what the U.S. President overlooks is that the current state of tensions is a product of his “maximum pressure” tactic.
  • A year ago Mr. Trump pulled the U.S. out of a nuclear deal with which Iran was fully compliant, setting off the escalation.
  • His plan was to squeeze the Iranian economy and force Tehran back to the table to renegotiate the nuclear issue as well as Iran’s missile programme and regional activism, for a “better deal”.
  • A year later, the U.S. and Iran are on the brink of a war.

Issues with maximum pressure

  • The problem with Mr. Trump’s “maximum pressure” approach is that he doesn’t seem to have a plan between the sanctions-driven pressure tactics and a potential military conflict.
  • Iran, on the other hand, is ready to take limited risks, as its actions such as the threat to breach the uranium enrichment limits set by the nuclear deal and the downing of the American drone suggest, to break the stranglehold of the sanctions.
  • As a result, Mr. Trump has a situation where maximum pressure is not producing the desired result, and both countries are edging towards a war he doesn’t want.
  • This is a strategic dilemma that warrants a recalibration of policy.
  • Mr. Trump’s decision to call off the strike and the new red line he set for Iran could create an opportunity for such a recalibration.
  • He could seize the moment to assure Iran that his primary goal is engagement, not conflict.

Way Forward

  • What Iran wants the most is relief from the sanctions.
  • Instead of sticking to a policy that has proved to be counter-productive and risky, Mr. Trump could offer Tehran some reprieve in return for its remaining in the nuclear deal, which could be followed up by a fresh diplomatic opening.
  • If he continues with the pressure tactics, tensions will stay high, the Strait of Hormuz would be on the brink, and further provocations by either side, or even an accident, could trigger a full-scale conflict.
  • That is a dangerous slope.