Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Understand the two types of the disease and what you can do to mitigate the effects

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

How China eliminated malaria and the road ahead for India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Malaria

Mains level : Non-communicable diseases burden on India

Recently, El Salvador and China were declared malaria-free by the WHO.

What is Malaria?

  • Malaria is a disease caused by a parasite called plasmodium vivax, p. filarium.
  • The parasite is spread to humans through the bites of infected mosquitoes.
  • People who have malaria usually feel very sick with a high fever and shaking chills.
  • While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

How many countries have successfully eliminated malaria?

  • Since 1900, 127 countries have registered malaria elimination. This is definitely not an easy task.
  • It needs proper planning and a strategic action plan based on the local situations.
  • All these countries followed the existing tools and strategies to achieve the malaria elimination goal.
  • The main focus was on surveillance.
How did China eliminate malaria?
  • China followed some specific strategies, namely strong surveillance following the ‘1-3-7’system: malaria diagnosis within 1 day, 3 days for case investigation and by day 7 for public health responses.
  • Molecular Malaria Surveillance for drug resistance and genome-based approaches to distinguish between indigenous and imported cases was conducted.
  • All borders to the neighboring countries were thoroughly screened to prevent the entry of unwanted malaria into the country.

What is the current scenario of malaria in India?

  • As per the Global Malaria Report 2020 by the World Health Organization (WHO) India shared 2% of the total global malaria cases in 2019.
  • India has a great history of malaria control.
  • The highest incidence of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 million deaths per year.
  • The launch of National Malaria Control Programme in 1953 and the National Malaria Eradication Programme in 1958 made it possible to bring down malaria cases to 100,000 with no reported deaths by 1961.
  • This is a great achievement been made so far.

Unexpected resurgence

  • But from a nearing stage of elimination, malaria resurged to approximately 6.4 million cases in 1976.
  • Since then, confirmed cases have decreased to 1.6 million cases, approximately 1100 deaths in 2009 to less than 0.4 million cases and below 80 deaths in 2019.
  • India accounted for 88% of malaria cases and 86% of all malaria deaths in the WHO South-East Asia Region in 2019.
  • It is the only country outside Africa among the world’s 11 `high burden to high impact’ countries.

Road ahead for India

Collaboration:

  • India is a signatory to National Framework for Malaria Elimination (NFME) 2016-2030 aiming for malaria elimination by 2030.
  • This framework has been outlined with a vision to eliminate the disease from the country which would contribute to improved health with quality of life and poverty alleviation.
  • China collaborated with Harvard University and the Massachusetts Institute of Technology, USA for Molecular Malaria Surveillance.
  • In India, there are very dedicated expert scientists who can take up such assignments.

Diagnosis:

  • India stands at a very crucial stage. The present challenge is the detection of asymptomatic cases in most endemic areas.
  • Molecular Malaria Surveillance must be used to find out the drug-resistant variants and genetic-relatedness studies to find out the imported or indigenous cases.
  • The surveillance must be strengthened and using smart digital surveillance devices would be an important step. Real-time and organic surveillance is needed even in remote areas.

Monitoring:

  • The results of each malaria case can be registered in a central dashboard at the National Vector Borne Disease Control Programme, as it is done for COVID-19 cases by Indian Council of Medical Research.
  • All intervention activities must strictly be monitored.
  • Vector biology, site of an actual vector mosquito bite, host shifting behaviour, feeding time, feeding behaviour and insecticide resistance studies need to be carried out to support the elimination efforts.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

What is Palliative Care?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Palliative Care

Mains level : Psychosocial impacts of the covid-19 pandemic

The newscard talks about palliative healthcare which may help when the world is reeling under this most unexpected and unprecedented pandemic, COVID-19.

Palliative Care is a promising approach to counter the psychosocial impacts of the COVID-19 outbreak. We can use this as an example to quantify the measures required to improve mental healthcare infrastructure in India.

Social sufferings caused by the pandemic

  • COVID-19, because of its unique nature and magnitude has brought in its wake, not only physical illness but more of emotional and social suffering.
  • These include- fear, anxiety, uncertainty, loss of loved ones and social distress such as losing jobs and income, inability to move freely to work and other places, frustrations, staying long hours at home and other hardships, all leading to psychological disturbances for many.

What is Palliative Care?

  • The literal meaning of the word ‘palliate’ is ‘to alleviate pain — physical and emotional’, meaning, relief of suffering. ‘Suffering’ literally means ‘the state of undergoing pain, distress, or hardship’.
  • It is an approach that improves the quality of life of patients and their families facing the problem associated with a life-threatening illness.
  • It involves prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
  • It is part and parcel of treatment for any patient for any disease at any stage, for any age. It is simply a ‘whole person’ approach to improving health in any patient.

A promising remedy

  • ‘Palliative Medicine’ is a medical speciality, which involves the treatment of pain, breathing difficulty and other distressing physical symptoms caused by chronic and life-limiting diseases.
  • It also addresses the psychological issues of both patient and family, with the sole aim of improving the quality of life. It is most beneficial when started early in the disease trajectory.
  • It is also a form of supportive care, giving that extra layer of support a patient needs, to alleviate suffering, alongside disease treatment even in acute illness.
  • In the present scenario, in addition to what physicians are toiling with to cure patients, and the government and health care policies and strategies, palliative care can play a supportive role.

Supportive role

  • Distressing physical symptoms like pain, breathing difficulty, restlessness (delirium) and others can be well relieved or palliated with medicines in consultation with the specialists.
  • Similarly, skilled counselling is an integral part of the palliative approach.
  • It helps address the psychological, social and spiritual issues, which both patient and family are experiencing in the present scenario.
  • There is a way of responding to their fears, anxieties and to questions. They rarely need antidepressants when we acknowledge their emotions as normal.

Conclusion

  • Active listening is by far the most important part of counselling.
  • This care can be availed of from psychologists, specialists in palliative medicine, as well as those from medical organisations who have the expertise and willingness to render their services.
  • Hence, Palliative care is the reinstatement of the humane aspects of medical care and is complementary to all medical specialities, a common thread running through the total care of all patients.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

The law cannot fall silent

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2-In fight against covid-19 epidemic we must follow the principles of international laws and treaty obligations.

Context

Amid the many developments in the wake of Covid-19 pandemic one of the facets that is also discussed is-How to read international law in the context of the pointers to the future?

Constitutional duty regarding international laws

  • Respect for the norms and standards of international law is among the paramount constitutional duties of the state under Article 51 of the Constitution.
  • The duty is regardless of the quibbles on whether the language here refers only to treaty/obligations or also to customary international law.
  • International norms remain relevant: Despite US President Donald Trump’s recent threat of actions against the WHO, international norms, standards, and doctrines remain relevant to making national policy and law.

Possibility of discussion over pandemic at UNSC

  • The difference between the United Nations as a site of normative discursivity and as a site of doing global power politics is sadly manifest even now in the accelerated pace of the pandemic.
  • Discussion extremely unlikely: President Trump’s insistence on calling it a “Chinese virus” renders it extremely unlikely that the pandemic will be discussed during the current monthly presidency of the UN Security Council by China.
  • Possibility of veto: The threat of veto by China and Russia will always loom large whenever the matter is placed for discussion.

Role of the UN in the codification of law

  • The UN is also a site of systems of norm enunciation.
  • Along with the International Law Commission, it is responsible for the progressive codification of law.
  • The UN system has developed lawmaking and framework treaties as well as provided auspices for systems of “soft” law that may eventually become the binding law.
  • There are three types of international laws which are described below.

1. The fundamental overriding principle of international laws

  • Jus cogens: Some of the norms of international law are robust and deeply relevant. For example, the peremptory jus cogens — a few fundamental, overriding principles of international law such as crimes against humanity, genocide, and human trafficking apply to all states.
  • And Article 53 of the Vienna Convention on the Law of Treaties goes so far as to declare that a “treaty is void if, at the time of its conclusion, it conflicts with a peremptory norm of general international law”.
  • And even when ingredients of genocide remain difficult to prove, the International Court of Justice (ICJ) has held, in 2007, that states have a duty to prevent and punish acts and omissions that eventually furnish elements for the commission of crime of genocide.
  • Erga omnes: There also exist erga omnes rules prescribing specifically-determined obligations which states owe to the international community as a whole.
  • This was enunciated by the ICJ in 1970 for four situations — the outlawing of acts of aggression; the outlawing of genocide; protection from slavery; and protection from racial discrimination.
  • A great significance of this judicial dictum is that it lays down obligations which transcend consensual relations among states.
  • In addition, there are three other sets of international law obligations.
  • These are primarily derived from the no-harm principles crystallised in the International Law Commission’s 2001 Draft Articles on the Prevention of Transboundary Harm (DAPTH) and the Paris Framework Agreement on Climate Change, 2015.
  • The DAPTH has carefully developed norms of due diligence, stressing all the way that these may be adapted to contextual exigencies.
  • But due diligence obligations certainly extend beyond local and national boundaries, especially because the environmental problems have a transboundary impact.
  • Each state is obliged to observe these standards in the fight against COVID-19 as a matter of international law.

2. International laws dealing with core human right measures

  • No law or policy to combat epidemics or pandemic can go against the rights of migrant workers, internally displaced peoples, and refugees and asylum seekers.
  • Respect for the inherent dignity of individuals in combating COVID-19 and for the rights of equal health for all, non-discrimination, and the norms of human dignity further reinforce accountability and the transparency of state and other social actors.
  • Panicky and sadist policing, including shoot-a- sight orders in collective exodus situations, and militaristic responses to food riots de-justify health lockouts and curfews.

3. International humanitarian law

  • The third set of obligations arises out of international humanitarian law. The Biological and Toxin Weapons Convention (BTWC) is pertinent here.
  • India did not subscribe to any conspiracy or racist theory about the origins of COVID-19 — in fact, India’s foreign minister rightly affirmed the BTWC obligations on March 26 (on the 40th anniversary of that Convention).
  • Surely, this global and non-discriminatory disarmament convention deserves applause because it outlaws a whole range of weapons of mass destruction.
  • India has, and rightly so, called for “high priority” to “full and effective implementation by all states parties”.

Conclusion

The starting point of a determined fight against COVID-19 has to be a full-throated repudiation of an ancient Latin maxim, inter arma enim silent leges (in times of war, the law falls silent). Combating this fearsome pandemic calls for re-dedication to nested international law obligations and frameworks.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

It’s time for the Red Berets

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Formation of special UN force to deal with the COVID-19 pandemic.

Context

The World Health Organisation (WHO) is not equipped to fight a pandemic of this proportion. The world needs a special UN force to fight COVID-19.

Limits of WHO in the fight against COVID-19

  • The World Health Organisation (WHO) is not equipped to fight a pandemic of this proportion.
  • Its responsibility is to monitor threats to public health and inform and advise the member states. The fight against COVID-19 has to be on a war footing.
  • The need for the composite force: For this we need a composite force that has the capabilities of massive sanitisation, testing, hospitalisation and providing support systems.
  • Signs of conflict: Even the most powerful nations are not able to cope with the effort and there are signs of conflict on account of shortages of equipment and trained personnel.
  • The only UN body which has the training for assembling fighting forces for emergencies is the Department of Peace Operations.

Pandemic as a threat to international peace and security

  • Contentions over pandemic: The UN Security Council (UNSC) stands paralysed because of petty battles on the name of the pandemic, its origin and the need for transparency.
  • It should hold an emergency meeting and authorise the UN Secretary-General to put together a force under Chapter VII of the UN Charter.
  • Interpreting the mandate: The mandate of the Charter should be interpreted to emphasise that this is the greatest threat to international peace and security.
  • Possibility of conflict: Moreover, conflicts are possible on account of the fragility of the international system.
  • Member states should be requested to send not only troops but also police, health workers and equipment.
  • Deploying the peace force: In war situations, the Secretary-General is able to put together a force in about four months. This operation requires greater emergency.
  • There is some delicacy about deploying the army internally in different political systems, but UN forces have been acceptable in most countries.
  • Who should bear the cost? As for the cost, the responsibility for the deployment of forces for peacekeeping, peace-building and peace enforcement is that of the permanent members.
  • Instead of competing with each other for leadership of the post-COVID-19 world, let them help create a post-COVID-19 world.
  • Fear of devastation in the poor countries: So far COVID-19 has spread in relatively prosperous regions of the world, which have stable infrastructure and health systems.
  • We cannot trust that it will not spread to less equipped states, in which the devastation will be much more.
  • Only a UN force which can enforce social distancing and lockdowns can prevent a catastrophe.

Resolution under Chapter VII

  • In which situation it is used: Most Chapter VII resolutions determine the existence of a threat to the peace, a breach of the peace, or an act of aggression in accordance with Article 39, and make a decision explicitly under Chapter VII.
  • A UNSC Resolution is considered to be ‘a Chapter VII resolution’ if it makes an explicit determination that the situation under consideration constitutes a threat to the peace, a breach of the peace, or an act of aggression, and/or explicitly/ implicitly states that the UNSC is acting under Chapter VII in the adoption of some or all operative paragraphs.
  • Chapter VII resolutions are very rarely isolated measures.
  • Often the first response to a crisis is a resolution demanding the crisis be ended. This is later followed by an actual resolution detailing the measures required to secure compliance with the first resolution.
  • Sometimes dozens of resolutions are passed over time to modify and extend the mandate of the first Chapter VII resolution.
  • The UN stands discredited today as the UNSC has not been able to meet.
  • It may take place, now that China has vacated the Security Council chair and Dominican Republic has taken over.
  • Several resolutions are in circulation, but none under Chapter VII.

Way forward

  • The first step will be to pass a resolution to take action to end the crisis and authorise the Secretary-General to request member states to make personnel available.
  • Meanwhile, another resolution must spell out the modalities of the operation.
  • Red berets: The UN peacekeeping forces are called Blue Berets because of the colour of the caps that they wear. The health force can have caps of another colour, probably red. The launch of the Red Berets will be a historic action to be taken at a critical moment.

Conclusion

This is the right time for the UN to act for the collective action against the pandemic which in turn help in establishing the UN’s relevance.

 

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

The spectre of a post-COVID-19 world

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- What are the possibilities that could be brought in the world by the epidemic.

Context

As COVID-19 spreads exponentially across the world, profound uncertainty and extreme volatility are wreaking havoc of a kind seldom encountered previously. It might, hence, be wise to start thinking of what next, if at least to try and handle a situation created by the most serious pandemic in recent centuries.

China’s important role

  • No previous experience: The problem with the novel coronavirus is that with the exception of China, which battled another coronavirus epidemic in 2003 — SARS epidemic — there is little available for most nations on which to base their assessment of what next.
  • Further drop in China’s growth rate: What is known is that China’s growth rate has further plummeted, even as it was confronting an economic slowdown which had been in the works for some time.
  • Economic downturn internationally: The consequences for the global economy of China ceasing to be the world’s biggest exporter of manufactured goods are considerable.
  • And with no country in a position to replace it, this development will precipitate a further economic downturn internationally.

Uncertainties before epidemic

  • The COVID-19 pandemic could not have come at a more difficult time.
  • Uncertain economic environment: The world was already having to contend with an uncertain economic environment, with industries in turn facing newer challenges such as having to adjust to a shift from cost efficiencies to innovation and breakthrough improvements.
  • Added to this were: a global slowdown, increasing political and policy uncertainties, alterations in social behaviour, new environmental norms, etc.
  • India’s position: Newly emerging economies, such as India, were even more affected by all this, than some of the older established ones.

Impact on India and what lies ahead?

  • Estimate of cost by ADB: An early estimate by the Asian Development Bank, soon after the epidemic was declared, was that it would cost the Indian economy $29.9 billion.
  • A recent industry estimate pegs the cost of the lockdown at around $120 billion or 4% of India’s GDP.
  • May require six months to recover after epidemic: The Confederation of Indian Industry (CII) had at one point warned that the COVID-19 impact, and the existing stress in the financial sector, meant that India would require up to six months even after the entire course of the COVID-19 epidemic is over to restore normalcy and business continuity.
  • The COVID-19 Taskforce under the Finance Minister come up with measures to mitigate the economic hardship engendered by the pandemic, and finally a three-week-long lockdown.
  • Several precautionary measures based on guidelines in vogue elsewhere in the world for preventing pandemics of this kind, have also been introduced including ‘home isolation’, ‘home quarantine’, etc.
  • The prognosis as to what lies ahead is indeed bleak.
  • On the economic plane, according to most experts, a global recession seems inevitable.
  • The decline in demand: Uncertainty, panic and lockdown policies are expected to cause demand worldwide to decline in a precipitous way.
  • Start of downward cycle: Decline in demand will inevitably lead to a vicious downward cycle, where companies close down, resulting in more lay-offs and a further drop in consumption.
  • A precipitous decline in GDP would follow.
  • Massive funds would be needed: To compensate for this loss, massive inflows of government funds would be needed, but most governments, India included, might find it difficult to find adequate resources for this purpose.
  • Right time for fund: Equally important, if not more so, is that such massive inflows of funds (if they are to be effective) should be here and now, and not later, by which time the situation may well have spiralled out of control. Global coordination was a must in the extant situation.

Disruption in the global order- Implications for the position of the US

  • COVID-19 is, in turn, expected to bring about major changes in the global order.
  • Changes would get accelerated: Some of these changes have, no doubt, been in the making for some time, but would get accelerated.
  • As of now, though the U.S. is no longer the global power that it once was, it is hardly in retreat.
  • Retreat from Afghanistan, not the end: The US is, without doubt, increasingly disinclined to act as the world’s gendarme, as instanced by its retreat from Afghanistan after a dubious accord with the Afghan Taliban,
  • But this was not the end of the road as far as U.S. power was concerned.
  • The US would step back further: Post COVID-19, however, and given that the U.S. is among the countries badly affected by this pandemic, together with existing uncertainties affecting its financial markets, the U.S. can be expected to step back even further — from one of assertion to neutrality in global affairs.
  • Already, U.S. command of the global commons has weakened. Meantime, China and Russia have strengthened their relationship and improved their asymmetric capabilities.
  • US not the largest economy by PPP: The challenge from China is becoming more obvious by the day — measured by purchasing power parity, the S. is not the largest economy in the world as of now.
  • Russian challenge: Even more daunting from a U.S. standpoint, and also representing a sea-change from the recent past, Russia has become far more economically and politically stable and an important power broker in West Asia.
  • Impact on liberal international order: These shifts cannot but, and are likely to, have a direct impact on the liberal international order. It could, in turn, give a boost to authoritarian regimes and authoritarian trends.

Impact on social behaviour

  • Moving away from the political and economic consequences of COVID-19 are other concerns arising from an extended lockdown, social distancing and isolation.
  • The epidemic of despair: Psychologists are even talking of an ‘epidemic of despair’ arising from a fear of unknown causes, resulting in serious anxiety and mental problems.
  • Problems due to extended isolation: Extended isolation, according to psychologists, can trigger a different kind of pandemic even leading to possible suicidal tendencies, fits of anger, depression, alcoholism and eccentric behavioural patterns.

Inequality and impact

  • The impact is not the same for all: Another fallout from the current epidemic might well be the extent to which inequality in incomes impact segments of the population, facing a common malaise.
  • Countries lacking a comprehensive nation-wide health system would find this an even more difficult situation to handle.
  • Meantime, as the economy weakens, accompanied by job losses, those without high levels of skills would fall further behind.
  • This is evident to some extent already given recent reports of mass migration across the Indian landmass.
  • Out of work migrant labour, unable to find new jobs since they lack the necessary skills, are attempting to return to their normal habitat, bringing in their wake untold suffering and, perhaps even the spread of the virus.
  • This has all the makings of a huge human tragedy. Existing curbs on their movement would further exacerbate the problem, and could even lead to a major law and order situation.

Possibility of the rise of digital authoritarianism

  • One possible, and unexpected, aspect of the COVID-19 epidemic could be the thrust it could provide to ‘digital authoritarianism’.
  • China’s authoritarian methods seem to have helped it to contain the spread of the virus — at least for the time being.
  • Somewhat similar tactics are being employed by some other countries as well.
  • In turn, leaders across many nations may find China’s methods, and the embracing of technology to refashion authoritarianism for the modern age irresistible, and a standard to be adapted, even if they profess to be democratic.
  • The rise of digital autocracies could lead to digital repression, and in the age of AI-powered surveillance, create a capacity for predictive control, or what is often referred to as ‘social management’.

Conclusion

The pandemic even after it’s over could change the world in more than one ways and we must be cautious in our approach in accepting or rejecting these changes brought about by the epidemic.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Making the private sector care for public health

Note4Students

From UPSC perspective, the following things are important :

Mains level : Paper 2- Government should consider taking control of the private healthcare sector to deal with the Covid-19 outbreak.

Context

As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic.

Need for roping in the private healthcare

  • No indication of an increase in expenditure on health: A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors.
  • However, so far, the Central and State governments have given little indication of bringing an increase in public expenditure on health.
  • So, an already overburdened public health system will be unable to meet the increase in moderate and severe cases of COVID-19 that would require hospitalisation.
  • Need for the comprehensive national policy: While some individual private sector companies have come forward with offers of creating capacity and making it available to COVID-19 patients, there is a need for a comprehensive national policy to ensure that private healthcare capacity is made available to the public.
  • Some states like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

What the government should do?       

  • Provide universal health service: The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all.
  • Tap into private sector capacity: This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector.
  • Faced with a serious health emergency, the silence of the government on the expected role of the private sector is intriguing.
  • Include COVID-19 testing in PM-JAY: The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY) but this proposal is still awaiting clearance.
  • Form the central command: The governance of the health service system is clearly fragmented and has created anxiety among the public.
  • There is a lack of a visible central command, which should be created under the supervision of the Union Health Minister, aided by a team of experts.
  • They should be tasked to make policies as and when required and communicate them to State governments, taking into account an evolving situation.
  • Ensure that there is no cost to the patient: There have been some tentative measures taken by States to allow individuals seeking testing for COVID-19 to access private laboratories at subsidised rates.
  • At present, the government has put a cap on the cost at ₹4,500 per test, which is a burden for even a middle-class patient.
  • The poor will clearly have no access to this and the government itself does not have adequate facilities to meet the increasing demand. It is here that the government needs to ensure that there is no cost to the patient.
  • Create adequate testing facilities: At this point, and certainly, before the lockdown is lifted, it is absolutely essential that adequate testing and quarantine facilities are created.
  • The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19.
  • One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.
  • Standard treatment protocol: The political directive for such a move needs to come from the Central government while ensuring that the Ministry of Health provides standard treatment protocols for health personnel.

Learning lessons from Spanish and British experience

  • The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period.
  • This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.
  • British trade unions have demanded that the government make the 8,000 beds in 570 private hospitals in the country available.
  • They have argued that while beds in private hospitals are lying empty, there is a severe shortage of beds in public hospitals.
  • The unions have also been critical of the U.K. government decision to rent these beds at an exorbitant cost to the exchequer.

Way forward

  • Rope in the private healthcare sector: In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them.
  • They are also well poised to provide specialised care and have the expertise and infrastructure to do so.
  • Bring in the universal public healthcare: Universal public healthcare is essential not only to curb outbreaks but also to ensure crisis preparedness and the realisation of the promise of the right to health.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

A pandemic in an unequal India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- How lockdown affects the poor disproportionately and what the state must do mitigate the impact.

Context

The official strategies to deal with the virus place the responsibility on citizens, a majority without privilege, to fight the virus.

The poor disproportionately affected

  • If the COVID-19 pandemic lashes India with severity, it will not be just the middle class who will be affected.
  • India’s impoverished millions are likely to overwhelmingly bear the brunt of the suffering which will ensue.
  • Inequality and impact of a pandemic: The privileged Indian has been comfortable for too long with some of the most unconscionable inequalities in the planet.
  • But with the pandemic, each of these fractures can decimate the survival probabilities and fragile livelihoods of the poor.

Inadequate capacity of the health system  

  • Low investment in public health: India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services.
  • A Jan Swasthya Abhiyan estimate is that a district hospital serving a population of two million may have to serve 20,000 patients, but they are bereft of the beds, personnel and resources to do this. Few have a single ventilator.
  • The poor left with meagre services: India’s rich and middle-classes have opted out of public health completely, leaving the poor with unconscionably meagre services.
  • The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

No planning and preparation by the state

  • Official strategies placing responsibility on citizens: Most of the official strategies place the responsibility on the citizen, rather than the state, to fight the pandemic.
  • No preparation by the states: The state did too little in the months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment.
  • This includes planning operations for food and work; security for the poor; for safe transportation of the poor to their homes; and for special protection for the aged, the disabled, children without care and the destitute.

What must be done?

  • 25 day’s minimum wage: For two months, every household in the informal economy, rural and urban, should be given the equivalent of 25 days’ minimum wages a month until the lockdown continues, and for two months beyond this.
  • Pensions must be doubled and home-delivered in cash.
  • There should be free water tankers supplying water in slum shanties throughout the working days.
  • Double the PDS entitlement: Governments must double PDS entitlements, which includes protein-rich pulses, and distribute these free at doorsteps.
  • Provide cooked and packed food: In addition, for homeless children and adults, and single migrants, it is urgent to supply cooked food to all who seek it, and to deliver packed food to the aged and the disabled in their homes using the services of community youth volunteers.
  • Ensure prisons are safe: To ensure jails are safer, all prison undertrial prisoners, except those charged with the gravest crimes, should be released.
  • Likewise, all those convicted for petty crimes. All residents of beggars’ homes, women’s rescue centres and detention centres should be freed forthwith.

Way forward

  • Commit 3% of GDP on health: India must immediately commit 3% of its GDP for public spending on health services, with the focus on free and universal primary and secondary health care.
  • Nationalise private healthcare: Since the need is immediate, authorities should follow the example of Spain and New Zealand and nationalise private health care.
  • An ordinance should be passed immediately that no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of COVID-19.

Conclusion

While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health care. Can we resolve to correct this in post-COVID India? Can we at least now make the country more kind, just and equal?

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Home and nation

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2-Role of administration in 21-day lock-down of country.

Context

A 21-day lockdown is extraordinary. Government, people must come together to ensure that supply chains and social trust must not break.

An unprecedented move

  • A 21-day nationwide lockdown: The way we conduct ourselves in these 21 days will be critical in our fight against the coronavirus.” With these words, Prime Minister announced a measure unprecedented in India’s 72-year-old history.
  • Never have the people of the country been asked to stay within the confines of their homes for this long a period, not even when the country has fought wars.
  • Yet extraordinary times demand extraordinary measures. As the PM underlined, “stringent social distancing and staying within the Lakshman Rekha of our homes is the only prevention against the coronavirus”, the only way to break its transmission cycle.

Challenges and consequences

  • There will be social and economic consequences and the PM did not equivocate on the challenges. He spoke of the vulnerable sections, and, as in last week’s speech, emphasised the imperative to be compassionate.
  • He lauded the frontline workers, doctors, nurses and other healthcare workers, expressed gratitude to safai karamcharis and praised the private sector and civil society.
  • A reworked social compact — more compassionate — will be necessary to confront the challenges posed by the lockdown.
  • It is now up to civil society, government agencies, the healthcare and corporate sectors to take their cues from the PM’s speech and ensure that the burden of fighting the pandemic does not fall too heavily on those at the margins, the migrant and daily wage labourers, the rickshaw pullers and others for whom these 21 days could prove to be the toughest.
  • Centre and state to work together: The Centre and state governments will need to work together, setting aside their political differences, to ensure that there is no shortage of essential commodities and the supply chains are not broken.

Measures to mitigate the impact

  • Earlier in the day, Finance Minister Nirmala Sitharaman had announced a slew of measures that could soften the blow of a 21-day lockdown.
  • The deadline for filing of income taxes for the financial year 2018-19 has been extended, as has the last date for filing GST returns.
  • Sitharaman also announced that the threshold for taking companies through the insolvency and bankruptcy proceedings has been increased from Rs 1 lakh to Rs 1 crore.
  • This will prevent creditors from taking small and medium-sized companies, who may be facing temporary cash flow management issues due to the lockdown, and hence are unable to meet their obligations, through the IBC process.
  • The Centre has also advised state governments to transfer funds to construction workers from the cess fund collected by the labour welfare boards.

Conclusion

As the PM said, “21 days is a long period”. It’s now up to the authorities and the people to own and implement his message — to ensure that not just supply chains, but also social trust, isn’t broken.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Taking a holistic approach to dengue

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Dengue vaccine

Mains level : Paper 2-Dealing with Dengue, stategies, suggestion, and holistic approach.

Context

The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.

Why the holistic approach is needed

  • Apart from promoting the use of the vaccine, gaining control over dengue will also require a holistic approach that has to include within its ambit vector control and proper case management.
  • Tetravalent vaccine: The vaccine is tetravalent i.e. it provides protection against all the four types of dengue viruses.
    • The vaccine confers about 80% protection to children vaccinated between 4 and 16 years of age without any major side effects.
  • Climatic factors: It is essentially a tropical disease that occurs in the countries around the Equator; hot weather and intermittent rainfall favour the sustenance of Aedes aegypti.
    • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
  • Risk factors: Urbanisation, poor town planning, and improper sanitation are the major risk factors for the multiplication of such mosquitoes.
    • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
    • Aedes mosquitoes cannot fly beyond a hundred meters. Hence, keeping the ambiance clean can help prevent their breeding.
    • Further, these mosquitoes bite during the daytime, so keeping the windows shut in the day hours is also useful.

What needs to be done?

  • Source reduction activities: Activities like preventing water stagnation and using chemical larvicides and adulticides.
    • These chemicals need to be applied in periodic cycles to kill the larvae that remain even after the first spray.
  • Dealing with the manpower shortage: The number of skilled workers available for such measures is low; many posts in government departments remain vacant despite there being a dire public health need.
    • Due to this deficiency of manpower, active surveillance is not being done in India, says the National Vector Borne Disease Control Program.
  • Ending the Under-reporting: Dengue cases are often under-reported due to political reasons and also to avoid spreading panic among the common people. Under-reporting needs to be dealt with.
  • Increasing coordination: There is a lack of coordination between the local bodies and health departments in the delivery of public health measures.
    • A comprehensive mechanism is required to address these issues.
  • Need for epidemiological measures: Any communicable disease needs the epidemiological approach. Singapore uses one successful model of mapping and analysing data on dengue, using Geographical Information System (GIS).
    • The use of GIS involves mapping the streets with dengue cases for vector densities.
  • Emphasis on the WHO guidelines: Fluid management in the body is the cornerstone in the management of severe diseases like dengue hemorrhagic fever and dengue shock syndrome.
    • According to the guidelines, coagulation abnormalities are not due to a reduction in the number of platelets alone.
    • This is why the WHO recommends fresh whole blood or packed cell transfusion in the event of bleeding.
  • Caution in using alternative medicine drugs: Modern medicine is not against any complementary medicine; when such a medicine is approved after rigorous testing.
    • However, in the absence of evidence, the efficacy of such medicines remains in the realm of belief instead of science.
    • So, medicines like Nilavembu kudineer and papaya leaf extract are only belief based.

Conclusion

The communicable nature of Dengue and its asymptomatic nature requires the holistic approach to successfully tackle the disease.

 

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