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

Aug, 17, 2018

[op-ed snap] A Law Past Its Sell-by Date

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Medical Termination of Pregnancy (MTP) Act

Mains level: Changes required in abortion law in India in order to make abortions safe as well as improve health of women


Context

Abortion law in India

  1. Abortion has been legal in India under the Medical Termination of Pregnancy (MTP) Act since 1971 when it was hailed as one of the more progressive laws in the world
  2. According to the Act, abortion can be provided at the discretion of a medical provider under certain conditions
  3. Though the Act was liberal for its time, it has limitations that pose barriers to women and girls seeking legal abortions

Objectives of the law

  1. To control the population resulting from unintended pregnancies (which even today are to the tune of 48 per cent)
  2. To reduce the increasing maternal mortality and morbidity due to illegal, unsafe abortions

What are the barriers in the law?

  1. Currently, the Act allows abortion up to 20 weeks
  2. When it comes to foetal abnormalities and pregnancies resulting from rape, this limit is proving to be a hurdle for both the woman and the provider
  3. Women seeking an abortion after the legal gestation limit (a phenomenon that is fairly common due to later detection of abnormalities in the foetus or shame and stigma associated with rape), often have no option but to appeal to the courts and run from pillar to post for permission to terminate the pregnancy

What does this lead to?

  1. Many women, when denied legal abortions, turn to unqualified providers or adopt unsafe methods of termination
  2. According to a study published in The Lancet recently, 15.6 million abortions took place in India in 2015 out of which about 11.5 million took place outside health facilities
  3. Estimates based on the Sample Registration System (SRS) 2001-03, indicate that unsafe abortions account for 8 per cent of maternal deaths in India

Amendments returned back

  1. In 2014, the Ministry of Health and Family Welfare recognised these barriers and proposed certain amendments to the Act
  2. It proposed various changes key amongst which were increasing the gestation limit from 20 to 24 weeks for rape survivors and other vulnerable women and removing the gestation limit in the case of foetal abnormalities
  3. In 2017, these amendments were returned to the ministry with the mandate to strengthen the implementation of the MTP Act as it stands

Way Forward

  1. We are living in times when abortion is at the centre of global conversations on reproductive health and rights
  2. Adopting and implementing the amendments will take us a few steps closer towards ensuring that all girls and women have access to safe abortion services
Aug, 16, 2018

Odisha launches health scheme for 70 lakh families

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

Mains level:  Non-compliance of states to AB-NHPM


News

Biju Swasthya Kalyan Yojana

  1. Odisha CM launched Biju Swasthya Kalyan Yojana, a health for all scheme, on the occasion of the 72nd Independence Day.
  2. The scheme provides health assurance coverage to 70 lakh families, covering more than 70% of the State’s population
  3. It may be recalled that the Odisha government had rejected the National Health Protection Scheme as it covered much lesser number of people in Odisha by adopting the 2011 census.
  4. The State government went ahead with its own scheme with coverage of up to ₹5 lakh per year per family. The amount is ₹7 lakh per family with women members.
Aug, 13, 2018

[pib] CSIR’s new patented Clot buster, PEGylated Streptokinase set to revolutionize the treatment of Strokes

Note4students

Mains Paper 3: Science & Technology | Awareness in the fields of IT, Space, Computers, robotics, nano-technology, bio-technology.

From UPSC perspective, the following things are important:

Prelims level: PEGylated Streptokinase

Mains level: Read the attached story.


News

What is Clot Buster?

A clot buster is used to break-up the clot that causes a blockage or disruption in the flow of blood to the brain and helps restore the blood flow to the area of the brain.

PEGylated Streptokinase

  1. It is a new clot buster developed by at CSIR-Institute of Microbial Technology (CSIR-IMTECH), Chandigarh.
  2. It is all set to revolutionize the treatment of ischemic strokes.
  3. Ischemic stroke is a condition caused by a dysfunction in the supply of blood to the brain due to emboli, thrombus or atherosclerosis occurring in cerebral arteries.
  4. PEGylated Streptokinase, the novel recombinant protein Thrombolytic molecule has been precisely engineered through decades of research for enhanced proteolytic stability.
  5. Its advantages are reduced probability of hemorrhage over current treatment regimens of thrombolytic drugs for acute stroke.

Developed under PPP

  1. CSIR-IMTECH and Epygen Biotech Pvt. Ltd., Mumbai, have entered into an agreement for the latter to develop PEGylated Streptokinase for treatment of Ischemic Stroke.
  2. Epygen is the first company in India with exclusive license of this Novel Biological Entity (NBE) thrombolytic protein for ischemic stroke.

Brain Stroke- the second biggest killer

  1. According to the American Stroke Association (ASA), brain strokes are the second leading cause of death in the world with a staggering 15 million people effected.
  2. It is causing 11 million people either die or become permanently disabled.
  3. Surprisingly, the prevalence of stroke is much higher in India than the West and about 87% of all strokes are ischemic strokes.

Back2Basics

Council of Scientific and Industrial Research

  1. The Council of Scientific and Industrial Research was established by the Government of India in 1942 is an autonomous body that has emerged as the largest research and development organisation in India
  2. It runs thirty-eight laboratories and thirty-nine field stations or extension centres throughout the nation, with a collective staff of over 12,000 scientists and scientific and technical personnel
  3. Although it is mainly funded by the Ministry of Science and Technology, it operates as an autonomous body through the Societies Registration Act, 1860
  4. The research and development activities of CSIR include aerospace engineering, structural engineering, ocean sciences, life sciences, metallurgy, chemicals, mining, food, petroleum, leather, and environmental science.

 

Aug, 08, 2018

[pib] Scheme of Assistance for Prevention of Alcoholism and Substance (Drug) Abuse

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

Mains level: Prevention of drug abuse


News

Assistance for Prevention of Alcoholism and Substance (Drug) Abuse

  1. Ministry of Social Justice and Empowerment implements this Central Sector Scheme for identification, counseling, treatment and rehabilitation of addicts through voluntary and other eligible organizations.
  2. Under this Scheme, financial assistance is provided to NGOs/Voluntary organizations and other eligible agencies for setting-up/running Integrated Rehabilitation Centre for Addicts (IRCAs).
  3. As per the norms of the scheme following organizations/institutions shall be eligible for assistance under the Scheme of Assistance for Prevention of Alcoholism and Substance (Drug) Abuse:
  • A Society registered under the Societies’ Registration Act, 1860 (XXI of 1860) or any relevant Act of the State Governments/ Union Territory Administrations or under any State law relating to the registration of Literary, Scientific and Charitable societies, or
  • Registered Societies formed by the State Governments.
  • District Hospitals subject to condition that they maintain separate accounts for de-addiction.
  • Railway Hospitals near major Railway Stations subject to condition that they maintain separate accounts for de-addiction.
  • A Public Trust registered under any law for the time being in force, or
  • A Company established under Section 25 of the Companies Act, 1956; or
  • Panchayati Raj Institutions (PRIs), Urban Local Bodies (ULBs),  organizations/institutions fully funded or managed by State/ Central Government or a local body; or
  • Universities, Schools of Social Work, other reputed educational institutions, NYKS, and such other well established organizations/ institutions which may be approved by the Ministry of Social Justice & Empowerment.
  1. The proposals of above eligible organizations are forwarded by the State Governments.
  2. However, the proposals of NGOs for release of grant in aid are considered in the Ministry only after it is inspected and recommended by the State Government.
Aug, 01, 2018

[op-ed snap] The public-private gap in health care

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme

Mains level: The inequality between public and the private sector in healthcare and its impact on citizens especially poor


Context

Lack of transparency in transplants

  1. The recent controversy about transparency in the working of the cadaver transplant programme in Tamil Nadu has provided an opportunity to revisit the vexed question of medical rationing in India
  2. It is a hard reality that not all medical interventions are available to every citizen who may need it

NITI Aayog’s vision document

  1. The NITI Aayog’s document, ‘Three Year Action Agenda, 2017-18 to 2019-20’, has a section on health care
  2. One of the recommendations is for the government to prioritise preventive care rather than provide curative care
  3. The document also advises the government to pay attention to stewardship of the health sector in its entirety rather than focussing on provision of health care

Mismatch between policy and actual programs

  1. Every government since Independence has stated egalitarianism as its goal in healthcare
  2. The policies, however, have not matched the statements
  3. Many interventions, especially those which are very expensive, continue to be provided only to those who can pay for them
  4. This is medical rationing of the covert kind
  5. The new Ayushman Bharat health scheme to provide secondary and tertiary care to those who are socio-economically deprived has a cap of ₹5 lakh per family per year
  6. It is quite obvious that many interventions cannot be accessed for this amount, certainly not human organ transplants
  7. In India, out-of-pocket expenses for medical care are about 70% of all medical expenditure

Organ transplant is a complex process

  1. Transplanting a human organ is not a single event, but a life-long process
  2. The actual act of transplantation itself needs expensive infrastructure and trained human resources
  3. For the continuing success of the transplanted organ, expensive medication is needed

Reverse flow of resources

  1. Healthcare in India is obviously not egalitarian
  2. Governments have been giving subsidies to private players, especially to corporate hospitals
  3. The repeated boast that India can offer advanced interventions at a fraction of the costs in the West does not take into account the cost of the subsidies that make this possible
  4.  Since it is all taxpayers’ money, it is a clear case of taking from the poor to give to the rich

Dependence on private sector

  1. Successive governments have been increasingly dependent on the private sector to deliver healthcare
  2. The Ayushman Bharat scheme is a further step in this process
  3. The benefit to patients is questionable but private players will see a large jump in profits
  4. It will further institutionalise medical rationing by explicitly denying certain interventions — a “negative list” presumably of procedures which will not be covered, which is not yet in the public domain

Poor effects of medical rationing

  1.  One is a distrust of the public in government hospitals
  2. The poor expect to get from them what the rich get in private hospitals
  3. With present policies, this is simply not possible
  4. Without a clearly defined mandate, morale among medical personnel in public hospitals is low
  5. The perception that doctors in the private sector are much better than those in the public sector has a severe debilitating effect on the professional image of medical personnel in public hospitals

Way Forward

  1. Every possible medical intervention should be available to every citizen
  2. The only pressure group which can ensure at least equitable medical care is the electorate
  3. Until such time as it demands this from governments, we will continue to witness the tragic drama of two levels of medical care in India
Jul, 27, 2018

[op-ed snap] Tackling HIV

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: United Nations Programme on HIV/AIDS (UNAIDS)

Mains level: Stigma associated with HIV/AIDS in India & how it affects various policies being framed to bring down incidences of this disease


Context

UNAIDS report: Reduction in HIV incidence

  1. A new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) bears good news for the global war against the syndrome
  2. Between 2010 and 2017, several countries made rapid progress in reducing HIV incidence and getting antiretroviral therapy to patients
  3. While the largest reduction in incidence came from eastern and southern Africa, Asia also made gains
  4. India, in particular, brought down the number of new cases and deaths by 27% and 56%, respectively, between 2010 and 2017

Efforts by India

  1. With 2.1 million cases, India is among the largest burden countries in the world
  2. Tuberculosis is the biggest killer of HIV patients across the world
  3. India is now able to treat over 90% of notified TB patients for HIV
  4. The social stigma surrounding AIDS-infected people in India, while high, is declining slowly too
  5. Survey data show that in the last decade, the number of people unwilling to buy vegetables from a person with HIV came down from over 30% to 27.6%

Gaps in policy

  1. The UNAIDS report points out that a country’s laws can legitimise stigma and give licence to the harassment of groups at the highest risk of HIV
  2. These include men who have sex with other men, people who inject drugs, and sex workers
  3. Indian laws don’t do well on this count
  4. The Immoral Traffic (Prevention) Act criminalises several aspects of sex work, while Section 377 of the IPC criminalises gay sex
  5. Studies show that fear of prosecution under such laws prevents homosexual men, drug users and sex workers from seeking HIV screening and treatment
  6. As a result, these groups lag behind average treatment rates, although their requirements are higher

What needs to be done?

  1. If India is serious about tackling HIV, it must find ways to reach such groups
  2. Short of changing the law, the Centre can consider targeted interventions
  3. An experiment in Karnataka, between 2004 and 2011, shows that sensitising police personnel and educating female sex workers can greatly reduce arbitrary police raids and arrests

Way Forward

  1. The right to health is universal
  2. India must take note of this to ensure that no one is left behind in the fight against HIV

Back2Basics

United Nations Programme on HIV/AIDS (UNAIDS)

  1. The Joint United Nations Programme on HIV and AIDS (UNAIDS) is the main advocate for accelerated, comprehensive and coordinated global action on the HIV/AIDS pandemic
  2. The mission of UNAIDS is to lead, strengthen and support an expanded response to HIV and AIDS that includes preventing transmission of HIV, providing care and support to those already living with the virus, reducing the vulnerability of individuals and communities to HIV and alleviating the impact of the epidemic
  3. UNAIDS seeks to prevent the HIV/AIDS epidemic from becoming a severe pandemic
  4. UNAIDS is headquartered in Geneva, Switzerland
  5. It is a member of the United Nations Development Group
  6. UNAIDS has five goals:
  • Leadership and advocacy for effective action on the pandemic
  • Strategic information and technical support to guide efforts against AIDS worldwide
  • Tracking, monitoring and evaluation of the pandemic and of responses to it
  • Civil society engagement and the development of strategic partnerships
  • Mobilization of resources to support an effective response
Jul, 23, 2018

[op-ed snap] Why private hospitals should join AB-NHPM

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level:  Under AB-NHPM, concerns raised by Private Hospitals over Pricing of healthcare services are obvious. But they can be sorted out. The newscard gives a brief over the solutions to this problem.


Context

NHPM scheme

  1. AB-NHPM aims to provide a benefit cover of ₹5 lakh for more than 1,300 specified and other unspecified medical and surgical procedures to more than 100 million families.
  2. It intends that within the next decade, the unacceptably high levels of out-of-pocket expenditures that poor households across the country currently incur in seeking healthcare especially secondary and tertiary-level care—will fade away.

Issue over Pricing-Model

  1. Some healthcare provider networks have raised concerns about the viability of the pricing model.
  2. Some private sector healthcare providers have shown reluctance in seeking empanelment under the initiative, saying the rates for treatment packages are too cheaper.

Treatment Rates- NOT the elephant in the room

  1. Setting treatment rates at the national level is not an easy task, especially when it is being done for the first time in the world.
  2. There is, admittedly, a dearth of national-level comprehensive costing studies; that will be one of the core research areas AB-NHPM will be looking into continuously.
  3. Nonetheless, the current rates have been determined following a rigorous process.

States examples are promising

  1. There are large schemes running successfully in states such as Tamil Nadu, Maharashtra and Karnataka which can be a rich source of information for the mission.
  2. These schemes have no dearth of empanelled hospitals which are providing healthcare services at the rates so provisioned.
  3. Recognizing the large variations in cost structures across the country, AB-NHPM gives states the flexibility to increase or decrease rates, depending on their contexts.
  4. By definition, these rates are median rates, and will need to be adjusted at the state level.

AB-NHPM mandates to timely  refine its approach

  1. The mission will continue to undertake costing studies and actuarial analysis besides periodically revisiting costing principles to reflect annual fluctuations in productivity and unit costs.
  2. The viewpoints of hospitals about the rates have been taken into consideration during the current costing exercise. Hospitals’ views will continue to be sought as the scheme evolves.
  3. AB-NHPM plans to move on to more sophisticated provider payment mechanisms, including variants of diagnosis-related group (DRG) models, which can assuage such concerns.
  4. It seeks to provide quality health services to all beneficiaries and, therefore, would urge all quality hospitals to participate in the process.

Hospitals should carefully consider the following issues

(A)The hospitals should understand that the nationally prescribed rates are not intended to cover the cost of capital and infrastructure in the short run but the marginal cost.

  • They seek to ensure that excess capacities are utilized, leading to greater efficiency in service utilization of hospitals.
  • This efficiency is not just in terms of empty beds but also more efficient hospital administration, optimum utilization of professionals and easier process flows for the patients with quicker turnaround times.

(B) Hospitals, especially the big ones, have a responsibility.

  • They should not expect to strengthen their balance-sheets based on services to the bottom 40% people of the country.
  • Universal health coverage is based on a social contract, where the rich need to pay for the poor, the healthy for the sick and the young for the elderly. Large and expensive hospitals need to do their bit as well.

(C) AB-NHPM wants a partnership with all quality hospitals so that the evolution of the scheme benefits from diverse inputs.

  • This partnership will be a win-win situation. The mission will benefit from the private sector capacity to provide services to large numbers.
  • At the same time, this provides the private sector an opportunity for shaping the most ambitious healthcare scheme in the world.

Way Forward

  1. Healthcare is a matter of utmost concern of time. AB-NHPM seeks to address this concern in a stipulated time.
  2. Private Hospitals can play a leading role and their reluctances over pricing are essentially considered by the government.
  3. It is often said that the foot soldiers in a revolution are unaware of their role in historic change. Same implies to the participation of these private players here.
  4. The evolutionary nature of the scheme provides ground for its immediate implementation so that the beneficiaries get affordable healthcare at their earliest.
Jul, 07, 2018

Ayushman Bharat: Hub-and-spoke model to help train health workers

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the ECHO Model, Ayushman Bharat Programme

Mains level: Read the attached story


News

Solving the Manpower Issue

  1. One of the biggest challenges in the rollout of Ayushman Bharat is manpower training for the 1,53,000 health and wellness centres.
  2. But a hub-and-spoke model developed by the University of New Mexico (UNM) has come to the rescue.

The ECHO Model for Telemedicine

  1. Developed by Indian-origin doctor Dr Sanjeev Arora in Albuquerque, ECHO (Extension for Community Healthcare Outcomes) is a collaborative model of medical education and care management that empowers health workers.
  2. For the HWCs, ECHO is one of several programmes that will be used to train ASHAs as, for the first time, primary care in India moves beyond reproductive health and vaccination to include screening for non-communicable diseases, geriatric care and mental health.
  3. The ECHO model does not actually “provide” care to patients, but it dramatically increases access to specialty treatment in rural and underserved areas through the use of teleconferencing.
  4. Thegoal is to use the telemedicine platform so that healthcare performance may be enhanced by access to knowledge. This programme is to conduct the training of ASHAs.

Particulars of the training

  1. A team from UNM travelled to India to kick off the first installment of the training. The first batch of 160 officials from four states was trained in ECHO over three days at a hotel here.
  2. Participants were acclimatized with the ECHO model consisting of:
  • an essentially non-hierarchical system of knowledge sharing;
  • Zoom, the software used for teleconferencing facility;
  • the essentials for setting up their own ECHOs; and also
  • an actual ECHO session where UNM professors joined in.
  1. The participant states — Gujarat, Uttar Pradesh, Delhi and Maharashtra — also clarified their doubts during the exercise.
  2. Under Ayushman Bharat, the plan is to create eight ECHO hubs, including in AIIMS Delhi, AIIMS Bhopal, KGMU Lucknow and PHI Nagpur.

 

Jul, 07, 2018

[pib] Creation of National Health Stack

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NHS

Mains level: Read the attached story


News

NITI Aayog has invited suggestions on creation of National Health Stack.

Context

  1. India is witnessing significant trends in health: increasing prevalence of non-communicable diseases for instance, as well as marked demographic shifts.
  2. Climbing out-of-pocket costs is becoming difficult for most households.

Proposed National Health Stack (NHS)

  1. The National Health Stack (NHS) envisages a centralized health record for all citizens of the country in order to streamline the health information and facilitate effective management of the same.
  2. The proposed NHS is an approach to address the challenge and seeks to employ latest technology including Big Data Analytics and Machine Learning Artificial Intelligence, a state of the art Policy Mark-up Language.
  3. It also aims to create a unified health identity of citizens – as they navigate across services across levels of care, i.e. Primary, Secondary and Tertiary and also across Public and Private.

Making Ayushman Bharat more promising

  1. This flagship health programme is designed with a powerful yet simple objective in mind: to develop a wellness focused strategy, ensuring cost effective healthcare for all.
  2. The program leverages a two-pronged approach:
  • On the supply side, substantial investments will be made to build 1.5 lakh health and wellness centers offering preventive and primary care; and
  • On the demand side, the Pradhan Mantri-Rashtriya Swasthya Suraksha Mission (PM-RSSM) will create a national insurance cover of up to 5 lakhs per year per family for over 10 crores households, towards secondary and tertiary care.

Achieving such scale requires a rethink the core technology backbone of our system and leverage cutting edge digital solutions to tackle the challenge.

Utility of the National Health Stack

  1. The innovativeness of the proposed National Health Stack design lies in its ability to leverage a shared public good – a strong digital spine built with a deep understanding of the incentive structures of the system.
  2. Once implemented, it will significantly bring down the costs of health protection, converge disparate systems to ensure a cashless and seamlessly experience for the poorest beneficiaries, and promote wellness across the population.
Jun, 28, 2018

[pib] Inauguration of NIMHANS Digital Academy, proposed Health and Wellness Centres

Note4students

Mains Paper 2: Governance | Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NIMHANS Digital Academy, Ayushman Bharat, HWCs

Mains level: Ensuring Mental Healthcare access in the country through capacity building by such institutions.


News

Promoting Mental Healthcare in India

  1. Union Minister of Health and Family Welfare inaugurated the NIMHANS Digital Academy and addressed the first batch of professionals enrolled for undergoing courses in the fields of Psychiatry and Psychiatric Social Work.
  2. The passing of the Mental Healthcare Act, 2017 brings forth a stronger and more robust legal scaffold and humane and patient-centric rights-based approach for mental health care in our country.
  3. Mental Healthcare Act, 2017 envisions adequate quality care for the citizens through skilled healthcare professionals so that we can reduce stigma against mental health disorders.

NIMHANS Digital Academy

  1. NIMHANS has established infrastructure for starting a Digital Academy to provide large-scale training to healthcare service providers like Medical Officer, Psychologists, Social Workers and Nurses to deliver quality mental healthcare services throughout the country.
  2. The main objective is to exponentially increase skilled capacity in mental health in the country.
  3. Up to 50 people can be trained in the virtual classroom with only a cell phone/mobile phone with 3G connection required at the receiver’s end.
  4. After successful completion of the course and evaluation, the participants will be awarded “Diploma in Community Mental Health” by NIMHANS, Bengaluru.
  5. The courses for different categories of healthcare providers would be of about 30 hours duration each and spread across a period of three months and would be digitally delivered to remotely located healthcare providers across the country.
  6. It will augment the existing skills in mental health in the country.

Health and Wellness Centres

  1. Under Ayushman Bharat, 150,000 sub-centres will be converted into Health and Wellness Centres (HWCs) that will deliver comprehensive primary health care.
  2. The HWCs would provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc.
  3. Government has initiated universal screening of common NCDs such as diabetes, hypertension and common cancers along with Tuberculosis and Leprosy, which will eventually help in reducing the disease burden of the country.
  4. In the coming times, it could be possible to detect mental health disorders at these centres and if it can be included in the universal screening along with these diseases.

Back2Basics

National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore

  1. Established in 1925, NIMHANS, the apex center for mental health and neuroscience education in the country
  2. It operates autonomously under the Ministry of Health and Family Welfare.
  3. The institute was inaugurated on 27 December 1974, establishing it as an autonomous body under the Societies Registration Act.
  4. NIMHANS is a multidisciplinary institute for patient care and academic pursuit in the frontier area of mental health and neurosciences.
Jun, 22, 2018

Govt may scrap trials for some IVD devices

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: In-Vitro Diagnostics (IVD) Devices, DTAB, Medical Devices Rule

Mains level: New rules seek to remove regulatory bottlenecks to Make in India while ensuring availability of better medical devices.


News

Clinical Trials of Medical Devices

  1. Medical devices under local rules are classified based on associated risks, into Class A (low risk), Class B (low moderate risk), Class C (moderate high risk) and Class D (high risk).
  2. The manufacturers of medical devices are required to meet risk proportionate regulatory requirements that have been specified in the rules and are based on best international practices.
  3. As of now, all medical devices that fall under regulation have to undergo single or multiple clinical trials to prove their performance and quality in comparison to products currently available in the market.
  4. Conduct of clinical investigations while following the international practices is conducted in a manner that ensures objectives of patient safety and welfare and discovery of new medical devices.

Proposed Amendment in Medical Devices Rules

  1. IVDs include all blood testing techniques, tests that can detect diseases, conditions or infections for major conditions such as HIV, HBV (Hepatitis B), HCV (Hepatitis C).
  2. The government has proposed to do away with clinical trials for in-vitro diagnostic (IVD) devices with the aim of speeding up availability of such devices in India.
  3. The Union health ministry will now release a notification to this effect, after a meeting of the Drug Technical Advisory Board (DTAB) at which the board agreed to the proposal to amend the provisions of the Medical Devices Rules

What are the amendments?

  1. The board deliberated the matter and agreed to the proposal to amend the provisions in Rule 64 making it identical for waiver of clinical performance evaluation of in-vitro diagnostic medical devices.
  2. This is in line with a waiver given for medical devices under Rule 63 of the Medical Device Rules.

What are the benefits of doing so?

  1. The new rules seek to remove regulatory bottlenecks to make in India, facilitate ease of doing business while ensuring availability of better medical devices for patient care and safety.
  2. Medical device experts believe that the move will help importers to a large extent as the exemption of trials would also mean accelerating approval of state-of-the-art devices.

But it raises few questions as well

  1. The question is whether the US, Japan and EU (European Union) will give a similar reciprocal advantage to Indian exporters and waive off the need for clinical evaluation if such devices are sold in India.
  2. Regulation is not only about patient’s safety. It is also about parity.
Jun, 20, 2018

India launches its first National Healthcare Facility Registry

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Registry and other stakeholders involved, National Health Profile

Mains level: Read the attached story


News

National Health Resource Repository (NHRR)

  1. The Union ministry of health and family welfare has launched the first ever registry in the country registry of authentic, standardised and updated geo-spatial data of all public and private healthcare.
  2. Objective: “to create a reliable, unified registry of country’s healthcare resources showing the distribution pattern of health facilities and services between cities and rural areas”
  3. The Indian Space Research Organisation (ISRO) is the project technology partner for providing data security.
  4. It will now be possible to provide comprehensive data on all private and public health establishments and other resources, including Railways, Employees’ State Insurance Corporation (ESIC), defense and petroleum healthcare establishments.
  5. Under the Collection of Statistics Act 2008, more than 20 lakh healthcare establishments such as hospitals, doctors, clinics, diagnostic labs, pharmacies and nursing homes would be enumerated under this census, which will capture data on more than 1,400 variables.
  6. The Central Bureau of Health Intelligence (CBHI) has looped in key stakeholders, including leading associations, allied ministries, and several private healthcare service providers.

What is it going to provide?

  1. This resource repository shall enable advanced research towards ongoing and forthcoming healthcare challenges arising from other determinants of health such as disease and the environment.
  2. Approximately 4,000 trained professionals are working with dedication to approach every healthcare establishment to collect information.
  3. It shall also enhance the coordination between central and state government for optimisation of health resources, making ‘live’ and realistic state project implementation plans (PIPs) and improving accessibility of data at all levels, including state heads of departments, and thus decentralise the decision making at district and state level.
  4. Additionally, it shall generate real-world intelligence to identify gaps in health and service ratios, and ensure judicious health resource allocation and management.
  5. It shall identify key areas of improvement by upgrading existing health facilities or establishing new health facilities keeping in view the population density, geographic nature, health condition, distance,” he said.
  6. The NHRR project aims to strengthen evidence-based decision making and develop a platform for citizens and provider-centric services by creating a robust, standardised and secured Information Technology (IT)-enabled repository of India’s healthcare resources.

National Health Profile (NHP)-2018

  1. The health minister also released the National Health Profile (NHP)-2018, prepared by CBHI.
  2. The National Health Profile covers demographic, socio-economic, health status and health finance indicators, along with comprehensive information on health infrastructure and human resources in health.
Jun, 19, 2018

In a first, WHO recommends quadrivalent influenza vaccine

Image result for influenza

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

The following things are important from UPSC perspective:

Prelims Level: Influenza Strain Types,  H#N# Subtypes

Mains level: Read the attached story


News

Quadrivalent vaccine approved

  1. Sanofi Pasteur’s injectable influenza vaccine (FluQuadri) containing two A virus strains — H1N1 and H3N2 — and two B virus strains — Victoria and Yamagata — for active immunisation of adults of age 18 to 64 years was approved in May last year by the Drug Controller General of India (DCGI).
  2. The application for the paediatric indication is under review by the DCGI and final approval is expected by the end of this month.
  3. Sanofi’s quadrivalent influenza vaccine was licensed for use by the U.S. Food and Drug Administration (FDA) in 2013; it is licensed in 26 countries.

Why Quadrivalent vaccine?

  1. While a trivalent influenza vaccine contains both A subtype viruses, it has only one of the B subtype virus, the quadrivalent vaccine offers a greater breadth of protection as it includes both B subtype viruses.
  2. It is because of a greater breadth of protection that a few other companies too have shifted from a trivalent to a quadrivalent vaccine.
  3. Since the vast majority of influenza vaccines manufactured were trivalent till recently, the World Health Organisation (WHO) used to recommend two A subtypes and one B subtype, plus an optional fourth strain (the other B virus strain).

Benefits of Quadrivalent Vaccine

  1. The quadrivalent vaccine will contain four influenza virus strains (two A subtypes and two B subtypes — H1N1 and H3N2, and Victoria and Yamagata respectively).
  2. The viruses used in the vaccine are killed and this eliminates the possibility of the virus in the vaccine itself causing infection.
  3. In India, the vaccine will be available as a single dose pre-filled syringe
  4. Eventually, it will be available in a vial for public health use.

Incidences of different Strains

  1. In the case of H1N1, there are two strains — California and Michigan — that cause influenza. In India, the Michigan strain was earlier circulating and has been replaced by the California strain.
  2. For 2018, the WHO has recommended the Michigan strain for the southern hemisphere, including India.
  3. Each year, the vaccine changes to reflect the different strains in circulation.
  4. Year-round, scientists across the globe track, analyze and classify the viral strains causing illness.

 Indian context

  1. Despite the high number of infections and mortality each year, India does not have in place a national policy for influenza immunization.
  2. Pregnant mothers, children aged below five and young people with asthma, cardiovascular disease, diabetes and high blood pressure are at a greater risk of infection and death.
  3. The Ministry of Health issues only H1N1 vaccination guidelines for different vulnerable groups including healthcare workers.
  4. If we want to reduce the influenza burden in adults, then we must target children as they act as reservoirs.

Back2Basics

Influenza

Influenza is a virus that actually has hundreds of different strains. The virus mutates frequently, but the strains are classified into one of three main categories—A, B, or C.

Influenza A is the group that most commonly causes illness in humans.

  1. All influenza A viruses are further broken down into H and N subtypes. So, any influenza virus that is described as “H#N#” (such as H1N1) is an influenza A virus.
  2. There are 16 H subtypes and nine N subtypes, but only three combinations have actually caused highly contagious illness in humans.
  3. Other combinations have been found to infect other species (such as birds and pigs), but they have not caused widespread human infections.
  4. The three combinations that cause almost all outbreaks of the flu in humans are H1N1, H2N2 and H3N2.
  5. Even in these subtypes, the influenza virus can mutate and change each year. For this reason, influenza viruses are also named using:
  • The host of origin (swine, chicken, etc., or no host if it is of human origin)
  • The geographical location of origin (Hong Kong, Alberta, etc.)
  • Strain number
  • Year of discovery (or isolation)

Influenza B

  1. Influenza B is less common but still causes outbreaks of seasonal flu.
  2. One or two strains of influenza B are included in the seasonal flu vaccine every year to protect people from the strain(s) that researchers believe are most likely to cause illness during the upcoming flu season.
  3. The quadrivalent flu vaccine contains two strains of influenza B but the traditional trivalent flu vaccine only contains one.
  4. Influenza B is not broken down into subtypes like influenza A is, but it is broken down into individual strains.
  5. Typically, two strains of influenza A and one strain of influenza B are included in the seasonal flu vaccine. Quadrivalent flu vaccines contain two strains of influenza A and two strains of influenza B.
  6. Influenza B can cause outbreaks of seasonal flu but they occur less frequently than outbreaks of influenza A.
Jun, 18, 2018

New health scheme flawed: IMA

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat Scheme

Mains level: The newscard highlights very important bottleneck in the implementation of the very ambitious health care initiative, which cannot be ruled out.


News

Limitations of Insurance Driven Healthcare

  1. The Indian Medical Association (IMA) has demanded a review of the Centre’s ambitious National Health Protection Scheme, saying it has “conceptual deficits and operational flaws”.
  2. It said current policy change in India will only end up strengthening the insurance business.
  3. In addition to non-creation of new public sector hospitals, the government will lose around ₹400 crore to private health insurance companies which will manage the scheme.

Issues highlighted by IMA

  1. The IMA demanded that the costing undertaken be transparent and be in public domain.
  2. The doctor’s body said the money allotted for the Ayushman Bharat — National Health Protection Scheme (AB-NHPS) would have better served the country if every district hospital is strengthened with an infrastructure of ₹2 crores each.
  3. The same money invested in our public hospitals would have brought secondary and tertiary care closer to poor in our government hospitals.
  4. The doctors body said the rates quoted by the government for various procedures are abysmal and impractical and most of them do not cover even 30% of the cost of the procedure.
  5. In the garb of cost-cutting, the government is exposing the people to danger in the hospitals.

Example: Caesarean sections underwritten for ₹9,000 cannot ensure the safety of the mother and the child

Key Suggestions

  1. IMA has suggested to the Union government that NHPS should be modeled as healthcare purchase directly from the provider hospitals removing the insurance companies and third-party administrators.
  2. These intermediaries siphon off 40% of the budgeted money and are breeders of corruption and unethical practices.
  3. The IMA said the way forward for the country is to invest in our government hospitals for better health infrastructure and manpower.

Back2Basics

Indian Medical Association

  1. The IMA is a national voluntary organization of Doctors of Modern Scientific System of Medicine in India, which looks after the interest of doctors as well as the well being of the community at large.
  2. It was established in 1928 as the All India Medical Association, renamed “Indian Medical Association” in 1930 and is headquartered in New Delhi.
  3. It is a society registered under The Societies Act of India, 1860.
  4. It delegates its powers to a Working Committee (A representative body of all state Branches) for implementation of programmes and activities.
  5. The Indian Medical Association is a founder member of the World Medical Association.
Jun, 15, 2018

[op-ed snap] Holes in the scheme

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme (NHPS)

Mains level: Various issues associated with the implementation of NHPS


Context

Launch of NHPS

  1. The Model Tender Document For The Selection of Implementing Agencies For the National Health Protection Scheme (NHPS), released by the Union Ministry of Health and Family Welfare tries to address various concerns related to NHPS
  2. The document states that nearly 47 percent of the packages under the NHPS, including those related to heart ailments and cancer, require pre-authorisation
  3. This means hospitals impanelled under the scheme cannot perform these procedures until they have an authorization letter from the NHPS’s Implementation Support Agency

Why this system of checks?

  1. Current scheme’s predecessor, the Rashtriya Swasthya Bima Yojana, was riddled with unethical practices such as unnecessary hospitalization, needless investigations and billing for superfluous and unrelated treatment packages

Associated Concerns 

  1. Hospitals might shift the onus of obtaining the authorization letter on the critically-ill or their families
  2. Several procedures, including emergency consultation for acute colic, nebulization for an asthma attack, hypoglycemia in a diabetic and treatment of “dengue without complication”, will be covered by the scheme only if the treatment is availed in a government hospital
  3. Without timely treatment, a dengue fever can aggravate to a life-threatening disease

Way forward

  1. Checks on the impanelled hospitals are well in order under NHPS
  2. It would prevent private hospitals to milk the NHPS by prescribing unnecessary investigations
  3. But it should also be ensured that these checks do not come in between providing emergency care to critically ill patients or put an extra burden on their families
Jun, 15, 2018

20 States on board to implement Ayushman Bharat

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme, Rashtriya Swasthya Bima Yojana, Senior Citizen Health Insurance Scheme, SECC

Mains level: Universal health coverage and related issues


News

Status of States Joining the ambitious programme

  1. Twenty States are on board to implement the Ayushman Bharat Scheme by having a MoU with the Union Ministry of Health and Family Welfare (MoHFW)
  2. States that are likely to go for the insurance model are Chhattisgarh, Haryana, Uttarakhand, Jharkhand, Jammu and Kashmir, Meghalaya, Nagaland, Tripura. Union Territories of Chandigarh, Daman and Diu, and Dadra and Nagar Haveli will also opt for the insurance model.
  3. Those keen on adopting a trust model are Andhra Pradesh, Arunachal Pradesh, Assam, Madhya Pradesh, Bihar, Lakshwadeep, Manipur, Puducherry, Telangana, Sikkim and Goa.
  4. Gujarat, Himachal Pradesh, Kerala, Maharashtra, Mizoram, Rajasthan and Tamil Nadu have expressed an interest to adopt the hybrid model.
  5. For example, for all payments under ₹50,000, Gujarat has proposed to opt for insurance payment and for anything above it has opted for trust-based payment.
  6. West Bengal and Delhi chose to keep away from signing the MoU.
  7. Odisha will most likely not be a part of Ayushman Bharat as it wants to launch its own state-based scheme for health insurance.

Back2Basics

Ayushman BharatNational Health Protection Mission (AB-NHPM)

  • The scheme was announced in the Budget 2018
  • The scheme will provide a cover of ₹5 lakh per family per year
  • There will be no cap on family size and age
  • The benefits cover will include pre and post-hospitalization expenses
  • All pre-existing conditions will be covered from day one of the policy
  • A defined transport allowance per hospitalization will also be paid to the beneficiary
Jun, 13, 2018

Pre-authorization must for nearly half of all treatments under NHPM

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Programme

Mains level: Universal health coverage and associated Moral hazard


News

Ayushman Bharat operational details

  1. Pre-authorisation will be mandatory for 636 of the 1,350 packages – or 47 per cent of all treatments covered under the National Health Protection Mission (NHPM), including all packages for cardiology, ophthalmology and oncology.
  2. The NHPM will not cover conditions that do not require hospitalization, dental procedures, congenital physical problems, vaccinations and fertility-related procedures, and will also not cover treatment of a person who has attempted suicide.
  3. The document also lays down that for a claim ratio of up to 120 percent, states will not pay any additional premium.

Pre-authorisation is essential to keep a check on “moral hazard” procedures

  1. “Moral hazard” in health insurance parlance is the tendency of people who are insured to buy/be sold additional healthcare interventions, irrespective of their actual needs
  2. This leads to expenses that do not necessarily add to their own health or well being but bleeds the insurer
  3. For this procedures such as emergency consultation for acute colic, high fever, cuts, stitches, soft tissue injury, single-bone fracture plaster, nebulization for asthmatic attack, moderate dehydration, hypoglycaemia in a diabetic, dengue without complication, and food poisoning will be covered in the scheme only if the treatment is availed in a government hospital
  4. For some specified conditions, pre-authorisation will be required for hospitalization beyond 10 days

A penalty for Delay in Premium

  1. The penalty provisions are stiff for any delays on the part of the insurer or the state health agency (SHA) either in paying the premium or in processing claims or refunds to the state.
  2. If claim payment to the hospital is delayed beyond 15 days, insurers will have to pay an interest of 1 percent for every seven days of delay.
  3. If the premium refund is not made by the insurer to SHA within 30 days of the communication for the refund, there will be 1 percent interest for every week of delay.
  4. If the premium is not paid to the insurer by the SHA within six months of the commencement of the AB-NHPM, insurers will get an interest of 1 percent of the premium amount for every seven days’ delay.

Administration of the Scheme

  1. For the purpose of administration of the scheme, states have been divided into two categories.
  2. Category A states include Arunachal Pradesh, Goa, Himachal Pradesh, Jammu and Kashmir, Manipur, Meghalaya, Mizoram, Nagaland, NCT Delhi, Sikkim, Tripura, Uttarakhand, and six Union Territories: Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Lakshadweep and Puducherry.
  3. States in Category B are Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Uttar Pradesh, and West Bengal.

Admin Cost Sharing

  1. In category A states, the administrative cost allowed is 10 percent if claim ratio less than 60 percent, 15 percent if claim ratio is between 60 percent and 70 percent and 20 percent if claim ratio is between 70 percent and 80 percent.
  2. In Category B states, administrative cost allowed will be 10 percent if claim ratio is less than 60 percent, 12 percent if claim ratio is between 60 percent and 70 percent, and 15 percent if claim ratio is between 70 percent and 85 percent
May, 05, 2018

National Health Protection Mission: For claim ratio below 85%, insurer can pocket 15%, give rest to govt

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Ayushman bharat scheme(read the attached story)

Mains level: The new framework.


News

Framework for the insurers: Under the National Health Protection Mission (NHPM)

  1. The government has told insurers that they will be under obligation to return part of the premium collected if they fall short of the 85-per cent claim ratio
  2. For any claim ratio below 85 per cent, the insurers can keep a maximum of 15 per cent of the unclaimed premium and return the rest to the government

Explanation

  1. For example, if only 50 per cent is consumed in medical claims of the total annual premium paid to an insurance company, the insurer cannot take the entire remaining sum
  2. It will have to return 35 per cent of the premium amount to the government at the end of the year, and take the remaining 15 per cent

What is the claim ratio?

  1. Claim ratio is calculated as the total value of all claims paid by the company divided by the total amount of premium collected in a financial year
  2. A claim ratio of 75-90 is usually thought to be an indicator of a robust claim settlement system by an insurer

Concern related to reverse bidding

  1. One of the concerns insurance companies raised at the meeting was that the reverse bidding(in which the top three bidders are allowed to revise their bids) should not be done for this programme,
    Another concern related to eligibility condition
  2. the eligibility conditions be relaxed so that new entrants in the insurance sector with less than three years experience can bid as well
Apr, 26, 2018

Expand national programmes to eliminate malaria by 2030: WHO

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: World Health Organization, World Malaria Day

Mains level: India’s target for Malaria elimination and issues related to it


News

Expanding the coverage of National Malaria Programmes

  1. The World Health Organization called on its member countries to expand the reach of their national malaria programmes among disadvantaged or neglected communities, including tribal, migrant or mobile populations, to achieve the disease elimination target by 2030
  2. On the eve of World Malaria Day (25th April) WHO urged member countries to ensure that national malaria programmes are provided sustainable funding along with strengthening surveillance

Targeting the Vulnerable

  1. WHO said that high-level commitment was crucial for elimination of malaria, and member countries should be focused on implementing a series of evidence-based interventions
  2. It means providing them access to long-lasting insecticidal nets (and ensuring they know how and why to use them)
  3. Other measures include- Carrying out the indoor residual spraying
  4. And providing pregnant women and children under-5 within these groups special attention, including increased access to antenatal services

Back2Basics

National framework for Malaria Elimination (NFME)

  1. NFME outlines the strategies for eradication of the disease by 2030
  2. It classifies districts or states/UTs depending upon their Annual Parasite Incidence (API) or malaria
    endemicity into categories 0,1,2,3
  3. API number gives the number of cases affected by malaria per 1000 population per annum
  4. The milestones and targets are set for 2016, 2020, 2022, 2024, 2027 and 2030 by when the entire country has sustained zero indigenous cases and deaths due to malaria for 3 years and initiated the processes for certification of malaria elimination status to the country
  5. The objectives of the NFME are to:
  • Eliminate malaria from all low (Category 1) and moderate (Category 2) endemic states/UTs (26) by 2022
  • Reduce the incidence of malaria to less than 1 case per 1000 population in all States/UTs and the districts and malaria elimination in 31 states/UTs by 2024
  • Interrupt indigenous transmission of malaria in all States/ UTs (Category 3) by 2027;
  • Prevent re-establishment of local transmission of malaria in areas where it has been eliminated and to maintain the malaria-free status of the country by 2030
Apr, 23, 2018

Health Ministry to roll out prog to combat hepatitis

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particular of the Hepatitis disease

Mains level: Targets set under the initiative.


News

Important decision taken by the Health Ministry

  1. The Health Ministry has decided to roll out an initiative for prevention and control of viral hepatitis
  2. Why: to address aspects such as surveillance, awareness generation, safe blood and injection safety to combat the disease

Particulars of the initiative: The ‘Integrated initiative for prevention & control of viral hepatitis’ 

  1. Under the initiative, the ministry has decided to establish a state coordination unit under the state NHM for efficient rollout of the programme in 26 large and four small states
  2. There is also a plan to set up 50 state laboratories for assisting in diagnosis and training of the district hospitals for screening of hepatitis
  3. The ministry intends to scale up to 100 treatment and 665 testing centres over a period of next three years

Budgetary provisions

  1. The National Health Mission (NHM) has decided to roll out ‘Integrated initiative for prevention & control of viral hepatitis’ with a budget of Rs 517.39 crore for three years

Back2basics

Hepatitis

  1. Hepatitis is inflammation of the liver tissue
  2. Some people have no symptoms whereas others develop yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea
  3. Hepatitis may be temporary (acute) or long term (chronic) depending on whether it lasts for less than or more than six months
  4. Acute hepatitis can sometimes resolve on its own, progress to chronic hepatitis, or rarely result in acute liver failure
  5. Over time the chronic form may progress to scarring of the liver, liver failure, or liver cancer
Apr, 20, 2018

Health ministry to name hospitals which do not perform under Kayakalp initiative

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: ‘Kayakalp’ initiative, Mera Aspataal initiative

Mains level: Steps taken by the government to raise the level of health services being provided in the country


News

Fixing accountability of medical institutions

  1. The Health Ministry has decided to name from next year onwards those health facilities which are not up to the mark on various parameters, including sanitation, waste management and infection control under its ‘Kayakalp’ initiative
  2. To fix accountability at various levels, the ministry will declare names of hospitals to which patients have not given positive feedback through its Mera Aspataal (My Hospital) app

Mera Aspataal initiative

  1. It aims at empowering patients by seeking their views on the quality of experience in a public healthcare facility
  2. Patient satisfaction is the ultimate test for assessing the quality of services, provided by a healthcare facility under this initiative
  3. It was launched in August 2016

Back2Basics

‘Kayakalp’ initiative

  1. ‘Kayakalp’ programme was launched by the health ministry following Prime Minister Narendra Modi’s call to the people of India to realise Mahatma Gandhi’s dream of “Swachh Bharat” (Clean India)
  2. It is an initiative for awarding public health facilities
  3. It aims to incentivise such facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control as well as inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation
  4. It was launched in May 2015
Apr, 13, 2018

[op-ed snap] Can Ayushman Bharat make for a healthier India?

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Scheme

Mains level: The important dimensions discussed in the newscard.


News

The Ayushman Bharat Scheme: Two important dimensions
FIRST DIMENSION: It aims to roll out comprehensive primary health care with Health and Wellness Centres (HWCs) serving the people

  1. A nationwide network of 1.5 lakh HWCs will be created by transforming the existing sub-centres and primary health-care centres by 2022
  2. This will constitute the very foundation of New India’s health care system

Issues with the older health policies

  1. So far, the country’s primary health care has been focussing on reproductive, maternal health, newborn and child health as well as controlling priority communicable diseases
  2. All this perhaps covers only 15% of our needs

Need of primary health care in India

  1. There is a huge unmet need for primary health care, namely, care for non-communicable diseases (hypertension, diabetes, chronic obstructive lung disease, and common cancers), mental health, care of the aged, adolescent health, palliative health care, basic eye care and dental health
  2. If we build a strong, robust next generation primary health-care system, it will save lives and will lead to a healthier India

Commitment of the government under the National Health Policy 2017

  1. The government has committed for two-thirds of resources to go into a comprehensive primary health care as part of the policy

SECOND DIMENSION: The scheme aims to provide health cover of Rs. 5 lakh per family per year for hospitalisation in secondary and tertiary care facilities

  1. The programme will cover half a billion people and would align with what the State governments are doing already, with significant resources coming from the Centre
  2. Many State governments would extend the benefits to additional beneficiaries through their own resources so that ultimately the population covered for catastrophic expenses could be two-thirds of India’s population, if not more
  3. This mission enables increased access to in-patient health care for the poor and lower middle class
  4. Treatment will be provided by empanelled public and private hospitals
  5. Private hospitals will have to agree to terms such as package rates, adherence to standards and guidelines, ethical practice, respectful care and client satisfaction, and transparency

The scheme will help in Employment generation in the Health Sector

  1. Ayushman Bharat will spur increased investment in health and generate lakhs of jobs, especially for women, and will be a driver of development and growth
  2. It is a turning point for the health sector

Back2basics

Ayushman Bharat-National Health Protection Mission

  1. Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization
  2. Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS)
Apr, 07, 2018

[op-ed snap] Healthy India, happy India

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: The article is written by Vice-President of India. His views on healthcare system in India are important.


News

India’s health indicators

  1. On health indices, there have been some successes but we still face innumerable, complex challenges
  2. Over the years, we have successfully eradicated diseases such as polio and tetanus, done reasonably well in the fight against malaria and in halting the spread of HIV

Current issues in Indian Healthcare System

  1. Today, the country is grappling with the twin problems of communicable and non-communicable diseases (NCDs) due to a variety of causes
  2. With India ranked at an unflattering 154th in a Lancet study on “Healthcare Access and Quality Index” published last year, we need to work hard to make India “Swasth Bharat” in the coming years
  3. Both the public and private sector have a big task on hand as a whole range of issues have to be tackled —
    from the problem of malnutrition to providing an inclusive and affordable healthcare to every citizen

Low doctor-population ratio in India

  1. India has less than one doctor for every 1,000 people, which is below the WHO norm
  2. The doctor-population ratio is estimated to be 0.62:1,000 as per the current population, while the number of hospital beds is estimated to be 0.5 per 1,000 people

The public expenditure on the health sector

  1. The first and foremost priority has to be to increase the public expenditure on the health sector
  2. With the economy projected to improve further in the coming years, public expenditure on the health sector has to be enhanced significantly

Need of providing proper healthcare to the elderly people

  1. Ensuring proper healthcare to the elderly is another major area of concern for the governments and all other stakeholders involved in the health sector
  2. The problems associated with geriatrics such as dementia, Alzheimer’s and Parkinson’s diseases are on the rise, while depression in both the young and old is becoming a major health issue
  3. Perhaps, it might be a good idea to set up special geriatric clinics in different localities in cities under public-private partnership

Ayushman Bharat scheme

  1.  the recently announced Ayushman Bharat scheme to provide health cover to 10 crore families and
  2. the proposal to set up 1.5 lakh health and wellness centres will go a long way in providing the much-needed affordable healthcare to millions across the country

The way forward

  1. There is a need of every individual to make lifestyle changes
  2. Healthcare should be affordable and accessible to the common man so that a healthy and happy India becomes a reality in the coming years
  3. The private sector must follow ethical practices and supplement the efforts of the government
Mar, 31, 2018

'Risk of bone fracture high in urban India’

Note4students

Mains Paper 3: Science & Technology | Science and Technology- developments and their applications and effects in everyday life Achievements of Indians in science & technology; indigenization of technology and developing new technology

From the UPSC perspective the following things are important:

Prelims Level: Osteoporosis and Osteopenia

Mains Level: Findings of the study


News

Indian Journal of Medical Research

  1. A study published in the Indian Journal of Medical Research showed that over 69% of people aged 38-68 in Delhi suffer from continuous bone loss and face high risk of fractures

Particulars of the study

  1. The study conducted on around 223 men and 222 women by performing a qualitative ultrasound of their bones, found that around 8.99% patients were suffering from osteoporosis and 59.55% had osteopenia
  2. With 8.99% patients of osteoporosis and 59.55% patients of osteopenia, the overall population at risk of fractures in this study was found to be approximately 69%

Particulars of the Osteoporosis 

  1. Osteoporosis is usually considered a “silent disease” until a fracture occurs
  2. Osteoporotic fractures are defined as fractures associated with low bone mineral density (BMD) and include clinical spine, hip, forearm and shoulder fractures

Particulars of the Osteopenia

  1. Osteopenia is a condition in which bone mineral density is lower than normal
  2. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis
Mar, 31, 2018

[op-ed snap] Billed for change: NMC Bill

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Prelims Level: Particulars of the NMC bill

Mains Level: Concerns discussed, regarding the NMC bill, in the newscard.


News

Acceptance of suggestions

  1. The Union Cabinet has recently approved six out of the dozens of changes to the contentious National Medical Commission (NMC) Bill that were suggested by a Parliamentary Standing Committee

These changes address some of the loudest criticisms of the Bill

  1. Among them, the final year MBBS exam is now merged with an exit exam for doctors,
  2. and a contentious bridge course for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy) practitioners has been removed
  3. Health-care experts had recommended other modifications, which the Cabinet ignored
  4. For example, despite the Cabinet’s amendments, the NMC, the regulatory body that will replace the Medical Council of India, will be heavily controlled by the government

Other changes accepted by the cabinet

  1. The amendments cleared by the Cabinet also increase State representation in the NMC from three part-time members to six, in what seems like a gesture to please the States
  2. Contrast this with the parliamentary committee’s recommendation to include 10 State representatives, given India’s vastness
  3. Another amendment that doesn’t go far enough is the decision to raise the proportion of private college seats for which fees will be regulated from 40% to 50%
  4. The fees for unregulated seats could then increase abruptly, pushing poorer medical aspirants out of the system

Future challenges

  1. Despite these deficiencies, if passed by Parliament, the legislation will mark a new era for medical education in India
  2. The next step will be to design rules and regulations that capture the intent of this law(NMC bill)
  3. This itself will be a massive challenge
  4. Another concern is that under the new amendments States now have the freedom to implement an AYUSH bridge course, even if no longer mandatory
  5. How will the Centre ensure the quality of such courses to prevent a new set of poorly trained doctors from emerging?
Mar, 31, 2018

Government to tweak Modicare for North-East states

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat, Atal Amrit Abhiyan

Mains level: Schemes for Universal health coverage


News

Special plan under Modicare for North-East India

  1. The Union ministry of health and family welfare is planning to tweak the ambitious entitlement scheme Ayushman Bharat-National Health Protection Mission (AB-NHPM) for the North-East, and draw up customized plans
  2. This is being done considering special needs of North-Eastern states such as geographical factors and lack of hospitals and diagnostic laboratories

Atal Amrit Abhiyan

  1. It is a healthcare scheme of Assam
  2. It has a provision for coverage of up to Rs2 lakh for six critical ailments and 468 other diseases
  3. Patients can avail cashless treatment at all government and Central Government Health Scheme (CGHS)-empanelled private hospitals across India through a smart health card
  4. Any resident of Assam earning up to Rs5 lakh annually is covered under the scheme
Mar, 29, 2018

Cabinet nod for changes to NMC Bill

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission (NMC) Bill

Mains level: Issues related to medical education regulation


News

Amendments to the National Medical Commission (NMC) Bill

  1. The provision dealing with bridge course for AYUSH practitioners to practice modern medicine to a limited extent has been removed in the official amendments to the National Medical Commission (NMC) Bill
  2. It has now been left to the State governments to take necessary measures for addressing and promoting primary health care in rural areas
  3. There will be a final MBBS examination to be held as a common exam across the country and would serve as an exit test called the National Exit Test (NEXT)

Back2Basics

National Medical Commission (NMC) Bill

  1. The Bill seeks to repeal the Indian Medical Council Act, 1956
  2. The Bill sets up the National Medical Commission (NMC)
  3. Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level
  4. The NMC will consist of 25 members, appointed by the central government
  5. Under the Bill, the central government will constitute a Medical Advisory Council
  6. The Council will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC
  7. The Bill sets up certain autonomous boards under the supervision of the NMC
  8. These boards are: (i) the Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB), (ii) the Medical Assessment and Rating Board (MARB) and (iii) the Ethics and Medical Registration Board
  9. There will be a uniform National Eligibility-cum-Entrance Test for admission to undergraduate medical education in all medical institutions regulated by the Bill
  10. There will be a National Licentiate Examination for the students graduating from medical institutions to obtain the license for practice and this exam will also serve as the basis for admission into post-graduate courses at medical institutions
Mar, 27, 2018

In draft digital health security law, 5-year jail term, Rs 5 lakh fine for data breach

Image source

Note4students

Mains Paper 3: Internal Security | Basics of cyber security

From UPSC perspective, the following things are important:

Prelims level: Digital Information in Healthcare Security Act (DISHA), National Electronic Health Authority, Clinical Establishments (Registration and Regulation) Act, 2010, National Health Protection Mission

Mains level: Concerns related to data security


News

Draft Digital Information in Healthcare Security Act (DISHA)

  1. The Centre has quietly put in the public domain the draft of a law to ensure the protection of health data
  2. The draft Digital Information in Healthcare Security Act (DISHA) lays down that any health data including physical, physiological and mental health condition, sexual orientation, medical records and history and biometric information are the property of the person who it pertains to
  3. The law makes any breach punishable by up to five years imprisonment and an Rs 5-lakh fine

Provisions of the act

  1. The Act envisages a health information exchange, a State Electronic Health Authority, and a National Electronic Health Authority
  2. It lays down that a clinical establishment (as defined in the Clinical Establishments (Registration and Regulation) Act, 2010) and these three authorities shall be duty-bound to protect the privacy, confidentiality, and security of the owner’s digital health data
  3. Any person or company who breaches digital health data, as per the draft Act, is liable to pay compensation to the person whose data has been breached
  4. The ten-member National Electronic Health Authority of India is designed in the long run to become the bulwark for the National Health Protection Mission
  5. NHPM is the ambitious health programme to cover 10.74 crore families against annual medical expenses of up to Rs 5 lakh

Judicial access 

  1. The draft Act says that no court shall take cognizance of any offense punishable under the Act except on a complaint made by the Central Government, State Government, the National Electronic Health Authority of India, State Electronic Health Authority, or a person affected
  2. This means a person or entity charged with data theft or breach does not have the option of challenging the punishment in court
  3. The Central and state adjudicating authorities formed under the Act will have powers of a civil court
Mar, 24, 2018

[op-ed snap] A first step: National Health Protection Mission

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS Scheme

Mains level: Complement this newscard with our previous newscards on the same issue(go through the attached story on the Health Sector)


News

Union Cabinet’s decision on the National Health Protection Mission(NHPS) scheme

  1. The Union Cabinet has recently approved the modalities of its implementation
  2. For a start, the apex council that will steer the programme and the governing board to operationalise it in partnership with the States need to be set up

Expectations from the state governments

  1.  The States, which have a statutory responsibility for provision of health care, have to act quickly and form dedicated agencies to run the scheme

Legal necessities

  1. Since the NHPM represents the foundation for a universal health coverage system that should eventually cover all Indians, it needs to be given a sound legal basis, ideally through a separate law
  2. This could be on the lines of legislation governing the rights to food and information
  3. Such legislation would strengthen entitlement to care, which is vital to the scheme’s success
  4. It will also enable much-needed regulatory control over pricing of hospital-based treatments

Targeted groups

  1. The initial norms set for availing benefits under the NHPM appear to make the inclusion of vulnerable groups such as senior citizens, women and children contingent on families meeting other criteria
    (except in the case of Scheduled Caste and Scheduled Tribe households)
  2. The government should take the bold step of including these groups universally
  3. the financial risk can be borne by the taxpayer

WHO on the NHPS

  1. Universal health coverage is defined by the WHO as a state when “all people obtain the health services they need without suffering financial hardship when paying for them”

Raising the core budgetary spending every year is not enough 

  1. Attention should be paid to social determinants of health
  2. Affordable housing, planned urban development, pollution control and road safety are some aspects vital for reducing the public health burden
  3. Unfortunately, governments are paying little attention to these issues, as the quality of life erodes even with steady economic growth

The way forward

  1. It is a challenging task to make all this a reality, and the government will have to work hard to put it in place
Mar, 22, 2018

Union Cabinet approves Ayushman Bharat health scheme

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme, Rashtriya Swasthya Bima Yojana, Senior Citizen Health Insurance Scheme, SECC

Mains level: Universal health coverage and related issues


News

Scheme for Universal Health Coverage

  1. The Union Cabinet on Wednesday approved the launch of the Ayushman BharatNational Health Protection Mission (AB-NHPM)
  2. The scheme was announced in the Budget 2018

About the scheme

  1. The scheme will provide a cover of ₹5 lakh per family per year
  2. It would take care of almost all secondary care and most of the tertiary care procedures
  3. There will be no cap on family size and age
  4. The benefits cover will include pre and post-hospitalization expenses
  5. All pre-existing conditions will be covered from day one of the policy
  6. A defined transport allowance per hospitalization will also be paid to the beneficiary

Inclusions in the scheme

  1. The target beneficiaries will be more than 10 crore families belonging to poor and vulnerable population based on SECC database
  2. AB-NHPM will subsume the on-going centrally sponsored schemes — Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS)
Mar, 13, 2018

[op-ed snap] Unhealthy Binaries

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme

Mains level: Healthcare infrastructure in India


Context

Misleading beliefs related to the healthcare sector

  1. The first, most deep-rooted misleading belief, is that private practitioners are less suited to deliver healthcare services than public healthcare professionals
  2. The second is that health outcomes of patients are immaterial, that there is no need to track patients or maintain records, spending more money on healthcare is enough

Institutional infrastructure to track health outcomes

  1. Tracking health status means that patient outcomes like disease, death, infection and so on, be regularly ascertained, reported and monitored
  2. In some countries, it is routine to set up such reporting systems
  3. They even set up disease-specific registers in which a variety of hospitals and physicians participate

Status of such infrastructure in India

  1. In India, till date, there has been no institutional framework fixing such key indicators
  2. There isn’t any general rule mandating that these should be reported regularly, whether in the public or private sector
  3. The need to track patient status is not given the importance it deserves

Optimal performance not possible

  1. In the absence of system-wide requirements, it is merely ideology and individual conscience that determines the quality of care available to patients
  2. Systems that are driven only by ideology and individual conscience can hardly perform optimally

Patient tracking

  1. It can be done by setting up a simple user-friendly software application
  2. This could be used to record patient data on a few key parameters
  3. Many state governments like Maharashtra, Andhra Pradesh, and Tamil Nadu use such software applications for secondary and tertiary care programmes
  4. These applications could be modified for patient tracking

Way forward

  1. India is moving towards creating structures for universal healthcare with the National Health Protection Scheme
  2. To successfully put care and quality back into healthcare, it is important to set up this kind of system to track the health status of patients
  3. Tracking health status will matter and effectiveness of resource use has little to do with the size of resources made available
Mar, 03, 2018

[op-ed snap] Follow the states: National Health Protection Scheme

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS

Mains level: Suggestions given in the newscard. And the lessons that government can learn from the Rajiv Gandhi Jeevandayi Aarogya Yojana(of Maharashtra).


News

Context

  1. National Health Protection Scheme (NHPS)

Same schemes are successfully implemented in many states

  1. National Health Protection Scheme(NHPS) is not the first public health insurance programme in the country
  2. Many states, including Maharashtra, Karnataka, Rajasthan, Andhra Pradesh, Goa and Tamil Nadu, have successfully implemented health insurance programmes, easily covering over 50 crore people

Maharashtra: Rajiv Gandhi Jeevandayi Aarogya Yojana

  1. In Maharashtra, the Congress-led government started the Rajiv Gandhi Jeevandayi Aarogya Yojana in 2012
  2. This is a universal coverage scheme that benefits 2.23 crore poor households (over 95 per cent of the state’s population)
  3. An insurance cover of Rs 1.5 lakh per year is provided to each insured family
  4. The public sector insurance company that was selected charged a premium of Rs 333 (plus taxes) per family
  5. Experience in Maharashtra suggests that the NHPS will have to consider many critical aspects
  6. The first is the total cost. There is a token provision of Rs 2,000 crore in the budget. However, the total cost is likely to be nearer Rs 20,000 crore per year
  7. A new 1 per cent cess will make about Rs 11,000 crore available to the government in a year

Selection of insurance provider for the scheme

  1. Selecting the insurance provider is an extremely complex process. Each step, such as whether private sector companies would be allowed to bid, must be considered carefully
  2. Otherwise, it could invite legal challenges

Accreditation of participating hospitals(under the scheme)

  1. The accreditation of participating hospitals is another difficult exercise
  2. The Rashtriya Swasthya Bima Yojana (RSBY) is a glaring example
  3. Many private hospitals registered under the RSBY were reported to have indulged in malpractices such as prescribing unnecessary diagnostic testing and hospitalisation

The NHPS is not enough

  1. Insurance-based intervention in the health sector can only be a partial solution
  2. The government cannot abdicate its responsibility of providing a high-quality and affordable public health infrastructure
  3. For the infrastructure, the National Health Policy has set a target of health expenditure to reach 2.5 per cent of the GDP by 2025
  4. Experience in Maharashtra has shown us that the implementation of such a large health insurance scheme requires huge preparation in the creation of infrastructure
Feb, 28, 2018

[op-ed snap] Health outcomes index: nudging India to progress

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the index

Mains level: Very important newscard. The creation of the index is one of the most important step taken by the government(in health sector).


News

“Healthy States, Progressive India” report

  1. The report has spurred a vibrant debate on the status and future of India’s health sector
  2. Through this report, the focus has been on the performance and annual progress of states and Union territories on a myriad of health indicators
  3. This index(Health outcomes index by the NITI Aayog) will help nudge states towards improving their health sector outcomes in the spirit of cooperative and competitive federalism
    State-wise performance
  4. Kerala is the leader among large states, closely followed by Punjab and Tamil Nadu
  5. Uttar Pradesh, Rajasthan and Bihar are the least-performing states

Goal of the Health outcomes index

  1. The goal of the index is not just to rank the states based on their historical performance, but also on their incremental performance
  2. The attempt is to capture the change made during the course of the year
  3. For example, Jharkhand, Jammu and Kashmir, and Uttar Pradesh are ranked first, second and third in their incremental performance ranking

Making of the “Performance On Health Outcomes” index

  1. The “Performance On Health Outcomes” index is made up of 24 indicators in three different domains—health outcomes, governance and information, and key inputs and processes
  2. The “health outcomes” account for 70% of the weight, and the other two domains weighs 12% and 18%, respectively
  3. The “health outcomes” domain has indicators such as total fertility rate (TFR), neonatal mortality rate (NMR), sex-ratio at birth (SRB), etc.
  4. The governance and information domain measures the quality of data (data integrity indicator) and the average occupancy in important health-related posts such as principal secretary (health), chief medical officer, etc.
  5. Key inputs and processes measure the current status of healthcare professional vacancies, infrastructure at district hospitals, and the speed of financial governance in the states

What are the key results that emerge from the health index?

  1. First, First, there are large gaps between states
  2. The gap between the best-performing states and the least-performing states is worrisome—Kerala and Uttar Pradesh are separated by 42.86 points
  3. Second, incremental performance reveals that there has been a decline in performance on some states
  4. Six states’ scores have declined—Kerala, Haryana, Gujarat, Karnataka, Himachal Pradesh, and Uttarakhand
  5. Third,  India has made significant strides in achieving the goals set out under the UN-SDG and our own National Health Policy
  6. Some of our states have already met or exceeded the goals a decade ahead of 2030

What are the lessons that emerge from the health outcomes index? 

  1. First, an exercise of this kind requires data on health outcomes
  2. The effort did show us significant gaps in the availability of such data, especially for the smaller states
  3. We need robust programmatic data than can be used for continuous monitoring
  4. Second, incentives need to be linked to performance
  5. The linking of the health index with incentives under the National Health Mission will further push states to improve outcomes

The way forward

  1. NITI Aayog is creating a framework to track the performance of government hospitals based on outcome metrics
  2. Together with the upgrading and setting up of health and wellness centres under the Ayushman Bharat Scheme and the National Health Protection Scheme
  3. these measures will help us realize the goal of “good health and well-being”( one of the UN-SDG) for all citizens
Feb, 24, 2018

NHPS beneficiaries to be drawn from economic, caste census: Centre to states

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme, SECC, National Health Agency, Rashtriya Swasthya Bima Yojana

Mains level: Universal health coverage and constraints in implementing it


News

SECC to be used

  1. The National Health Protection Scheme (NHPS) will cover an estimated 9.91 crore households across the country
  2. The beneficiaries have been selected on the basis of “deprivation and occupational criteria” as per Socio-Economic and Caste Census (SECC) data
  3. A National Health Agency (NHA) is also to be set up to manage NHPS

Criteria for selection

  1. The proposed target population is
  • families that belong to any of the 7 deprivation criteria
  • automatically included families as per SECC database for rural areas and
  • defined occupational criteria for urban areas

2. The total target of 9.91 crore households also includes 0.22 crore families currently enrolled under Rashtriya Swasthya Bima Yojana (RSBY) but not in the targeted SECC data

Aadhar to be used

  1. The Ministry of Health and Family Welfare has proposed to “use Aadhaar-based authentication” for validation of beneficiary
  2. No person will be denied benefits under the scheme “merely on the (basis of) non-availability of Aadhaar

Back2Basics

Socio-Economic and Caste Census (SECC)

  1. SECC was conducted in 2011 and is meant to provide data on various socio-economic indicators, and most importantly, on caste
  2. The SECC 2011 was conducted in all states and union territories of India
  3. SECC 2011 is also the first paperless census in India conducted on hand-held electronic devices by the government in 640 districts
  4. SECC 2011 was the first-ever caste-based census since 1931 Census of India
  5. SECC 2011 was not conducted under 1948 Census of India Act which made information disclosure voluntary for citizens, and not a mandatory disclosure
  6. Socio-Economic and Caste Census 2011 was the fourth exercise conducted by Government of India to identify households living below the poverty line (BPL) in India that would get various entitlements, after three censuses in 1992, 1997 and 2002
  7. SECC 2011 has three census components conducted by three separate authorities but under the overall coordination of Department of Rural Development in the Government of India:
  • Census in Rural Area has been conducted by the Department of Rural Development
  • Census in Urban areas is under the administrative jurisdiction of the Ministry of Housing and Urban Poverty Alleviation
  • Caste Census is under the administrative control of Ministry of Home Affairs: Registrar General and Census Commissioner of India
Feb, 23, 2018

[op-ed snap] Saving lives

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Unicef’s report and Janani Suraksha Yojana.

Mains level: Some possible solutions suggested in the report, for countering the issue of high neonatal mortality rate.


News

Report by the United Nations Children’s Fund (Unicef): “Every Child Alive”

  1. The report is on country-wise ranking of neonatal mortality rates
  2. It ranks India behind poorer countries such as Bangladesh, Nepal and Rwanda
  3. The ranking shows that financial resources are not the biggest constraint in improving this health indicator; political will is
  4. According to the report, average newborn mortality in low-income nations is nine times that of high-income ones

Several countries showing a way forward for India

  1. For example, Sri Lanka and Ukraine, which like India are categorised as lower-middle income economies, had a neonatal mortality of around 5/1000 in 2016
  2. In comparison, the U.S., a high-income economy, did only slightly better with a rate of 3.7/1000
  3. India saw the 31st highest newborn-mortality rate, at 25.4 deaths per 1000 in 2016, while Pakistan had the highest
  4. This means India lost 640,000 babies in 2016, more than any other country

How can we solve this problem? 

  1. The report points out that the most powerful solutions are not necessarily the most expensive
  2. The 10 critical products that hospitals must stock to save newborns include a piece of cloth to keep a baby warm and close to the mother to encourage breastfeeding
  3. The list also includes antibiotics and disinfectants, the use of which can stave off killers like sepsis and meningitis
  4. There are factors outside the healthcare system, like female literacy rates, that make a big difference to healthcare-seeking behaviour
  5. But changes in education levels will come slowly
  6. Some other solutions will need greater investment

Biggest cause of death

  1. The biggest cause of death is premature birth, while the second is complications like asphyxia during delivery
  2. Preventing these would mean paying attention to the mother’s health during pregnancy and ensuring she delivers in a hospital attended by trained doctors or midwives
  3. India has programmes such as the Janani Suraksha Yojana for this, but must expand its reach in laggard States like Uttar Pradesh and Madhya Pradesh

The way forward

  1. States like Kerala and Tamil Nadu show that by focussing on these factors, newborn deaths can be brought to fewer than 15 per 1000 in Indian settings
  2. It’s time for the rest of India to follow suit
Feb, 22, 2018

Complaints over medical bills: Centre seeks states’ response

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Clinical Establishments (Registration and Regulation) Act, 2010, Article 252

Mains level: Financial exploitation of patients by private hospitals and laws to curb it


News

Complaints of inflated medical bills rising

  1. Complaints are mounting against private hospitals over inflated medical bills
  2. Seeing this, the ministry of health and family welfare has sought a response from all states on implementation of the Clinical Establishments (Registration and Regulation) Act, 2010
  3. The act aims to monitor, assess and regulate laboratories, hospitals, and health centers
  4. Most of the states are yet to prescribe rates of procedures and services under the Act

Ministry’s directive

  1. The states have been asked to take immediate action for determining the standard procedure cost for some common procedures in consultation with both Government and Private sector medical experts
  2. Only one rate has to be informed to the patients and the same should be charged till discharge of the patient

Act not adopted by all states yet

  1. The Clinical Establishments (Registration and Regulation) Act, 2010 has been in effect in the four states—Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim—and all Union Territories except Delhi since 1 March 2012
  2. Uttar Pradesh, Uttarakhand, Rajasthan, Bihar, Jharkhand, and Assam have also adopted the Act under clause (1) of article 252 of the Constitution

Back2Basics

Clinical Establishments (Registration and Regulation) Act, 2010

  1. It has been enacted by the Central Government to provide for registration and regulation of all clinical establishments in the country with a view to prescribing the minimum standards of facilities and services provided by them
  2. The Act is applicable to all types (both therapeutic and diagnostic types) of Clinical Establishments from the public and private sectors, belonging to all recognized systems of medicine, including single doctor clinics
  3. The only exception is Clinical Establishments run by the Armed forces

Article 252 Constitution of India

  1. Power of Parliament to legislate for two or more States by consent and adoption of such legislation by any other State
  2. If it appears to the Legislatures of two or more States to be desirable that any of the matters with respect to which Parliament has no power to make laws for the States except as provided in Articles 249 and 250 should be regulated in such States by Parliament by law
  3. and if resolutions to that effect are passed by all the House of the Legislatures of those States, it shall be lawful for Parliament to pass an Act for regulating that matter accordingly
  4. any Act so passed shall apply to such States and to any other State by which it is adopted afterwards by resolution passed in that behalf by the House
  5. Any Act so passed by Parliament may be amended or repealed by an Act of Parliament passed or adopted in like manner and not by Legislature of that State
Feb, 20, 2018

Despite having maximum newborn deaths, India reduces under-five mortality rate by 66%

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: MDG, SDG, UNICEF, National Health Policy

Mains level: Status of child care in India


News

Reduction in under-five deaths

  1. India has notched up a 66 percent reduction in under-five deaths between 1990 to 2015
  2. Still, India has the largest number of babies dying in the world
  3. India is the only major country in the world to have a higher mortality for girls as compared to boys

Meeting MDG target

  1. India has almost met its Millennium Development Goal (MDG) target, though it is way past the MDG era
  2. With the current rate of decline, India is back on track to meet the Sustainable Development Goals (SDG) target for the under-five mortality of 25 per 1,000 live births by 2030
  3. This was highlighted in a UNICEF report named “Every Child Alive”
  4. Reducing child mortality s not only a part of the Sustainable Development Goals but also a part of the National Health Policy

Back2Basics

Neonatal and Infant Mortality Rate

  • Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births
  • Neonatal mortality rate: Probability of dying during the first 28 days of life, expressed per 1,000 live births
Feb, 15, 2018

National Health Protection Scheme will not help its intended beneficiaries

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the scheme

Mains level: Complement this newscard with our previous newscards on the same scheme.


News

Context

  1. The National Council of Applied Economic Research labels the ‘proposed beneficiaries of the NHPS’  as “Deprived Households”
  2. The annual income of these households lurks below Rs1.5 lakh
  3. Some 135 million households fall in the deprived category, constituting 56% of the total households in India
  4. And yet, there has appeared not a single report highlighting their opinion

Medical expenses: Deprived households

  1. On an average, the medical expenses of such deprived households with low income capacity hover between 5-6% of total expenses
  2. The pursuit of health may trap them in medium- or long-term therapy regimens, pulling this single-digit proportion into a catastrophic range of 10% or above
  3. Hence, the majority of them do not report sickness, until rendered inactive to work and earn, either by injury or the flare-up of a chronic condition

Hospitalization is not enough

  1. The top ailments adding the maximum burden of disease on deprived classes include ischaemic heart diseases, lower respiratory tract infections such as bronchitis and asthma, chronic obstructive pulmonary disorder, tuberculosis and diarrhoeal diseases
  2. Most of these are chronic conditions that require regular outpatient consultations to manage disease prognosis.
  3. Hospitalization is a one-off event
  4. Eighty per cent of the time, the out-of-pocket expenditure of patients within this strata is, therefore, on outpatient clinics that don’t come under the ambit of NHPS
  5. Therefore, for deprived households, the NHPS holds limited value
  6. It cannot deliver on the grand claim of complete health for them

What should be done?

  1. The NHPS will not reduce the ever-increasing monthly medical bills that go towards managing the chronic diseases they are most susceptible to
  2. It will not bring an iota of change in their health-seeking behaviour
  3. That can happen only if the expenditure on health, which has hovered around 1% of gross domestic product (GDP), doubles in the near future to improve access and quality of healthcare to the last mile

Will there be any benefit of the scheme?

  1. No doubt, insurance of Rs5 lakh per annum would be a comforting thought if one needs hospitalization and surgical intervention
  2. Such events may be few and far between
Feb, 12, 2018

[op-ed snap] Hardly a gamechanger

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the scheme(read our previous newscards on the NHPS)

Mains level: The NHPS is a very ambitious scheme, recently announced in the Budget. The newscard cites some issues related to the scheme. Complement this newscard with our previous newscards on the NHPS.


News

National Health Protection Scheme(NHPS)

  1. The National Health Protection Scheme announced in this year’s Budget has generated a lot of debate
  2. As only Rs. 2,000 crore in 2018-19 has been allotted to finance this scheme, various government functionaries have come up with estimates between Rs. 10,000 to Rs. 12,000 crore as its actual cost

Debate on crucial issues
FIRST: Financial issues

  1. The government’s target group seems to be the bottom 40% (50 crore) of the population
  2. A good starting point would be to look at the insurance coverage that this section already has
  3. The NSS  data shows that only 11.3% of the bottom 40%  population has any insurance coverage as against 17.9% for the top 60%
  4. In other words, just to bring the entire 40% of the population under health insurance is a huge task, with fiscal implications
  5. The NSS data shows, the total cost of medical expenditure (including reimbursements) for hospitalisations incurred by the bottom 40% was Rs. 14,286.82 crore in 2014
  6. Therefore, with Rs. 5 lakh coverage, the premium which needs to be paid would be much higher than the government’s estimate
  7. There has not been much allocation for it in the Budget

SECOND: Low reimbursement in government schemes

  1. Reimbursement as a percentage of medical cost of hospitalisation in government schemes is very low, especially for the bottom 40% of the population
  2. Only 4.5% of total hospitalisation expenses are reimbursed to the bottom 40% and 11.9% for the entire population
  3. This raises questions about the efficacy of government schemes
  4. Even with the meagre coverage of Rs. 30,000 (RSBY), the proportion of hospitalisation cost reimbursed is low
  5. There is no guarantee that increasing coverage will improve this

THIRD: Unwillingness to pay reimbursement

  1. The proportion of hospitalisation cost reimbursed is much higher for insurance schemes directly bought by households than government ones
  2. In the case of insurance being paid by the government, insurance companies are most often unwilling to pay the reimbursement as compared to when a household pays
  3. Why: This could be a result of low premiums paid by the government

Other important issues

  1. A significant proportion (more than 50%) of the population opt for private facilities
  2. Thus, health insurance creates a larger market for private players
  3. A sudden expansion of the government-funded insurance market may aggravate the problem of hospital-induced demand for medical care such as an unnecessary hospital stay, diagnostic tests and surgeries

The way forward

  1. If the government is serious about providing health care to even the bottom 40% of the population, it should increase its current budgetary allocation
  2. Also, government should strengthen the health infrastructure at all levels which includes a strong regulatory mechanism
Feb, 12, 2018

[op-ed snap] States of health: On NITI Aayog’s first Health Index

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NITI Aayog Health Index, Sustainable Development Goals, National Health Protection Scheme

Mains level: State of health sector in India


Context

NITI Aayog Health Index

  1. States with a record of investment in literacy, nutrition and primary health care have achieved high scores in NITI Aayog’s first Health Index
  2. The Index, with all its limitations given uneven data availability, hopes to make a difference by encouraging a competitive approach for potentially better outcomes

Responsibilities of different tiers of government

  1. Health-care delivery is the responsibility of States; the Centre provides financial and policy support
  2. Being able to meet the Sustainable Development Goals over the coming decade depends crucially on the States’ performance
  3. Both the Centre and the States have the responsibility to scale up their investment on health as a percentage of their budgets

Lack of sufficient data

  1. The Index uses metrics such as institutional deliveries, systematic reporting of tuberculosis, access to drugs for people with HIV/AIDS, immunization levels, and out-of-pocket expenditure
  2. Data on other key aspects such as non-communicable diseases, mental health, governance systems and financial risk protection lack the integrity to form part of a good composite index

Way forward

  1. National Health Protection Scheme announced in the Union Budget may be able to address some of the financial risk associated with ill-health
  2. But, it will take systematic improvements to preventive and primary care to achieve higher scores in the Index
  3. As the experience from countries in the West and now even other developing economies shows, socialization of medicine with a reliance on taxation to fund basic programmes is the bedrock of a good health system
Feb, 10, 2018

NITI Aayog launches ‘Healthy States Progressive India Report’; Kerala, Punjab, Tamil Nadu best performers

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Healthy States Progressive Report, Neonatal Mortality Rate, Under-five Mortality Rate

Mains level: Issues related to health sector


News

Healthy States Progressive Report

  1. The NITI Aayog has launched the Healthy States Progressive Report in an effort to better assess health outcomes across India
  2. The report is the first step to establish an annual systematic tool to measure and understand the complexity of nation’s performance in health

About the report

  1. Health Index has been evolved through comprehensive study and inputs from World Bank India and the Ministry of Health
  2. The report ranked states and Union territories on their year-on-year incremental change in health outcomes, as well as overall performance with respect to each other
  3. The Health Index is a weighted composite index, which for the larger states is based on indicators in three domains — health outcomes (70%), governance and information (12%) and key inputs and processes (18%)
  4. Each domain is assigned a weight based on its importance
  5. Performance on indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART) were taken into account

Common challenges across states

  1. Vacancies in medical institutions
  2. Establishment of functional district Cardiac Care Units
  3. Quality accreditation of public health facilities and
  4. Institutionalization of Human Resources Management Information System
Feb, 07, 2018

[op-ed snap] Is Ayushman Bharat a game changer?

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the scheme

Mains level: We have recently published some newscard on the same scheme. This is a comprehensive newscard on the health scheme. Complement it with our previously published newscards.


News

Health Sector: Challenges infront of India

  1. The country is having to confront the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer
  2. Infectious diseases such as tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance remain a continued threat to health and economic security
  3. The health infrastructure is already under severe strain
  4. Out of pocket expenditure force families to sell their assets for getting required health services

National Health Protection Scheme (NHPS)

  1. The scheme was announced in the recent budget
  2. The scheme will provide Rs 5 lakh insurance cover per family per year
  3. The scheme is for secondary and tertiary healthcare, mainly for hospital care
  4. This flagship scheme is likely to benefit more than 37% of the population

Financial support

  1. The government will require Rs 12000 crore for it’s implementation, with cost shared on a 60:40 basis between central and state governments

Health and Wellness centres

  1. The finance ministry has also announced setting up or converting some 150,000 subcentres in the country into so-called “health & wellness” centres
  2. These centres will offer a set of services including maternal and child health services, mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers

The Ayushman Bharat programme: Two main aims

  1. To strengthen primary health care which has been lacking in the country and
  2. To offer finacial protection from catastrophic expenditure

How can the programme be a game changer?

  1. The scheme, if implemented properly could be a game changer by enhancing access to health care including early detection and treatment services by a large section of society who otherwise could not afford them
  2. Ultimately, NHPS could help country move towards universal health coverage and equitable access to healthcare which is one of the UN Sustainable Development Goals or SDGs

Not all issues will be solved with this scheme

  1. The NHPS scheme, which primarily offers support for clinical services such as hospitalization, is unlikely to help fix the broken public health system in the country
  2. Most primary health care centres suffer from perennial shortage of doctors and even district hospitals are without specialists
  3. Without addressing the human resouce situation, public sector health care will remain of poor quality and largely unacceptable, forcing patients to go to the private sector
  4. Therefore, it seems as if NHPS is likely to benefit private parties more than government health services

Suggestions for effective implementation

  1. For the success of the programme, effective implementation is the key
  2. For this an independent body or unit may be set up within the ministry of health & family welfare to plan
  3. This unit can help to plan, coordinate, and provide technical backstopping to states, including in capacity building and development of standards and guidelines for the programme
Feb, 06, 2018

Global cancer survival rates improve, but wide gaps remain

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: Findings of the study


News

Findings of the study

  1. Cancer patients’ survival prospects are improving, even for some of the deadliest types such as lung cancer
  2. But there are huge disparities between countries, particularly for children
  3. While brain tumour survival in children has improved in many countries, five-year survival is twice as high in Denmark and Sweden, at around 80%, as it is in Mexico and Brazil, at less than 40%
  4. For most cancers over the past 15 years, survival is highest in just a few wealthy countries – the United States, Canada, Australia, New Zealand, Finland, Norway, Iceland and Sweden
    Possible reason behind this disparity
  5. This gap was most likely due to variations in the availability and quality of cancer diagnosis and treatment services

Particular case of the Breast Cancer

  1. For women diagnosed with breast cancer in Australia and the United States between 2010 and 2014 for example, five-year survival is 90%
  2. That compares to 66% for women diagnosed in India. Within Europe, five-year breast cancer survival increased to at least 85% in 16 countries including Britain, compared with 71% in Eastern Europe

Particulars of the research

  1. Research: the CONCORD-3 study
  2. It is published in The Lancet medical journal
  3. In the research, the scientists analysed patient records from 322 cancer registries in 71 countries and territories, comparing five-year survival rates for 18 common cancers for more than 37.5 million adults and children
Feb, 06, 2018

[op-ed snap] Making health insurance work

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS

Mains level: The government has announced an ambitious Healthcare programme in the budget 2018. The article comprehensively discusses concerns related to it.


News

 Health programme: Budget 2018

  1. It is unusual for a health programme to become the most prominent feature of a Union Budget
  2. The recommendations of the High-Level Expert Group on Universal Health Coverage (2011) resonate in the Budget of 2018
  3. The budget commits
    (1) universal health coverage,
    (2) strengthening of primary health care (especially at the sub-centre level),
    (3) linking new medical colleges to upgraded district hospitals,
    (4) provision of free drugs and diagnostics at public health facilities, and
    (5) stepping up financial protection for health care through a government-funded programme that merges Central and State health insurance schemes

The National Health Protection Scheme

  1. The scheme will provide cost coverage, up to Rs. 5 lakh annually, to a poor family for hospitalisation in an empanelled public or private hospital
  2. The precursor of the National Health Protection Scheme (NHPS), the Rashtriya Swasthya Bima Yojana (RSBY), provided limited coverage of only ₹30,000, usually for secondary care
  3. Though it improved access to health care, it did not reduce out-of-pocket expenditure (OOPE), catastrophic health expenditure or health payment-induced poverty
  4. The NHPS addresses those concerns by sharply raising the coverage cap
  5. But the NHPS too remains disconnected from primary care.

How will the scheme work?

  1. The NHPS will pay for the hospitalisation costs of its beneficiaries through ‘strategic purchasing’ from public and private hospitals
  2. In the NHPS the government will pay most of the money on behalf of the poor, unlike private insurance where an individual or an employer pays the premium
  3. Caution: Both Central and State health agencies or their intermediaries will have to develop the capacity for competent purchasing of services from a diverse group of providers
  4. Otherwise, hospitals may undertake unnecessary tests and treatments to tap the generous coverage

What is the main concern?

  1. Reduced allocation for the National Health Mission and sidelining of its urban component raise concerns about primary care
  2. If primary health services are not strong enough, there is great danger of an overloaded NHPS disproportionately draining resources from the health budget
  3. That will lead to further neglect of primary care and public hospitals, which even now are not adequately equipped to compete with corporate hospitals in the strategic purchasing arena
  4. That will lead to decay of the public sector as a care provider
  5. This must be prevented by proactively strengthening primary health services and public hospitals

Financial issues regarding the scheme

  1. The NHPS will need more than the Rs. 2,000 crore presently allocated
  2. As the scheme starts in October 2018, the funding will cover the few months before the next Budget
  3. It is expected to require Rs. 5,000-6,000 crore to get it going in the first year and Rs. 10,000-12,000 crore annually as it scales up

Responsibility of the State Government

  1. State governments have the main responsibility of health service delivery and also need to bear the major share of the public expenditure on health
  2. The National Health Policy (NHP) asks the States to raise their allocation for health to over 8% of the total State budget by 2020, requiring many States to double their health spending
    Some issues
  3. The NHPS needs a buy-in from the States, which have to contribute 40% of the funding
  4. Even with the low cost coverage of the RSBY, several States opted out. Some decided to fund their own State-specific health insurance programmes, with distinctive political branding
  5. Will they agree to merge their programmes with the NHPS, with co-branding?
  6. The NHPS requires a high level of cooperative federalism
Feb, 05, 2018

‘Mega health plan may cost Rs. 1 lakh cr. a year’

Note4students

Mains Paper 3: Economy | Government Budgeting

From UPSC perspective, the following things are important:

Prelims level: National Institute of Public Finance and Policy

Mains level: The government has recently announced an ambitious healthcare plan in the Budget 2018. The research paper discusses some financial issues related to the same announcement.


News

Possible cost of implementing healthcare plan of the Budget 2018 

  1. According to a research paper, the healthcare plan for the poor announced in the Budget will cost about Rs. one lakh crore annually
  2. And it will also curtail States’ autonomy in designing their own policies in the sector
  3. The research paper is published by the National Institute of Public Finance and Policy

Other particulars of the research

  1. Assuming that 60% of this burden would be borne by the Union Government and the rest passed on to the States, the Union Government would still need to fork out an additional Rs. 60,000 annually

Back2baiscs

 National Institute of Public Finance and Policy

  1. The National Institute of Public Finance and Policy (NIPFP) is an autonomous research institute under India’s Ministry of Finance
  2. Based in New Delhi, India, the centre conducts research on public finance and contributes to the process of policy-making relating to public finance
  3. The NIPFP also works jointly with the Department of Economic Affairs at the Ministry of Finance to research the effects of past economic policy
  4. NIPFP is overseen by a governing board comprising a chairman and representatives from the Ministry of Finance, Planning Commission of India and Reserve Bank of Indi
  5. Vijay Kelkar is the present chairman and Rathin Roy is the present director of the Institute
  6. The previous director was M. Govinda Rao
Feb, 05, 2018

Modicare will find it tough to get out of the blocks

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme, RSBY

Mains level: Lacunae in public health infrastructure in India


Context

World’s largest public healthcare scheme

  1. It was announced in Budget 2018
  2. National Health Protection Scheme aims to provide medical insurance cover of 5 lakhs Rs. per annum to each family covered under the scheme

India’s perennial healthcare failure

  1. According to World Bank data, 62.4% of total health expenditure in the country was out of pocket (OOP) as of 2014
  2. This was very high compared to a global average of a little over 18%
  3. This adds around seven percentage points to India’s poverty figures

International experiments similar to Modicare

  1. European states have implemented government or government mandated insurance first in the 1920s
  2. A number of southern European countries followed suit in the 1960s
  3. They achieved coverage and outcomes that are among the best in the world
  4. Germany’s system relies on high formal sector employment to partly fund government insurance managed by independent trusts
  5. In Switzerland, the most free-market model in the world is being used, with the government subsidizing private insurance on a sliding scale
  6. China has used publicly funded health insurance to achieve wide coverage

Results from these experiments

  1. In the absence of the European states’ governance capabilities outcomes have been poor and OOP expenditure has not decreased

RSBY in India

  1. Rashtriya Swasthya Bima Yojana was implemented in 2008
  2. It aimed to cover Below Poverty Line (BPL) households, funding private insurance for inpatient coverage of Rs30,000 for five members per household
  3. The scheme had failed in both its primary objectives
  4. It covered only 12.7% of households among the poorest quintile at the national level
  5. It failed to significantly impact OOP expenditure or reduce health-related poverty

Why this failure?

  1. At both the central and state levels, governments have lacked the capacity to regulate RSBY effectively
  2. Effective targeting has not been a priority
  3. Doctors and hospitals have fallen into the supplier-induced demand trap, recommending unnecessary procedures in order to claim reimbursements

Way forward

  1. Healthcare lies at a confluence of inelastic demand, political sensitivity, economic consequences and ethical governance
  2. This makes the state’s role crucial
  3. Government insurance works to improve healthcare access and outcomes if the state has the agility, expertise and regulatory capacity to implement it effectively which is currently lacking in India
Feb, 03, 2018

[op-ed snap] Get cracking: Ayushman Bharat programme

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Programme

Mains level: Ayushman Bharat Programme discussed in the newscard and its possible benefits.


News

What is the issue?

  1. The government has lost precious time in initiating a health scheme that serves the twin purposes of achieving universal coverage and saving people from high health care costs

Fresh hopes: Ayushman Bharat

  1. Fresh hopes have been raised with the announcement of Ayushman Bharat in Budget 2018
    The plan has the components of 
  2. Opening health centres for diagnostics, care and distribution of essential drugs as envisaged in the National Health Policy
  3. And a National Health Protection Scheme (NHPS) to provide a cover of up to Rs. 5 lakh each for 10 crore poor and vulnerable families for hospitalisation
  4. The government has provided Rs. 3,200 crore for the programme areas
  5. The task before the Centre is to now draw up an implementation roadmap

Lessons from other developing countries

  1. Developing countries that launched universal health coverage schemes over a decade ago, such as Mexico, had to address some key challenges
  2. These included transfer of resources to provinces, recruitment of health personnel, and purchase and distribution of medicines to the chosen units
  3. All these apply to India

Need of insurance in health care system

  1.  A national health system will also have to subsume all existing state-funded insurance schemes
  2. This will give beneficiaries access not just within a particular State but across the country to empanelled hospitals
  3. But the early experience with state-funded insurance for the poor shows that some private hospitals may resort to unnecessary tests and treatments to inflate claims
  4. Determination of treatment costs by the government is therefore important

Health Centres under the Ayushman Bharat programme

  1. Local health centres are planned under the Ayushman Bharat programme
  2. These centres has tremendous potential to play a preventive role by reducing the incidence and impact of non-communicable diseases such as diabetes and hypertension
  3. Such centres can dispense free essential medication prescribed by all registered doctors and procured through a centralised agency
Jan, 24, 2018

Clinical trials: stringent draft rules put onus of injuries, death on drugmakers

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Clionical trials, bioavailability, bioequivalence

Mains level: Risk associated with clinical trials of drugs and measures to avert it


News

Draft rules for clinical trials

  1. Pharmaceutical firms conducting clinical trials of drugs in India will no longer be able to escape responsibility in case of injury or death of participants
  2. If the sponsor fails to provide “medical management” to their trials, not only will the trial be canceled, but the company will also be restricted from holding any more trials

Ease of doing trials

  1. For drugs proposed to be manufactured and marketed in India, the permission for trials will be granted within 45 days
  2. The proposed regulatory framework also suggests doing away with clinical trials for drugs that have proved their efficacy in developed markets, in a move to speed up the availability of drugs in India

Other measures

  1. Companies will have to pay compensation if the drug fails to provide the intended therapeutic effect
  2. The sponsor of the trial for bioavailability or bioequivalence (BA/BE) study of a new drug will have to provide free medical management for as long as required
  3. BA/BE studies measure the rate and extent of absorption of drugs in the human body
Jan, 22, 2018

[op-ed snap Capacity building for primary health care

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the AYUSH.

Mains level: The newscard discusses the relevance of the AYUSH practitioners in solving issues, related to India’s primary health care system.


News

Contentious element of the National Medical Commission (NMC) Bill 2017 

  1. Section 49, Subsection 4 of the bill
  2. It proposes a joint sitting of the Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine
  3. The debates around this issue have been ranging from writing-off the ability of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners
  4. Currently, AYUSH practitioner can’t cross-practise allopathy due to restrictions

How can AYUSH help?

  1. India’s primary health system is struggling with a below-par national physician-patient ratio (0.76 per 1,000 population, amongst the lowest in the world) due to a paucity of MBBS-trained primary-care physicians
  2. And the unwillingness of existing MBBS-trained physicians to serve remote/rural populations
  3. Therefore, there is an urgent need for a trained cadre to provide accessible primary-care services
  4. AYUSH practitioners can help to improve this situation

Issue of AYUSH cross-prescription

  1. The issue has been a part of public health and policy discourse for over a decade, with the National Health Policy (NHP) 2017 calling for multi-dimensional mainstreaming of AYUSH physicians
  2. There were 7.7 lakh registered AYUSH practitioners in 2016, according to National Health Profile 2017 data
  3. Their current academic training also includes a conventional biomedical syllabus covering anatomy, physiology, pathology and biochemistry(important for primary health care system)
  4. Efforts to gather evidence on the capacity of licensed and bridge-trained AYUSH physicians to function as primary-care physicians have been under way

The 4th Common Review Mission Report 2010 of the National Health Mission 

  1. It reports the utilisation of AYUSH physicians as medical officers in primary health centres (PHCs) in Assam, Chhattisgarh, Maharashtra, Madhya Pradesh and Uttarakhand as a human resource rationalisation strategy
  2. In some cases, it was noted that while the supply of AYUSH physicians was high, a lack of appropriate training in allopathic drug dispensation was a deterrent to their utilisation in primary-care settings
    What should be done?
  3. The focus should be on deploying a capacity-building strategy using AYUSH physicians upskilled through a bridge-training programme
  4. This will help to deliver quality, standardised primary health care to rural populations
  5. Example: The Maharashtra government has led the way in implementing bridge training for capacity-building of licensed homoeopathy practitioners to cross-prescribe

Is capacity-building of licensed AYUSH practitioner enough?

  1. AYUSH is only one of the multi-pronged efforts required to meet the objective of achieving universal health coverage set out in NHP 2017
  2. Current capacity-building efforts also include other non-MBBS personnel such as nurses, auxiliary nurse midwives and rural medical assistants, etc.

Back2basics

AYUSH

  1. AYUSH is an acronym that is used to refer to the non-allopathic medical systems in India. It includes the Indian medical system of Ayurveda, Yoga, Unani, Siddha, and also Homeopathy.
  2. In the current terminology of the Ministry of Health in India, non-allopathic doctors are now referred to as AYUSH ( meaning “life” in Sanskrit) doctors
  3. Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was created in March,1995 and re-named as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003 with a view to providing focused attention to development of Education & Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy systems
  4. Department of AYUSH come under Ministry of Health and Family Welfare
  5. This is to imply that the AYUSH systems of medicine and its practices are well accepted by the community, particularly, in rural areas
  6. The medicines are easily available and prepared from locally available resources,economical and comparatively safe
  7. With this background, it will be more useful for the mainstreaming/integration of AYUSH systems in National Health Care Delivery System under “ National Rural Health Mission (NRHM)”
  8. Presently, approx. 23,630 dispensaries are functioning and about 6,91,470 registered practitioners are available under AYUSH in the country.

Objectives of the AYUSH

  1. To upgrade the educational standards in the Indian Systems of Medicines and Homoeopathy colleges in the country
  2. To strengthen existing research institutions and ensure a time-bound research programme on identified diseases for which these systems have an effective treatment.
  3. To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems.
  4. To evolve Pharmacopoeial standards for Indian Systems of Medicine and Homoeopathy drugs

 

Jan, 18, 2018

[op-ed snap] The price prescription

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: It is an interesting newscards, as it discusses the relationship between the GST and tobacco consumption in India.


News

Context

  1. India is the second largest consumer and producer of tobacco-based products — categorised as sin goods or demerit goods
  2. And it has become imperative for policymakers to devise measures(including taxation regime) to effectively curb their use

Health of a citizen has primacy: SC

  1. The SC has recently stayed a Karnataka High Court order
  2. The HC order had set aside the 2014 amendment rules to the Cigarettes and Other Tobacco Products Act, 2003
  3. This(stay) is in contrast to the High Court order that viewed the 2014 rules violating constitutional norms as being an “unreasonable restriction” on the right to do business and earn a livelihood
  4. The Supreme Court observed that the “health of a citizen has primacy”

WHO’s survey on tobacco consumption in India

  1. The WHO’s Global Adult Tobacco Survey (GATS 2016-17) highlights India’s distinct pattern of tobacco consumption in multiple forms such as cigarettes, bidis, chewing tobacco and khaini (smokeless tobacco)
  2. This is in contrast to the global trend of cigarettes being the primary source of consumption
  3. The average unit price of a bidi or smokeless tobacco is significantly lower than of a cigarette
  4. Therefore, the former is a cheaper source for consumers who are mostly from the low-income segment of society

Effects of the GST on tobacco consumption

  1. The nationwide implementation of the goods and services tax (GST) has not improved the situation either
  2. All tobacco-related products have been placed in the 28% tax slab
  3. There has only been a marginal rise in the price of bidi for other pack sizes after the roll-out of the GST
  4. In comparison, the price rise post-GST is much higher for cigarettes
  5. Therefore, one may be able to postulate that the GST roll-out has not had much of an impact either
    (1) on the pricing of various tobacco products or
    (2) in reduction of the vast disparity between its different variants
  6. The impact has been negligible in the case of bidis

What should be done?

  1. The revisions in the taxation policy concerning tobacco products should ideally have a mix:
    (1) of a removal of all excise and other tax exemptions irrespective of the size of the unit,
    (2) restrictions on sales of loose sticks and raising taxes/duties on bidis and smokeless tobacco by a significantly higher level
  2. Keeping in mind the increased probability of health-related issues among low-income poor households and the health-care burden
Jan, 18, 2018

NPPA fixes retail price of 30 drug formulations

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Pharmaceutical Pricing Authority (NPPA), Drugs (Prices Control) Order, 2013

Mains level: Regulation governing medical sector in India


News

Fixing retail price of essential drugs

  1. National Pharmaceutical Pricing Authority (NPPA) said it has fixed the retail price for 30 drug formulations
  2. It includes those used for treatment of diabetes, bacterial infections and high blood pressure
  3. NPPA has fixed/revised ceiling prices/retail prices of 33 formulations under Drugs (Prices Control) Order, 2013

Back2Basics

National Pharmaceutical Pricing Authority

  1. The National Pharmaceutical Pricing Authority (NPPA) is a government regulatory agency that controls the prices of pharmaceutical drugs in India
  2. It was formed on 29 August 1997
  3. The NPPA regularly publishes lists of medicines and their maximum ceiling prices
  4. The NPPA is mandated to fix/revise the prices of controlled bulk drugs and formulations and to enforce prices and availability of the medicines in the country
  5. It also monitors the prices of decontrolled drugs in order to keep them at reasonable levels
  6. The regulator implements and enforces the provisions of the Drugs (Prices Control) Order
  7. It is also entrusted with the task of recovering amounts overcharged by manufacturers for the controlled drugs from the consumers
Jan, 17, 2018

New regulatory system must to tackle shortage of doctors, says Ram Nath Kovind

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission

Mains level: The statements of the President and the Prime Minister on such issues are important for the exam. Because these statements shows the point of views of government on important issues. And give an insight of the government policies.


News

Statement by the President

  1. President of Indian has said that the restructuring the Medical Council of India (MCI) is one of the reforms needed to address the acute shortage of doctors in India
    The Statement
  2. “We need a new regulatory system to enhance availability of doctors and medical professionals in our society
  3. We have to overcome regulatory bottlenecks and interest groups that have prevented the growth of quality medical education in our country
  4. This gives us far fewer medical graduates and postgraduates every year than our people need”

Why is this statement important?

  1. According to the ministry of health and family welfare, a total 1.02 million allopathic doctors were registered with the MCI or with state medical councils as of 31 March 2017
  2. Going by these figures, India barely has seven allopathic doctors per 10,000 population

The statement come amid the Indian Medical Association’s protest against the National Medical Comtmission(NMC)

  1. The IMA  is protesting against a proposed bill that seeks to replace the MCI with a NMC
  2. The apex medical body earlier this month called a one-day strike in hospitals across the country, shutting down outpatient services claiming the bill sas “anti-poor, anti-people, non-representative, undemocratic and anti-federal”
  3. However, Government called it “beneficial” to the medical profession while addressing the Parliament in earlier this month
  4. The bill was later referred to a parliamentary standing committee following nationwide protests
Jan, 11, 2018

[op-ed snap] Prescription for the future

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Attached stories and particulars of the NMC bill

Mains level: Complement this newscard with two of our recent newscards on the same bill, Medical panel Bill finalised, sent to Cabinet and [op-ed snap] Heed the patient


News

What is the issue?

  1. The National Medical Commission Bill, aimed at reforming Indian medical education and practice, is in trouble
  2. After protests, the Bill was referred by the Lok Sabha to a Parliamentary Standing Committee for a re-look
  3. Whatever be the outcome of this exercise, the altered Bill is unlikely to please everyone

Reasons behind these protests(against the bill)

  1. Because the questions it seeks to address are knotty, with no straightforward answers
  2. First, how can India produce enough competent doctors to meet its evolving health-care challenges?
  3. Second, how can it minimise opportunities for rent-seeking(the fact or practice of manipulating public policy or economic conditions as a strategy for increasing profits) in medical education and practice?

Issues with the Medical Council of India(MCI)

  1. The MCI’s failures are well known
  2. For years, it was mired in allegations of bribery and going soft on unethical doctors

National Medical Commission (NMC): A step in right direction

  1. The National Medical Commission (NMC), intended by policymakers to be a dynamic regulator responsive to India’s needs, unlike the opaque MCI
  2. In contrast with the MCI, which does everything from advising universities on curriculum to disciplining errant doctors
    the NMC distributes powers among four autonomous boards
    (1) those for undergraduate education,
    (2) postgraduate education,
    (3) medical assessment and rating, and
    (4) ethics and registration
  3. Also, unlike the MCI, the commission includes non-doctors like patient-rights advocates and ethicists, in line with the medical regulators of the U.K., Australia and Canada
  4. These are all steps in the right direction

Flawed electoral process of the MCI: Solution through NMC bill

  1. The committee headed by ex-vice chairman of Niti Aayog, argued that the electoral process through which MCI members were picked was fundamentally flawed, because conscientious doctors tended to avoid such elections
  2. Because there was no bar on re-elections, this had created a revolving door through which the same group of members controlled the MCI for years
  3. The NMC Bill’s solution to the flawed electoral process is that, under it, the central government will select most of the commission’s members
  4. But according to some experts, it will increase interference of the bureaucracy

The NMC Bill misses an opportunity to plan for India’s rural health- care

  1. The NMC eases regulations to set up private medical colleges, a move that will hopefully produce more doctors, this measure isn’t enough
  2. As of today, India has one doctor for 1,700 people, compared to the WHO norm of 1:1,000
  3. Most of these doctors are in urban regions, while close to 70% of Indians live in rural provinces. This gap isn’t going to close any time soon
  4. A 2015 Parliamentary Standing Committee report mentioned that even if India were to add 100 medical colleges per year for five years, it would take till 2029 to achieve the WHO prescribed ratio

Solution through non-doctors

  1. Several sub-Saharan countries have successfully addressed the problem by training non-doctors in basic medicine and even surgery
  2. Such non-doctors include nurses, or even informal health-care providers, often referred to as quacks
  3. Evidence from countries like Mozambique and Thailand shows that such training can be a safe, effective and cheap way to provide life-saving health care when no doctors are available
  4. This is why even Chhattisgarh attempted to create a cadre of rural doctors in 2001, through a three-year programme
  5. Even though the Indian Medical Association has strongly opposed such ideas, they cannot be off the table, given the evidence backing them
Jan, 05, 2018

[op-ed snap] Heed the patient

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission Bill 2017, Indian Medical Association (IMA), Medical Council of India, National Health Policy 2016

Mains level: Reforms required in health sector


Context

National Medical Commission Bill 2017

  1. It has brought to the fore a disturbing aspect of an ongoing controversy — the activities of medical lobbies that have persistently thwarted efforts to put consumer interest above their own

Most medical practitioners do not possess educational qualification

  1. There are some 10.4 lakh private medical establishments with hospitals accounting for under 8 percent of them
  2. Most are lone practitioners running small nursing homes and clinics
  3. Most do not possess a medical qualification
  4. 2016 WHO study has brought out that only 58 percent of urban doctors had a medical degree and only 19 percent in rural areas
  5. Only 31.4 percent of allopathic doctors were educated to the secondary school level and 57.3 percent did not have any medical qualification
  6. NSSO reports show there are more unqualified practitioners than regular doctors

Role of IMA in quackery

  1. The interests of all allopathic doctors, regardless of their competence, are looked after by the Indian Medical Association (IMA)
  2. It is a voluntary registered society with state chapters which register doctors as members and lobby with the government, resorting to agitations and strikes whenever doctors’ interests are affected
  3. Many of the IMA’s members are single practitioners and they run their clinics with the assistance of young school dropouts engaged as helpers
  4. They train them to handle acute illnesses and treat acute medical conditions with antibiotics, IV fluids and steroid injections
  5. Once sufficiently skilled, these assistants set up independent practice using the prefix “doctor”
  6. They run a lucrative business charging a fraction of a qualified doctor’s fees
  7. The IMA and the Medical Council of India, both at the apex level and in their state units, are aware of what is happening

National Medical Commission Bill 2017 overlooks this problem

  1. The National Medical Commission Bill 2017 and the National Health Policy 2016 overlook this countrywide phenomenon altogether
  2. Under law, the Medical Council of India and the state medical councils are enjoined to take action against those who practise allopathic medicine without being enrolled on the allopathic medical register
  3. As consumer safety is at stake, this is a serious omission from a bill which seeks to replace the medical council

What is needed now?

  1. The new Bill must take stock of and address what the country actually needs
  2. Community-level accredited practitioners — not full-fledged doctors — after training should be equipped to provide the first line of care for acute conditions and to make referrals to a regular doctor within a GPS-supervised system
  3. A new system of community-based trained health workers (not government employees) who are enrolled in the state medical register is needed to take health benefits to village level
  4. The new Bill should promote integrative medicine enabling people to access multiple choices but available under one roof, particularly for chronic conditions or even as adjuvant therapy

Way forward

  1. The government has done well to bring forward new legislation to replace the medical council
  2. But unless the Bill confronts reality and addresses it, keeping consumer interest paramount, the new law will make little difference to people’s lives
Dec, 30, 2017

[op-ed snap] India and the future of life sciences innovation

Note4students

Mains Paper 3: Science & Technology | Science and Technology- developments and their applications and effects in everyday life Achievements of Indians in science & technology; indigenization of technology and developing new technology

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: The newscard talks about a very important aspect of Indian Pharmaceutical Sector i.e. Medical Innovation


News

Status of Indian Pharmaceutical Sector

  1. The Indian pharmaceutical industry is a world leader in bringing generic drugs to the market in a cost-effective way
  2. Additionally, many Western pharmaceutical companies have established small-molecule development and manufacturing in India
  3. More recently, Indian pharma companies have demonstrated the capability to develop biosimilars for global healthcare markets
  4. These activities are highly valuable, providing essential and established medicines at more affordable prices to people around the world

The Future of India in Pharmaceutical Sector

  1. The future of India will go beyond generics and biosimilars
  2. There are many attractive features that the existing Indian ecosystem can offer the life sciences industry
  3. And India will eventually play a critical role in the advancement of innovative medicines

How is India a fertile ground for Medical Innovations?

  1. Sixty years ago, the total number of physicians in India was less than 50,000; today there has been a 16-fold increase to nearly 800,000 registered medical practitioners
  2. Public health centres, the foundation of rural healthcare in the country, have increased from less than 100 to more than 23,000
  3. This explosive growth is fertile ground for thought leaders, investors, regulators and medical centres to collaborate on developing
    (1) the capabilities to nurture the type of start-up environment that will focus on innovation and
    (2) better ways of healthcare delivery,
    with an eye on long-run rather than short-term profitability

What should be done to capitalize on these opportunities?

  1. There are a number of steps that India can take
  2. For example, incentives for start-up biotech firms, and commitment to rigorous global compliance standards that help increase trust in the Indian life sciences industry
  3. These trends are under way globally, but, in some respects, have yet to be initiated by experts with roots in India

The way forward

  1. The medical innovations don’t happen in isolation
  2. They emerge from collaborative networks
  3. Today, innovation occurs in a global village, not in a single country
  4. With so much to offer the life sciences, India is poised to become a dominant player
  5. The potential for this groundswell to materialize is happening today. It’s exciting to be a part of it
Dec, 28, 2017

[pib] Maternity Benefits Under Pradhan Mantri Matru Vandana Yojana

Note4Students

From UPSC perspective, the following things are important:

Prelims level: Pradhan Mantri Matru Vandana Yojana (PMMVY)

Mains level: Measures for improving health indicators related to women and child


News

  • The maternity benefits under Pradhan Mantri Matru Vandana Yojana (PMMVY) are available to all Pregnant Women & Lactating Mothers (PW&LM) except those in regular employment with the Central Government or State Government or Public Sector Undertaking
  • Or those who are in receipt of similar benefits under any law for the time being in force, for the first living child of the family
  • This is because normally the first pregnancy of a woman exposes her to new kind of challenges and stress factors

The objectives of the scheme are

  • Providing partial compensation for the wage loss in terms of cash incentives so that the woman can take adequate rest before and after delivery of the first living child; and
  • The cash incentives provided would lead to improved health seeking behaviour amongst the Pregnant Women and Lactating Mothers (PW&LM)

Also

  • To address the problem of malnutrition and morbidity among children, the Anganwadi Services Scheme, which is universal, is available to all PW&LM including the second pregnancy
  • Further, in order to address the malnutrition and morbidity during pregnancies a number of interventions are provided to the pregnant women viz. universal screening of pregnant women for Anaemia and Iron and Folic Acid (IFA) supplementation, Calcium supplementation in pregnancy, Deworming in pregnancy, Weight gain monitoring and Counselling on nutrition, family planning and prevention of diseases
Dec, 27, 2017

[op-ed snap] Mental Healthcare Act: A paradigm shift

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the act

Mains level: Particulars, uniqueness and importance of the act. The act is first-of-its kind in India.


News

Why is the Mental Healthcare Act, 2017 important and unique?

  1. For the first time in our country, the Act creates a justiciable right to mental healthcare
  2. This is fascinating because physical healthcare is not yet a statutory right
  3. The law also requires the government to make provisions for persons with mental illness to live in the community and not be segregated in large institutions
  4. It has also effectively decriminalized suicide attempts by ‘reading down’ the power of section 309 of the Indian Penal Code

Provisions for ‘advance directives’ in the act

  1. There are times when persons with mental illness are unable to express or communicate their preference for treatment to their treating psychiatrists
  2. Therefore, the new Act makes provision for writing an advance directive which people can make when they are well
  3. Through such advance directives, people nominate a person who could take decisions on their behalf in such situations
  4. This kind of provision has been made for the first time in healthcare legislation in India

Rights conferred under the act

  1. The Act provides persons with mental illness protection from cruel, inhuman and degrading treatment
  2. It also provides right to information about their illness and treatment, right to confidentiality of their medical condition and right to access their medical records, to list just a few rights

Responsibilities for the government

  1. Under the act, the government is explicitly made responsible for setting up programmes for the promotion of mental health, prevention of mental illness and suicide prevention programmes
  2. Given the huge shortage of trained mental health professionals in the country, the Act requires the government to meet internationally accepted norms for the number of mental health professionals
    (within 10 years of passing this law)

Issues that should be taken care of

  1. Passing the Mental Healthcare Act, 2017, is the start of a long, arduous implementation process
  2. There are many examples of progressive policies and legislation in India which do not get effectively implemented
  3. We should ensure that this Act does not suffer the same fate
  4. Once again, we need cross-party support for effective implementation so that persons with mental illness and their families benefit fully
Dec, 26, 2017

Govt to assess impact of Hepatitis B immunization drive

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: UIP(Read B2B)

Mains level: Hepatitis B is a serious issue(to be tackled) in India’s Health missions


News

Assessing the impact

  1. The Union health ministry has planned to assess the impact of the Hepatitis B immunization drive on the population
  2. The Hepatitis B vaccine was introduced, 10 years ago, in the Universal Immunisation Programme (UIP)
  3. Under the health ministry’s plan, the Indian Council of Medical Research (ICMR) aims to identify the barriers leading to low Hepatitis B coverage under UIP
  4. And study the impact of the immunization done over the years

Seriousness of the Hepatitis B problem

  1. Viral hepatitis, despite government efforts, continues to be a serious public health problem in India.
  2. More than 52 million people in the country are currently infected with chronic hepatitis, according to the World Health Organization (WHO)
  3. There is however, a paucity of nationally representative data to establish accurate disease burden

National Action Plan for Viral Hepatitis (NAPVH)

  1. The health ministry is developing a comprehensive integrated three-year NAPVH
  2. With the key objective of providing an actionable framework of evidence based, priority interventions to support the national response for prevention, control and management of viral hepatitis in the country
  3. Under the plan, studies will be conducted to understand the efficacy of alternative medicine in preventing and treating viral hepatitis, comparison of indigenous and Chinese hepatitis vaccines in clinical trials
  4. And understand the modes of transmission of viral hepatitis B

Back2basics

Universal Immunization Programme(UIP)

  1. Universal Immunization Programme is a vaccination program launched by the Government of India in 1985
  2. It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005
  3. The program now consists of vaccination for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, Hepatitis B, Diarrhoea, Japanese Encephalitis, rubella, Pneumonia( Heamophilus Influenza Type B)and Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis). Hepatitis B and Pneumococcal diseases[1] was added to the UIP in 2007 and 2017 respectively
  4. The other additions in UIP through the way are inactivated polio vaccine (IPV), rotavirus vaccine (RVV) ,Measles-Rubella vaccine (MR)
  5. Four new vaccines have been introduced into the country’s Universal Immunisation Programme (UIP), including injectable polio vaccine, an adult vaccine against Japanese Encephalitis and Pneumococcal Conjugate Vaccine
Dec, 25, 2017

[pib] Charges on Health Services

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Clinical Establishments (Registration and Regulation) Act, Article 252 of the Constitution, National Council for Clinical Establishments

Mains level: Regulation of health sector and associated issues


News:

  1. Health is a State subject and it is the responsibility of the State Governments to regulate hospitals including private hospitals in their States as per provisions of the Act and rules applicable in the States to provide affordable treatment to patients
  2. The Government of India has enacted Clinical Establishments (Registration and Regulation) Act, 2010 and notified Clinical Establishments (Central Government) Rules, 2012 for registration and regulation of the Clinical Establishments
  3. Currently, the Act is applicable in 10 States namely Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Uttar Pradesh, Bihar, Jharkhand, Rajasthan Uttarakhand and Assam and all Union Territories except Delhi.
  4. Other States may adopt the Act under clause (1) of Article 252 of the Constitution

Provisions

  • In accordance with the Clinical Establishments (Central Government) Rules, 2012 under the said Act, one of the conditions for registration and continuation of clinical establishments is that the clinical establishments (in the States / Union Territories where the said Act is applicable) shall charge the rates for each type of procedure and services within the range of rates determined by the Central Government from time to time in consultation with the State Governments
  • The clinical establishments are also required to display the rates charged for each type of services provided and facilities available, at a conspicuous place both in the local language and English
  • The National Council for Clinical Establishments has approved a standard list of medical procedures and a standard template for costing of medical procedures and shared the same with the States and Union Territories
  • Further action lies within the purview of the State/UT Governments

Nodal Ministry: The Minister of State (Health and Family Welfare)

Dec, 23, 2017

India recorded about 3.9 million cancer cases in 2016, data shows

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NPCDCS, PMSSY, etc.

Mains level: Various efforts done by the government for countering the menace of Cancer


News

Rising number of cancer cases in India

  1. According to the National Cancer Registry Programme, India recorded an estimated 3.9 million cancer cases in 2016
  2. It is a programme under the  Indian Council of Medical Research (ICMR)

State-wise data

  1. The worst affected states were Uttar Pradesh with 674,386 cases, followed by Maharashtra with 364,997 and Bihar with 359,228
  2. In South India Tamil Nadu recorded 222,748 cases, Karnataka 202,156, Andhra Pradesh 159,696, Telangana 115,333 and Kerala 115,511 cases of cancer

Programme under the National Health Mission, for Non-communicable diseases

  1. An initiative of prevention, control and screening for common non-communicable diseases (NCDs) (diabetes, hypertension and oral, breast and cervical cancer) has been rolled out in more than 100 districts in 2017-18 under the NHM

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)

  1. The central government is implementing a “Strengthening of Tertiary Care Cancer facilities” Scheme under NPCDCS to assist states in establishing State Cancer Institutes (SCI)
  2. And Tertiary Care Cancer Centres (TCCC) in different parts of the country
  3. NPCDCS is being implemented under NHM for interventions up to district level
  4. The objectives of NPCDCS include awareness generation for cancer prevention, screening, early detection and referral to an appropriate level institution for treatment
  5. The focus is on three types of cancer namely breast, cervical and oral cancer

Other efforts done by the government

  1. Oncology, and its various aspects, has been a focus at places such as new AIIMS and many upgraded institutions, under the Pradhan Mantri Swasthya Suraksha Yojna (PMSSY)
  2. The setting up of National Cancer Institute at Jhajjar in Haryana and a second campus of the Chittranjan National Cancer Institute, Kolkata, has also been approved
  3. All these are aimed at enhancing the capacity for screening, prevention and treatment of cancer in the country
Dec, 13, 2017

[op-ed snap] Powering rural healthcare

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Indian Public Health Standards, National Health Policy, etc.

Mains level: The article talks about an interesting connection between renewable energy and Indian health care system. The UPSC is known to ask questions on these type of issues. Very important.


News

What is the issue?

  1. Around 38 million Indians rely on health facilities without electricity
  2. Without access to regular power supply, numerous life-saving interventions cannot be undertaken

‘Powering Primary Healthcare through Solar in India: Lessons from Chhattisgarh’

  1. It is a study published by Council on Energy, Environment and Water (CEEW)
  2. It has evaluated 147 primary healthcare centres (PHCs) across 15 districts in Chhattisgarh
    HIGHLIGHTS OF THE STUDY
  3. It highlights the role of solar energy in bridging the gaps in electricity access in rural healthcare facilities
  4. The Rural Health Statistics 2016 data has found, of the functional PHCs, 4.6% are not electrified
  5. The fourth round of District Level Household and Facility Survey data indicates that one in every two PHCs in rural India is either unelectrified or suffers from irregular power supply
  6. Positive part: The CEEW study found that the solar-powered PHCs in Chhattisgarh admitted over 50% more patients
  7. And conducted almost twice the number of child deliveries in a month compared to the power-deficit PHCs without a solar system
  8. The ability of solar-powered PHCs to maintain cold chains to store vaccines and drugs and operate new-born care equipment has significantly improved

How can renewable power sources help in this situation?

  1. They could help PHCs augment or even substitute traditional grid-based power systems
  2. It can facilitate reliable and uninterrupted electricity supply critical for 24/7 emergency services, deliveries and neonatal care, as well as inpatient and outpatient services

Continuous power supply has improved efficiency of PHCs in Chhattisgarh

  1. Continuous electricity supply must be ensured to cold chains at PHCs, especially in rural Chhattisgarh, which has an infant mortality rate that is higher than the average for rural India
  2. Further, patients showed more willingness to get admitted for treatment at the solar-powered PHCs due to facilities like running fans
  3. Also, 90% of PHCs with solar systems reported cost savings due to lower electricity bills or reduced expenditure on diesel

Can solar systems be scaled up in Rural India?

  1. Scaling-up solar-powered systems across PHCs in rural India is dependent on three factors
    FIRST
  2. To recognise the critical nature of electricity access in the entire health system infrastructure
  3. The Indian Public Health Standards has set minimum service-level benchmarks for all activities of PHCs, indicating that every PHC should have power supply with a back-up option
  4. The National Health Policy 2017 reiterates the commitment to improve primary healthcare by strengthening infrastructure
    SECOND
  5. The second is the ability to adapt solar systems around the local needs and considerations of PHCs including the burden of disease, weather, terrain, and power availability
    THIRD
  6. There must be a focus on making ‘Solar for Health’ a national priority

The way forward

  1. Significant opportunities exist to simultaneously address the multisectoral goals of energy access, energy security, resource management, and health outcomes
  2. Solar power for healthcare in Chhattisgarh is a crucial opportunity
  3. With evidence that scaling this initiative can meet national and regional ambitions for energy access and improved health outcomes
Dec, 07, 2017

[op-ed snap] Universal health coverage is the best prescription

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Health Policy-2017, Clinical Establishments Act, Universal Health Care, Sustainable Development Goals

Mains level: Improving healthcare system in India


Context

Recent incidents of conduct of high-profile corporate hospitals

  1. Three recent incidents involving the health-care sector in Delhi have sparked widespread outrage over the alleged mercenary motives and callous conduct of high-profile corporate hospitals
  2. Two cases involved children with dengue who died soon after leaving these hospitals in a serious condition after their families were presented huge hospitalisation and treatment bills
  3. The third case involved a live premature baby being “declared dead” and handed over to the parents wrapped in plastic

Major issues

  1. Three major issues are involved when we assess health care: access, quality and cost
  2. Access to readily reachable, trustworthy and affordable health care is a major challenge before poorly served rural areas and overcrowded urban areas
  3. The inadequacy of organised primary health services here is compounded by a weakness at the intermediate level of care in many district hospitals and nursing homes
  4. Government institutions of advanced care suffer from low budgets and a lack of managerial talent

Steps to improving access

  1. The pathway to improving access lies in expanding the network of public sector facilities at all levels
  2. This calls for
  • higher levels of public financing,
  • investment in training and incentivised placements of more health personnel and
  • improved management through the creation of a public health management cadre

3. These measures have been envisaged in the National Health Policy, 2017 and need urgent and earnest implementation

Steps to improving quality of care

  1. There must be an emphasis on the benefit and safety of tests and treatment
  2. It must be ensured that satisfaction levels of patients, families, care providers in the nature of institutional processes as well as human interactions are met
  3. This requires ensuring conformity to accepted scientific and ethical standards
  4. The Clinical Establishments Act is a good beginning, in moving health-care facilities towards registration, ensuring compliance with essential standards of equipment and performance, adopting standard management guidelines, grievance redress mechanisms, and respecting encoded patient rights

Managing cost

  1. High out-of-pocket spending on health care leads to unacceptable levels of impoverishment
  2. Both private insurance and employer provided insurance can cover only small population segments
  3. Government-funded social insurance schemes do not provide financial protection as they cover only part of the hospitalisation cost and none of the expenses of prolonged outpatient care which forms a higher percentage of out-of-pocket spending
  4. The solution lies in doubling the level of public financing to at least 2.5% of GDP by 2019, rather than 2025, as proposed in the National Health Policy
  5. Also by pooling tax funding, all Central and State insurance schemes and employer-provided health insurance into a “single payer system”
  6. It can be managed by an empowered autonomous authority which purchases services from a strengthened public sector and, as necessary, from empanelled private health-care providers

Universal Health Care is solution

  1. The UHC provides the framework in which all three elements can be integrated
  2. It is now also enshrined in the Sustainable Development Goals
Dec, 05, 2017

India will need 2.07 million more doctors by 2030, says study

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: Specially mentioned in the syllabus


News

Particulars of the report

  1. According to the report, to achieve a modest doctor-to-population ratio of 1:1,000, India will need 2.07 million more doctors by 2030
  2. The study was published in the Indian Journal of Public Health
  3. The prospects of the numbers increasing over the next 15-year period, it looks like an impossible task to achieve even a modest doctor-population ratio of 1:1000 by 2030
  4. Due to non-availability of data, the leakage of doctors for reasons such as those who discontinued medical practice due to change in profession, death or for any other reason during 1979-2014 (35-year period) is assumed to be zero

Comparison of the results of the study by WHO’s comment

  1. According to the World Health Organization (WHO) and the ministry of health, India has seven doctors per 10,000 people
  2. The research paper found that there were only 4.8 practising doctors per 10,000 people available in India in 2014
Dec, 02, 2017

[pib] Health Ministry and ICMR launch India Hypertension Management Initiative (IHMI)  

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: India Hypertension Management Initiative

Mains level: Rising incidents of diseases like diabetes, hypertension etc.


News

  • The India Hypertension Management Initiative (IHMI) is a collaborative project of Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare (MoHFW), State Governments, World Health Organization (WHO), and Resolve to Save Lives initiative of Vital Strategies.
  • The primary goal of this project is to reduce morbidity and mortality due to CVDs, the leading cause of death in India, by improving the control of high blood pressure, which is a leading risk factor for CVDs among adults in India.
  • IHMI will be progressively rolled out in 25 districts in the first two years across districts selected by the Health Ministry for expansion of active screening and intensification of treatment activities for hypertension.

Aim:

  • To reduce disability and death related to cardiovascular disease (CVD),
  • The leading cause of death in India, by improving the control of high blood pressure (hypertension), reducing salt consumption and eliminating artificial trans-fats, leading risk factors for CVD.
  • To raise awareness about NCDs amongst families regarding packaged food and processed foods with excessive salt and trans-fat.
  • Need for incorporating yoga in one’s life for prevention and management of hypertension.

Essential Components

  • It will support the adoption of standardized simplified treatment plans for managing high blood pressure.
  • ensure the regular and uninterrupted supply of quality-assured medications, task sharing so health workers who are accessible to patients can distribute medications already prescribed by the medical officer, and patient-centered services that reduce the barriers to treatment adherence.
  • Data on hypertension will be improved through streamlined monitoring systems, and the lessons learned and practice-based evidence will inform further interventions to improve cardiovascular care.
Dec, 02, 2017

[op-ed snap] The Missing Healing Touch

 Note4students
Mains Paper 2 : Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Prelims level: not much

Mains level: 2015 question: Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest?


News

Context
  1. Seven-year-old girl, Aadya, lost her life due to dengue-related complications in Fortis Hospital Gurugram last month.
  2. Root cause: the government has increasingly ceded space to the private sector in matters related to health.
  3. Despite, the article 47 mandating the improvement of public health as among the primary duties of government.
Growth of Private Sector
  1. Result of the government’s failure to provide affordable, accessible and equitable healthcare.
  2. Widened demand-supply gap and government’s inability to provide quality health care.
  3. 2007 paper in the EPW :“high absenteeism, low quality in clinical care, low satisfaction levels with care and rampant corruption plague the system.”
  4. High Level Expert Group formed by Planning Commission: “From 8 percent in 1947, the private sector now accounts for 93 per cent of all hospitals.
Attempts at Regulation
  1. The Clinical Establishments (Registration and Regulation) Act, 2010, model legislation for hospitals regulation by state governments has had a low uptake.
  2. Standard Treatment Guidelines for specific conditions and diseases not taken seriously.
  3. The West Bengal Clinical Establishments (Registration, Regulation and Transparency) Act, 2017, and the Karnataka Private Medical Establishments (Amendment) Bill, 2017 have been criticised as draconian.
  4. Insurance companies could work as a de facto check on false billing. But health insurance has penetrated only 3-4 per cent of the country’s population.
National Health Policy 2017
  1. Lays out a roadmap for public-private partnerships in healthcare.
  2. Recognises primary care will forever be in the domain of the government
  3. Talks of “strategic purchasing” of secondary and tertiary care from the private sector.
Conclusion
  1. For success of public-private partnership in healthcare, either the private sector should raise its trust quotient or
  2. the government should devise an effective regulatory mechanism to drill transparency into the private healthcare system.
Nov, 30, 2017

[op-ed snap] How to free Indians from the medical poverty trap

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Generic medicines, bioequivalence

Mains level: Issues related to health sector and way forward


Context

Dichotomy in medicine sector

  1. India is the largest supplier of generic drugs in the world
  2. Indian pharmaceutical companies have famously succeeded in pushing down the cost of medication in many countries across the world
  3. Yet, too many Indian citizens do not get access to medicines owing to high costs

Problems

  1. Thin insurance cover that leads to most patients paying for medical expenses out of their pockets after they have been diagnosed with an ailment
  2. Medicines are a major component of total health expenses—72% in rural areas and 68% in urban areas
  3. Healthcare costs pushed 60 million Indians below the poverty line in 2011

Government’s role

  1. The government is aware of the problem, which is why it has been fixing the prices of “essential medicines” for some time, and even medical devices such as stents and knee replacement caps from this year
  2.  But the solution of the government right now—price control—is suboptimal

Generic medicines

  1. Generic medicines are affordable versions of the drug, introduced after a company loses patent over a medicine
  2. These medicines are sold either by their salt-name or by a brand (called branded generics)
  3. For example, Crocin is a branded generic whose active ingredient is paracetamol

What can be done?

  1. Cheaper generics are one of the important factors for reducing healthcare cost
  2. The practice of generic substitution is strongly supported by health authorities in many developed countries where bioequivalence tests are mandatory

Challenges before generic medicines can become mainstream

  1. The poor regulatory regime has dented perceptions about the quality of generic drugs
  2. Since generic products don’t advertise—and save costs that way—the good-quality manufacturers are not able to compete with shoddy manufacturers on cost
  3. The incentive to cut costs increases as massive government contracts are allocated to the lowest bidder

Back2Basics

Bioequivalence

  1. In most countries, the generic drug manufacturers have to prove “bio-equivalence”, i.e. the generic medicine works the same way, to the same extent and for the same purpose, as the originally patented drug
  2. The regulations in India until April 2017, required bioequivalence testing only during the first four years of a drug becoming available for generic production
  3. After four years, manufacturers only need permission from the state licensing authorities that don’t demand the data
  4. The law has changed to require bioequivalence tests for some classes of generic medicines, but its coverage is not universal
Nov, 25, 2017

[op-ed snap] States of healthcare

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Health related studies, research, etc. are important for the Mains exam. Also, they are specially mentioned in the Mains syllabus.


News

Context

  1. Data from Global Burden of Disease study(given in the article) will help states chart their individual Health Targets
  2. States need to beef up disease monitoring systems

How health status changes around the world?

  1. Health status of populations across the world changes over time in response to socio-economic, demographic, nutritional, scientific, technological, environmental and cultural shifts
  2. Reason behind health transitions: Such health transitions have been especially profound in the past half-century due to sweeping
    (1) industrialisation,
    (2) rapid urbanisation and
    (3) relentless globalisation in most parts of the world

Why is it necessary to understand these health transitions?

  1. It is necessary to understand, and even predict, the patterns and dynamics of health transition so that multi-sectoral actions can be taken to protect and promote the health of populations

Why was ‘Global Burden of Disease’ initiated?

  1. The Global Burden of Disease study was initiated 26 years ago to chart the changing patterns of disease-related death and disability from 1990 onwards
  2. Working areas: Since then, estimates are periodically provided for years of life lost to premature mortality as well as for years of disease-related disability that is weighted for severity
  3. A combined measure of these two metrics is expressed as the loss of Disability Adjusted Life Years (DALYs) attributable to any disease or risk factor

First-of-its-kind Indian effort to map state-level disease burdens

  1. It was undertaken by over 1,000 experts of the Public Health Foundation of India, in partnership with the Indian Council of Medical Research and the team that leads the global study
  2. The results, reported recently, highlight significant trends common to all states as well as important differences between them

Results of the study:
Life expectancy at birth improved in India

  1. Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males
  2. However, life expectancy of women in Uttar Pradesh is 12 years lower than that of women in Kerala, while the life expectancy of men in Assam is 10 years lower than that of men in Kerala

Under-five mortality rate

  1. The under-five mortality rate has reduced substantially in all states in these 25 years
  2. But there was a four-fold difference in this rate between the highest, in Assam and Uttar Pradesh, as compared with the lowest in Kerala in 2016
  3. India has wide gaps to bridge: The under-five mortality of India is six times higher than Sri Lanka and burden of child and maternal malnutrition 12 times higher than in China

Different classes of diseases

  1. Communicable, maternal, neonatal, and nutritional diseases contributed to 61 per cent of India’s disease burden in 1990. This dropped to 33 per cent in 2016
  2. But the share of non-communicable diseases in the disease burden increased from 30 per cent in 1990 to 55 per cent in 2016
  3. Statewise trends: Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases
  4. But this ratio is much lower in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan

Five leading individual causes of disease burden in India

  1. In 2016, three of the five leading individual causes of disease burden in India were non-communicable
  2. The ischaemic heart disease and the chronic obstructive pulmonary disease are the top two causes
  3. And stroke the fifth leading cause

Causes behind different diseases

  1. A group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes
  2. Ambient air pollution and household air pollution both rank high as risk factors in 2016
  3. The former rising(air pollution) and the latter(household pollution) declining in the past 25 years

The study will help us in making Health strategy of individual states

  1. These data highlight the need to develop specific strategies to address the major contributors to disease burden within each state
  2. The data will help to tailor customised state-level responses while summated time trends will help the National Health Policy to set and track the progress towards country-level targets

The way forward

  1. The broad national agenda should be elimination of malnutrition, reduction of child and maternal mortality, control of infectious diseases and containment of risk factors contributing to non-communicable diseases
  2. This report provides each state the GPS to chart their individual journeys towards those goals, from different starting points.
Nov, 10, 2017

[op-ed snap] Paradise Papers, Gorakhpur

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Connection between tax avoidance and Health Budget of India


News

Two important incidents

  1. Paradise Papers: the new set of documents on offshore finances being investigated in collaboration with the International Consortium of Investigative Journalists (ICIJ) and Suddeutsche Zeitung, Munich
  2. These documents show a link to 714 Indian names
  3. Recent tragedy in Gorakhpur: 30 children die in 48 hours at Gorakhpur’s BRD Hospital, six due to encephalitis

Relation between the two incidents

  1. While the two stories seem to be unrelated, they are intimately linked
  2. As, revenue lost due to corporate tax avoidance(as shown in the paradise papers) could fund universal healthcare

Need of a Higher Health Budget

  1. A major reason for India’s health care crisis is that it spends only about 1.3 per cent of its GDP on health when the global average is 6 per cent
  2. The High Level Expert Group (HLEG) on universal health coverage (UHC) submitted its report in November 2011
  3. It estimated that financing the proposed UHC system will require expenditure on health to be stepped up to at least 2.5 per cent of GDP by 2017 and 3 per cent by 2022
  4. The National Health Policy 2017 also intends on gradually increasing public expenditure to 2.5 per cent by 2025

How can we improve our health budget?

  1. It will probably not be possible to do so until India’s tax to GDP ratio(which at 1.7 per cent is one of the lowest in the world) is raised
  2. This could be done if India had the political will to stop hemorrhaging its tax revenues due to the legal and illegal ways employed by the corporate sector

‘Revenue loss’ around the world

  1. Revenue losses due to tax avoidance are around $500 billion globally (Alex Cobham and Petr Jansky, March 2017)
  2. In addition, the studies show that the intensity of losses is substantially greater in low and lower middle-income countries
  3. So at one end we have countries such as Guyana and Chad, that are likely to be losing a staggering 7 per cent of GDP to tax avoidance and at the other end we have the UK losing only 0.02 per cent

India’s Position on revenue loss

  1. India falls somewhere in between. It is estimated to be losing 2.34 per cent of GDP due to corporate tax avoidance
  2. This is significantly more than the 1.3 per cent of GDP that it currently spends on healthcare and more than enough to help it reach its target of 2.5-3.0 per cent to achieve universal health coverage

The way forward

  1. Tax havens are at the heart of the inequality crisis, enabling corporations and wealthy individuals to dodge paying their fair share
  2. This prevents countries from funding vital public services and combating poverty and inequality, with especially damaging effects for developing countries like India
  3. The corporate sector needs to stop discussing whether these tax minimising schemes are legal or illegal
  4. Schemes that are causing revenue losses that could prevent two children younger than five dying every minute in India are at least highly unethical
Nov, 07, 2017

Tuberculosis cases: Govt announces steps to check under reporting

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the TB

Mains level: Government aim of eliminating TB by 20125


News

Directions to Private hospitals

  1. The union health ministry has asked private hospitals to notify it all cases of the disease reported in their facilities
  2. The government is aiming to eliminate tuberculosis (TB) by 2025

Why this direction?

  1. The aim is to check under-reporting of tuberculosis, which has been flagged as a major area of concern by UN health agency World Health Organisation (WHO)

Other steps by the government

  1. The ministry will also set up two 24X7 call centres — in Maharashtra and Uttar Pradesh — so that patients can avail all information related to the disease by calling up these toll free numbers
  2. The ministry has also roped in the Indian Medical Association for further sensitisation of the health institutions

Level of TB in India

  1. According to a report by the WHO, despite the reduction, India topped the list of seven countries accounting for 64% of the 10.4 million new tuberculosis cases worldwide in 2016
  2. India along with China and Russia accounted for almost of half of the 490,000, multi drug-resistant TB (MDR- TB) cases registered in 2016
Oct, 31, 2017

Fewer TB deaths in India: WHO

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

The following things are important from UPSC perspective:

Prelims Level: Particulars of the TB disease, Click here

Mains level: The WHO reports on India are important for Mains.


News

Decline in TB deaths

  1. According to a report from the WHO, death from tuberculosis in India saw a 12% decline from last year even as the number of new cases saw a 5% increase
  2. With 1.7 million new cases in 2016, India continued to be the largest contributor to the global burden with up to a quarter of the 6.3 million new cases of TB
  3. In spite of this year’s dip, India accounts for about 32% of the number of people worldwide who succumbed to the disease

Government’s plan against TB

  1. The government has committed to achieve a ‘90-90-90 target’ by 2035 (90% reductions in incidence, mortality and catastrophic health expenditures due to TB)
Oct, 28, 2017

India has the second highest unvaccinated children for measles in world

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Measles

Mains level: Important report showing inability of Indian government to counter the disease. 


News

New report on Measles

  1. According to a report by the the US Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF and the World Health Organization (WHO), around 20.8 million children across the world are still missing their first measles vaccine dose
  2. More than half these unvaccinated children live in six countries
    (1) Nigeria (3.3 million), (2) India (2.9 million), (3) Pakistan (2.0 million), (4) Indonesia (1.2 million), (5) Ethiopia (0.9 million), and (6) Democratic Republic of the Congo (0.7 million)

India’s situation

  1. India has the second highest population of children who haven’t been vaccinated against measles
  2. It happened despite the government’s focused campaign to check the highly contagious infection

Back2basics

Measles

  1. Measles is a highly contagious infection caused by the measles virus
  2. Initial signs and symptoms typically include fever, often greater than 40 °C (104.0 °F), cough, runny nose, and inflamed eyes
  3. Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik’s spots.
  4. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms.
  5. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.[5][6] Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others
  6. Rubella (German measles) and roseola are different diseases.
Oct, 16, 2017

[op-ed snap] The case for a public health cadre

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: Not much

Mains Level: Specially mentioned in the Mains Syllabus


News

Context

  1. The article talks about a service, on the lines of the IAS, which can improve India’s health-care delivery

Different committees in the past supporting dedicated personnel for public health management

  1.  Mudaliar Committe(1959): It had observed that “personnel dealing with problems of health and welfare should have a comprehensive and wide outlook and rich experience of administration at the state level”
  2. Kartar Singh Committee(1973): It had said that “doctors with no formal training in infectious disease control, surveillance systems, data management, community health related problems, and lacking in leadership and communication skills, with no exposure to rural environments and their social dynamics, nor having been trained to manage a facility or draw up budget estimates, were ill-equipped and misfits to work in public facilities”
  3. Other observations: It was also felt that “the medical education that [a doctor] receives has hardly any relevance to the conditions in which he would be required to work, either in the state-run health programme or even in private practice
  4. Since medical education is based almost entirely on the western model, and where he is more suitable for the conditions that prevail in western countries than in his own

12th Five Year Plan and the National Health Policy, 2017

  1. They have also strongly advocated establishing a public health management cadre to improve the quality of health services
  2. How: by having dedicated, trained and exclusive personnel to run public health facilities

Public health cadre by Odisha

  1. It has notified the establishment of a public health cadre in the hope of ensuring vast improvement in the delivery of health care

Why India’s Health care system should have a cadre?

  1. Doctors with clinical qualifications and even with vast experience are unable to address all these challenges, thereby hampering the quality of our public health-care system
  2. Doctors recruited by the States and the Ministry of Health and Family Welfare (through the UPSC) are to implement multiple, complex and large public health programmes besides applying fundamental management techniques
  3. In most places, this is neither structured nor of any quality
  4. In the absence of a public health cadre in most States, doctors with hardly any public health knowledge is required to implement reproductive and child health or a malaria control programme
  5. Further, at the Ministry level, the highest post may be held by a person with no formal training in the principles of public health to guide and advise the country on public health issues
  6. With a public health cadre in place, we will have personnel who can apply the principles of public health management
  7. And may avoid mistakes such as one that led to the tragedy in UP as well as deliver quality services

The Way Forward

  1. Such an exclusive department of public health will help in developing the recruitment, training, implementation and monitoring of public health management cadre
  2. Doctors recruited under this cadre may be trained in public health management on the lines of the civil service
  3. Financial support for establishing the cadre is also to be provisioned by the Central government under the Health Ministry’s budget
Oct, 12, 2017

Underweight and obese children: Alarm bells ring at both ends in India, Lancet study raises concern

Obese fat boy check heart by stethoscope. Tight shirt of pajamas,healthy concept

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: BMI

Mains Level: These days, Obesity is a serious health issue among children.


News

A new study in The Lancet

  1. The study was released on World Obesity Day on October 11
  2. The study looked at BMI (body mass index) trends in 200 countries from 1975-2016
    (a) Obese Population
  3. It has found that the number of obese girls in age group 5-19 has risen from 5 million to 50 million in 40 years
  4. And that of boys from 6 million to 74 million.
    (b) Underweight Polpulation
  5. The researchers say that if current world trends continue, “obese” will soon be more common than “underweight”

Results of the study on India

  1. India has among the largest shares of underweight children and teenagers
  2. And at the other end, it is part of a trend that has seen the number of obese under-20s worldwide rising tenfold in 10 years
  3. In India, the prevalence of obesity is between 1-2 %
  4. The prevalence of mild to severe underweight under-20s in India is 22.7% among girls and 30.7% among boys

Why is obesity increasing among children?

  1. The middle class and upper middle class in India have fewer children and tend to overfeed them under the pretext of pampering
  2. As per the Lancet study, the percentage is between 1-2 in India but these will increase as social structures are changing in India

Back2basics

Body Mass Index(BMI)

  1. The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual
  2. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in metres
Oct, 11, 2017

East, NE States score high in curbing infant mortality

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: What IMR is, SRS bulletin.

Mains Level: IMR is an important health factor.


News

What is IMR?

  1. Infant Mortality Rate(IMR) is counted as the number of deaths per 1,000 live births

Data released by the Sample Registration Survey (SRS) bulletin

  1. According to the SRS’ data, states from the east and northeastern part of the country have registered a significant drop in IMR
  2. The all-India IMR has also decreased from 37 in 2015 to 34 in 2016
  3. The SRS bulletin, published by the office of Registrar General of India\

Statewise performance

  1. Bihar, which has the highest density of population in the country, has recorded a drop of four points in IMR from 42 in 2015 to 38 in 2016
  2. In Assam, the IMR has dropped from 47 to 43 and in Jharkhand, it has dropped from 32 to 29
  3. In Odisha, the IMR have dropped from 46 to 44
  4. West Bengal, which has been showing a steady decline over the past few years, has recorded a drop of one point from 26 in 2015 to 25 in 2016
Oct, 09, 2017

Impact evaluation: Why flagship BPL health insurance scheme is in rather poor health

Image source

Note4students

Mains Paper 1: Social issues | Social empowerment

From UPSC perspective, the following things are important:

Prelims level: Indian Council of Medical Research, World Health Organisation, RSBY

Mains level: Necessity of Impact evaluation, performance of big-ticket government schemes and other related issues


News

Indian makes it to WHO leadership

  1. The head of the Indian Council of Medical Research, Dr Soumya Swaminathan, has become the first Indian on the global leadership team of the World Health Organisation

Quantitative evaluation of the Rashtriya Swasthya Bima Yojana (RSBY)

  1. One of the main objectives of any health insurance scheme is to provide financial coverage (or risk protection) by reducing such burden while enhancing use of healthcare
  2. RSBY has not been able to reduce out-of-pocket payment for healthcare for the poor, and they face the catastrophic impact of such payments

Where is India going wrong with RSBY?

  1. Outpatient care comprises up to 70% of total healthcare utilization in India and 60% of total health expenditure
  2. It has by far been excluded from RSBY coverage
  3. Because OP is not covered, people could delay seeking care until they are more severely ill, which is costly both from the perspective of costs and health
  4. Despite rising healthcare costs, the scheme continues to be capped at Rs 30,000 since 2008
  5. For a family of 4 or 4.5 persons, this is grossly inadequate

Positive impact of the scheme

  1. One positive impact of the scheme was in non-medical spending
  2. The poor increased their household consumption level, or non-medical spending, after RSBY intervention
  3. This can be called “virtual income transfer”

Other such regional schemes and their impact

  1. An evaluation of the Yeshasvini scheme in Karnataka by researchers from Delhi University reported an over 70% reduction in out-pocket spending and a 30% reduction in borrowings
  2. Evaluating the Rajiv Aarogyasri scheme in Andhra Pradesh in 2012, the nonprofit think tank Centre for Global Development found reduced inpatient out-of-pocket spending among enrolled families in phase I of the study, but relatively small impacts on outpatient out-of-pocket spending, and catastrophic payments

Back2Basics

Rashtriya Swasthya Bima Yojana (RSBY)

  1. RSBY, a tax-financed health insurance that is managed through private insurance companies, was introduced in 2008 for inpatient care to Below Poverty Line (BPL) families
  2. The scheme aims to provide health insurance coverage to the unrecognized sector workers belonging to the BPL category and their family members shall be beneficiaries under this scheme
  3. Scheme enables them to receive inpatient medical care of up to ₹30,000 per family per year in any of the empanelled hospitals
  4. The scheme has won plaudits from the World Bank, the UN and the ILO as one of the world’s best health insurance schemes
Oct, 09, 2017

Health ministry approves new tuberculosis drug

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Bedaquiline and Delamanid.

Mains level: The New drug will help in countering the multi-drug resistant (MDR) issue.


News

New Drug against Tuberculosis

  1. The technical group on tuberculosis in the ministry of health has given approval to ‘Delamanid’
  2. The ‘Delamanid’ is in its phase 3 clinical trials
  3. Health Ministry will initially conduct a trial with this drug on over 400 patients in a controlled manner
  4. New Drug will be included in the Revised National TB Control Program (RNTCP) from this month in parallel to Bedaquiline, another therapy

Reason behind this approval

  1. Due to the increasing number of multi-drug resistant (MDR) and extensive drug resistant (XDR) tuberculosis cases in India

Government’s expectations from the ‘Delamanid’

  1. Delamanid has proved effective in many clinical trials in South Africa and Japan
  2. Taking a cue from this, government are expecting that over 70-80% patients will respond to tuberculosis treatment

Back2basics

Bedaquiline

  1. Bedaquiline, sold under the brand name Sirturo, is a medication used to treat active tuberculosis
  2. It is specifically used to treat multidrug-resistant tuberculosis (MDR-TB) when other treatment cannot be used
  3. It should be used along with at least three other medications for tuberculosis
  4. It is used by mouth
Oct, 04, 2017

[op-ed snap] The cold facts: on tracking influenza outbreak

Image Source

Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: The article effectively targets India’s bad surveillance system in Health Sector


News

Context

  1. The article talks about India’s bad surveillance system and how it is affecting the strategy to eradicate influenza viruses like H1N1 and H3N2

H1N1 outbreaks in India

  1.  H1N1 landed on Indian shores in 2009, and from that year outbreaks have been an annual occurrence
  2. The worst was in 2015, when 2,990 people succumbed to it
  3. This year the virus has been particularly active; mortality, at 1,873 by the last week of September, is quickly catching up with the 2015 toll
  4. In comparison, official figures show 2016 to be a relatively benign year, with an H1N1 death toll of 265

Problems with official figures of infected persons

  1. These figures only capture H1N1 numbers, a practice that has been adopted in response to the severity of the 2009 pandemic
  2. But influenza was present in India even before 2009 in the form of H3N2 and Influenza B virus types
  3. Out of these, H3N2 is capable of causing outbreaks as big as H1N1, and yet India does not track H3N2 cases as extensively as it does H1N1
  4. All this indicates that India’s surveillance systems are still poor and underestimate the influenza burden substantially

Influenza in rural areas

  1. It has found that influenza accounts for nearly 20% of fevers across rural areas in 10 Indian States — fevers that are often undiagnosed and classified as “mystery fevers”
  2. During the years when the H1N1 burden is low in these regions, H3N2 and Influenza B circulation tends to spike

Other issues originated from India’s poor surveillance system

  1. Researchers from the MIT pointed out, India submits a very small number of H1N1 genetic sequences to global open-access databases for a country of its size and population
  2. Why is sequencing important: Sequencing is important because it can detect mutations in genetic material that help the virus evade human immune systems, making it more deadly
  3. Because India does not sequence a large enough sample of viral genomes, it would be missing mutations that could explain changes in the lethality of the virus

The way forward

  1. Vaccination is the best weapon that India has against this menace
  2. Because Oseltamivir, the antiviral commonly deployed against flu, is of doubtful efficacy unless administered early enough
  3. Yet, India has far stayed away from vaccinating even high-risk groups such as pregnant women and diabetics
  4. Better surveillance of influenza will possibly change this perception by revealing the true scale of this public health issue
Sep, 30, 2017

India’s infant mortality rate declines 8% in 2016

Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.

From UPSC perspective, the following things are important:

Prelims level: IMR

Mains level: IMR is a crucial health factor.


News

Decline in infant mortality rate (IMR)

  1. India has attained an 8% decline in the IMR in 2016 from a year ago
  2. According to the Sample Registration System (SRS) bulletin, IMR has declined to 34 per 1,000 live births last year from 37 per 1,000 live births in 2015
  3. The Bulletin is released by the Office of the Registrar General
  4. It attributed the improvement to countrywide efforts to expand health services coverage, including reproductive, maternal and newborn health services

More takeaways from the bulletin

  1. IMR declined in 29 states and Union territories, was stable in two states and increased in five states and Union territories
  2. The highest decline of 7 points was reported by Chandigarh and the highest increase of 6 points was reported by Arunachal Pradesh
Sep, 21, 2017

[op-ed snap] Who knew healthcare was so complex

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Challenges that government can face after accepting NITI Aayog’s recommendations


News

Context

  1. The op-ed talks about Indian Health Sector and NITI Aayog’s recommendations on it
  2. NITI Aayog’s recommendation to improve access
    (1) reduce out-of-pocket expenditure
    (2) create infrastructure and
    (3) augment capacity at district hospitals for non-communicable diseases (NCDs), is urgent and necessary

NITI Aayog’s Plan to improve Indian Health Sector

  1. The NITI Aayog’s solution is to incentivize the private sector via public private partnerships (PPPs)
  2. And the government will provide land, infrastructure, capital for viability gap funding, and patients via referrals from public screening programmes
  3. In return, the government fixes the price of basic services to ensure a reasonable rate of return
  4. The first assumption here is that if sufficient incentive were provided to the private sector, through land and capital, then it would earn a reasonable return on equity and decide to enter

Possible Challenges of the above system

  1. The above plan(by NITI Aayog) suffers from two challenges
    (1) It will attract private players with the greatest capacity to manipulate the system and not necessarily the most efficient ones
    (2) In a competitive environment, performance of a firm changes over time depending on new and better management practices and technology
    Firms with dynamic efficiency survive, while others stagnate

Other Challenges
Challenge related to tariff

  1. Tarrifis non-negotiable and fixed by government
  2. The biggest constraint in expanding health services is shortage of qualified human resources like onco-surgeon, clinical cardiologist and specialized nurses
  3. To induce migration from metros to smaller cities, private players will have to pay higher compensation
  4. With fixed tariffs, this lowers profitability of the venture
  5. For viability, there will be cost-cutting, potentially lowering the quality and quantity of care

Challenge related to key performance indicators (KPIs)

  1. Unfortunately, riskiness of patients is not considered while assessing quality of care
  2. If payment is linked to KPIs, which are not adjusted for risk, then private players are disincentivized from treating risky patients while over-treating safer patients

Challenge related to payments

  1. It creates three types of patients: (1) government-sponsored, (2) self-paying, and (3) patients insured under government schemes
  2. Government-sponsored patients are more expensive because 70% of their payment is released within 30 days while 30% is released within 45 days after “due diligence”
  3. For self-paying patients, funds are transferred within 15 days of receipt
  4. Facilities, therefore, prefer self-paying patients and are reluctant to provide the same level of services to government-sponsored patients who are typically poorer
Sep, 09, 2017

[op-ed snap] Indicators that matter: on the quality of public healthcare

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: After the recent UP incident, it has become a hot topic of discussion. Also, it is specially mentioned in the Mains Syllabus.


News

Context

  1. The article talks about the low quality health services in India and suggests some ways to improve Health Sector.

Poor Performance of Indian Health Sector

  1. According to the latest Global Burden of Disease Study, which ranks countries on the basis of a range of health indicators, India has the 154th rank
  2. It much below China, Sri Lanka and Bangladesh

Low Health Budget in States

  1. Health is a State subject
  2. It implies that the primary responsibility of providing quality health services to the people lies with the States
  3. But States have been reducing their health-care spending efforts in relation to total government spending
  4. In 2013-14, the per capita public expenditure on health in U.P. was Rs. 452
  5. Such low spending cannot be expected to deliver much
  6. The number of primary health centres, the first point of contact for patients in the rural areas of U.P. went down from 3,808 in 2002 to 3,497 in 2015
  7. These statistics show that health has never been a political priority in the State
  8. The government’s lack of understanding of the importance of public health has played the most important part in U.P.’s health predicament

Consequences of bad Health Services on poor people

  1. As public health-care provisioning is becoming more limited and the quality of services deteriorating, people are left with no option but to seek services from private providers
  2. Every year, around 60 million people become impoverished through paying health-care bills in India
  3. More than 20% of people do not seek health care, despite being unwell, because of their inability to pay for it

Things we can learn from other countries

  1.  The experience from other nations that have done relatively well in health suggests that political commitment to health is a prerequisite for improving the health scenario of any country
  2. For instance, Thailand has enacted a law to make quality health care a constitutionally guaranteed right
  3. Thailand has undertaken structural reforms in the health sector to achieve the goals stated in the Health Act
  4. Even before it started reforms to attain universal health coverage, it began massive investments to build public health facilities in rural areas
  5. Cuba did the same thing many decades ago
  6. Health care is a right there and the government assumes the fiscal and administrative responsibility of ensuring access to free health care

The Way Forward

  1. The tragedies in Uttar Pradesh should be a loud and clear call for our policy makers
  2. The government’s approach towards health needs to be radically changed
  3. We need more resources available for health
  4. Health needs to be integrated as a pillar of development and it must be recognised as a public good
Sep, 01, 2017

Nationwide programme to test all TB patients

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: GeneXpert

Mains level: Effective step to counter TB problem in India.


News

Nationwide Programme against TB

  1. Health authorities will commence a nationwide programme to test every tuberculosis (TB) patient for signs of resistance to first-line drugs
  2. This could also reveal a large number of hidden tuberculosis patients, as well greater numbers of those with multiple infections of TB and HIV

Level of TB problem in India

  1. India tops the world in the number of tuberculosis cases, the WHO estimates that possibly as many as a million Indians with TB could be outside government scrutiny
  2. In 2015 alone, nine million Indians were tested for suspected tuberculosis and about 900,000 were confirmed to be ailing from it
  3. Nearly 3% of new TB cases and 18% of prevalent cases are believed to be drug resistant

Universal Drug Sensitivity Test

  1. The new policy, called the Universal Drug Sensitivity Test, will be implemented using a molecular diagnostic test called GeneXpert
  2. GeneXpert is a US-developed technology tool being used worldwide since 2010
  3. It can detect the TB bacterium as well check for resistance to rifampicin, one of the standard key TB drugs, within 90 minutes
  4. Conventional tests take at least a day or more and require well-trained personnel for similar results

Alternative to GeneXpert

  1. GeneXpert kits are known to be expensive, as well as requiring air-conditioned settings and reliable electricity access for optimal output
  2. The Indian Council of Medical Research (ICMR) is in the process of testing a cheaper alternative to GeneXpert called Truenat MTB
  3. Truenat MTB is reportedly more portable, battery-operated, and performs as well at lower costs
Aug, 26, 2017

Forging the ‘New Delhi Consensus’ on health

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Issues related to Indian Health Sector and there solution


News

Context

  1. In the Article, writer talks about the Public health policy of the Central Government

Government is less sensitive on health issues

  1. The Gorakhpur tragedy shows that healthcare is not a political priority till the point there are large-scale deaths
  2. Systemic issues which effects health sector often do not receive the importance they deserve
  3. The Government has implemented many reforms in health sector
  4. But the contradictory nature of the policy moves suggests the lack of a coherent policy framework to deal with India’s health challenges

Difference stands of Health Ministry and the NITI Aayog

  1. The Health Ministry do not support PPP Model(in health sector) but NITI Aayog supports it
  2. The conflict between the health ministry and the planning body is not new
  3. The previous UPA regime witnessed a similar argument between the former Planning Commission and the ministry as well

Are subsidized Health Insurance products a solution for Indian Health Sector?

  1. Economies which tend to depend heavily on medical insurance tend to have higher expenditure on healthcare on aggregate
  2. The US is a classic example, where the widespread provision of subsidized insurance products has led to a sharp escalation of costs
  3. A tendency to over-utilize medical services, and adopt expensive innovative procedures even when evidence of their effectiveness is lacking has made health spending in the US extremely inefficient

How can Preventive Public Health contribute to India?

  1. It can counter Indian Health care problems
  2. One example would be a well-functioning drainage and waste management system
  3. It, by lowering the chances of infectious diseases can contribute to overall welfare and reduces health expenses

Is Swacch Bharat Abhiyan a good Preventive Public Health Policy?

  1. The Swachh Bharat (Clean India) has marked a radical change when it was announced
  2. However, the narrow focus of the programme has meant that its impact will be far lesser than what it could have been
  3. The programme has progressed slower than planned, and not all of the toilets that have been built are being used

The way forward

  1. It is time the Indian government should reconsider its approach and identify a priority list of interventions in healthcare based on the desirability and cost-effectiveness 
  2. It is very likely that in the process, the bias in Indian health policy against preventive healthcare will be corrected
  3. Such a process will also help clarify the role of the state in healthcare
  4. And will also help forge a political consensus across parties and states on which areas need attention the most
Aug, 17, 2017

After stent, price of knee implants capped: 60 per cent rate cut

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: NPPA

Mains level: Good step by government. It will drastically decrease the price of Knee surgeries, which will be very helpful for middle class and poor families


News

Capping of Prices

  1. The Central government has capped the prices of knee implants in the range of Rs 54,720 to Rs 1,13,950,  exclusive of the GST
  2. Why: To check unethical profiteering and exploitative pricing at the cost of the patients in an unregulated market
  3. The average price reduction of knee implants after this cap would be in the range of 59 per cent to 69 per cent

Drug Prices Control Order (DPCO)

  1. The DPCO of 2013 authorises the Central Government to fix the ceiling price or retail price of any drug (or notified medical devices)
  2.  According to the NPPA,  Central Government has found that such “extraordinary situation in the case of knee implants does exist
  3. The National Pharmaceutical Pricing Authority (NPPA) and the Department of Pharmaceuticals (DOP) come under Ministry of Chemicals and Fertilisers
Aug, 17, 2017

[op-ed snap] On rural India’s health systems: the health checklist

 

Image SourceNote4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Q.) “Equity in access to doctors, diagnostics and medicines for rural India must be a priority.” Examine.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Problems and solutions related to Indian Rural Health Sector.


News

Context

  1. The article presents a brief picture of Rural Health Sector in India

Some proofs of Bad Health Sector in India

  1. Recently happened crisis at the Baba Raghav Das Medical College in Gorakhpur
  2. The CAG’s report on reproductive and child health under the National Rural Health Mission for the year ended March 2016
  3. In Uttar Pradesh, the CAG found that about 50% of the primary health centres (PHCs) did not have a doctor, while 13 States had significant levels of vacancies

Main Issues

  1. Government’s inability to absorb the funds allocated
  2. Shortage of staff at primary health centres (PHCs)
  3. Community health centres (CHCs) and district hospitals
  4. lack of essential medicines
  5. broken-down equipment and unfilled doctor vacancies

Government’s Efforts

  1. The Centre has set ambitious health goals for 2020
  2. And is in the process of deciding the financial outlay for various targets under the National Health Mission
  3. The goals also includes reduction of the infant mortality rate to 30 per 1,000 live births, from the recent estimate of 40

What we need to achieve health goals?

  1. This will require sustained investment and monitoring
  2. We also need access to a health facility with required medical and nursing resources within a 3-km radius, from every individual
  3. Our disease surveillance system needs to be strengthened in both community and hospital settings, to provide reliable real-time data
  4. Periodic quality audits must include technical, administrative and social audits
  5. To make this happen, we need to invest in training and deploying professionals in public health management at different levels of the system

The Way Forward

  1.  Government doctors must be well paid but barred from private practice
  2. Giving access of doctors, diagnostics and medicines to the rural population has to be a priority for the National Health Mission
Aug, 04, 2017

8.8 million blind in India in 2015, says study in Lancet

Image Source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Important issue related to Health Sector


News

A Study by the Lancet Global Health journal

  1. According to the study, 8.8 million people in India were found to be blind in 2015
  2. And another 47.7 million people had moderate and severe vision impairment

Level of Problem around the world

  1. According to the study, there are an estimated 36 million people worldwide, who are blind and this is set to increase to almost 115 million people by 2050
  2. This increase will be seen in developing countries in Asia and sub-Saharan Africa

Is this problem increasing?

  1. The rates of blindness and vision impairment have decreased in recent years
  2. The number of cases has risen as the world population has aged
Nov, 28, 2016

[pib] Brush your facts regarding National Health Mission (NHM)

  1. National Health Mission (NHM): has 2 Sub-Missions, viz. the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM)
  2. While NRHM was launched in April 2005, launch of NUHM was approved by the Cabinet on 1st May 2013
  3. 3 main programmatic components: Health System Strengthening in rural and urban areas, (RMNCH+A) interventions and control of Communicable and Non-Communicable Diseases.
  4. RMNCH+A: Reproductive-Maternal-Neonatal-Child and Adolescent Health
Nov, 28, 2016

[pib] What is Family Planning 2020?

  1. Family Planning 2020 (FP2020) is a global partnership that supports the rights of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have.
  2. FP2020 is an outcome of the 2012 London Summit on Family Planning
  3. India is a signatory to FP2020
  4. FP2020 is based on the principle that all women, no matter where they live should have access to lifesaving contraceptives
  5. What are the steps taken by India?
  6. Introducing New Contraceptive Choices: The current basket of choice has been expanded to include new contraceptives viz. Injectable contraceptive, Centchroman and Progrsterone Only Pills (POP)
  7. Refurbishing Contraceptive Packaging: The packaging for Condoms, OCPs and ECPs has now been improved and redesigned so as to increase the demand for these commodities.

Note: These schemes and international commitments can be used as healthy points to differentiate your answers in Mains. FP2020’s focus is on family planning and these are unique initiatives by GOI around contraceptives and its promotion

Nov, 26, 2016

HIV community rejects AIDS Bill in current form

  1. What: The HIV community rejected the long awaited HIV/AIDS Bill in its current form
  2. It demanded removal of the phrase “as far as possible” from the proposed legislation
  3. The current version of the HIV Bill has shocked the HIV community as it dilutes rights to access treatment
  4. The Bill was approved by the Cabinet in Oct and was expected to guarantee the rights of India’s 2.4 million HIV positive community
  5. Problems with current version of Bill: The Bill has been amended to state that governments are required to focus on prevention — and not on treatment — that too, as far as possible
  6. The public health legislation is first on the list of legislative business of the RS with Health Minister J.P. Nadda set to move the Bill
Nov, 24, 2016

[op-ed snap] E-pharma sales need to adhere to a “code of conduct”

  1. Drugs and Cosmetics Act, 1940, requires a retailer to check a licensed and registered doctor’s prescription in the presence of a pharmacist
  2. Prescription drug abuse — using dated prescriptions or using medicines legally bought by a person who no longer needs them — is rampant
  3. The Drug and Cosmetics Act, 1940, is not equipped to deal with e-pharma business
  4. The Internet Pharmacy Association’s Self Regulating Code of Conduct asks e-pharmacies to process scheduled medicines against a valid copy of prescription of a registered medical practitioner
  5. Ensure that no schedule X and other sensitive habit-forming medicines are processed through their platform
  6. Online pharmacy sector has also been asked to devise mechanisms to address consumer queries or grievances
  7. Advantage of e-pharmacy: They can aggregate supplies, making otherwise-hard-to-find medicines available to consumers across the country
  8. Steps needed: Proper tracking and monitoring of sales of drugs, checking the authenticity of online pharmacists and scrutinise prescriptions and details of patients
  9. Care should be taken to ensure patients’ privacy
Nov, 21, 2016

[op-ed snap] Healthcare system needs to be restructured

  1. Centers for Disease Control: fights against infectious diseases
  2. Traditionally, WHO has been the leader in global public health issues but a funding crunch has tied its hands for many years now. Steadily, the US’ CDC is rising to the challenge
  3. India’s public healthcare system is struggling to provide even basic primary care to all its citizens
  4. There is enough scope to convert this enormous burden of disease into an opportunity for innovation and global leadership
  5. India has had some major successes such as containing HIV infections and leprosy and eradicating polio
  6. Limitations: Particularly with the vertical model for disease control (specific programmes for specific diseases) which do not allow an integrated approach
  7. Anti-malaria programme has been converted into a broad-based National Vector Borne Disease Control Programme
  8. This includes interventions against other vector-borne infectious diseases such as dengue and chikungunya
  9. Comprehensive review and restructuring of the healthcare system needed
  10. Focus on upgrading primary healthcare centres, manned by a well-trained cadre of health professionals required
Nov, 19, 2016

[pib] What is Pradhan Mantri Surakshit Matritva Abhiyan?

  1. Aim: To provide fixed-day assured, comprehensive and quality antenatal care universally to all pregnant women on the 9th of every month
  2. A package of antenatal care services would be provided to pregnant women in their 2nd / 3rd trimesters
  3. Support from private sector doctors to supplement the efforts of the government
  4. IMP: Identification and follow-up of high risk pregnancies and red stickers would be added on to the Mother and Child Protection cards of women with high risk pregnancies
  5. OBGY specialists / Radiologist/ Physicians working in the private sector are encouraged to volunteer for the campaign. Just encouraged. No coercion.
Nov, 12, 2016

[op-ed snap] Time to fight tobacco menace

  1. Context: Nations from around the world gather in Delhi to advance global commitment to tobacco control
  2. Need: to advance our own health and SDGs
  3. Measures that can be taken: GST legislation offers the government an opportunity to use taxation policy for public health and development and tax ‘demerit’ goods heavily
  4. Heavy tobacco taxation: an immediate need
  5. Single most cost-effective for persuading tobacco users to quit tobacco use
  6. High level consumption of smokeless tobacco made India the world leader in head, neck and throat cancers
  7. Tobacco use, a primary risk factor for NCDs — heart disease, strokes, diabetes, cancer and chronic lung diseases
  8. Philippines Model: passed “Sin Tax Reform Law”
  9. Simplified complex tobacco tax structure and increased rates by 341% for low-priced brands in the first year
  10. Increased revenues earmarked for financing country’s universal health care programme
Oct, 17, 2016

Health spending: How States splurge on salaries

  1. Main finding: Bulk of the total public money spent in State-level healthcare system is not spent on medical services, but goes to wages and salaries of human resource.
  2. Wages and salaries account for 86 per cent of the total public expenditure in Punjab, 72 per cent in Maharashtra, 65 per cent in Kerala, 52.5 per cent in Madhya Pradesh and 35 per cent in Odisha.
  3. However, the per capita ‘total cost of care’ — which includes money spent by patients as well as that spent by the government on paying salaries to staff, for health subsidy etc — is mostly cheaper in the public sector than in the private sector.
  4. Source: A study of State Health Accounts of Kerala, Tamil Nadu, Odisha, Maharashtra, Madhya Pradesh and Punjab. Public Health Foundation of India in collaboration with the State governments, studied health accounts for these six States for the year 2013-14.
  5. The findings show important contribution by other sources. For instance, in Maharashtra, 23 per cent of healthcare money comes from local bodies.
  6. For the first time, Health Accounts Estimates have been conducted at the state level in India.
Oct, 15, 2016

[op-ed snap] Doctor is not in

  • Theme: The Indian Health System and need for changes.
  • The Indian health system: India follows a vertical approach in its health sector, which focuses on disease-specific national programmes.
  • While these have been successful, there is a need to strengthen health systems to deal with problems like the annual outbreak of diseases like dengue and chikungunya, as well as to prepare for the upcoming onslaught of non-communicable diseases such as cancer and diabetes.
  • As per the World Health Organisation (WHO), an effective and efficient health system consists of six key building blocks — service delivery, medicines, information, health workforce, financing and governance.
  • The way ahead: To fix India’s healthcare scenario, what is most needed is “systems thinking” to strengthen the country’s health system in its entirety, with an equal focus on disease prevention, health promotion, and disease diagnosis and treatment.
  • This translates into ramping up our commitment to disease surveillance and data collection systems, better medical research, health workforce training and staff-retention programmes, public provision of quality healthcare and nutrition services, equal access to safe and efficacious medicines, increased public financing for healthcare and nutrition, and effective public and financial management of our national healthcare and nutrition service delivery programmes.
  • There is an urgent need to ensure health and nutrition service delivery as health and nutrition are inextricably linked to each other.
  • The political leadership cutting across party lines needs to come together and look at new and more efficient ways to deliver healthcare to our citizens keeping in mind India’s changing demographic and epidemiological profile.
Oct, 12, 2016

Global Hunger Index (GHI), 2016- III

  1. Globally, the Central African Republic, Chad, and Zambia were estimated to have the highest levels of hunger
  2. For the developing world, the GHI score is estimated to be 21.3
  3. It is at the lower end of the ‘serious’ category
  4. Bright spots: The level of hunger in developing countries has fallen by 29% since 2000, with 20 countries reducing their GHI scores by around 50% each since 2000
  5. If hunger continues to decline at the same rate it has been falling since 1992, around 45 countries, including India, Pakistan, Haiti, Yemen, and Afghanistan will still have ‘moderate’ to ‘alarming’ hunger scores in year 2030
  6. This is far short of the United Nations’ goal (SDG) to end hunger by 2030
  7. India is slated to become the world’s most populous nation in just six years
  8. Hence, it’s crucial that we meet this milestone with a record of ensuring that the expected 1.4 billion Indians have enough nutritious food to lead healthy and successful lives
Oct, 12, 2016

Global Hunger Index (GHI), 2016- II

  1. Two out of five children below five years of age are stunted in India
  2. Stunting: Measures chronic malnutrition and affected children’s height would be considerably below the average for their age
  3. Improvements: At the end of 2016, around 15% of the country’s population was undernourished, down from 17% at the end of 2009
  4. Prevalence of wasting in children has declined from 20% in 2010 to 15% in 2015
  5. Stunting in children below the age of five has also declined from 48% to 38.7%
  6. The under-five mortality rate has declined from 6.6 to 4.8 over the same period
Oct, 12, 2016

Global Hunger Index (GHI), 2016- I

  1. India: 97th out of 118 countries
  2. Scored 28.5 on the GHI index, up from 36 in 2008
  3. Since 2000, the country has reduced its GHI score by a quarter
  4. Still rated with ‘serious’ hunger levels in the 2016 Index
  5. Behind Nepal, Sri Lanka, Bangladesh, among others, but ahead of Pakistan and three other Asian countries
  6. Only the fifth highest rank in the whole of Asia, better than only North Korea (98), Pakistan (107), Timor-Leste (110) and Afghanistan (111)
  7. Also, the lowest rank among BRICS nations, with Brazil in the top 16, Russia at 24, China at 29 and South Africa at 51
  8. Last year: 80th out of 104 countries
Oct, 12, 2016

Early childhood development should be a priority for India

  1. Source: A recent study by Program in Global Health Economics and Social Change at Harvard Medical School
  2. The numbers of children at risk of poor development fell from 279.1 million in 2004 to 249.4 million in 2010
  3. China and India have contributed the most to reducing the number of children at risk of poor development over the past decade
  4. Yet, India continued to have the largest number of children at risk in 2010
  5. 52% of the country’s 121 million children less than 5 years of age were at risk
  6. Children under 12 years of age have the highest poverty levels among all age groups, especially in low income countries
  7. Children at risk of poor development: Those who were either stunted (height-for-age below two standard deviations from the median of the international reference population recommended by the WHO in 2006) or were living in extreme poverty (less than $1.25 a day at 2005 international prices)
Oct, 10, 2016

Not licensed to heal: ‘Foreign doctors’ flunk qualifying test

  1. Only a woefully small percentage of doctors with foreign degrees equivalent to the MBBS get to practice in the country — at least legally
  2. Around 70-80% of these students fail to clear the mandatory screening examination conducted by the National Board of Examinations (NBE)
  3. Since 2002, it has been mandatory for all Foreign Medical Graduates (FMGs) to clear an examination Foreign Medical Graduates Examination (FMGE) to secure a Medical Council of India (MCI) registration, without which they cannot practice in India
  4. In the most recent test, only 600 out of the 5,349 candidates (11.2%) passed despite relaxed examination norms and the opportunity to take the test innumerable times
  5. Countries: A number of the unsuccessful students have graduated from medical universities in China, Russia and Ukraine, which are a big draw for Indians aspiring to be doctors
  6. Why students go there? These countries offer undergraduate degrees equivalent to the Indian MBBS at a far lower cost and without the tough entrance examinations and admission process
Oct, 10, 2016

Janani Suraksha Yojana pays dividends: Study- II

  1. The usage of maternal healthcare services by the OBC, Dalit, Adivasis and Muslim women increased between the surveys
  2. Women in their early twenties were more likely to avail of each of the three maternal health care services as compared to their older women
  3. Also, the incidence of women availing maternal healthcare services decreases with the increase in the number of children they have delivered
  4. Significance: While previous studies had shown the impact of JSY in reducing maternal mortality, it was not known if it had reduced socioeconomic inequalities
Oct, 10, 2016

Janani Suraksha Yojana pays dividends: Study- I

  1. Source: A study conducted using data from two rounds of the India Human Development Survey (IHDS)- conducted in 2004-05 and 2011-12
  2. Equity: JSY has led to an enhancement in the utilisation of health services among all groups
  3. This is especially among the poorer and underserved sections in the rural areas, thereby reducing the prevalent disparities in maternal care
  4. The increase in utilisation of all three maternal healthcare services between the two rounds is remarkably higher among illiterate or less educated and poor women
Oct, 07, 2016

Leading risk factors

  1. Source: The Global Burden of Diseases report
  2. For both sexes, the leading risk factors are high systolic blood pressure, fasting plasma glucose, ambient particulate matter, household air pollution, and unsafe water
  3. Smoking is a bigger risk factor for Indians than even cholesterol and iron deficiency
  4. Childhood under-nutrition and lack of whole grains also figure in list
  5. Iron-deficiency anaemia is the leading cause of years lived with disability in the case of India
  6. This is followed by lower back and neck pain, sense organ diseases, and depression
Oct, 07, 2016

Under 5 deaths

  1. Source: The Global Burden of Diseases report
  2. In 2015 alone, the number of under-5 deaths in India was 1.26 million
  3. The number of stillbirths alone was 0.53 million
  4. India recorded the largest number of under-5 deaths in 2015, at 1.3 million (1.2–1.3 million), followed by Nigeria (726,600) and Pakistan (341,700)
  5. Neonatal pre-term birth complications, lower respiratory infections, diarrhoeal diseases and measles were some of the leading causes of under-5 mortality
  6. The rate of under-5 deaths was 48.9 deaths per 1,000 live births. For every 1,000, live births there were 29.06 neonatal deaths (0-27 days after birth), 20.25 stillbirths, 11.74 post-neonatal (28 days to 1 year) deaths, and 8.80 deaths during the 1-4 years

Discuss: Remember a recent report about babies falling victim to microbial resistance? You can expand the dimension of this topic by adding those facts with these in an answer

Oct, 07, 2016

Slower reduction in MMR

  1. Source: The Global Burden of Diseases report
  2. Along with Nepal and Bhutan, India has registered a slower reduction in maternal mortality rate (MMR)
  3. MMR was reduced by a little over 50% in 25 years (1990 to 2015), from over 130,000 deaths in 1990 to nearly 64,000 deaths in 2015
Oct, 07, 2016

Other reasons of mortality

  1. Source: The Global Burden of Diseases report
  2. Injuries killed 0.6 million males and 0.3 million females in 2015 alone
  3. India had the highest number of suicide deaths in the world last year, with nearly 132,000 deaths in men and over 76,000 deaths in women
  4. At 0.36 and 0.31 million, neonatal disorders killed nearly equal number of males and females
  5. The other leading causes of deaths last year in both sexes were ischemic stroke, haemorrhagic stroke, TB, lower respiratory infections and diarrhoea
Oct, 07, 2016

Non-communicable diseases killed more Indians in 2015- Global Burden of Diseases

  1. Source: The Global Burden of Diseases report
  2. In 2015, India, like other developed countries, had more number of deaths caused by non-communicable diseases (NCDs)
  3. In the case of males, deaths due to NCDs (3.6 million) were more than double that were caused by communicable diseases (1.5 million), while it was nearly double in females
  4. Cardiovascular diseases were the leading cause of death in both sexes in India — 1.6 million in males and 1.1 million in females
  5. The next biggest cause of deaths was chronic respiratory diseases — 0.68 million in males and 0.5 million in females
Oct, 06, 2016

HIV and AIDS Bill, 2014 gets approval- II

  1. Step in right direction: The Bill comes at a time when the national HIV programme has weakened due to Budget slashes and patients are facing drug shortages across the country
  2. Way ahead: We also need to address the inadequate funding, the procurement system that is resulting in drug shortages and the lack of clarity in the HIV policy
  3. Stats: There are approximately 21 lakh persons estimated to be living with HIV in India
  4. The percentage of patients receiving antiretroviral therapy (ART) treatment currently stands at a mere 25.82% as against the global percentage of 41%, according to the 2015 Global Burden of Diseases (GBD)
Oct, 06, 2016

HIV and AIDS Bill, 2014 gets approval- I

  1. Cabinet approved the long-awaited amendments to the HIV Bill, granting stronger protection to the country’s HIV community
  2. Aim: Seeks to prevent stigma and discrimination against people living with HIV
  3. Discrimination: Will bring legal accountability and establish a formal mechanism to probe discrimination complaints
  4. What kind of discrimination? Accessing healthcare, acquiring jobs, renting houses or in education institutions in the public and private sectors, provision of insurance
  5. Redressal: Will allow families that have faced discrimination to go to court against institutions or persons being unfair
  6. Privacy: No person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order

Discuss: In India, the social ostracism and stigma is even more virulent than the virus when it comes to prejudice and the stigma for people living with HIV (PLHIV). Why does this happen? How can it be addressed?

Oct, 05, 2016

Quacks dominate rural healthcare, says survey- III

  1. Determinant of quality care: The socio-economic status of a village and not household determines the quality of care people receive
  2. Households with low socio-economic status in villages with high socio-economic status were able to access more competent health care providers
  3. But households with low socio-economic status located in villages with low socio-economic status use low quality care
Oct, 05, 2016

Quacks dominate rural healthcare, says survey- II

  1. State PHCs: Despite the availability of state primary care centres and the competence of doctors in this sector, doctors in the public sector spent on an average only 2.1 hours a day seeing patients
  2. Why? Fewer patients actually approach them
  3. Competency: Doctors with formal training are more competent as they exhibited higher correct diagnosis and correct treatment rates than health-care providers trained in alternative medicine and those without any training whatsoever
Oct, 05, 2016

Quacks dominate rural healthcare, says survey- I

  1. Source: A survey of 23,000 households across 100 villages in rural Madhya Pradesh, published in the journal Health Affairs
  2. While the number of private health care providers has increased, many of them had no formal medical training
  3. On average, people had access to 11 health-care providers in a village
  4. 71% of these providers were in the private sector but only 51% of them had any formal medical training
  5. In terms of primary care visits, the private sector accounted for 89%, of which 77% were to the providers who had no formal training
  6. In contrast, only 11% of all primary care visits were to the public health sector and only 4% were to providers with an MBBS degree
Oct, 01, 2016

Name all recalcitrant officers, SC tells Delhi

  1. Delhi Govt (AAP): Blamed the spread of chikunguniya infection in the national capital on officers hesitant to work
  2. Officers are not willing to take any responsibility and files are sent to the Lieutenant Governor’s office for clearance
  3. SC: File an affidavit on oath giving their (officers’) full details
  4. And you (govt) will be personally responsible for any false facts
  5. Context: The hearing was based on a suo motu PIL petition concerning the suicides of parents of Avinash, a 7-year-old boy who died of suspected dengue in 2015
  6. The boy died after allegedly being denied treatment by five private hospital
Aug, 27, 2016

WHO report sounds alarm on doctors in India- II

  1. Density of doctors: Including allopathic, ayurvedic, homoeopathic and unani, at the national level was 80 doctors per lakh population compared to 130 in China
  2. Nurses and midwives: India had 61 workers per lakh population compared to 96 in China
  3. There is substantial variation in the density of health workers across States and districts where better-off States seemed to afford more doctors plus nurses per capita
Aug, 27, 2016

WHO report sounds alarm on doctors in India- I

  1. Report: The Health Workforce in India
  2. Findings: Almost one-third (31%) of those who claimed to be allopathic doctors in 2001 were educated only up to the secondary school level
  3. Also 57% did not have any medical qualification
  4. Rural: The situation is far worse, where just 18.8% of allopathic doctors had a medical qualification
  5. Female healthcare workers- 38% of the total- were found to be more educated and medically qualified than their male counterparts
Aug, 27, 2016

High out of pocket expenditure (OOPE) on health

  1. OOPE: The money individuals pay on their own rather than being covered by insurance or health benefits
  2. It has been estimated to be around Rs. 2.9 lakh crore or 69% of total health expenditure (THE) in the country
  3. This is alarmingly high and India stands among the highest in this metric worldwide
  4. Half of all the household money that is spent on healthcare- around Rs. 1.5 lakh crore- goes to pharmacies which includes chemists, community and independent pharmacies
Aug, 27, 2016

Low public spending on health

  1. Source: National Health Accounts (NHA) Estimates for the financial year 2013-14, recently released by the Health Ministry after almost a decade
  2. Total: India spent a total of Rs. 4.5 lakh crore on healthcare in 2013-14 at 4% of the GDP, of which Rs. 3.06 lakh crore came from households
  3. Public spending: Abysmally low, constituting around 29 % of the total health expenditure- 1% of GDP
  4. Preventive care: Gets just 9.6% of the total money that flows in India’s healthcare system, including all the government-funded national health programmes such as the National Disease Control Programmes
Aug, 27, 2016

Indians spend 8 times more on private hospitals than on govt. ones

  1. Source: National Health Accounts (NHA) Estimates for the financial year 2013-14, recently released by the Health Ministry after almost a decade
  2. Indians spent 8 times more on private hospitals and twice as much on transporting patients compared to costs in government hospitals
  3. Considering all revenue sources, including government funding, expenditure on private hospitals is double that on government hospitals
  4. NHA: monitors the flow of resources in the country’s health system and provides details of health finances
Jul, 21, 2016

Way ahead for regulation of medical devices

  1. According to the World Health Organisation, the methodology used for medicines cannot be replicated with medical devices when it comes to ‘essentiality
  2. Moreover, coronary stents is a category and not products, just like antibiotics/vaccines are also a category of medicines, which have different drug molecules within them, which can be essential
  3. Way ahead: Singular focus on capping prices of stents will not help improve access to medical devices for patients, as it will not impact the overall procedure cost and will limit the introduction of innovative products
  4. More clarity and a comprehensive, consultative multi-stakeholder approach that involves contributions from all stakeholders is the need of the hour
Jul, 21, 2016

Health Ministry’s notice on reducing coronary stent price

  1. News: Health Ministry issued a notification adding coronary stents to 2015 National List of Essential Medicines (NLEM)
  2. Aim: To bring down prices of stents
  3. Concern: The medical device industry- the price control mechanism would not bode well in creating a conducive environment for FDI in the country
  4. Confederation of Indian Industry (CII): The decision is contradictory to its recent efforts to press forward with legislation that would create separate and appropriate laws for medical devices
  5. Devices v/s drugs: Given the clear distinction between medical devices and drug formulations, the methodology for price control of drug formulations cannot be applied to devices
  6. Medical devices in India are regulated under the Drugs & Cosmetics Act
  7. Background: In response to the government’s call, CII members have already submitted their proposal of voluntary price reduction to the Ministry of Health
  8. This has enabled access of ‘value stent’ at CGHS prices below Rs. 25,000 to all patients
Jun, 27, 2016

Bar coding of drugs to come soon

  1. News: An integrated approach would be undertaken to ensure that sub-standard medicines are weeded out
  2. To be implemented by the Drug Controller General of India (DCGI) along with the Union Health Ministry
  3. Bar coding for medicines, training for drug manufacturers and an integrated approach toward zero tolerance for sub-standard medicines to be followed
  4. Aim: Drugs to be made available to the common man with 100% potency and that aren’t sub-standard
  5. Background: Circulation of sub-standard medicines in the market has come down from 10% in 2002 to 4-4.5% currently
  6. Though India has a barcode system in place for exported medicines, no system is there for domestically produced and imported medicines
May, 19, 2016

Aizawl has highest incidence of cancer in men: Report

  1. Context: According to latest cancer data, Aizawl has the highest incidence of cancer in men while Arunachal Pradesh has highest number of cancer in women
  2. The data was released by the Indian Council of Medical Research (ICMR) collected under Population-Based Cancer Registry (PBCR) programme
  3. Cause: High usage of tobacco in daily life of North eastern states
  4. Top five cancer in men: Lung, Stomach, Prostate, Oesophagus , Brain
  5. In women: Breast, Cervix, Ovary, Thyroid, Mouth
  6. In case of stomach cancer, Chennai has highest incidences than Aizawl
Apr, 14, 2016

Elderly women outnumber men, says NSS report

  1. News: India has more elderly women than men with the sex ratio of the country’s 60-plus population recorded at 1033 in the 2011 Census, up from 1029 in the 2001 census
  2. The share of 60-plus women is higher than that of men in both rural and urban areas
  3. Reason: Women are living longer than men and outlast their husbands by an average of 7 years
  4. Challenge: This is feminisation of ageing, which in the context of a developing country like India, brings with it health and financial concerns
  5. Women traditionally have a much lower economic status than men in the household
Apr, 06, 2016

Govt sacks some foreign-funded consultants

  1. Context: India is firing dozens of foreign-funded health experts working inside the government
  2. It is seen as part of a broader clampdown to reduce the influence of NGOs on policy
  3. Impact: Signature programmes to combat HIV/ AIDS and tuberculosis may suffer
  4. Magnitude: Of the nearly 140 people who run India’s HIV/AIDS programme, 112 are consultants seconded from foreign organisations
Apr, 06, 2016

Govt plans pharma zones to reduce API imports

  1. Context: Govt is considering setting up specified pharmaceutical zones
  2. Aim: To boost domestic manufacture of active pharmaceutical ingredients (APIs)
  3. Why? To reduce the country’s dependence on China for the raw material that is used to produce drugs
  4. Dependence: India has a heavy dependence on China for APIs, importing 90-100% APIs for more than 10 types of drugs
  5. Some of these are crucial drugs such as antibiotics and anti-diabetic medicines
Mar, 31, 2016

Norms for clinical trials eased

  1. News: Health Ministry has amended the Drug and Cosmetics Act (D&C Act)
  2. Context: This exempt clinical trials conducted at academic institutions from taking the hitherto mandatory permission from Drug Controller General of India (DCGI)
  3. Aim: To speed up innovation and research in India
  4. Move is a setback for those working towards a safer, more transparent clinical trials regime
  5. Background: Clinical trials came under SC scrutiny in 2013, after at least 370 deaths were attributed to Serious Adverse Events (SEAs) during
    such trials
  6. In 2013, SC ruled that no new clinical trials be permitted until the regulatory mechanism was reformed
  7. Relevance: Amendment to the D&C Act follows recommendations by the Professor Ranjit Roy Choudhury Committee
Mar, 30, 2016

Health Ministry launches GIS-enabled HMIS application, self-printing of e-CGHS Card

  1. News: Two major Digital initiatives to provide easy access to health services to the public, GIS-enabled HMIS application and the self-printing of e-CGHS card
  2. Context: To strengthening public health systems and providing user-friendly health services in the country
  3. About: GIS-enabled HMIS (Health Management Information System) services will provide comprehensive data on a GIS platform on 1.6 lakh
    Govt Health facilities
  4. HMIS is a web-based monitoring system, to monitor health programmes and provide key inputs for policy formulation and interventions
  5. Self-printing of the E-CGHS (Central Government Health Scheme) card, provide ease and access to all beneficiaries such as the pensioners who may find it difficult to go to the CGHS centres for renewal
Mar, 17, 2016

Kayakalp awards felicitate Public Health Facilities

  1. Context: Felicitation ceremony of Kayakalp awardees for their work in maintaining high standards of sanitation and hygiene in public health facilities
  2. Objectives of Kayakalp awards scheme:
  • To promote cleanliness, hygiene and infection control practices in public health care facilities
  • To incentivize and recognize such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control
  • To inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation
  • To create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes
Mar, 16, 2016

PPP for district hospitals: NITI

  1. Context: Recent presentation on the outcomes in the health sector by NITI Aayog
  2. Govt is in process of developing a framework for PPP in district hospitals
  3. Why? To improve the service levels of district hospitals
  4. Also, India is on track to meet 12th Plan targets in total fertility rate and under-five mortality by 2017
Mar, 15, 2016

OCD, the ‘silent enemy’

  1. News: 3 in every hundred people suffer from some form of obsessive compulsive disorder (OCD), and they may not even be aware of problem
  2. Context: Most people fail to seek treatment at the initial stages but approach a specialist only after 3 or 4 years of suffering from the condition
  3. By then, the treatment becomes difficult as the obsession may have reached an uncontrollable state
  4. Effects: Person suffering from chronic and long-lasting disorder has uncontrollable, recurring thoughts and behaviours, and feels the urge to repeat an action over and over again
  5. What to do? When this causes substantial amount of anxiety and distress and affects family and social life, then person should approach a specialist and seek help
Mar, 14, 2016

Health Ministry launches project Clean Street Food

  1. Aim: To raise the safety standards of foods sold on streets across the capital city of New Delhi
  2. Training: To 20,000 roadside vendors on aspects of health and hygiene, in the first phase
  3. Partnership: Food Safety and Standards Authority of India(FSSAI) with Ministry of Skill Development & Entrepreneurship
  4. Under Recognition of: Prior Learning (RPL) category of Govt’s flagship skills training scheme- Pradhan Mantri Kaushal Vikas Yojana (PMKVY)
  5. Significance: Project shall upgrade the skills of the street food vendors and also contribute to preventive and promotive health
Mar, 07, 2016

Rotavirus vaccine by month-end

  1. News: Indian Council of Medical Research will launch the rotavirus vaccine through the national immunisation programme soon
  2. Background: In Mar, 2015, India launched its first indigenously developed Rotavirus vaccine “Rotavac”
  3. It will be initially provided to all children in AP, Haryana, Odisha and HP and later expanded across the country
  4. Impact: It is expected to bring down the large number of infant deaths due to the Rotavirus diarrhoea in India and across the globe
Mar, 01, 2016

A New Health Protection Scheme announced

  1. Context: A serious illness of family member(s) causes severe stress on the financial condition of poor and economically weak families, shaking the foundation of their economic security
  2. To help families: Govt will launch a new health protection scheme which will provide health cover up-to rupees 1 lakh per family
  3. For Senior citizens: an additional top-up package up to Rs.30,000 will be provided
  4. Another initiative: 3,000 stores under Prime Minister’s Jan Aushadhi Yojana will be opened during 2016-17
  5. This will reinvigorate the supply of generic drugs
Feb, 26, 2016

Low awareness among employees about health cover benefit

  1. Context: Recent ICICI Lombard survey
  2. Finding: Employees have very low awareness about the benefits offered under the group health scheme of their organisations
  3. Only 19% were aware of all benefits provided by the health insurance scheme
  4. Only 8% find the assured sum adequate
  5. Way forward: There could be health care assistance models which would come up in the industry
  6. Staying with an insurer for group health scheme for a longer duration would enable more accountability and better services
Feb, 26, 2016

Birth Companions allowed during Delivery in Public Health facilities

  1. News: Health Ministry has allowed birth companions during delivery in public health facilities
  2. Objective: To reduce Maternal Mortality Ratio and Infant Mortality Rate
  3. Importance: It signifies India’s commitment under SDGs
  4. The WHO promotes labor companionship as a core element of care for improving maternal and infant health
Feb, 22, 2016

Health Minister urges Himachal Govt to take necessary steps to check Jaundice

  1. Context: Health and Family Welfare Minister expressed concern over the situation arising out of outbreak of jaundice in Shimla, Himachal Pradesh
  2. News: Minister urged the state government to take all necessary steps to handle the situation while assuring full support from the Centre in this regard
  3. Relevance: Union Health Ministry sanctions Rs 70 lakh for Indian Council of Medical Research(ICMR) study on Jaundice in Shimla
  4. Aim: To conduct a study so that reoccurrence of this situation can be avoided
  5. Experts’ advise: Sanitation and cleanliness in affected areas need to be improved and contamination of water needed to be checked
Feb, 17, 2016

Collect health insurance cess

  1. Context: The Indian govt’s expenditure in healthcare is amongst the lowest in the world due to tight fiscal discipline
  2. Background: India spends 4.2% of its GDP on healthcare out of which only 1% is contributed by the public sector
  3. Importance: Every $1 invested in the healthcare industry helps to generate $4 through its ancillary industries
  4. Need: To provide health insurance to all citizens as significant percentage of private spending is out-of-pocket
  5. How?- Collect a health-insurance cess for general citizens including BPL population and mandating subscription-based contributions from the organised sector
Feb, 11, 2016

4-day National Arogya Fair-2016 at Dehradun concludes successfully

The 8 Free Government (AYUSH) clinics served more than 1000 patients in four days

  1. The Arogya Fair was organized by the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa & Homoeopathy (AYUSH)
  2. Thousands of visitors benefited from the information gathered about AYUSH Systems in 4 days
  3. The Fair attracted immense participation from all stakeholders, residents, practitioners, academicians, corporates, institutes, university heads and students
  4. Themes – Immune system, Homeopathy in Women’s disorders, Treatment in Ayurveda, Yog se Arogya and
    Non-Communicable Diseases management in Siddha System
Feb, 10, 2016

Health Ministry launches National Deworming initiative

National Deworming initiative to benefit more than 27 crore children in 536 districts of the country

  1. The Union Health Minister stated that India shall be in the forefront of the war against Neglected Tropical Diseases
  2. The Ministry had first launched National Deworming Day (NDD) in 2015 which was implemented in 11 States/UTs, targeting children aged 1 to 19 years
  3. The National Deworming Day will mobilize health personnel, state governments and other stakeholders
  4. To prioritize investment in control of Soil Transmitted Helminth (STH) infections—one of the most common infections
  5. It aims to create mass awareness about the most effective and low-cost STH treatment— administering Albendazole tablets
  6. Deworming has been shown to reduce absenteeism in schools, improve health, nutritional, and learning outcomes
Jan, 25, 2016

32% of girls in AP got married before 18. Says who?

  1. The data on State wide key health indicators of the NFHS is out.
  2. What’s NFHS? National Family Health Survey.
  3. The shocking trend was prevailed across the Andhra Pradesh, despite functioning of Child Protection Committees at various levels in the district.
  4. This survey was the fourth in the series and was released on Tuesday by the Ministry of Health and Family Welfare.
Jan, 25, 2016

Mixed diagnosis on lifestyle diseases

Public health policy should take cognisance of ‘new’ lifestyle diseases

  1. Although, there’s still a long way for much of India to come anywhere near the infant mortality rate levels of Kerala (13) and Tamil Nadu (21) .
  2. Most states have registered significant improvements in maternal and child health indicators compared to the last survey that was carried out in 2005-06.
  3. On the negative side, we are also witnessing the emergence of “new” diseases linked mainly to unhealthy diets and sedentary lifestyles of people.
  4. Virtually all states have a high proportion of men consuming alcohol — from a quarter to well over half — alongside a worrying decline in sex ratios.
  5. These are indicative of a deeper social malaise in a country where growth and rising incomes also create tensions and uncertainties of a different kind.
  6. Public health policy cannot afford to ignore them, even while continuing the fight against the “old” problems of mortality and under-nutrition.
Jan, 23, 2016

The unmet health challenge

India has to use its newly created wealth to alter a dismal record of nutritional deprivation, ill-health.

  1. The first set of data from the National Family Health Survey-4 shows that percentage of underweight children declined from 39 to 34% over a decade.
  2. We need to make access to nutrition and health a right for all.
  3. Asserting this right would require the strengthening of the Integrated Child Development Services scheme
  4. Even within the ICDS, there is a clear deficit in caring for the needs of children under three.
  5. Other key areas requiring intervention are access to antenatal care, reduction of high levels of anaemia among women, and immunisation.
  6. There is a need to assess the health of citizens more frequently than the current NFHS cycle of seven to 10 years allows.
Jan, 22, 2016

National Family Health Survey- 4 (2nd update)

A part of India’s touted demographic dividend — the population below 15 years of age — has decreased in the past decade.

  1. Sikkim has highest decline with 23.1% from 30.7%, followed by MP- 7% decrease.
  2. Our standard of living has shown a rise during the last decade.
  3. Standard of living includes 5 parameters – sanitation facilities, clean cooking fuel source, electricity connection, clean drinking water source and using iodised salt.
  4. Uttarakhand is the only state which showed significant improvement in all five parameters.
Jan, 21, 2016

The case for going universal

Maternity entitlements are an important policy tool for encouraging better maternal health. We need to do away with conditionality in cash transfer scheme.

  1. 2013-2014 Rapid Survey on Children finds that a little less than half of the women aged 15-18 are underweight.
  2. Maternal nutrition is so poor that Indian women actually weigh less at the end of pregnancy than sub-Saharan African women do at the beginning.
  3. Government should put new emphasis on educating women and their families about weight gain during pregnancy.
  4. It should combat the common, though false, notion that women should eat less, not more, during pregnancy
  5. But conditional transfers solve only demand problems while India chiefly faces supply problems ie unavailability of health services.
  6. Also the need to document the fact that conditions have been met invites corruption.
Jan, 21, 2016

Let's know about some more findings of NFHS-4

  1. Indian States have seen some improvements in child nutrition over the last decade, but over one-third children’s are still stunted, and over one-fifth underweight.
  2. Karnataka has recorded a decline in use of modern family planning methods by married women, with just over 50% using them.
  3. Karnataka’s preference for male children appears to be only getting worse with child sex ratio declining to 910 now.
Jan, 21, 2016

Widespread lack of HIV awareness among Indian adults

  1. The latest National Family Health Survey (NFHS) data findings reveal widespread ignorance about HIV/AIDS among adults in India.
  2. This is seen as a direct result of budget cuts, with information, education and communication (IEC) measures and targeted intervention activities coming to a screeching halt.
  3. The Ministry has historically relied heavily on IEC activities, since prevention is the only key method of curbing and reversing the epidemic.
Jan, 20, 2016

Health Ministry to establish two National Centres of Ageing

  1. Govt of India has approved establishment of 2 National Centres of Ageing at AIIMS, New Delhi and Madras Medical College, Chennai.
  2. This is under the tertiary level component of National Programme for Health Care of the Elderly (NPHCE) during the 12th FYP Period.
  3. These National Centres of Ageing are expected to be Centres of Excellence in the field of Geriatric Care in the country.
  4. The functions of the National Centres will be-
    • Health care delivery
    • Training of health professionals
    • Research activities along with 200 bedded in-patient services
Jan, 20, 2016

National Family Health Survey- 4 Phase-1

It covered 11 states – Goa, Meghalaya, Uttarakhand, Tripura, Tamil Nadu, Sikkim, Madhya Pradesh, Karnataka, Haryana, Bihar, West Bengal.

  1. Average sex ratio is 985 in 2015-16 as compared to 1000 in 2005-06 (Last NFHS).
  2. Only Uttarakhand saw an increase in sex ratio. All other states saw a disturbing fall in sex ratio.
  3. Women’s literacy has increased 12.15% since 2005-06.
  4. Institutional deliveries increased by 32.8% in last decade where Karnataka, MP, Bihar saw huge rise of 54.6%, 44.8%, 43.9% respectively.
  5. Almost all mothers have received antenatal care for their most recent pregnancies, and an increasing number of women are receiving the recommended four or more visits by the service providers.
  6. IMR declined in all the states and union territories surveyed—ranging from a low of 10 in Andaman and Nicobar Islands to a high of 51 deaths per 1000 live births in Madhya Pradesh.
  7. Except in Madhya Pradesh, Meghalaya and Bihar, all states and the union territories have achieved replacement level of fertility.
  8. Child marriages also saw a reduction- 13.17% for females & 6.7% for males.
  9. Child malnutrition as well as MMR have declined significantly.
Jan, 19, 2016

Rashtriya Swasthya Bima Yojana to be tech-driven

  1. The universal health cover programme is under review to reduce its premium requirement and wider coverage.
  2. Because of its high loss ratio, public sector insurance companies have been unable to procure reinsurance coverage.
  3. The performance of the Pradhan Mantri Fasal Bima Yojana is expected to provide guidance on how high-tech content can make a difference
  4. Larger use of digital data will do away with the role of patwaris and junior district-level officials to use their discretion to figure out the extent of cropping and to measure the extent of the loss.
Jan, 09, 2016

Healthcare service providers want tax sops in Budget

Healthcare Federation of India (Nathealth), which represents hospitals, medical equipment manufacturers, and insurance companies, has few demands from upcoming budget.

  1. Patient treatment service is currently exempted from service tax and this should continue under GST regime (which would put various sectors under purview of service tax) for at least 10 years.
  2. Increase in tax holidays for establishment of healthcare facilities in non-metros from 5 to 10 years and rise in tax exemption limits on preventive health check-up.
  3. Increase depreciation rate applicable on medical and pathological equipment and medical devices from 15 to 30 per cent and extend tax incentives to hospitals with 50 beds.
  4. This initiative will extend benefits to smaller facilities and will encourage healthcare facilities in Tier-II and -III cities.
  5. Creation of funds to boost medical innovation and healthcare infrastructure in India.
Dec, 26, 2015

On Good Governance Day, Health Minister announces 4 new IT-based initiatives

  1. A major IT initiative, Kilkari is an audio-based mobile service that delivers weekly audio messages to families about pregnancy, childbirth and child care.
  2. A new mobile-based application, Mobile Academy, has been developed through which about 9000,000 ASHAs will be trained using mobile services.
  3. By making the Revised National TB Control Programme (RNTCP) more patient-centric.
  4. Under dedicated toll free number initiative, callers can give a missed call to get complete support for diagnosis, treatment and support on national toll free number.
  5. ‘M-Cessation’ will be an IT-enabled tool to help tobacco users to quit tobacco.
Dec, 21, 2015

Mainstreaming of AYUSH is one of the strategies in NHM

National Policy on Indian Systems of Medicine & Homoeopathy, 2002, envisages integration of AYUSH with the Health Care Delivery System.

  1. This seeks to provide affordable and quality health care in order to improve the existing health care delivery system.
  2. The engagement of AYUSH Doctors/Paramedics and their training is supported by the Department of Health & Family Welfare.
  3. The support for AYUSH infrastructure, equipment/furniture and medicines are provided by Ministry of AYUSH under shared responsibilities.
  4. Medical Council of India (MCI) and IMA have consulted on issue of permitting the medical practitioner.
  5. Under the AYUSH system of medicine to practice allopathy treatment in a limited way.
Dec, 17, 2015

Karnataka has highest stillbirth rate

According to the Sample Registration Survey (SRS) 2013 Karnataka has the highest stillbirth rate in India. That is, 12 deaths per 1,000 births.

  1. The survey notes that Karnataka’s perinatal mortality rate stands at 30 per 1,000 live births.
  2. This is higher than the country’s average of 26 per 1,000 births.
  3. Stillbirths and perinatal mortality are the only two health indicators where Karnataka fares badly.
  4. Higher number of stillbirths also grossly indicates the low pre-natal and natal care for pregnant women in primary health centres.
Dec, 11, 2015

Do governments have a role to play in healthcare? And how?


 

  1. Pure capitalist markets say that the invisible hand of the market will produce the best possible outcomes.
  2. But, we know that such markets do not by design have the ability to provide public goods to all. Why?
  3. What are public goods? We will see the definition later.
  4. Hence, even the market purists relent and say that provision of public goods is a legitimate part of government intervention in the economy.
  5. But what should we do for healthcare? There are more factors involved than just pricing of drugs.
  6. You have asymmetric distribution, communication gaps between providers & patients and so on.
Nov, 25, 2015

Now, COPD to take your breath away

  1. Some recent studies have indicated that Chronic Obstructive Pulmonary Disease (COPD), a progressive disease that makes it hard to breathe is on the rise in the Capital.
  2. Doctors in the city are now being advised to identify and counsel patients who visit them with the problem.
  3. According to experts, after pollution, lack of awareness about this condition is the major reason for increased risk of COPD deaths.
Nov, 21, 2015

Bengal government to train quacks as health workers

  1. The WB govt. has decided to train informal health care providers, referred to as quacks, operating in rural areas of the State.
  2. They will be acknowledged as village health workers with clear delineation of the care that they can provide.
  3. A standard operating procedure will be prepared in consultation with clinical pharmacologist, physician, surgeon and administrators.
  4. This is a very positive step as informal heath care providers operating in rural areas needs to be integrated to the health system.
Nov, 19, 2015

Cabinet approves setting up of National Resource Facility for Bio-medical Research (NARF)

Setting up of a National Resource Facility for Bio-medical Research (NARF) at Genome Valley in Hyderabad by the Indian Council for Medical Research (ICMR).

  1. Institution will be first of its kind for quality laboratory animals for basic and applied biomedical research in country.
  2. It will be developed as a world-class facility for breeding and housing of animals.
  3. Such as primates, cabines and other specialized models such as transgenic and knockout rodents required for testing of various R&D products.
  4. Facility will create, develop and provide access to a range of laboratory animals and technological resources for advancement of biomedical research in country.
Nov, 18, 2015

India tops child deaths due to pneumonia and diarrhoea: study

The report stated that India accounts for one out of five child deaths due to the two diseases.

  1. India carries the highest burden of pneumonia and diarrhoea deaths in children, latest report of John Hopkins Bloomberg School of Public Health said.
  2. In 2015, a projected 2.97 lakh pneumonia and diarrhoea deaths are estimated in children aged less than five in country.
  3. Of the projected 5.9 million deaths of children (aged less than five) in 2015 across the world.
  4. Pneumonia was the top killer at 16 per cent, while diarrhoea came second at 9 per cent share globally.
  5. India had fallen short of the MDG targets of reducing under five-year-olds’ child mortality by two-thirds from 1990 till 2015.
Nov, 18, 2015

Does increased spending mean improved maternal mortality?

  1. The Central government has spent Rs 12,330 crores under Janani Suraksha Yojana (JSY) in the last 10 years and 8,37,19,668 have availed the scheme since its inception.
  2. The scheme saw an increased spending of 20% between 2009-10 and 2014-15.
  3. Institutional Deliveries increased from 38.7% to 72.9% since the launch of JSY.
  4. Kerala, MH and TN have MMR of below 100 with Andhra Pradesh and WB likely to follow soon.
  5. Despite considerable dropdown in MMR, Empowered Action Group states along with Assam have a lot of ground to cover.
  6. Of the total JSY beneficiaries reported in 2014-15, nearly 87% belong to rural areas.
Oct, 30, 2015

Nutrition bureau axed, anti-poverty schemes starved

The National Nutrition Monitoring Bureau (NNMB) has been shut down by the Union Health Ministry.

  1. Reason to shut down, as bureau was running in project mode and Government programmes that run in a project mode for this long are not sustainable.
  2. NNMB provides a good understanding of what people eat and what, therefore, can be culturally accepted nutritional interventions.
  3. NNMB plays a very important role in projecting data in terms of what people are eating.
  4. The data gathered by the NNMB informs the policy intervention to address under-nutrition.

National Nutrition Monitoring Bureau, has a mandate to generate data on the nutritional status of socially vulnerable groups, established in 1972 by Indian Council of Medical Research (ICMR).

Oct, 23, 2015

RSBY failing to provide risk cover

An evaluation of the Rashtriya Swasthya Bima Yojana (RSBY) has concluded that the scheme had little or no impact on medical impoverishment in India.

  1. Despite high enrolment in RSBY, health expenditures have steadily increased for both in-patients and outpatients, over the last two decades.
  2. A major design flaw in RSBY is its narrow focus on secondary and tertiary care hospitalisation.
  3. The govt.-financed health insurance models are designed with the intention to address low-volume, high-value financial transactions.
  4. These health transactions could result in catastrophic expenditure and impoverishment of households.
Oct, 21, 2015

WHO cautions against slashing health spending

Health sector ‘should not be seen as a black hole of expenditures’, says WHO director general Margaret Chan

  1. India is confronted with rising disease burden, worsening pollution and growing shortage of clean drinking water and sanitation.
  2. In this year’s Union budget, Rs.33,152 crore allocated for health and family welfare for fiscal 2016.
  3. India spends about 1.2% of its GDP on public health.
  4. It missed the United Nations Millennium Development Goals targets for infant mortality, under-five mortality and maternal mortality.
  5. Many of India’s health challenges are linked to the poor state of sanitation. It tops the world in open defecation.

India has the highest number of people living below poverty line of $1.6 per day, according to the World Bank.

Oct, 21, 2015

Expert team conducts rapid assessment to declare India Yaws-free

  1. Yaws is a chronic infectious skin disease caused by treponema pallidum subspecies pertenue.
  2. It affects the skin, bone and cartilage and if left untreated, can lead to deformities of the nose and leg bones.
  3. In India the disease was eliminated in Sep, 2006, but field assessment are being conducted to ensure that it has been fully eradicated.
  4. This disease was found more in tribal pockets and hence, elimination has been one of the success stories for public health.
Oct, 20, 2015

Blood banks can borrow blood units from one another

This decision is expected to sort out the issue of shortage.

  1. Union Ministry of Health & Family Welfare made a major modification in the National Blood Policy (NBP), 2002.
  2. The Ministry took this decision as part of reforms to the handling of blood units in the country.
  3. It will increase the availability of essential life saving medicines like immunoglobulins, human albumin and clotting factors which are all derived from plasma.
  4. Reduce the country’s dependence on import of these products.

National Blood Policy aims to ensure easily accessible and adequate supply of safe and quality blood and blood components procured from a voluntary non-remunerated blood donor in well equipped premises, which is stored and transported under optimum conditions.

Sep, 23, 2015

National Health Profile highlights poor doctor-patient ratio

The National Health Profile 2015 is prepared by the Central Bureau for Health Intelligence.

  1. The new official data shows, every govt. hospital serves an estimated 61,000 people in India, with one bed for every 1833 people.
  2. There is a steady increase in out-of-pocket private expenditure on health, with the cost of medicines and hospitalisation accounting for the largest share of the household expenditure.
  3. India spends less of its GDP on health than some of the world’s poorest countries.
  4. The Centre’s share of total public expenditure on health has fallen over the last two years.
  5. Non-communicable diseases are on the rise with cardiovascular diseases accounting for a quarter of deaths from non-communicable diseases and cancer accounting for 6%.
Sep, 18, 2015

Health gives nod to use of injectable contraceptives

Deoxy medroxy progesterone acetate (DMPA) is an injectable drug that prevents pregnancy for three months.

  1. The Health Ministry has given in principle nod to the introduction of injectable contraceptives for women in the family planning programme.
  2. India should provide the option of DMPA in its family planning programme to widen the basket of contraceptive choices for women.
  3. DMPA has a female hormone that prevents the egg from being released from the ovary. It is injected into the arm or buttock muscle.
Aug, 08, 2015

[Discuss] Health as a Fundamental Right

Should India make health a fundamental right? Impediments and Opportunities.


 

We go back to time and start the discussion with this –

The draft National Health Policy 2015 (NPH) released by the National Democratic Alliance (NDA) government on 31 December 2014 seems to have its heart in the right place.

The idea of making health a fundamental right is an old, comfortable, feel-good debate. So let’s consider its broad contours. The case in favour can be summed up as follows: the right to health is a natural corollary of the right to life and, therefore, denying someone healthcare is like denying a living human being the right to live out her natural life span.

What is the case against?

Aug, 06, 2015

India celebrated 1st National Deworming Day

  1. The first national deworming day was celebrated on 10 Feb, 2015.
  2. Agency – Ministry of Health and Family Welfare.
  3. It aims to protect more than 24 crore children in the ages of 1-19 years from intestinal worms by providing Albendazole tablets.
  4. India is now targeting intestinal worms among the children to achieve the status of being “Worm-free”
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