Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Addressing Antimicrobial Resistance (AMR) in the Pandemic Treaty
From UPSC perspective, the following things are important :
Prelims level : AMR, Pandemic Treaty
Mains level : Not Much
Central Idea
- Pandemic Treaty: The latest version of the draft Pandemic Instrument, also known as the “pandemic treaty,” was shared with Member States at the World Health Assembly.
- Removal of AMR Mentions: It became apparent that all mentions of addressing antimicrobial resistance in the Pandemic Instrument were at risk of removal.
What is AMR?
- Antimicrobial resistance (AMR) is the development of resistance in microorganisms to drugs that were once effective against them.
- Microorganisms, including bacteria, fungi, viruses, and parasites, can become “immune” to medications used to kill or control them.
- Misuse or overuse of antibiotics can contribute to the development of AMR.
About the Pandemic Treaty
- Initiation of Work: Work on the Pandemic Instrument began in December 2021.
- Objective: The instrument aims to protect nations and communities from future pandemic emergencies under the WHO’s Constitution.
Importance of Addressing Antimicrobial Resistance (AMR)
- Calls for Inclusion: Civil society and experts, including the Global Leaders Group on Antimicrobial Resistance, have emphasized the inclusion of AMR in the Pandemic Instrument.
- Not Limited to Viruses: Not all pandemics in the past or future are caused by viruses, with bacterial pandemics like plague and cholera being devastating examples.
- Impact of Bacterial Infections: Bacterial infections cause one in eight deaths globally and contribute to the rise of drug-resistant infections.
Need for Comprehensive Pandemic Preparedness
- Wider Range of Threats: Planning and developing effective tools to respond to a broader range of pandemic threats, beyond viruses, is crucial.
- Secondary Bacterial Infections: Even in viral pandemics like COVID-19, secondary bacterial infections become a serious issue, requiring effective antibiotics.
Concerns over Potential Removal of AMR Measures
- Risk to Future Pandemics: The removal of AMR measures from the Pandemic Instrument could hinder efforts to protect people from future pandemics.
- At-Risk Measures: Measures at risk of removal include better access to safe water, infection prevention and control, integrated surveillance, and antimicrobial stewardship.
Strengthening the Pandemic Instrument to Address AMR
- Inclusion of AMR Measures: Measures to address AMR can be easily incorporated into the Pandemic Instrument.
- Recommendations for Inclusion: Recommendations include addressing bacterial pathogens, tracking viral and bacterial threats, and harmonizing AMR stewardship rules.
Efforts to Highlight AMR in the Pandemic Instrument
- Involvement of Specialized Organizations: Civil society and research organizations participated in the WHO’s Intergovernmental Negotiating Body, providing analysis on AMR in the draft.
- Publication of Special Edition: Leading academic researchers and experts published a special edition outlining the importance of addressing AMR in the Pandemic Instrument.
Current State and Next Steps
- Concerns over Removal: Insertions related to AMR are at risk of removal after closed-door negotiations by Member States.
- Importance of the Pandemic Instrument: The instrument is vital for mitigating AMR and safeguarding antimicrobials for treating secondary infections in pandemics.
- Global Political Action: Collaboration and collective efforts are needed to address AMR and support the conservation and equitable distribution of safe and effective antimicrobials.
Safeguarding Antimicrobials for Future Pandemic Response
- Undermining Goals: Missing the opportunity to address AMR in the Pandemic Instrument undermines its broader goals of protecting nations and communities.
- Core Role of Antimicrobials: Antimicrobials are essential resources for responding to pandemics and must be protected.
- Call for Strengthened Measures: Member States should strengthen measures to safeguard antimicrobials and support actions for conserving their effectiveness within the instrument.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
WHO’s advisory on Non-Sugar Sweeteners
From UPSC perspective, the following things are important :
Prelims level : Non-Sugar Sweeteners
Mains level : Read the attached story
Central Idea: The World Health Organization (WHO) issued new guidelines advising against the use of non-sugar sweeteners (NSS) as a healthy alternative to sugar.
What are Non-Sugar Sweeteners?
- NSS are low or no-calorie alternatives to sugar, including aspartame, saccharin, stevia, and others.
- They are marketed for weight loss and controlling blood glucose in individuals with diabetes.
WHO’s Finding
- The WHO analyzed 283 studies on NSS intake in adults and children.
- Higher intake of NSS was associated with a 76% increase in obesity risk and a 0.14 kg/m2 increase in BMI.
- No evidence of long-term benefits on reducing body fat was found, and long-term use of NSS may increase the risk of Type 2 diabetes, cardiovascular diseases, chronic kidney disease, and cancer.
- WHO suggests that NSS should not be used for weight control or reducing the risk of diet-related non-communicable diseases.
Concerns and Recommendations
- India has a high obesity rate and a significant number of people with pre-diabetes.
- Lifestyle-related Type 2 diabetes is increasing among young individuals.
- WHO recommends focusing on a balanced diet and minimally processed, unsweetened foods and beverages.
What lies ahead?
- WHO’s conditional guideline requires further discussions among policymakers before adoption as national policy.
- Efforts should be made to educate youngsters about taste preferences and healthy eating habits.
- Doctors can now provide more confident guidance to patients regarding NSS consumption.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India nears milestone with first indigenous Dengue Vaccine
From UPSC perspective, the following things are important :
Prelims level : Dengue
Mains level : Not Much
Central Idea: Serum Institute of India and Panacea Biotec have applied to the ICMR’s call for Expression of Interest for collaborative Phase-III clinical trials for an indigenous dengue vaccine.
What is Dengue?
Details | |
Transmission | Primarily transmitted through the bite of infected Aedes mosquitoes |
Virus and Serotypes | Dengue virus belonging to the Flaviviridae family
Four distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4 |
Symptoms | High fever, severe headache, joint and muscle pain, rash, pain behind the eyes, mild bleeding |
Severe Dengue | Progression to severe dengue can cause plasma leakage, bleeding, organ impairment |
Geographic Distribution | Endemic in more than 100 countries, particularly in tropical and subtropical regions |
Incidence and Global Impact | 100-400 million dengue infections occur annually globally, affecting healthcare systems and economies |
Vector and Breeding Sites | Aedes aegypti mosquito breeds in stagnant water containers found near human dwellings |
Treatment | No specific antiviral treatment available; supportive care, rest, fluid intake, symptom management |
Prevention and Control | Reduce mosquito breeding sites, proper water storage, cleaning of water containers, use of insecticides |
Dengue Virus Disease and Global Impact
- Dengue virus disease causes significant morbidity and mortality worldwide, with 2 to 2.5 lakh (200,000 to 250,000) cases reported annually in India.
- The global incidence of dengue has increased dramatically, with over half of the world’s population at risk.
- The World Health Organization (WHO) has identified dengue as one of the top ten global health threats in 2019.
- Currently, there is no specific treatment for dengue, highlighting the urgent need for effective vaccines.
Desirable Characteristics of a Dengue Vaccine
The ICMR highlights the desirable characteristics of a dengue vaccine, including a-
- Favorable safety profile
- Protection against all four serotypes of dengue
- Reduced risk of severe disease and death
- Induction of a sustained immune response and
- Effectiveness regardless of previous sero-status and age
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India’s G20 Presidency: Strengthening Global Health Governance for Safer and Equitable World
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Universal Health Coverage, challenges and India's G20 presidency
Central Idea
- India’s G20 presidency is gaining momentum, with a focus on harnessing shared responsibilities and collaborative governance to enhance global safety from pandemics. It seeks to bridge the gap between the Global North and Global South, recognizing the inclusive memberships of G20 and other plurilateral arrangements that span the global community.
Importance of Health as a global public good
- Interconnectedness: In today’s interconnected world, diseases can quickly spread across borders, transcending geographical boundaries. The health of individuals and communities in one part of the world can have direct implications for others. Therefore, addressing health issues becomes a shared responsibility for all nations.
- Impact on Global Stability: Health crises, such as pandemics, can have severe social, economic, and political consequences. They can disrupt economies, strain healthcare systems, and cause social unrest. By ensuring health as a global public good, we contribute to global stability, sustainable development, and peaceful coexistence.
- Humanitarian Imperative: Health is a fundamental human right. Everyone deserves access to quality healthcare and the opportunity to lead a healthy life. Treating health as a global public good ensures equitable access to healthcare services, regardless of an individual’s nationality or socioeconomic status.
- Economic Productivity: Healthy populations are essential for economic productivity and growth. By investing in health as a global public good, we can create conditions for individuals to thrive, contribute to their communities, and participate actively in economic activities.
- Prevention and Preparedness: Addressing health as a global public good requires proactive measures to prevent and prepare for health emergencies. By investing in disease surveillance, research, and robust healthcare systems globally, we can better detect and respond to outbreaks, mitigating their impact and saving lives.
- Collaboration and Knowledge Sharing: Recognizing health as a global public good encourages collaboration among nations. By sharing knowledge, best practices, and resources, countries can collectively work towards improving public health outcomes, fostering innovation, and finding solutions to complex health challenges.
- Achieving Sustainable Development Goals: Health is intricately linked to several Sustainable Development Goals (SDGs), including good health and well-being (SDG 3), poverty eradication (SDG 1), and gender equality (SDG 5). Treating health as a global public good support the achievement of these interconnected goals, leading to a more equitable and sustainable world.
India’s response to Covid-19: Whole-of-society and whole-of-government approach
- Early Measures and Nationwide Lockdown: India implemented one of the world’s largest and strictest nationwide lockdowns in March 2020 to contain the spread of the virus. This decision aimed to break the chain of transmission and provide time to strengthen healthcare infrastructure.
- Testing and Surveillance: India significantly ramped up its testing capacity, expanding the network of testing laboratories across the country. The government implemented various testing strategies, including rapid antigen tests and RT-PCR tests, to detect and track Covid-19 cases.
- Healthcare Infrastructure: To bolster healthcare infrastructure, the government initiated several measures such as establishing dedicated Covid-19 hospitals, increasing the number of ICU beds, ventilators, and oxygen supply, and mobilizing healthcare professionals to regions facing surges in cases.
- Vaccine Development and Rollout: India played a crucial role in vaccine development, with its indigenous vaccine candidates receiving regulatory approval. The country launched an ambitious vaccination drive, prioritizing healthcare workers, frontline workers, and vulnerable populations. India also contributed to global vaccine supply through the export of vaccines under the Vaccine Maitri initiative.
- Economic Relief Measures: Recognizing the socioeconomic impact of the pandemic, the government introduced economic relief measures, including financial assistance, direct benefit transfers, and welfare schemes to support vulnerable sections of society affected by lockdowns and job losses.
- Collaborations and International Aid: India engaged in international collaborations, sharing its experiences and expertise, and cooperating with other countries in areas such as research, drug repurposing, and knowledge exchange. The country also received international assistance in the form of medical supplies and equipment.
- Focus on Healthcare Infrastructure and Research: The government emphasized strengthening healthcare infrastructure, investing in research and development, and promoting indigenous manufacturing of medical equipment and supplies. Efforts were made to enhance testing capacity, develop innovative solutions, and support research on therapies and diagnostics.
- Communication and Awareness: The government and health authorities prioritized public communication and awareness campaigns to disseminate accurate information, promote preventive measures, and combat misinformation related to the virus.
What is Universal Health Coverage (UHC) by 2030?
- UHC 2030 is a global movement and partnership that aims to accelerate progress towards achieving Universal Health Coverage (UHC) by the year 2030.
- UHC 2030 is a collaborative initiative led by multiple stakeholders, including governments, international organizations, civil society, and the private sector, with the goal of ensuring that all individuals and communities have access to essential healthcare services without suffering financial hardship.
- UHC 2030 builds upon the commitment made by United Nations member states in 2015 through the Sustainable Development Goals (SDGs).
Challenges in achieving UHC by 2030?
- Financing: Adequate and sustainable financing is crucial for UHC. Many countries struggle with limited healthcare budgets, inefficient resource allocation, and inadequate public financing. Mobilizing sufficient funds to cover the costs of expanding healthcare services and ensuring financial protection for all individuals can be a significant challenge.
- Health Workforce: The availability, distribution, and quality of healthcare professionals pose challenges to UHC. Many countries face shortages of skilled healthcare workers, particularly in rural and remote areas. Strengthening the health workforce, ensuring equitable distribution, and improving their training and retention are critical for delivering quality healthcare services.
- Health Infrastructure: Insufficient and inadequate healthcare infrastructure, including facilities, equipment, and technologies, can hinder the achievement of UHC. Many regions, especially in low-income countries, lack the necessary healthcare infrastructure to provide essential services to all populations. Investments in infrastructure development and strengthening are required to expand access and ensure quality care.
- Inequities and Vulnerable Populations: UHC aims to address health inequities and reach vulnerable and marginalized populations. However, socioeconomic disparities, gender inequalities, and discrimination can hinder equitable access to healthcare services. Special attention is needed to address these inequities and ensure that UHC benefits all individuals, irrespective of their social or economic status.
- Health Information Systems: Establishing robust health information systems is essential for effective UHC implementation. However, many countries face challenges in data collection, management, and utilization. Strengthening health information systems, including electronic health records and data analytics, is crucial for monitoring progress, making informed decisions, and improving service delivery.
- Political Will and Governance: UHC requires strong political commitment and effective governance. Political will at the national level is necessary to prioritize UHC, allocate resources, and implement necessary policy reforms. Ensuring transparency, accountability, and efficient governance mechanisms are crucial to prevent corruption, ensure equitable service delivery, and maintain public trust.
- Changing Disease Patterns: The evolving burden of diseases, including the rise of non-communicable diseases, poses challenges to UHC. Chronic conditions require long-term management and specialized care, placing additional strain on healthcare systems. Adapting healthcare delivery models and integrating prevention and control strategies for these diseases are essential components of UHC.
- Global Health Security: Public health emergencies and global health security threats, as witnessed during the Covid-19 pandemic, can disrupt healthcare systems and hinder progress towards UHC. Strengthening health emergency preparedness and response capacities is vital to mitigate the impact of outbreaks and ensure continuity of healthcare services.
How India’s G20 presidency: Significant role in achieving UHC by 2030
- Knowledge Sharing and Best Practices: As the G20 president, India can facilitate the sharing of knowledge and best practices among member countries. This includes sharing successful UHC models, innovative healthcare delivery approaches, and strategies to overcome challenges. By promoting knowledge exchange, countries can learn from each other’s experiences and accelerate progress towards UHC.
- Advocacy for UHC: India can use its platform as G20 president to advocate for UHC as a global priority. Through diplomatic channels and international forums, India can emphasize the importance of UHC in achieving sustainable development and equitable healthcare access. This advocacy can encourage other G20 member countries to prioritize UHC and align their policies and actions accordingly.
- Collaboration with Global Health Organizations: India’s G20 presidency can facilitate collaboration with global health organizations such as the World Health Organization (WHO), World Bank, and other relevant entities. By working closely with these organizations, India can contribute to the development and implementation of strategies and initiatives that support UHC, including capacity building, technical assistance, and funding mechanisms.
- Promoting Innovative Financing Mechanisms: India can explore and promote innovative financing mechanisms for UHC. This includes advocating for increased public investment in healthcare, exploring public-private partnerships, and encouraging the development of social health insurance schemes. By identifying and sharing successful financing models, India can provide valuable insights to other G20 countries on sustainable funding for UHC.
- Strengthening Primary Healthcare Systems: India’s G20 presidency can focus on strengthening primary healthcare systems, which are integral to UHC. This involves enhancing access to quality primary healthcare services, addressing health workforce shortages, improving infrastructure, and promoting preventive and promotive healthcare measures. Sharing India’s experiences and initiatives in primary healthcare can inspire other countries to invest in this essential aspect of UHC.
- Leveraging Digital Health Technologies: India has made significant strides in adopting digital health technologies, and its G20 presidency can highlight the potential of these technologies in advancing UHC. By sharing digital health success stories and facilitating collaborations in areas such as telemedicine, health information systems, and mobile health applications, India can accelerate the adoption of digital solutions for healthcare access and delivery.
- South-South Cooperation: India’s G20 presidency can promote South-South cooperation and collaboration among G20 member countries and other nations from the Global South. By fostering partnerships, sharing experiences, and supporting capacity-building efforts, India can facilitate collective progress towards UHC in regions that face similar challenges.
Conclusion
- India’s G20 presidency aims to leverage collaborative governance and shared responsibilities to create a safer world from pandemics. India’s engagement with Japan’s G7 presidency and the focus on resilient, equitable, and sustainable UHC and global health architecture development further demonstrate shared responsibilities and the commitment to addressing public health emergencies. Through collective efforts, we can heal our planet, foster harmony within our global family, and offer hope for a better future.
Also Read:
Digital healthcare Services |
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Govt. program for Non-Communicable Diseases renamed
From UPSC perspective, the following things are important :
Prelims level : Non-Communicable Diseases (NCDs)
Mains level : Govt policies and actions against NCDs
Central Idea: The article discusses the decision by the Indian Ministry of Health and Family Welfare to rename and expand its program for the control and prevention of non-communicable diseases (NCDs).
What are Non-Communicable Diseases (NCDs)?
- NCDs are also known as chronic diseases, which are not caused by infectious agents and are not transmissible from person to person.
- NCDs are long-lasting and progress slowly, typically taking years to manifest symptoms.
- Examples of NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
- These diseases are often caused by modifiable risk factors such as unhealthy diet, lack of physical activity, tobacco and alcohol use, and environmental factors.
- NCDs are a major cause of morbidity and mortality worldwide, accounting for around 70% of all deaths globally.
Why in news?
- The addition of many new diseases and health initiatives have prompted the Indian government to expand and rename its NCD program.
Renaming of the NCD Program and Portal
- The Ministry has renamed the NPCDCS as the “National Programme for Prevention & Control of Non-Communicable Diseases [NP-NCD].”
- The application or software named Comprehensive Primary Healthcare Non-Communicable Disease (CPHC NCD IT) will now be renamed “National NCD Portal.”
- The Ministry communicated this decision to the States on May 3, 2023, through a one-page letter and asked them to adhere to the changes.
Implementation and future action
- The NPCDCS is implemented under the National Health Mission across India.
- The letter addressed to Principal Secretaries and Health Secretaries of all States and Union Territories advised the government to use the new names for the scheme and portal in all their future references and correspondences with the Indian government.
- Under NPCDCS, 677 NCD district-level clinics, 187 District Cardiac Care Units, 266 District Day Care Centres and 5,392 NCD Community Health Centre-level clinics have been set up.
Burden of NCDs in India
- The study ‘India: Health of the Nation’s States – The India State-Level Disease Burden Initiative in 2017’ by the ICMR estimated that the proportion of deaths due to NCDs in India has increased from 37.9% in 1990 to 61.8% in 2016.
- The four major NCDs are:
- Cardiovascular diseases (CVDs)
- Cancers
- Chronic respiratory diseases (CRDs) and
- Diabetes
- The study shared four behavioural risk factors – unhealthy diet, lack of physical activity, and the use of tobacco and alcohol.
Solutions to mitigate NCD burden
- Promote healthy lifestyle: Encourage people to adopt healthy lifestyle habits such as regular physical activity, balanced and nutritious diet, avoiding tobacco and alcohol, and getting enough sleep.
- Increase awareness and education: Increase awareness among the public about the risk factors of NCDs and educate them about ways to prevent these diseases.
- Improve healthcare infrastructure: Increase access to healthcare facilities, especially in rural and remote areas, to ensure early detection, treatment, and management of NCDs.
- Implement policies and regulations: Implement policies and regulations that promote healthy living, such as increasing taxes on tobacco and alcohol products, and regulating the marketing of unhealthy food products.
- Foster public-private partnerships: Foster partnerships between the government, private sector, and civil society organizations to work collaboratively towards preventing and managing NCDs.
- Increase research and innovation: Increase research and innovation in the prevention, early detection, and treatment of NCDs to develop new and effective interventions.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Tele-MANAS counsels distressed people
From UPSC perspective, the following things are important :
Prelims level : Tele-MANAS
Mains level : Mental health and telemedicine
Central Idea: The Institute of Mental Health and Neurosciences (IMHANS) in Srinagar has received 10,500 calls from people in distress across Jammu and Kashmir over the past six months.
What is Tele-MANAS?
- Tele Mental Health Assistance and Networking across States (Tele-MANAS) initiative has been launched by Ministry of Health & Family Welfare during October 2022.
- It aims to provide free tele-mental health services all over the country round the clock, particularly catering to people in remote or under-served areas.
Implementation of the scheme
- Counselling: The programme includes a network of 38 tele-mental health centres of excellence spread across 27 States and UTs working in over 20 languages.
- Helpline: A toll-free, 24/7 helpline number (14416) has been set up across the country allowing callers to select the language of choice for availing services. Service is also accessible with 1-800-91-4416.
Two-tier working
- Tele-MANAS will be organised in two-tier system; Tier 1 comprises of state Tele-MANAS cells which include trained counsellors and mental health specialists.
- Tier 2 will comprise of specialists at District Mental Health Programme (DMHP)/Medical College resources for physical consultation and/or e-Sanjeevani for audio-visual consultation.
Expansion of the scheme
- The initial rollout providing basic support and counselling through centralized Interactive Voice Response system (IVRS) is being customized for use across all States and UTs.
- It is being linking with other services like National tele-consultation, e-Sanjeevani, Ayushman Bharat, mental health professionals, health centres, and emergency psychiatric facilities for specialized care.
- This will not only help in providing immediate mental healthcare services, but also facilitate continuum of care.
- Eventually, this will include the entire spectrum of mental wellness and illness, and integrate all systems that provide mental health care.
Back2Basics: National Tele Mental Health Programme (NTMHP)
- The Indian Government announced the National Tele Mental Health Programme (NTMHP) in the Union Budget 2022-23.
- The National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru is the nodal centre for the programme.
- The programme sought to establish a digital mental health network that can address the mental health crisis in the wake of the COVID-19 pandemic.
- The pandemic has brought forth the challenges of mental health, and the NTMHP aims to provide accessible and affordable mental health services to all.
- The programme will involve the use of digital platforms such as teleconsultations, chatbots, and mobile applications to deliver mental health services.
- The NTMHP will integrate with existing mental health services to provide a comprehensive and coordinated approach to mental healthcare.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India’s One Health Approach to Tackle Future Pandemics
From UPSC perspective, the following things are important :
Prelims level : Global Health Security Index, PM ABHIM and related schemes and facts
Mains level : India's One health approach
Central Idea
- The Covid-19 pandemic exposed weaknesses in the world’s health systems, including countries ranked high in the Global Health Security Index. It has also provided an opportunity to build stronger health systems to prevent and respond to future pandemics. India’s One Health approach aims to address the health of people, animals, and ecosystems together in order to prevent, prepare, and respond to pandemics.
What is PM Ayushman Bharat Health Infrastructure Mission (PM ABHIM)?
- PM ABHIM is being rolled out as India’s largest scheme to scale up health infrastructure.
- It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.
- Key features:
- Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
- Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
- Integrated public health labs: It will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
- Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
- Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.
Facts for prelims
What is Global Health Security Index?
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What is mean by One health?
- One Health is an interdisciplinary approach that recognizes the interconnectedness of human, animal, and environmental health.
- It emphasizes the need for collaboration between various sectors, including public health, veterinary medicine, environmental science, and others, to achieve optimal health outcomes for all.
key components of India’s One Health approach
- Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): The flagship program launched in October 2021 aims to prevent, prepare, and respond to pandemics. It seeks to fill the gaps in health systems at the national and state levels.
- National Institute for One Health: The foundation for the institute was laid recently in Nagpur. It will identify hotspots for endemic and emerging zoonotic diseases to contain their spread early on.
- Creation of a network of institutions for genomic surveillance: During the COVID-19 pandemic, India created a formidable network of institutions that can identify new pathogens. This can now be complemented with wider testing of wastewater and samples from incoming ships and aircraft.
- Coordination between ministries: Several ministries, including health, animal husbandry, forests, and biotechnology, have been brought under the Principal Scientific Advisor to address overlapping mandates and improve coordination.
- Expansion of research laboratories: India is expanding its network of research laboratories, which primarily focused on influenza, to cover all respiratory viruses of unknown origin.
- Partnerships between research bodies and manufacturers: Indian manufacturers produced vaccines, test kits, therapeutics, masks and other items at very competitive prices, both for India and other countries. The partnerships between research bodies and manufacturers will need to be sustained and enhanced to make India a global hub in the biopharma sector.
- Clinical trial network: The clinical trial network set up under the National Biopharma Mission is a positive step toward improving access to affordable new vaccines and drugs in India and around the world.
- Ayushman Bharat Digital Health Mission: The mission can facilitate the bringing of private hospitals and clinics under a common platform and placing data in the public domain to augment surveillance in vulnerable areas.
- Municipal corporations mandated to provide early alerts: Municipal corporations have been mandated to identify the most vulnerable areas and provide early alerts. For this to be successful, strong partnerships with communities, dairy cooperatives, and the poultry industry will be needed to identify new infections.
What are the potential advantages of the One Health approach?
- Holistic approach: The One Health approach looks at the interconnectedness of human, animal, and environmental health. By taking a holistic approach, it enables a better understanding of the complex interconnections between human, animal, and environmental health, and can lead to more effective interventions and solutions
- Early disease detection: The One Health approach emphasizes the importance of early disease detection in animals, which can serve as an early warning system for potential human outbreaks. This approach can help prevent the spread of diseases and reduce the risk of pandemics.
- Better disease surveillance: The One Health approach facilitates better disease surveillance by enabling the sharing of information and resources between different sectors, including human health, animal health, and environmental health.
- More effective responses: The One Health approach can lead to more effective responses to outbreaks by facilitating collaboration between different sectors and stakeholders, and ensuring a coordinated response.
- Improved animal health: The One Health approach recognizes the importance of animal health and welfare, and can lead to improved animal health through better disease control and prevention measures.
- Better environmental management: The One Health approach also recognizes the importance of environmental management and conservation, and can lead to more sustainable environmental practices that benefit both human and animal health.
Conclusion
- India’s One Health approach is a positive step towards addressing the health of people, animals, and ecosystems together. The country’s efforts to tackle future pandemics are commendable, and the success of these efforts will be critical. The rise of new pathogens, zoonotic diseases, and antibiotic resistance highlights the need for a comprehensive approach to prevent future pandemics. India’s efforts to build stronger health systems, prevent pandemics, and respond to outbreaks will help protect its citizens and set an example for the world.
Mains Question
Q. What do you understand by mean One Health? Discuss the advantages of One health approach the efforts of India in this direction.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Latest National Health Account figures on India’s Healthcare Sector
From UPSC perspective, the following things are important :
Prelims level : National Health Account (NHA) estimates
Mains level : Read the attached story
Central idea: The National Health Account Estimates 2019-20 report shows an increase in government spending and a decline in out-of-pocket expenditure on healthcare.
About National Health Account (NHA) estimates
- The NHA estimates for India 2019-20 is the seventh consecutive report prepared by the National Health Systems Resource Centre (NHSRC).
- NHSRC was designated as National Health Accounts Technical Secretariat (NHATS) in 2014 by the Union Health Ministry.
- The NHA estimates use an accounting framework based on the internationally accepted standard of System of Health Accounts, 2011 developed by the WHO.
- India now has a continuous series of NHA estimates from 2013-14 to 2019-20, making the estimates comparable internationally.
- The estimates enable policymakers to monitor progress in different health financing indicators of the country.
Key highlights
Description |
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Government spending as % of GDP |
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Declining out-of-pocket expenditure |
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Government spending on primary healthcare |
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Increase in social security expenditure |
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Increase in spending on insurance |
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Health spending by states |
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Key issues
- Marginal increase: Activists are concerned about the marginal increase in government spending.
- Global laggard: This increase in government health expenditure as a percentage of GDP also takes into account capital spending, which puts India in 164th place out of 184 countries in terms of government health spending.
- No proportional increase: Total spending on health as a proportion of GDP has been going down, from 3.9% in 2015 to 3.3% in 2020, indicating a decline in consumption of healthcare services.
Conclusion
- Overall, the report shows that government spending on healthcare has been increasing, while out-of-pocket expenditure has been declining.
- There is a need to invest in public health and insurance and increase the contribution of states towards healthcare.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
[pib] Cabinet approves the Policy for the Medical Devices Sector
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : National Medical Devices Policy, 2023
Central idea: The Union Cabinet, chaired by Hon’ble Prime Minister, approved the National Medical Devices Policy, 2023.
National Medical Devices Policy, 2023
- The Policy, 2023 aims to facilitate an orderly growth of the medical device sector to meet the public health objectives of access, affordability, quality, and innovation.
- The policy lays down a roadmap for accelerated growth of the medical devices sector to achieve various missions.
Objectives
- The policy aims to make the industry competitive, self-reliant, resilient, and innovative.
- It focuses on meeting the healthcare needs of not only India but also the world.
- It aims to accelerate the growth of the medical devices sector.
- It takes a patient-centric approach to meet the evolving healthcare needs of patients.
- It provides support and directions to the medical devices industry to achieve these goals.
Strategies to Promote Medical Device Sector
The medical devices sector will be facilitated and guided through a set of strategies that cover six broad areas of policy interventions:
Key measures and actions |
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1. Regulatory Streamlining | Enhance ease of doing research and business, balance patient safety with product innovation, create a Single Window Clearance System for licensing of medical devices, enhance the role of Indian Standards like BIS, and design a coherent pricing regulation. |
2. Enabling Infrastructure | Establish and strengthen large medical device parks and clusters equipped with world-class common infrastructure facilities in proximity to economic zones with requisite logistics connectivity. |
3. Facilitating R&D and Innovation | Promote research and development in India, establish centres of excellence in academic and research institutions, innovation hubs, and support for startups. |
4. Attracting Investments in the Sector | Encourage private investments, funding from venture capitalists, and public-private partnerships, in addition to existing schemes and interventions like Make in India, Ayushman Bharat program, Heal-in-India, and Start-up mission. |
5. Human Resources Development | Ensure a steady supply of skilled workforce across the value chain by leveraging available resources in the Ministry of Skill Development and Entrepreneurship, supporting dedicated multidisciplinary courses for medical devices in existing institutions, and developing partnerships with foreign academic/industry organizations to develop medical technologies. |
6. Brand Positioning and Awareness Creation | Create a dedicated Export Promotion Council for the sector under the Department, initiate studies and projects for learning from best global practices of manufacturing and skilling system, promote more forums to bring together various stakeholders for sharing knowledge, and build strong networks across the sector. |
Medical devices sector in India: A quick recap
- The medical devices sector in India is an essential and integral part of the Indian healthcare sector.
- The sector has contributed significantly to the domestic and global battle against the COVID-19 pandemic through the large-scale production of medical devices & diagnostic kits.
Growth potential in India
- The market size of the medical devices sector in India is estimated to be $11 billion (approximately, ₹ 90,000 Cr) in 2020, and its share in the global medical device market is estimated to be 1.5%.
- The Indian medical devices sector has enormous potential to become self-reliant and contribute towards the goal of universal health care.
Current initiatives in this sector
- The Government of India has initiated the implementation of the PLI Scheme for medical devices.
- It supports for setting up of four Medical devices Parks in the States of Himachal Pradesh, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Preparedness and Resilience for Emerging Threats (PRET) Initiative
From UPSC perspective, the following things are important :
Prelims level : PRET Initiaitve
Mains level : Not Much
Central Idea: The World Health Organization (WHO) has launched a PRET initiative to be better prepared for future outbreaks of a similar scale and devastation as the COVID-19 pandemic.
What is PRET Initiative?
- The Preparedness and Resilience for Emerging Threats (PRET) initiative is launched by the WHO to prepare for future outbreaks of a similar scale and devastation as the COVID-19 pandemic.
- It is aimed at providing guidance on integrated planning for responding to any respiratory pathogen such as influenza or coronaviruses.
- The current focus of PRET is on respiratory viruses, but work is already underway to assess what should be the next group of pathogens to be mitigated under this initiative.
- It can serve to operationalize the objectives and provisions of the Pandemic Accord, which is currently being negotiated by WHO Member States.
Three-pronged approach of PRET
- The three-pronged approach includes-
- Updating preparedness plans
- Increasing connectivity among stakeholders in pandemic preparedness planning, and
- Dedicating sustained investments, financing, and monitoring of pandemic preparedness.
- The approach has a special focus on bridging the gaps highlighted during the COVID-19 pandemic and ensuring community engagement and equity are at the centre of preparedness and response efforts.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Malaria soon to be a notifiable disease across India
From UPSC perspective, the following things are important :
Prelims level : Malaria
Mains level : Read the attached story
Malaria is all set to become a notifiable disease across India, which will require cases to be reported to government authorities by law.
About Malaria
Description | |
Definition | A potentially life-threatening disease caused by parasites that are transmitted through the bite of infected female Anopheles mosquitoes |
Causes | Four species of plasmodium parasites, namely plasmodium vivax, plasmodium falciparum, plasmodium malariae, and plasmodium ovale |
Spread | Bite of infected female Anopheles mosquitoes |
Symptoms | Fever, chills, headache, muscle pain, fatigue, nausea, vomiting |
Diagnosis | Blood test |
Treatment | Antimalarial drugs |
Prevention | Insecticide-treated bed nets, indoor residual spraying, wearing protective clothing, using mosquito repellent, avoiding mosquito bites |
Vaccine | RTS,S/AS01 (Mosquirix) |
Why in news?
- The move is part of India’s vision to become malaria-free by 2027 and to eliminate the disease by 2030.
Menace of malaria in India
- In India, 80% of malaria cases occur among 20% of its population living in the 200 high-risk districts of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, West Bengal and the seven north-eastern states.
- With only fewer than half of those infected reaching a clinic or hospital, the cases and deaths are much higher than recorded.
What is Notifiable Disease?
- A notifiable disease is a disease that is required by law to be reported to government authorities.
- In India, the Ministry of Health and Family Welfare maintains a list of notifiable diseases under the National Health Mission.
- This is done to track the spread of the disease and to take necessary measures to control and prevent its spread.
- Reporting notifiable diseases is important for public health surveillance and response to outbreaks.
Malaria as a Notifiable Disease
- Malaria is currently a notifiable disease in 33 states and Union Territories in India.
- Bihar, Andaman and Nicobar Islands, and Meghalaya are in the process of putting malaria in the notifiable disease category.
Other measures to curb malaria
- Malaria Elimination Programme: The government has launched the National Framework for Malaria Elimination in India 2016-2030 to eliminate malaria from the country by 2030.
- Joint Action Plan: The Health Ministry has initiated a joint action plan with the Ministry of Tribal Affairs for malaria elimination in tribal areas. This plan aims to bring down malaria cases to zero in tribal areas, which are among the most vulnerable to the disease.
- HIP-Malaria Portal: The Ministry has ensured the availability of near-real-time data monitoring through an integrated health information platform and periodic regional review meetings to keep a check on malaria growth across India.
Vaccines developed so far
- The WHO has approved the rollout of two first-generation malaria vaccines, RTS,S and R21, in high-transmission African countries.
- Bharat Biotech, an Indian company, has been licensed to manufacture the RTS,S vaccine, with adjuvant provided by GSK.
- The R21 vaccine, developed by scientists at Oxford University, has shown promising results in phase 2 clinical studies and has been approved by regulatory authorities in Ghana and Nigeria.
- Scientists at the International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi have developed and produced two experimental blood-stage malaria vaccines, with Phase I clinical trials completed for one of them.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India’s population to edge ahead of China’s by mid-2023: UN
From UPSC perspective, the following things are important :
Prelims level : Freedom of speech and reasonable restrictions
Mains level : Global population trends
Central idea: India is set to overtake China as the world’s most populous country by mid-2023, according to data released by the United Nations.
State of World Population Report
- The report is an annual report published by the United Nations Population Fund (UNFPA), which provides a global overview of population trends and issues.
- The report covers a wide range of topics related to the population, such as fertility, mortality, migration, family planning, and gender equality.
- It also includes analysis and recommendations for policymakers and governments to address population challenges and promote sustainable development.
- The report is widely regarded as a key reference for researchers, policymakers, and international organizations working on population and development issues.
Highlights of the 2023 report
Facts |
Data |
World Population (2022) | 8 billion |
Most populous regions | Eastern and Southeastern Asia, Central and Southern Asia |
World Population Growth Rate (since 2020) | Less than 1% |
Fertility Rate (replacement level) | 2.1 children per woman |
Population aged 65 years or above (2050) | 16% |
Persons aged 65 years and above (2050) | More than double that of 5-year-olds and same as 12-year-olds |
Regions with fertility rate at or below 2.1 | 60% |
Top countries accounting for global population increase by 2050 | DR Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, Philippines, Tanzania |
Population anxieties in India
Facts | |
India’s population | India is now the most populous country in the world, having overtaken China in population, with 1,428.6 million people. |
Age distribution | 68% of India’s population belongs to the 15-64 years category, and 26% in the 10-24 years group, making India one of the youngest countries in the world. |
Fertility rate | National Family Health 5 Survey (2019-21) found that India attained a Total Fertility Rate of 2.0 for the first time, less than the replacement level of 2.1, falling from 2.2 in NFHS 4 (2015-16). |
Life expectancy | Life expectancy for men in India is 71 years, the same as the global life expectancy, while it is marginally lower for women at 74 years. |
Population growth | India’s population growth rate has decreased from 2.3% in 1972 to less than 1% now. |
Demographic dividend | With 68% of its population as youth, and working population, India could have one of the largest workforces in the world, giving it a global advantage. |
Way forward
The UNFPA report strongly recommended that governments introduce policies with gender equality and rights at their heart to address changing demographics. These recommendations include:
- Parental leave programs: Introducing parental leave programs that provide paid leave to both mothers and fathers after the birth or adoption of a child. This can help promote gender equality in the workplace and support families in raising children.
- Child tax credits: Providing tax credits or financial support to families with children to help them meet the costs of raising children. This can help address child poverty and support families in providing for their children’s basic needs.
- Policies to promote gender equality at workplace: Implementing policies and practices that promote gender equality in the workplace, such as equal pay for equal work, flexible work arrangements, and anti-discrimination policies.
- Universal access to sexual and reproductive health and rights: Ensuring that all people have access to comprehensive sexual and reproductive health services, including family planning, maternal health services, etc. This can help prevent unintended pregnancies, reduce maternal mortality, and promote the health and well-being of individuals and families.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Healthcare: Need For Compassionate Leadership
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Role of compassion in healthcare
Central Idea
- India’s rapid strides in health and healthcare with the help of a digital boom and the Ayushman Bharat Digital Mission, and the need for compassionate leadership to ensure respectful healthcare.
India’s healthcare sector
- India’s healthcare sector has shown improvement in multiple metrics due to the push for healthcare digitization, infrastructure, coverage, and other inputs.
- However, healthcare is not just about the treatment of diseases or the availability of infrastructure but also about the overall wellness of the person.
- Respectful healthcare that is available, affordable, accessible, and compassionate is a determinant of the quality of care.
Importance of Compassionate leadership
- Respectful and compassionate healthcare is essential: Healthcare is a perpetually evolving, stressful, and high-risk industry that puts a vast burden on healthcare providers. It is essential to navigate and manage the situation compassionately to deliver respectful care.
- Compassion is a beating heart if healthcare: Compassionate leadership is required to build this type of healthcare system, as it is the quiet, beating heart of the entire healthcare system.
Curriculum for compassionate healthcare
- Compassionate curriculum is very necessary: To integrate compassion into the healthcare system at every stage, it is necessary to build a curriculum and deliver it to those responsible for administering healthcare respectfully.
- Curriculum with Dalai Lama’s vision rolled out in Bihar: An eight-stage curriculum, developed by Emory University, that furthers the Dalai Lama’s vision of educating both heart and mind for the greater good of humanity is being rolled out in Bihar.
- Impact: To date, 1,200 healthcare providers across 20 districts have been impacted by the vital components of the cognitive-based compassion training, creating compassionate leaders at every level.
Institutionalizing compassionate healthcare
- Institutionalizing will bring in real change: While the curriculum is a quantum leap towards building compassionate leadership, institutionalizing it will bring in real change.
- Adopting at each level: Every academic institution and every department mandated with the responsibility to deliver health-related learning should develop and adopt compassion-based curricula.
- Building capacity: State and regional health institutions must also be built with the capacity to deliver compassionate leadership. Partnerships with established academia and development sector organizations can enable the organizing of master coaches and master facilitators, thereby creating public goods that can be delivered by all.
Strengthening internal systems
- Making compassion intrinsic to the ethos: All healthcare providers are expected to carry out a wide range of tasks within the system, which often leads to burnout and impacts patient experience adversely. It is vital to strengthen systems internally to make respect and compassion intrinsic to the ethos.
- Building a network: Building a network of compassionate practitioners in every state, district and block hospital is crucial to fan the winds of change by starting with self-compassion first and then moving to compassion for others.
- Valuing and measuring organizational culture: Valuing and measuring organizational culture is just as critical as patient outcomes. Developing sound metrics to measure culture and employee satisfaction, self-compassion, and compassion for the team assumes greater significance to building an institution whose foundation is compassion.
Conclusion
- Respectful healthcare is already mentioned in the National Health Mission (NHM) guidelines, and such guidelines need to be the warp and weft of every policy and every guideline developed by public health authorities to improve patient experience. Compassionate leadership can truly realize India’s historically known values of compassion and bring alive the words of Hippocrates, the father of medicine, “Wherever the art of medicine is loved, there is also a love of humanity”.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Sodium Intake Target: Challenge of Cardiovascular Disease and Hypertension
From UPSC perspective, the following things are important :
Prelims level : Related facts
Mains level : Sodium Intake, and burden of Hypertension and cardio vascular diseases
Central Idea
- The WHO recently published the ‘Global Report on Sodium Intake Reduction’ which sheds light on the progress of its 194 member states towards reducing population sodium intake by 30% by 2025. Regrettably, progress has been lethargic, with only a few countries making considerable headway towards the objective. Consequently, there is a proposal to extend the deadline to 2030.
The target of reducing population sodium intake
- The target of reducing population sodium intake by 30% by 2025 was set by the World Health Organization (WHO) in its Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2013.
- The plan aims to reduce premature deaths from non-communicable diseases, including cardiovascular diseases, by 25% by 2025, and to achieve a 30% reduction in the mean population intake of salt/sodium.
- The target of reducing population sodium intake is aimed at reducing the burden of hypertension, which is a major risk factor for cardiovascular disease.
Why reducing sodium intake is essential for India?
- Reduced sodium intake and decreased blood pressure: There is a strong correlation between reduced sodium intake and decreased blood pressure, leading to a decrease in stroke and myocardial infarction incidence. Lowering sodium intake by 1 gram per day leads to a 5 mm Hg reduction in systolic blood pressure, as per a study in The BMJ.
- Cardiovascular disease: Elevated BP is a critical risk factor for cardiovascular disease, which is the leading cause of mortality worldwide. It contributed to 54% of strokes and 47% of coronary heart diseases globally in 2001.
- Economic impact of cardiovascular disease on LMICs: Cardiovascular disease has a staggering economic impact on LMICs, estimated at $3.7 trillion between 2011 and 2025 due to premature mortality and disability. This represents 2% of the GDP of LMICs. The Indian economy alone faces losses surpassing $2 trillion between 2012 and 2030 due to cardiovascular disease, highlighting the need for effective interventions to mitigate the economic and health consequences of the disease in LMICs.
How cardiovascular disease and hypertension pose significant challenges in India?
- Cardiovascular diseases as primary cause of mortality and morbidity:
- As per data from the Registrar General of India, WHO, and the Global Burden of Disease Study, cardiovascular diseases have emerged as the primary cause of mortality and morbidity. Data from the Registrar General of India, WHO, and the Global Burden of Disease Study
- Age-adjusted cardiovascular disease mortality rate increased by 31% in the last 25 years
- Hypertension as leading risk factor for such diseases in India
- Prevalence of hypertension in India:
- More prevalent among men aged 15 and above compared to women
- More common in southern states, particularly Kerala, while Punjab and Uttarakhand in the north also report high incidence rates
- Pre-hypertensive population in India
- Defined by systolic blood pressure levels of 120-139 mmHg or diastolic blood pressure levels of 80-89 mmHg
- 5% of women and 49.2% of men at the national level
- Significant risks of cardiovascular disease, stroke, and premature mortality for Indians with BP readings between 130 and 139/80-89 mmHg
- Many Indians classified as pre-hypertensive are now included in the newly defined stage-I hypertension by the American guidelines.
- Circulatory system diseases: The 2020 Report on Medical Certification of the Cause of Death shows that circulatory system diseases account for 32.1% of all documented deaths, with hypertension being a major risk factor.
Global Efforts to Reduce Sodium Intake
- The WHO aims to reduce population sodium intake by 30% by 2025
- Only a few countries have made considerable progress towards the objective
- India’s score of 2 on the WHO sodium score signifies the need for more rigorous efforts to address the health concern
Government Initiatives
- Voluntary programmes: The Union government has initiated several voluntary programmes aimed at encouraging Indians to decrease their sodium consumption
- Eat Right India: The FSSAI has implemented the Eat Right India movement, which strives to transform the nation’s food system to ensure secure, healthy, and sustainable nutrition for all citizens
- Aaj Se Thoda Kam: FSSAI launched a social media campaign called Aaj Se Thoda Kam.
Urgent Need for a Comprehensive National Strategy
- Despite of awareness efforts, the average Indian’s sodium intake remains alarmingly high. Evidence shows an average daily consumption of approximately 11 grams.
- India needs a comprehensive national strategy to curb salt consumption
- Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake
Conclusion
- The excessive consumption of salt can lead to severe health consequences, and India has a pressing need to reduce its sodium intake. While the government has initiated several voluntary programs, these have fallen short of the goal. India needs a comprehensive national strategy, engaging consumers, industry, and the government, to curb salt consumption. Collaboration between State and Union governments is essential to combat hypertension, often caused by excessive sodium intake.
Mains Question
Q. Reducing population sodium intake is a critical step towards preventing and controlling non- cardiovascular diseases and hypertension. Comment.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Autism Spectrum Disorders: Prevalence in India and Way Ahead
From UPSC perspective, the following things are important :
Prelims level : Autism
Mains level : Autism spectrum disorders, Prevalence in India and way ahead
Central Idea
- In India, the prevalence of autism spectrum disorders (ASD) is a widely debated issue due to a lack of systematic estimates. Most estimates have been derived from studies based on school children, revealing that over one crore Indians may be on the autism spectrum. However, there are notable cultural differences in diagnosing autism between countries, which highlights the need to assess the prevalence of autism spectrum disorders specifically in the Indian context.
What is Autism?
- Spectrum disorder: Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects communication, social interaction, and behaviour. It is called a spectrum disorder because the symptoms and severity can vary widely between individuals.
- Common symptoms: Some common symptoms of autism include difficulty with social interactions, such as maintaining eye contact or understanding nonverbal cues, delayed speech and language development, repetitive behaviors, and sensory sensitivities.
- Cause: Autism is believed to be caused by a combination of genetic and environmental factors, but the exact cause is not yet fully understood.
- Cure: There is currently no cure for autism, but early interventions and therapies can help individuals with autism lead fulfilling and independent lives.
Prevalence of Autism in India
- Lack of systematic estimates: Autism is a global issue and affects individuals of all cultures, ethnicities, and socioeconomic backgrounds. However, there is a lack of systematic estimates of autism prevalence in India.
- Methos failed: Researchers have attempted to estimate prevalence through government hospitals, but this method failed due to the absence of central medical registries.
- Conservative estimates: As a result, prevalence was estimated through school-based assessments. According to conservative estimates, well over one crore Indians are on the autism spectrum. This highlights the need for further research and attention to address the prevalence of ASD in India.
- Cultural Differences and Diagnosis of Autism:
- Notable cultural differences exist in the diagnosis of autism spectrum disorder. In the US and UK, the majority of children with autism spectrum diagnosis are verbal, with average or higher IQ, and attending mainstream schools.
- However, in India, a significant majority of children with a clinical diagnosis of autism also have intellectual disability and limited verbal ability. This difference is driven by sociological factors, such as access to appropriate clinical expertise, provisions for inclusion in mainstream schools, and availability of medical insurance coverage.
Challenges in Assessing Autism
- Assessment tools: Assessment of autism spectrum disorder is primarily behavioral, and most widely used autism assessment tools are not available in Indian languages.
- Indigenous autism assessment tools challenges: There has been a rise in the development of indigenous autism assessment tools. Despite the development of these tools, it can be challenging to compare across different assessment measures.
Demand and Supply in India
- Shortage of mental health professionals: Most autism assessment tools need to be administered by specialist mental health professionals. However, there is a significant shortage of mental health professionals in India, with less than 10,000 psychiatrists, a majority of whom are concentrated in big cities.
- Delay is costly: Delay in interventions can be costly for neurodevelopmental conditions such as autism.
- Demand and supply gap need to be met: This gap between demand and supply cannot be met directly by specialists alone, and parallel efforts to widen the reach of diagnostic and intervention services through involving non-specialists is required. Emerging evidence suggests the feasibility of involving non-specialists in autism identification and intervention through digital technology and training programs.
Way ahead: Need for an All-India Program
- National program on autism: The need of the hour is to develop a national program on autism in India that links researchers, clinicians, service providers to the end-users in the autism community.
- Essential components: This program needs to have three essential components that are joined up: assessment, intervention, and awareness.
- Assessment: Research is needed to develop appropriate assessments and design efficient implementation pathways.
- Intervention: Clinical and support service workforce needs to be expanded by training non-specialists such that a stepped-care model can be rolled out effectively across the nation.
- Awareness: Large-scale initiatives need to be launched to build public awareness that can reduce the stigma associated with autism and related conditions.
Conclusion
- There are challenges in diagnosing and assessing autism in India which highlights the need for a comprehensive and coordinated effort to address them. By expanding the clinical and support service workforce, training non-specialists, and developing appropriate assessments and interventions, India can improve outcomes for those on the autism spectrum and reduce the stigma associated with the condition. This national program needs to be informed by consultation with different stakeholders, with a primary focus on end-users within the Indian autism community.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Duty exemption for drugs for Rare Diseases
From UPSC perspective, the following things are important :
Prelims level : Rare Diseases
Mains level : Not Much
Central idea: The Centre has exempted all drugs and food for special medical purposes, imported for personal use, for the treatment of rare diseases listed under the National Policy for Rare Diseases 2021 from basic customs duty.
What are Rare Diseases?
- Rare diseases are those medical conditions that affect a small percentage of the population.
- In India, a disease is considered rare if it affects less than 1 in 2,000 people.
- These diseases are often genetic and are chronic, degenerative, and life-threatening.
- There are over 7,000 known rare diseases, and it is estimated that about 70 million people in India are affected by them.
- Many of these diseases do not have a cure, and the treatment can be expensive and difficult to access.
Need for duty exemption
- This decision has been taken to help reduce the burden of the cost of treatment for patients and families.
- The drugs and food required for the treatment of these rare diseases are often expensive and need to be imported.
- This exemption will result in substantial cost savings and provide much-needed relief to patients with rare diseases.
Key medicines under this exemption
- The central government has fully exempted Pembrolizumab (Keytruda), a drug used in the treatment of various types of cancer, from basic customs duty.
- Previously, the GST rate for Keytruda was cut to 5 per cent from 12 per cent in a meeting held in September 2021 by the GST Council.
- Life-saving drugs Zolgensma and Viltepso used in the treatment of spinal muscular atrophy were exempted from GST when imported for personal use.
How the new duty exemption works?
- The exemption has been granted by the Central Board of Indirect Taxes and Customs (CBIC) by substituting “Drugs, Medicines or Food for Special Medical Purposes (FSMP)” instead of “drugs or medicines”.
- To avail of this exemption, the individual importer has to produce a certificate from the central or state director health services or district medical officer/civil surgeon of the district.
How are life-saving medicines taxed?
- Drugs/medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs/vaccines attract a concessional rate of 5 per cent or nil.
- In its meeting in September 2021, the GST Council had reduced tax rates for several life-saving drugs.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Healthcare: Remarkable Progress But The Gaps Needs to be Addressed
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Healthcare progress and challenges
Central Idea
- The Indian healthcare system has overcome many challenges and has made significant progress, but there are still many tough health challenges that need to be addressed. There is need to bridge the gap between the services available in metropolitan and Tier-II and Tier-III cities, provide healthcare insurance to the unorganised middle class, and use Artificial Intelligence and digital technology to improve healthcare services.
Overcoming past challenges
- The Indian healthcare system has overcome seemingly insurmountable problems, including high maternal and infant mortality rates, and low hospital delivery rates.
- The National Family Health Survey (NFHS-5) results show that even in the so-called BIMARU states, hospital deliveries have soared to 89 per cent.
Current Health Challenges
- Five interrelated challenges: The current macro picture shows at least five interrelated challenges that are pervading the population, including non-communicable diseases (NCDs), obesity, and chronic respiratory diseases.
- NCDs: The proportion of deaths due to NCDs has increased from around 38 per cent in 1990 to 62 per cent in 2016.
- Obesity: Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5. Awareness about leading healthy lives will save millions from illness and decelerate premature death.
Current state of healthcare in India
- Infrastructure:
- The state of infrastructure matters. Since 2018, governments at the Centre as well as the state have been trying to bolster primary healthcare by establishing health and wellness centres.
- But there are still huge variations between states, and some states have better arrangements than others. States must step up efforts to improve infrastructure in the healthcare sector.
- Bridging the gap in hospital services:
- In urban areas, the challenge is to bridge the gap in hospital services between large urban agglomerations and Tier-II and Tier-III cities.
- Large hospital chains provide only 4-5 per cent of the beds in the private sector.
- Standalone hospitals and nursing homes provide 95 per cent of private hospital beds but are unable to provide multi-specialty, leave alone tertiary and quaternary care.
- The gaps between services available in the metros and big cities and in districts must be bridged.
- Health Insurance Coverage:
- Low health insurance penetration and the very high personal outgo on healthcare remain a challenge.
- But over the past three years, more than four crore Indians have bought health insurance.
- From 2018, the Ayushman Bharat insurance scheme for 10 crore poor families has been undertaken to provide insurance against hospitalisation for up to Rs 5 lakh per year per family.
- Nearly 74 per cent of Indians are either covered or eligible for health insurance coverage.
- Use of Artificial Intelligence and digital technology:
- An emerging concern is the use of Artificial Intelligence (AI) and digital technology to improve healthcare services.
- Surgery assisted by robots, the use of genetic codes, clinical decision support systems, and telemedicine can help in making healthcare more accessible and efficient.
Conclusion
- India has shown how the impossible can be achieved, but the healthcare system needs to overcome various challenges to fully redeem its advantage of having the youngest population. The government needs to step up efforts in improving infrastructure, bridging the gap in hospital services, and providing health insurance coverage for the unorganized middle class. It is also essential to regulate the use of AI and digital technology in the healthcare sector to ensure accountability and prevent malpractice.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Healthcare: Public Health and The Insurance Funding
From UPSC perspective, the following things are important :
Prelims level : Various Insurance Schemes
Mains level : Insurance based healthcare funding, benefits and drawbacks
Central Idea
- The Tamil Nadu public health model has achieved success in improving healthcare outcomes and maintaining equity in healthcare delivery. However, the shift in healthcare funding to insurance companies has brought both benefits and drawbacks to the public healthcare system.
The key features of the Tamil Nadu public health model
- Primary Healthcare: The Tamil Nadu public health model is based on a strong emphasis on primary healthcare, which is the first point of contact for patients seeking medical attention. Primary healthcare centres provide basic healthcare services and preventive care, which are critical to reducing the burden of disease.
- Public Health Infrastructure: The state has a well-established public health infrastructure, including a network of primary healthcare centres, secondary and tertiary care hospitals, and medical colleges. The state government has also invested in health infrastructure, including sanitation facilities, water supply, and waste management.
- Health Insurance: The Tamil Nadu government has implemented a comprehensive health insurance scheme, the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which provides free healthcare services to families living below the poverty line and low-income groups.
- Human Resource Development: The state government has also focused on developing human resources in healthcare. It has set up a large number of nursing and paramedical institutions to train healthcare professionals.
- Health Awareness: The Tamil Nadu government has launched various health awareness campaigns to educate people about health issues, including communicable and non-communicable diseases. The government has also launched campaigns to promote healthy lifestyle choices, such as a balanced diet and regular exercise.
- Partnership with NGOs: The government has partnered with non-governmental organizations (NGOs) to implement various health programs. These partnerships have helped in the effective delivery of healthcare services in remote and rural areas of the state.
- Innovations: Tamil Nadu has implemented several innovative approaches in healthcare, such as telemedicine, which enables patients to receive medical consultation and treatment remotely using technology. The state has also established mobile clinics to provide healthcare services to people living in remote areas.
Benefits of Decentralization
- Improved access to healthcare: Decentralization can help to improve access to healthcare services, particularly in rural or remote areas. By empowering local communities and healthcare providers to make decisions about healthcare delivery, services can be tailored to meet the specific needs of the population.
- Better quality of care: Decentralization can lead to better quality of care by enabling healthcare providers to respond more quickly and effectively to the needs of their patients. It can also promote innovation and experimentation in healthcare delivery, leading to new and improved approaches to patient care.
- Increased accountability: Decentralization can increase accountability in healthcare delivery by empowering local communities and healthcare providers to monitor and evaluate the quality of care. This can help to identify and address problems in healthcare delivery, leading to improved outcomes for patients.
- Cost savings: Decentralization can lead to cost savings in healthcare delivery by reducing the administrative costs associated with centralized decision-making and management. It can also promote greater efficiency in healthcare delivery, leading to reduced waste and duplication of services.
Insurance Funding in healthcare
- Insurance funding in healthcare refers to the use of insurance mechanisms to finance healthcare services. This involves pooling financial resources from individuals or groups through insurance schemes, which are then used to pay for healthcare services.
- Insurance funding can help to mitigate the financial risks associated with healthcare, and ensure that individuals have access to the care they need without incurring excessive costs.
Drawbacks of Insurance Funding
- Shifted focus: The focus on indemnity and negotiations with insurance companies has shifted the focus of hospitals from patient care to claiming money.
- Compromised quality of service: The appointment of contractual employees with meager pay has created a divide between permanent high-paid staff and temporary low-salaried staff, leading to a compromise in the quality of service.
Facts for prelims
Type of Insurance Funding | Description |
Private health insurance | Purchased by individuals or employers to cover healthcare costs. Coverage, cost, and benefits vary widely and may be offered by commercial insurers, nonprofit organizations, or government programs |
Public health insurance | Provided by government-run programs, typically funded through taxes or other government revenues. Coverage is provided to eligible individuals based on criteria such as age, income, or medical need. Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government-funded health insurance program that provides free health coverage to economically disadvantaged families across India. |
Social health insurance | A hybrid model that combines elements of private and public insurance. Individuals and employers contribute to a national insurance fund that is used to pay for healthcare services, typically managed by a government agency but delivered by private providers |
Employer-sponsored insurance | Private insurance provided by employers to their employees, often mandatory in many countries. Employers are required to provide a certain level of coverage to their employees. |
Conclusion
- While insurance funding has brought benefits, it has also created challenges, including the erosion of compassion among health professionals and a diversion of funds from public to private hospitals. It is necessary to strike a balance between decentralization, insurance funding, and preserving the fundamental principles of equity, compassion, and excellence in care to maintain the success of Tamil Nadu’s public healthcare system.
Mains Question
Q. Highlight the benefits of decentralization in healthcare delivery. Analyse the benefits and drawbacks of insurance funding in India?
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ICMR releases Ethical Guidelines for AI usage in Healthcare
From UPSC perspective, the following things are important :
Prelims level : AI in healthcare
Mains level : Read the attached story
The Indian Council of Medical Research (ICMR) has recently released the first-ever set of ethical guidelines for the application of artificial intelligence (AI) in biomedical research and healthcare.
Ethical Guidelines for AI usage in Healthcare
- The guidelines aim to create “an ethics framework which can assist in the development, deployment, and adoption of AI-based solutions” in specific fields.
- Through this initiative, the ICMR aims to make “AI-assisted platforms available for the benefit of the largest section of common people with safety and highest precision possible”.
- It seeks to address emerging ethical challenges when it comes to AI in biomedical research and healthcare delivery.
Key features
- Effective and safe development, deployment, and adoption of AI-based technologies: The guidelines provide an ethical framework that can assist in the development, deployment, and adoption of AI-based solutions in healthcare and biomedical research.
- Accountability in case of errors: As AI technologies are further developed and applied in clinical decision making, the guidelines call for processes that discuss accountability in case of errors for safeguarding and protection.
- Patient-centric ethical principles: The guidelines outline 10 key patient-centric ethical principles for AI application in the health sector, including accountability and liability, autonomy, data privacy, collaboration, risk minimisation and safety, accessibility and equity, optimisation of data quality, non-discrimination and fairness, validity and trustworthiness.
- Human oversight: The autonomy principle ensures human oversight of the functioning and performance of the AI system.
- Consent and informed decision making: The guidelines call for the attainment of consent of the patient who must also be informed of the physical, psychological and social risks involved before initiating any process.
- Safety and risk minimisation: The safety and risk minimisation principle is aimed at preventing “unintended or deliberate misuse”, anonymised data delinked from global technology to avoid cyber attacks, and a favourable benefit-risk assessment by an ethical committee among a host of other areas.
- Accessibility, equity and inclusiveness: The guidelines acknowledge that the deployment of AI technology assumes widespread availability of appropriate infrastructure and thus aims to bridge the digital divide.
- Relevant stakeholder involvement: The guidelines outline a brief for relevant stakeholders including researchers, clinicians/hospitals/public health system, patients, ethics committee, government regulators, and the industry.
- Standard practices: The guidelines call for each step of the development process to follow standard practices to make the AI-based solutions technically sound, ethically justified, and applicable to a large number of individuals with equity and fairness.
- Ethical review process: The ethical review process for AI in health comes under the domain of the ethics committee which assesses several factors including data source, quality, safety, anonymization, and/or data piracy, data selection biases, participant protection, payment of compensation, possibility of stigmatisation among others.
Policy moves for streamlining AI in Healthcare
- India already offers streamlining of AI technologies in various sectors, including healthcare, through the National Health Policy (2017), National Digital Health Blueprint (NDHB 2019), and Digital Information Security in Healthcare Act (2018) proposed by the Health Ministry.
- These initiatives pave the way for the establishment of the National Data Health Authority and other health information exchanges.
Potential applications of AI in healthcare
Artificial Intelligence (AI) has revolutionized the healthcare industry by enabling various applications. These applications include:
- Diagnosis and screening: AI can be used to identify diseases from medical images like X-rays, CT scans, and MRIs.
- Therapeutics: AI can assist in the development of personalised medicines by analyzing a patient’s genetic makeup.
- Preventive treatments: AI can predict the risk of developing a disease, helping healthcare professionals to take preventive measures.
- Clinical decision-making: AI can analyze large amounts of data to assist healthcare professionals in making treatment decisions.
- Public health surveillance: AI can be used to monitor disease outbreaks and inform public health policies.
- Complex data analysis: AI can analyze large amounts of data from multiple sources to identify patterns and inform healthcare decision-making.
- Predicting disease outcomes: AI can predict disease outcomes based on patient data, enabling early
- Behavioural and mental healthcare: AI can help diagnose and treat mental health conditions.
- Health management systems: AI can assist in managing patient records, appointment scheduling and reminders, and medication management.
Various challenges for imbibing
- Data privacy and security: With the use of AI in healthcare, there is a significant amount of personal and sensitive data is collected. This data needs to be kept secure and protected from potential cyber-attacks.
- Regulatory and ethical issues: AI technology is still in its early stages of development and there are no clear guidelines or regulations in place for its use in healthcare. There are also ethical considerations, such as accountability, transparency, and bias that need to be addressed.
- High cost involved: The implementation of AI in healthcare requires significant investment in terms of infrastructure, software, and training. This cost can be a major challenge for healthcare organizations, especially in developing countries.
- Integration with existing systems: AI systems need to be integrated with existing healthcare systems and processes. This can be challenging, especially in cases where the existing systems are outdated or incompatible with AI technology.
- Lack of trust and acceptance: AI technology is still relatively new in healthcare and there is a lack of trust and acceptance among healthcare professionals and patients. This can be a major hurdle in the widespread adoption of AI in healthcare.
Threats posed by AI to healthcare
- Data privacy and security: The use of AI in healthcare requires the collection and analysis of vast amounts of personal health data, which could be at risk of being stolen or misused.
- Bias and discrimination: There is a risk that AI algorithms could perpetuate existing biases and inequalities in healthcare, such as racial or gender bias.
- Lack of transparency: Some AI models are complex and difficult to understand, which can make it difficult to explain the reasoning behind a particular decision.
- Medical errors: AI systems can make errors if they are trained on biased or incomplete data, or if they are used inappropriately.
- Ethical concerns: There are several ethical concerns associated with the use of AI in healthcare, including the potential for AI to replace human doctors, the impact on patient autonomy, and the implications for informed consent.
Way forward
- Develop a national AI strategy for healthcare: This strategy should include policies for data sharing, privacy, and security, as well as guidelines for the ethical and responsible use of AI.
- Invest in AI research and development: The government should invest in research and development of AI technologies that can help address the challenges in healthcare.
- Promote collaboration between stakeholders: Collaboration between stakeholders such as healthcare providers, researchers, government agencies, and industry can help accelerate the development and adoption of AI technologies in healthcare.
- Train healthcare professionals in AI: The government can work with academic institutions and the industry to create training programs and certifications for healthcare professionals.
- Address regulatory challenges: The government should work to address regulatory challenges related to the use of AI in healthcare.
- Focus on affordability and accessibility: This can be achieved by promoting innovation, encouraging competition, and ensuring that AI technologies are integrated into existing healthcare infrastructure.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Rajasthan becomes first state to guarantee Right to Health
From UPSC perspective, the following things are important :
Prelims level : Right to Health
Mains level : Read the attached story
The Rajasthan Assembly passed the Right to Health (RTH), even as doctors continued their protest against the Bill, demanding its complete withdrawal.
Right to Health (RTH): A conceptual insight
- RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
- It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.
Scope of RTH
- RTH covers various health-related issues, including-
- Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
- Accessible, affordable, and quality healthcare services,
- Eliminating barriers to healthcare access
- Informed consent to medical treatment and accessing information about their health.
What is the Rajasthan Right to Health Bill?
- Free treatment: RTH gives every resident of the state the right to avail free Out Patient Department (OPD) services and In Patient Department (IPD) services at all public health facilities and select private facilities.
- Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
- Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
- No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
- State reimbursement of charges: After emergency care and stabilisation, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.
Existing schemes in Rajasthan
- The flagship Chiranjeevi Health Insurance Scheme provides free treatment up to Rs 10 lakh, which has been increased to Rs 25 lakh in the latest budget.
- The Rajasthan Government Health Scheme covers government employees, ministers, current and former MLAs, etc.
- The Nishulk Nirogi Rajasthan scheme provides free OPD and IPD services in government hospitals and covers about 1,600 medicines, 928 surgicals, and 185 sutures.
- The Free Test scheme provides up to 90 free tests in government hospitals and has benefited 2.93 crore persons between March-December 2022.
Need for the RTH Scheme
- The state prioritizes healthcare and wants Rajasthan to be a great example of good health.
- The Health Minister has received many complaints about private hospitals asking for money from patients who have the Chiranjeevi card.
- So, they are bringing in a new law to stop this.
- The new law will make sure that future governments follow it and provide free healthcare to everyone.
Controversy with the RTH Law: Emergency Care Provisions
- Emergency care was a contentious issue in the RTH.
- The clause states that people have the right to emergency treatment and care for accidental emergency, emergency due to snake bite/animal bite and any other emergency decided by the State Health Authority under prescribed emergency circumstances.
- Emergency treatment and care can be availed without prepayment of requisite fee or charges.
- Public or private health institutions qualified to provide such care or treatment according to their level of health care can offer emergency care.
Issues raised by healthcare professionals
- Existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
- Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
- Unnecessary obligations: The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.
Way forward
- Given the contentious nature of the Bill, it is important for all stakeholders to come to the table and engage in constructive dialogue to resolve the issues at hand.
- It should involve liaison between government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
- This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
- Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.
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Rising Cancer Cases in India And Economic Burden
From UPSC perspective, the following things are important :
Prelims level : Cancer and Innovative Treatment and therapies
Mains level : Rising Cancer and economic burden
Central Idea
- Cancer cases in India are predicted to cross the 15 lakh mark by 2025, highlighting concerns about the economic burden of expensive cancer treatments and the accessibility of affordable healthcare for patients.
Cancer
- Cancer is a group of diseases that arise when cells in the body begin to grow and divide uncontrollably, leading to the formation of tumors.
- Normally, cells in the body grow, divide, and die in an orderly fashion, but in cancer, this process goes awry, leading to the accumulation of abnormal cells that can form a mass or tumor.
- There are many different types of cancer, which can affect any part of the body. Some cancers, such as leukemia, do not form tumors but still involve the uncontrolled growth of abnormal cells.
- Symptoms of cancer can vary depending on the type and location of the cancer, but common signs include unexplained weight loss, fatigue, pain, and changes in the skin or the appearance of a lump or mass.
Economic Burden of Cancer Treatment
- Inaccessible and Increasing Costs:
- The average medical expenditure per hospitalization case for cancer treatment was ₹68,259 in urban areas, according to the NSS 2017-18 report.
- A Parliamentary Standing Committee report expressed concern about the inaccessible and increasing cost of cancer treatment.
- Regulatory Challenges:
- While anti-cancer medicine costs can be regulated, the cost of radiotherapy cannot, as it has not been declared an essential service.
- Insurance Coverage and Out-of-Pocket Expenses.
- Impact on Patients:
- Cancer often strikes around the retirement age, leading to mounting debt burdens.
- The average hospital stay for 14.1% of cancer patients is more than 30 days, further increasing bills.
Insurance Coverage and Out-of-Pocket Expenses
- Poor Insurance Penetration: More than 80% of hospital bills are paid out of pocket, as per the NSS 2017-18 report.
- Ayushman Bharat Limitations: The Committee observed that the Ayushman Bharat insurance scheme launched in 2018 does not cover entire prescriptions, latest cancer therapies, or many diagnostic tests.
- State-Specific Insurance Schemes: The Committee suggested a convergence of State and Central schemes, as some State-specific insurance schemes have been highly beneficial.
State-wise Variation in Cancer Treatment Expenditure
- State-wise average medical expenditure per hospitalization case for cancer treatment in government hospitals varies, with the lowest in Tamil Nadu and Telangana, and the highest in northern and north-eastern India.
Facts for Prelims: CAR T-cell therapy
- Unlike chemotherapy or immunotherapy, which require mass-produced injectable or oral medication, CAR T-cell therapies use a patient’s own cells.
- The treatment involves modifying a patient’s own T-cells, which are a type of immune cell, in a laboratory to target and attack cancer cells.
- CAR stands for chimeric antigen receptor, which refers to the genetically engineered receptor that is added to the patient’s T-cells.
- The patient’s T-cells are collected and genetically modified in a laboratory to express the CAR.
- The modified T-cells are then infused back into the patient’s body, where they can seek out and destroy cancer cells that express the antigen targeted by the CAR.
- The cells are even more specific than targeted agents and directly activate the patient’s immune system against cancer, making the treatment more clinically effective.
- This is why they’re called living drugs.
- CAR T-cell therapy has shown promising results in treating certain types of blood cancers, including leukemia and lymphoma.
Conclusion
- The rising number of cancer cases in India underscores the need to address the economic burden of expensive cancer treatments and improve the accessibility of affordable healthcare for patients. Converging State and Central insurance schemes, expanding insurance coverage, and exploring ways to regulate treatment costs are essential steps to ensure that patients can access life-saving treatments without facing insurmountable financial challenges.
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Universal Health Coverage (UHC) Must be Affordable to All
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Primary Health care and Universal Health care
Central Idea
- The Universal Health Coverage (UHC) and its implementation in India raises the question of whether we believe in health as a basic human right, which India’s Constitution guarantees under the right to life. The UHC should encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.
The Definition of Health
- The definition of health according to the World Health Organization (WHO), which includes mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
- We cannot achieve health in its wider definition without addressing health determinants, which necessitates an intersectoral convergence beyond medical and health departments.
Difference between Primary health care (PHC) and Universal health care (UHC)
- The main difference between PHC and UHC is that PHC is a level of care within the health care system, while UHC is a broader goal of ensuring access to health care for all individuals.
- PHC is typically provided at the primary care level, while UHC includes all levels of care, from primary to secondary and tertiary care.
- PHC is focused on basic health care services and health promotion, while UHC aims to provide comprehensive health care services to all individuals.
Health for All by 2000
- The slogan Health for All by 2000 proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977. It argues that universal health care/coverage (UHC) was implied as early as 1977.
- India committed itself to the ‘Health for All’ goal by 2000 through its National Health Policy 1983.
International Conference on PHC
- The International Conference on Primary Health Care, at Alma Ata, 1978, which listed eight components of minimum care for all citizens.
- Components included: It mandated all health promotion activities and the prevention of diseases, including vaccinations and treatment of minor illnesses and accidents, to be free for all using government resources, especially for the poor.
- Components excluded: Chronic diseases, including mental illnesses, and their investigations and treatment were almost excluded from primary health care. When it came to secondary and tertiary care, it was left to the individual to seek it from a limited number of public hospitals or from the private sector by paying from their own pockets.
Concerns around The Astana Declaration
- The Astana declaration of 2018, which calls for partnership with the private sector. However the commercial private sector, which contributes to alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution, is well established.
- The Astana declaration never addressed poverty, unemployment, and poor livelihood, but eulogizes quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.
Conclusion
- Every individual has a right to be healed and not have complications, disability, and death. That right is guaranteed only by individualism in public health, the new global approach to UHC, where nobody is left uncounted and uncared for. The Alma Ata declaration of primary health care can be left behind as a beautiful edifice of past concepts, and we should move forward with a newer concept of UHC.
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What is ‘e-Sanjeevani App’?
From UPSC perspective, the following things are important :
Prelims level : E-Sanjeevani App
Mains level : Telemedicine
The eSanjeevani app was featured in Prime Minister’s “Mann Ki Baat” address as part of the government’s efforts to promote digital healthcare in the country.
What is the e-Sanjeevani app?
- E-Sanjeevani is a browser-based platform-independent application that allows for both ‘doctor-to-doctor’ and ‘patient-to-doctor’ teleconsultations.
- During the Covid pandemic, the union health ministry launched the e-Sanjeevani telemedicine services to ensure that health consultations reach people even in remote villages.
- At the time of its launch, the union health ministry stated that it was a doctor-to-doctor telemedicine service that would provide general and specialised health care in rural areas.
How does e-Sanjeevani work?
- The e-Sanjeevani service establishes a virtual link between the beneficiary and doctor or specialist at the hub, which will be a tertiary healthcare facility.
- This network’s spoke would be a paramedic or generalist at a health and wellness centre.
- It allows for real-time virtual consultations between doctors and specialists at the hub and the beneficiary (via paramedics) at the spoke.
- The e-prescription generated at the conclusion of the session is used to obtain medications.
What is the reach of e-Sanjeevani?
- Sanjeevani HWC is currently operational in approximately 50,000 health and wellness centres across the country.
- As PM Modi stated in ‘Mann Ki Baat’, the number of tele-consultants using the e-Sanjeevani app has now surpassed 10 crore.
- Health minister has stated that 100.11 million patients were served at 115,234 Health and Wellness Centres (as spokes) via 15,731 hubs and 1,152 online OPDs staffed by 2,29,057 telemedicine-trained medical specialists and super-specialists.
- More than 57% of e-Sanjeevani beneficiaries are women, with only about 12% being senior citizens, according to union health ministry.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Understanding India’s Mental Healthcare Act, 2017
From UPSC perspective, the following things are important :
Prelims level : Mental Healthcare Act, 2017
Mains level : Not Much
Central idea: The article discusses the challenges faced in implementing India’s Mental Healthcare Act, 2017 and the need for better mental healthcare services in the country.
Mental Healthcare Act, 2017
The Mental Healthcare Act, 2017 is a comprehensive legislation that provides for the protection and promotion of the rights of people with mental illness. Some of the key features of the Act are:
- Decriminalization of suicide: The Act decriminalizes suicide and prohibits the use of inhuman and degrading treatment towards those who attempt suicide.
- Advance directives: The Act allows individuals to make advance directives, specifying the type of treatment they would like to receive in the event of a mental health issue.
- Informed consent: The Act mandates that patients have the right to give or refuse consent to treatment, and to be informed about the benefits, side effects, and alternatives of the treatment.
- Mental health review boards: The Act establishes Mental Health Review Boards at the national and state levels to oversee the implementation of the Act and protect the rights of people with mental illness.
- Prohibition of inhuman treatment: The Act prohibits the use of inhuman treatment methods, including chaining, electroconvulsive therapy (ECT) without anaesthesia, and solitary confinement.
- Right to access mental healthcare: The Act guarantees the right to access mental healthcare services, and mandates the establishment of mental health services in every district.
- Protection of rights and dignity: The Act aims to protect the rights and dignity of people with mental illness, and prohibits discrimination and stigmatization on the basis of mental illness.
- Establishment of a Central Mental Health Authority: The Act establishes a Central Mental Health Authority to regulate mental health services in the country.
NHRC flags alert
- Pity over healthcare institution: The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.
- Prolonged hospitalization: The report notes that the facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”.
- Need for Assessment: These observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHA).
Major issue: Lack of implementation
- Despite the act’s provisions, mental health institutions in India have been plagued by a lack of adequate infrastructure, staff, and training.
- Patients have reported human rights violations, including abuse, neglect, and violence.
Need for effective implementation
- The Mental Healthcare Act needs effective implementation and oversight to ensure that patients receive the care and treatment they need with dignity and respect.
- This requires increased investment in mental health infrastructure, including facilities, staff, and training.
Way forward
- Ensuring proper implementation of the Act: There is a need for proper implementation of this act across the country, with a focus on ensuring the rights and dignity of patients in mental healthcare institutions.
- Increasing awareness: Awareness needs to be raised about the Act, and the rights of mental healthcare patients among the general public, healthcare professionals, and law enforcement agencies.
- Providing training and capacity building: Healthcare professionals, including doctors, nurses, and caregivers, need to be trained and equipped with the skills and knowledge to provide quality care and support to mental healthcare patients.
- Strengthening mental healthcare infrastructure: There is a need to strengthen the infrastructure and facilities in mental healthcare institutions, including better staffing, improved physical facilities, and access to quality medication.
- Encouraging community-based care: Community-based care for mental health patients can help reduce the burden on mental healthcare institutions and provide a more supportive environment for patients.
- Promoting human rights: There is a need for greater emphasis on the human rights of mental healthcare patients, including the right to dignity, privacy, and freedom from discrimination and abuse.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Its high time to focus on Mental Health
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Mental health problems and solutions
Context
- Suicides rates in India are amongst the highest when compared to other countries at the same socio-economic level. According to WHO, India’s suicide rate in 2019, at 12.9/1,00,000, was higher than the regional average of 10.2 and the global average of 9.0. Suicide has become the leading cause of death among those aged 15–29 in India.
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Background: Mental Health
- While every precious life lost through suicide is one too many, it represents only the tip of the mental health iceberg in the country, particularly among young adults. Women tend to suffer more.
- Across the world, the prevalence of some mental health disorders is consistently higher among women as compared to men.
Prevalence of Mental ill-health
- The pandemic has further exacerbated the problem: Globally, it might have increased the prevalence of depression by 28 per cent and anxiety by 26 per cent in just one year between 2020 and 2021, according to a study published in Lancet.
- Increased among younger age groups: Again, the large increases have been noted among younger age groups, stemming from uncertainty and fear about the virus, financial and job losses, grief, increased childcare burdens, in addition to school closures and social isolation.
- Use of social media exacerbating the stress: Increased use of certain kinds of social media is also exacerbating stress for young people. Social media detracts from face-to-face relationships, which are healthier, and reduces investment in meaningful activities. More importantly, it erodes self-esteem through unfavourable social comparison.
Socio-economic implications of Mental ill-health
- People living in poverty are at greater risks: Mental ill health is a leading cause of disability globally and is closely linked to poverty in a vicious cycle of disadvantage. People living in poverty are at greater risk of experiencing such conditions.
- People experiencing mental health problems likely to fall in poverty: On the other hand, people experiencing severe mental health conditions are more likely to fall into poverty through loss of employment and increased health expenditure.
- Stigma and discrimination: Stigma and discrimination often further undermine their social support structures. This reinforces the vicious cycle of poverty and mental ill-health.
- Higher income inequality has high prevalence of ill mental ill health: Not surprisingly, countries with greater income inequalities and social polarization have been found to have a higher prevalence.
Approach to protect, promote and care for the mental health of people?
- Killing the deep stigma surrounding mental health issues: The first step should be killing the deep stigma which prevents patients from seeking timely treatment and makes them feel shameful, isolated and weak. Stigma festers in the dark and scatters in the light. We need a mission to cut through this darkness and shine a light.
- Making Mental health an integral part of public health programme: There is need to make mental health an integral part of the public health programme to reduce stress, promote a healthy lifestyle, screen and identify high-risk groups and strengthen interventions like counselling services. Special emphasis will need to be given to schools.
- Paying attention to highly vulnerable: In addition, we should pay special attention to groups that are highly vulnerable because of the issues such as victims of domestic or sexual violence, unemployed youth, marginal farmers, armed forces personnel and personnel working under difficult conditions.
- Creating a strong infrastructure for mental health care and treatment: Lack of effective treatment and stigma feed into each other. Currently, only 20-30 per cent of people with such disorders receive adequate treatment.
- Mental health services should be made affordable for all: Improved coverage without corresponding financial protection will lead to inequitable service uptake and outcomes. All government health assurance schemes, including Ayushman Bharat, should cover the widest possible range.
Why is the wide treatment gap?
- One major reason for a wide treatment gap is the problem of inadequate resources.
- Less than two per cent of the government health budget, which itself is the lowest among all G20 countries, is devoted to mental health issues.
- There is a severe shortage of professionals, with the number of psychiatrists in the country being less than those in New York City, according to one estimate.
- Substantial investments will be needed to address the gaps in the health infrastructure and human resources.
- Currently, most private health insurance covers only a restricted number of mental health conditions. Similarly, the list of essential medicines includes only a limited number of WHO-prescribed medications.
Conclusion
- We need an urgent and well-resourced whole of society approach to protecting, promoting and caring for the mental health of our people, like we did for the Covid pandemic. Brock Chisholm, the first Director General of WHO, famously said, “there is no health without mental health”.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Norovirus Cases detected in Kerala
From UPSC perspective, the following things are important :
Prelims level : Norovirus
Mains level : Not Much
The Kerala Health Department confirmed two cases of the gastrointestinal infection norovirus in class 1 students in Ernakulam district.
What is Norovirus?
- Norovirus is an important cause of acute non-bacterial gastroenteritis in children as well as adults worldwide.
- It leads to diarrhoea, vomiting, nausea, and abdominal pain. Being a diarrhoeal disease, it can lead to dehydration, so drinking plenty of fluids is recommended.
- The virus was first discovered in connection with an outbreak of acute diarrhoeal disease in Norwalk, Ohio, in 1968 and was called the Norwalk Virus.
- Later, several stomach flu viruses closely linked to the Norwalk virus were found and together, these are now called Noroviruses.
- Many stomach flu outbreaks typically in cruise ships have been traced to NoV.
How deadly is this?
- Norovirus is not new; it has been circulating among humans for over 50 years and is thought to be one of the primary causes of gastroenteritis.
- The virus is estimated to kill 200,000 persons globally every year, with most deaths occurring among those below the age of five years and those over the age of 65 years.
- The virus is capable of surviving low temperatures, and outbreaks tend to be more common during the winter and in colder countries — that is why it is sometimes referred to as “winter vomiting disease”.
What is the incidence of infection in India?
- Cases of norovirus are not as common in India as in many other places — at the same time.
- The infection has been reported in previous years as well, mainly from Southern India, and especially from Kerala.
- A 2021 study from Hyderabad reported that norovirus was detected in 10.3% samples of children who came in with acute gastroenteritis.
Can norovirus infection cause a large-scale outbreak?
- Even though more cases of norovirus are being detected, experts say that this is unlikely to lead to a large-scale outbreak.
- There is no epidemiological study to co-relate of these cases.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Mental Health Problem and effective policy
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Strategy for better mental health policy
Context
- The fifth Global Mental Health Summit, co-sponsored by over half a dozen organisations engaged with mental health, was held in Chennai to discuss mental health in the context of human rights, ethics and justice. Highlighting the importance of mental health, it gave a call for action against the continued neglect by society at large and the governments at central and state levels, in particular.
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Findings of national mental health survey
- The National Mental Health Survey (NMHS): The latest National Mental Health Survey (NMHS) conducted by National Institute of Mental Health and Neuro Sciences (NIMHANS) in collaboration with the Ministry of Health and Family Welfare and WHO, was published in 2016.
- Prevalence of mental disorder: According to the survey, the prevalence of mental disorders among adults in India is around 10.6%. The most common disorders were anxiety disorders (7.3%) and mood disorders (4.5%).
- Higher among women than men: The survey also found that the prevalence of mental disorders was higher among women than men, and that the majority of people with mental disorders did not receive any treatment.
- Prevalence of mental disorders is higher in urban areas: It also found that the prevalence of mental disorders was higher in urban areas than in rural areas, and that there was a higher prevalence of mental disorders among people with lower levels of education and income.
- Gap in treatment coverage for people with mental disorder : The survey highlighted that there is a significant gap in treatment coverage for people with mental disorders, and that the majority of people with mental disorders do not receive any treatment.
- Plan for mental health: The survey has provided an important information for Indian government and mental health professional to plan and implement mental health programs and policies in the country.
What constitutes good policy making on mental health?
- Policy should be based on research and findings: Policies should be based on sound research and evidence from scientific studies. This helps to ensure that policies are effective in addressing mental health issues and are not based on assumptions or stereotypes.
- Active engagement of stakeholders: Policy making should involve a wide range of stakeholders, including people with lived experience of mental health issues, mental health professionals, and representatives from relevant government departments and non-governmental organizations.
- A comprehensive and integrated approach: Mental health policies should be comprehensive and address a wide range of issues, including prevention, early intervention, treatment, and recovery. They should also be integrated with other policies, such as those related to education, housing, and employment.
- Ensure easy access to mental health care: policies should ensure that people have access to appropriate and affordable mental health care, including both medication and psychosocial therapies.
- Public awareness and Sensitization : policies should ensure that people with mental health issues are treated with dignity and respect, and that their human rights are protected.
Case study: How India tackled HIV/AIDS?
- Active surveillance system: The need for crafting strategic interventions based on epidemiological evidence from an active surveillance system.
- Modelling different options: The importance of modelling different options of addressing the wide array of interventions required in different geographies, among different target groups, to provide the data related to cost effectiveness as well as efficacy of the interventions required for scaling up.
- Proactive advocacy of systemic issues among all influencers: The proactive advocacy of systemic issues among all influencers the media, judiciary, politicians, police and other intersectoral departments whose programmes and activities have had a direct bearing on the key populations being worked on.
- Community engagement: The use of peer leaders and civil society that was allocated over 25 per cent of the budget. Though a central sector programme was fully funded by the central government, every intervention was formulated with active participation and dialogue among the states and constituencies of local leaders.
Strategy for better implementation of mental health policy
- Clear goals and objectives: Having clear and measurable goals and objectives can help to ensure that policies are implemented effectively and that progress can be tracked.
- Training and capacity building: Providing training and capacity building for mental health professionals, as well as for other relevant stakeholders such as community leaders, can help to ensure that policies are implemented effectively.
- Community engagement: Involving communities in the planning and implementation of mental health policies can help to ensure that policies are responsive to the specific needs and priorities of local populations.
- Monitoring and evaluation: Regularly monitoring and evaluating the implementation of policies can help to identify any barriers or challenges, and make adjustments as necessary.
- Multi-sectoral approach: Adopting a multi-sectoral approach that involves collaboration between different sectors, such as health, education, social welfare, housing, and employment can help to ensure that policies are implemented in a coordinated and effective manner.
- Policy flexibility: Policies should be flexible enough to adapt to changing circumstances, and be responsive to feedback and suggestions from the community and stakeholders.
latest research in mental health domain
- The growing recognition of the importance of early intervention in mental health: Research has shown that early intervention can prevent mental health issues from becoming more severe, and can help individuals to recover more quickly.
- The use of technology in mental health: There has been an increase in the use of technology, such as mobile apps, virtual reality, and teletherapy, to deliver mental health care. Studies have shown that these technologies can be effective in improving mental health outcomes.
- The impact of the COVID-19 pandemic on mental health: The pandemic has had a significant impact on mental health, and research has been conducted to understand the extent of the impact and to develop strategies to mitigate it.
- Advancements in brain imaging and genetics: Researchers are using brain imaging techniques and genetic studies to gain a better understanding of the underlying causes of mental disorders and to develop more effective treatments.
- The use of personalized medicine in mental health: There is growing interest in the use of personalized medicine, which involves using genetic and other information to tailor treatment to the individual patient, to improve mental health outcomes.
- The benefits of nature-based interventions for mental health: Studies have shown that spending time in nature can have a positive impact on mental health, including reducing symptoms of stress, anxiety, and depression.
- The importance of social determinants of mental health: Research has highlighted the importance of social determinants such as poverty, education, and social support in mental health.
- The importance of addressing mental health in the workplace: Studies have highlighted the impact of workplace stress and burnout on mental health and the importance of workplace interventions to promote mental well-being.
Do you know Neuralink?
- Neuralink is a gadget that will be surgically inserted into the brain using robotics. In this procedure, a chipset called the link is implanted in the skull.
- Neuralink can be used to operate encephalopathy. It can also be used as a connection between the human brain and technology which means people with paralysis can easily operate their phones and computer directly with their brain.
Conclusion
- Mental health problems and not related to age of persons. From children to old age all can suffer from this menace. Government of the must formulated, implement the effective, resulted oriented mental health policy as earliest as possible
Mains Question
Q. What factors need to be taken care while drafting sound mental health policy? Suggest a strategy for better implementation of metal health policy.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Digital healthcare Services
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat, UHC, ABHA etc
Mains level : Digital public goods, Success of Ayushman Bharat and India's G20 presidency.
Context
- India leveraged information and communications technologies (ICTs) during the pandemic. Digital health solutions played a crucial role in bridging the gap in healthcare delivery as systems moved online to accommodate contactless care.
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India’s spectacular demonstration of digital public good (DPG) so far
- Aadhar and UPI are like the building blocks of DPG: India has demonstrated its digital prowess by building digital public goods the digital identity system Aadhaar, the DPGs built on top of Aadhaar and the Unified Payments Interface.
- Aadhar for PDS and UPI for payments: While Aadhaar has become central to India’s public service delivery architecture, UPI has transformed how payments are made.
- One of the largest internet users: Our digital public infrastructure has reached the last mile, enabled by 1.2 billion wireless connections and 800 million internet users.
- Some examples of DPGs developed during the pandemic: For instance, the Covid Vaccine Intelligence Network (CoWIN) and the Aarogya Setu application. CoWIN propelled India to adopt a completely digital approach to its vaccination strategy. Aarogya Setu provided real-time data on active cases and containment zones to help citizens assess risk in their areas.
- Increasing use of Telemedicine platforms: Telemedicine platforms saw a steep increase in user acquisitions, as 85 per cent of physicians used teleconsultations during the pandemic, underscoring the need to better incorporate cutting-edge digital technologies into healthcare services.
Acknowledging the current need?
- Although the impact of the pandemic on health services put the spotlight on the benefits of digital innovation and technology-enabled solutions, private entities, health technology players, and the public sector have been driving digitisation in the sector for some time now.
- It has become clear that a comprehensive digital healthcare ecosystem is necessary to bring together existing siloed efforts and move toward proactive, holistic, and citizen-centric healthcare.
Government efforts in this direction?
- Shared public goods for healthcare: Recognising this need, the government has created shared public goods for healthcare and developed a framework for a nationwide digital health system. This brought healthcare to a turning point in India.
- Ayushman Bharat Digital Mission (ABDM): The PM launched the Ayushman Bharat Digital Mission on September 27, 2021, under the aegis of the National Health Authority. Within a year of its launch, ABDM has established a robust framework to provide accessible, affordable, and equitable healthcare through digital highways. The ABDM has implemented vital building blocks to unite all stakeholders in the digital healthcare ecosystem.
- The Ayushman Bharat Health Account (ABHA): ABHA creates a standard identifier for patients across healthcare providers. With the ABHA and its associated Personal Health Record (PHR) app, citizens can link, store, and share their health records to access healthcare services with autonomy and consent. With more than 300 million ABHAs and 50 million health records linked, the mission is growing at a massive rate.
- The Health Facility Registry (HFR) and the Health Professional Registries (HPR) for central digital health information: HFR and HPR accounts provide verified digital identities to large and small public and private health facilities and professionals. This enables them to connect to a central digital ecosystem while serving as a single source for verified healthcare provider-related information. HFR and HPR improve the discovery of healthcare facilities and help health professionals build an online presence and offer services more effectively. The
- Drug registry for centralised repository of approved drugs: It is a crucial building block designed to create a single, up-to-date, centralised repository of all approved drugs across all systems of medicine.
- Unified Health Interface (UHI) enables a connect between healthcare providers with end users: It aims to strengthen the health sector by enabling all healthcare service providers and end-user applications to interact with each other on its network. This will provide a seamless experience for service discovery, appointment booking, teleconsultations, ambulance access, and more. The UHI is based on open network protocols and can address the current challenge of different digital solutions being unable to communicate with each other.
What the government is planning next in this domain?
- To give UHI the necessary push, the government is repurposing Aarogya Setu and CoWIN: Aarogya Setu is being transformed into a general health and wellness application. At the same time, CoWIN will be plugged with a lite Hospital Management Information System (HMIS) for small clinics, to bring digitisation to the masses.
- Addressing well the patient registration process at the hospital counters: Another use-case of ABDM is scan and share, which uses a QR code-based token system to manage queues at hospital counters. It uses the foundational elements of ABHA and PHR to streamline the outpatient registration process in large hospitals
- Expanding healthcare digital initiative worldwide: The government is also planning to expand its digital initiatives in the healthcare sector with Heal by India, making India’s healthcare professionals’ services available worldwide.
- Platform for organ donation: Additionally, a platform is being developed to automate the allocation of deceased organ and tissue donations, making the process faster and more transparent.
Way ahead
- Digitise insurance claim settlement process: With the implementation of digital solutions, the next step is to digitise and automate the insurance claim settlement process through the Health Claim Exchange platform.
- Making claim settlement process inexpensive and transparent: There is need to make claim-related information verifiable, auditable, traceable and interoperable among various entities, enabling claim processing to become inexpensive, transparent and carried out in real time.
- Bringing together global efforts for digital health: India assumes the G20 presidency this year. The G20 Global Initiative on Digital Health calls for the creation of an institutional framework for a connected health ecosystem to bring together global efforts for digital health.
- Accelerating UHC by scaling up the technologies: It also calls for the scaling-up of technologies such as global DPGs to accelerate Universal Health Coverage.
Conclusion
- The ABDM has proven to be a valuable asset and its adoption across states has been accelerated by the National Health Authority. It aims to build the foundation for a sustainable digital public infrastructure for health, enabling India to achieve universal health coverage. The mission embodies G20’s theme of “Vasudhaiva Kutumbakam” or “One Earth. One Family. One Future”
Mains question
Q. India has demonstrated spectacular success in digital public goods, specifically in Digital health. Discuss how the government efforts are taking shape in this direction and suggest a way ahead in short.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Naegleria fowleri: The Brain-eating Amoeba
From UPSC perspective, the following things are important :
Prelims level : Naegleria fowleri
Mains level : Not Much
South Korea reported its first case of infection from Naegleria fowleri or “brain-eating amoeba”.
What is Naegleria fowleri (Amoeba)?
- Amoeba is a type of cell or unicellular organism with the ability to alter its shape, primarily by extending and retracting pseudopods.
- Naegleria is an amoeba, a single-celled organism, and only one of its species, called Naegleria fowleri, can infect humans.
- It was first discovered in Australia in 1965 and is commonly found in warm freshwater bodies, such as hot springs, rivers and lakes.
- So far, Naegleria fowleri has been found in all continents and declared as the cause of PAM in over 16 countries, including India.
How does it infect humans?
- The amoeba enters the human body through the nose and then travels up to the brain.
- This can usually happen when someone goes for a swim, or dive or even when they dip their head in a freshwater body.
- In some cases, it was found that people got infected when they cleaned their nostrils with contaminated water/ vapour/ or aerosol droplets.
- Once Naegleria fowleri goes to the brain, it destroys brain tissues and causes a dangerous infection known as primary amebic meningoencephalitis (PAM).
What are the symptoms of PAM?
- The CDC says the first signs of PAM start showing within one to 12 days after the infection.
- In the initial stages, they might be similar to symptoms of meningitis, which are headache, nausea and fever.
- In the later stages, one can suffer from a stiff neck, seizures, hallucinations, and even coma.
- The infection spreads rapidly and on average causes death within about five days.
How its spread is linked to climate change?
- With the rising global temperatures, the chances of getting Naegleria fowleri infection will go up as the amoeba mainly thrives in warm freshwater bodies.
- The organism best grows in high temperatures up to 46°C and sometimes can survive at even higher temperatures.
- Various recent studies have found that excess atmospheric carbon dioxide has led to an increase in the temperature of lakes and rivers.
- These conditions provide a more favourable environment for the amoeba to grow.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India’s G20 Presidency: Healthcare should be a central agenda
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Linking PHC with UHC, India's G20 presidency and healthcare agenda
Context
- Health needs to be a central agenda for the G20 2023. It has been one of the priority areas for G20 deliberations since 2017, when the first meet of health ministers of G20 countries was organised by the German presidency. The G20 now has health finance in its financial stream and health systems development in the Sherpa stream.
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Background: Prioritizing Health
- An annual G20 meeting of health ministers and a joint health and finance task force reflects the seriousness the subject has gained.
- The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance.
- The Covid-19 pandemic gave added urgency to pandemic preparedness and the Indonesian presidency in 2022 made it the major focus. The Indian presidency needs to advance these agendas.
Global community engagement to strengthen Health systems
- Universal Health Coverage (UHC): The concept of UHC was born in the 2000s to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalizing health insurance coverage.
- UHC as a strategy to ensure healthcare for all: The UHC has been the big global approach for health systems strengthening since 2010, also adopted in 2015 as the strategy for Sustainable Development Goal-3 on ensuring healthcare for all at all ages.
- Limited impact of UHC: However, the limited impact of this narrow strategy was soon evident, with expenditures on outdoor services becoming catastrophic for poor households and preventing access to necessary healthcare and medicines, while many unnecessary/irrational medical interventions were being undertaken.
What are the new approaches developed to strengthen healthcare system?
- Highlighted the need to prioritise primary healthcare (PHC): In 2018, the Astana Conference organised by WHO and UNICEF put out a declaration stating that primary healthcare (PHC) is essential for fulfilling the UHC objectives.
- Combined UHC- PHC approach: In 2019, the UN General Assembly adopted the combined UHC-PHC approach as a political declaration.
- World bank report on benefits of PHC services during pandemic: The World Bank published a report in 2021, “Walking the Talk: Reimagining Primary Health Care After COVID-19”. The dominant hospital-centred medical system is becoming unaffordable even for the high-income countries, as apparent during the 2008 recession and subsequently.
What is PHC-with-UHC approach?
- It means strengthening primary level care linked to non-medical preventive action (food security and safety, safe water and air, healthy workspaces, and so on)
- It works through whole-of-society and whole-of-government approaches, and extending the “PHC principles” to secondary and tertiary care services.
- This could be the most cost-effective systems design the comprehensive game changer that global health care requires.
What is to be strengthened, what initiatives can be applied and how?
- Making health central to development in all sectors: Health in all policies, one health (linking animal and human health for tackling antimicrobial resistance and zoonotic diseases), planetary health, pandemic preparedness.
- Health systems strengthening: Designing PHC-with-UHC for diverse contexts. Conceptualised as a continuum of care from self-care in households to community services, to primary level para-medical services and first contact with a doctor, services provided as close to homes as possible, affordable and easily deliverable.
- Appropriate technologies to be adopted as a norm: By strengthening health technology assessment, ethics of healthcare, equitable access to pharmaceutical products and vaccines, integrative health systems using plural knowledge systems rationally.
- Health and healthcare from the perspective of the marginalised: Gendered health care needs, Health care of indigenous peoples globally, occupational health, mental health and wellbeing, healthy ageing.
- Easy access to health knowledge for all: decolonization and democratization of health knowledge, with interests and perspectives of low-middle-income countries (LMICs), prevention and patient-centred healthcare.
India’s G20 Presidency: An opportunity to contribute and make inclusive healthcare system
- India has several pioneering initiatives that can contribute to the PHC-with-UHC discussion:
- National Health mission and dedicated health facilities: Lessons from the National Health Mission for strengthening public health delivery; the HIV-control programme’s successful involvement of affected persons/communities and a complex well-managed service structure.
- Democratized health knowledge: Pluralism of health knowledge systems, each independently supported within the national health system.
- Certified Health personnel: Health personnel such as the ASHAs, mid-level health providers and wellness centres, traditional community healthcare providers with voluntary quality certification;
- R&D and widely acknowledged pharmaceutical capacity: Research designed for validation of traditional systems; pharmaceutical and vaccines production capacity;
- Digital health as an example: Developments in digital health; social insurance schemes and people’s hospital models by civil society.
Conclusion
- What is required is the drafting of PHC-with-UHC (a PHC 2.0) with a broad global consensus and commitment to a more sustainable and people-empowering health system. Pursuing such an agenda would involve much dialogue within countries, regions and globally. India should use its presidency to draft a model policy focusing on primary healthcare that commits to a universal, affordable, inclusive and just healthcare system
Mains Question
Q. What is Primary HealthCare and Universal healthcare integrated approach? What steps are necessary to further strengthen sustainable healthcare system? Discuss how India can contribute to it under its G20 presidency?
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Students suicides: A mismatch between rising aspirations, shrinking opportunities
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Addressing the issues of Students pressure, suicides, reasons and way ahead
Context
- Three students committed suicide within 12 hours in Rajasthan’s Kota, which is regarded as the education and coaching hub of India. Known for producing IITians, doctors and engineers, Kota has been in the news for the last few years because of the students’ suicides and depression they suffer.
What is Suicide?
- Suicide is the act of intentionally causing one’s own death.
- Mental and physical disorders, substance abuse, anxiety and depression are risk factors.
- Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.
- Despite being entirely preventable, India has been increasingly losing individuals to suicide.
The National Crime Records Bureau’s Accidental Deaths and Suicide in India report 2021.
- The report released this year shows that the number of students’ deaths by suicide rose by 4.5 per cent in 2021.
- Maharashtra bearing the highest toll with 1,834 deaths, followed by Madhya Pradesh with 1,308, and Tamil Nadu with 1,246.
- According to the report, student suicides have been rising steadily for the last five years.
- According to a 2012 Lancet report, suicide rates in India are highest in the 15-29 age group the youth population.
- According to the National Crime Record Bureau (NCRB), in 2020, a student took their own life every 42 minutes; that is, every day, more than 34 students died by suicide.
What are the reasons behind these alarming stats of student’s suicide in India?
- Education is for livelihood more than knowledge: Education in India has been viewed as a gateway to employment and livelihood rather than to knowledge.
- Pressure to get into government jobs or highly paid private sector: Many students and their families dream of the coveted ‘sarkari naukri’ (government job) to escape the precarious social, caste and class predicaments they find themselves in.
- Limited educational infrastructure: The failure of the Union government to improve the country’s educational infrastructure means that exam-oriented coaching had become the norm.
- Coaching centres as prisons for many students: Cashing in on the ‘hope for a better future,’ coaching centres emerged as one of the predominant industries in the education sector. However, these centres are now being seen as prisons for the many youngsters who join them; where their bodies, souls and dreams are tamed.
- Number of factors marginalising students who are already vulnerable: Students from marginalised sections are pushed further to the margins through a number of factors, such as the lack of English-medium education; private institutions charging high fees; poor quality education in government-run schools and institutes; ever-growing economic inequality; graduates not having the adequate skills to secure jobs; and caste discrimination.
- Social ideology of success and failure: The rise of neoliberalism as an economic and social ideology has pushed the youth to blame themselves for their failure to secure their ‘dream job’ while the government continues to shirk its basic responsibility.
- Flawed neoliberal agenda for failure and success: The neo-liberal agenda keeps propagating the belief that it is not that hard to find success if one works hard enough, normalising the notion that the youth should blame themselves for their ‘failures’.
What are various solutions have been proposed?
- The myth of the Indian family being supportive also need to be called out: Family, being the primary social unit of the society, shapes the aspirations and dreams of the youth. Family should be supportive in true sense.
- Deeper introspection is needed instead of make shift solutions: Deeper introspection on structural aspects of the education system is the need of the hour. Instead, we take pride in coming up with Jugaad (makeshift solutions) to manage affairs peripherally, without dealing with the root of problem.
- Easing pressure in the students: Others have suggested like the guidelines issued by the Board of Intermediate Education in Andhra Pradesh in 2017 to ease the pressure on students, including yoga and physical exercise classes and maintaining a healthy student-teacher ratio.
- Realising today’s realities and making changes: It is painfully evident that the failure to address the larger issue of a punishing education system that is simply not designed to support young minds or prepare them for today’s economic realities continues.
- Collective responsibility: Not only family plays a significant role in students life, even the society has a huge influence. We as a society should realise true essence of life and not confine students into success and failure tags. Instead support them empathically in realising their true potential.
Did you know this solution? What any sensitive person will think of this?
- Some suggested bordering on the ludicrous, like the Indian Institute of Science’s reported move last year to replace ceiling fans in hostel rooms with those that are wall-mounted.
Conclusion
- Scholars have long linked farmers’ suicides to India’s agrarian crisis; it is time that civil society starts looking at students’ suicides as an indicator of a grave crisis of the country’s educational structure, including the institutional structure, curriculum, and the like. The combination of a large population of young people with rising aspirations and an economy with shrinking opportunities has created a public health crisis that requires urgent attention.
Mains Question
Q. There has been a steady increase in student suicides in India over the past few years. What are the reasons and suggest what should be done?
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Curbing individualism in public health
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Issues in public health management
Context
- A failure to examine and interpret public health problems from a population perspective is leading to ineffective and unsustainable solutions as far as complex public health problems are concerned. There is a strong tendency in public health to prioritise individual-oriented interventions over societal oriented population-based approaches, also known as individualism in public health.
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What are the problems in public health approach?
- Micronutrient supplementation at Individualistic level instead sustainable approach at public level: Problems such as undernutrition, for which individualist solutions such as micronutrient supplementation and food fortification have been proposed as solutions in lieu of sustainable approaches such as a strengthening of the Public Distribution System, supplementary nutrition programmes, and the health services.
- Diagnosis and treatment than the solutions that modify health behaviours: Similar is the case with chronic disease control, wherein early diagnosis and treatment is the most popular solution, with little scope for solutions that can modify health behaviours (through organised community action).
Recent evidences that show individualism is preferred over population-based approach
- Pradhan Mantri Jan Arogya Yojana (PMJAY): A nationwide publicly-funded insurance scheme, the Pradhan Mantri Jan Arogya Yojana (PMJAY) falls under Ayushman Bharat. It is the largest health insurance scheme in the country covering hospitalisation expenses for a family for ₹5 lakh a year. The goal is to ensure ‘free’ curative care services for all kinds of hospitalisation services so that there is no financial burden to the beneficiary.
- Approach needed: What is not talked about in the entire scheme is the need for hospitalisation services per year for any population.
- Approach preferred: Instead, every individual is given an assurance that if there is a need for hospitalisation expenses, the scheme will cover the expenses, highlighting the risk/probability of every individual facing hospitalisation in a year.
- Individualistic response: This is an individualistic response to the problem of hospitalisation expenditure faced by populations. This becomes obvious when one examines the data on annual hospitalisation across populations.
- vaccination for COVID-19 unlike other vaccinations: It was evident that a COVID-19 vaccine cannot prevent people from getting the disease but only reduce hospitalisation and deaths in the event of contracting COVID-19.
- Approach needed: To effectively manage COVID-19, what was needed was to have primary, secondary, and tertiary health-care facilities to manage the above proportion of cases. This is what a population-based approach to epidemic would be focusing on.
- Approach preferred: Instead, by focusing on a vaccination programme for the entire population, it is again an assurance and a promise to every individual that even if you get COVID-19, you will not need hospitalisation and not die. Even after the entire crisis, not much is talked about in terms of the grossly inadequate health-care infrastructure to ensure the necessary primary, secondary and tertiary care services for COVID-19 patients, in turn leading to many casualties.
- Individualistic response: The entire focus has been on the success story that every individual is protected from hospitalisation and death achieved through vaccine coverage. Most of the deaths due to COVID-19 are a reflection of the failure to offer ventilator and ICU support services to the 1%-2% in desperate need of it. Curative care provisioning is never planned at an individual level as epidemiologically, every individual will not necessarily need curative care every time. The morbidity profile of a population across age groups is an important criterion used to plan the curative care needs of a population.
What the data on population hospitalization suggests?
- Episode of hospitalization a year: Data from the National Sample Survey Organisation (75th round) show that on an average, only 3% of the total population in India had an episode of hospitalisation in a year (from 1% for Assam to 4% for Goa and 10% for Kerala the need also a function of availability). The proportion hovers around 3%-5% across most Indian States.
- Population based healthcare planning is necessary: This is population-based health-care planning. Instead, giving an assurance to every individual without ensuring the necessary health-care services to the population is not really helping in a crisis.
Determinants of individualistic approach
- Misconception in philosophy of public health: The dominance of biomedical knowledge and philosophy in the field of public health with a misconception that what is done at an individual level, when done at a population level, becomes public health. This is despite the contrasting philosophy and approaches of clinical medicine and public health and the evidence that support the latter and must be based on population characteristics and economic resources.
- Visibility impact and mistake of judging a population’s characteristics: Health effects are more visible and appear convincing at the individual level, wherein improvements at the population level will be clear only after population-level analysis; this needs a certain level of expertise and orientation about society an important skill required for public health practitioners.
- Market’s role and the effect of consumerism in public health practice: The beneficiaries for a programme become the maximum when 100% of the population is targeted. Instead of making efforts to supply evidence of the actual prevalence of public health problems, market forces would prefer to cast a wide net and cover 100% of beneficiaries. Propagating individualism has always been a characteristic feature of a consumerist society as every individual can then be a potential ‘customer’ in the face of risk and susceptibility.
Conclusion
- The need of the hour is population-level planning, which means, population as a single unit needs to be considered. All forms of individualistic approaches in public health need to be resisted to safeguard its original principles of practice, viz. population, prevention, and social justice.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
The depopulation alert
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Population and population decline trend
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Context
- Recently, when the world population touched eight billion, several headlines focused on how India was the largest contributor to the last billion and is set to surpass China as the world’s most populous nation by 2023. But missing in this conversation is the real threat of depopulation that parts of India too face, and the country’s complete lack of preparedness to deal with it.
Note: “The population and Population decline are continuously in the headlines which makes the population and associated topics important for the upcoming Mains Examinations.”
India’s Population trend
- The total population of India currently stands at 1.37 billion which is 17.5% of the world population.
- Between 1992 and 2015, India’s Total fertility rate (TFR) had fallen by 35% from 3.4 to 2.2.
- Young people (15-29 age years) form 27.2% of the population in 2021. This made India enter the Demographic dividend stage.
- The percentage of the elderly population has been increasing from 6.8% in 1991 to 9.2% in 2016.
What is depopulation?
- The depopulation decline (also sometimes called population decline, underpopulation, or population collapse) in humans is a reduction in a human population size.
- Over the long term, stretching from prehistory to the present, Earth’s total human population has continued to grow; however, current projections suggest that this long-term trend of steady population growth may be coming to an end.
The depopulation discussion and the missing links
- Falling fertility rate and discussing reversal: Demographers, policy experts and politicians in countries such as Japan, South Korea and Europe, which are experiencing falling fertility and nearing the inflection point of population declines, are beginning to talk about what the future holds and whether reversal is possible.
- The missing key elements in the conversation: Talking about equitable sharing of housework; access to subsidized childcare that allows women to have families as well as a career; and lowered barriers to immigration to enable entry to working-age people from countries which aren’t yet in population decline is missing.
Fertility in India
- Falling fertility rate: It is now well-established that fertility in India is falling along expected lines as a direct result of rising incomes and greater female access to health and education. India’s total fertility rate is now below the replacement rate of fertility.
- Many states are on the verge of population decline: Parts of India have not only achieved replacement fertility, but have been below the replacement rate for so long that they are at the cusp of real declines in population. Kerala, which achieved replacement fertility in 1998, and Tamil Nadu, which achieved this in 2000, are examples.
- Decline in working age population: In the next four years, both Tamil Nadu and Kerala will see the first absolute declines in their working-age populations in their histories. With falling mortality (barring the pandemic), the total population of these States will continue to grow for the next few decades, which means that fewer working-age people must support more elderly people than ever before.
What is Replacement Level Fertility (RLF)?
- Replacement level fertility is the level of fertility at which a population exactly replaces itself from one generation to the next.
- In simpler terms, it denotes the fertility number required to maintain the same population number of a country over a given period of time.
- In developed countries, replacement level fertility can be taken as requiring an average of 2.1 children per woman.
- In countries with high infant and child mortality rates, however, the average number of births may need to be much higher.
- RLF will lead to zero population growth only if mortality rates remain constant and migration has no effect.
A depopulating future and the challenges
- Invisible trend because infuse of migrants: Access to working-age persons notably different from the situation in other States with low fertility. For instance, Delhi and Karnataka which are both net recipients of migrants, and will not confront population decline in the near future.
- A skewed sex ratio remains a danger: As the latest round of the NFHS showed, families with at least one son are less likely to want more children than families with just one daughter.
- Difference in education: The stark differences between northern and southern States in terms of basic literacy as well as enrolment in higher education, including in technical fields, will mean that workers from the southern States are not automatically replaceable.
Conclusion
- With decades of focus on lowering fertility, the conversation in India is stuck in a rut. It is for the southern States to break away from this outmoded, data-free rhetoric and join the global conversation on depopulation. India’s cannot ignore the depopulation in the name of migration to meet its current labour needs.
Mains question
Q. What is depopulation, which has been a hot topic in recent times? Where do you see India in global population trends? Discuss.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Union Health Ministry rolls out India’s 1st Suicide Prevention Policy
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : National Suicide Prevention Strategy
The Ministry of Health and Family Welfare announced a National Suicide Prevention Strategy, the first of its kind in the country.
What is Suicide?
- Suicide is the act of intentionally causing one’s own death.
- Mental and physical disorders, substance abuse, anxiety and depression are risk factors.
- Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.
- Despite being entirely preventable, India has been increasingly losing individuals to suicide.
Why need such strategy?
Ans. Suicides in India
- The burden of deaths by suicide has increased in India — by 7.2 per cent from 2020 — with a total of 1,64,033 people dying by suicide in 2021.
- In India, more than one lakh lives are lost every year to suicide, and it is the top killer in the 15-29 years category.
- In the past three years, the suicide rate has increased from 10.2 to 11.3 per 1,00,000 population, the document records.
- The most common reasons for suicide include family problems and illnesses, which account for 34% and 18% of all suicide-related deaths.
- The report follows a 2021 Lancet study that noted “India reports the highest number of suicide deaths in the world”.
About the National Suicide Prevention Strategy
The NSPS puts a time-bound action plan and multi-sectoral collaborations to achieve reduction in suicide mortality by 10% by 2030. The strategy broadly seeks to establish-
- Effective surveillance mechanisms for suicide within the next three years,
- Establish psychiatric outpatient departments that will provide suicide prevention services through the District Mental Health Programme in all districts within the next five years, and
- Integrate a mental well-being curriculum in all educational institutions within the next eight years.
The strategy also envisages:
- Developing guidelines for responsible media reporting of suicides and
- Restricting access to means of suicide
Significance of the strategy
- The most important thing is that the government has acknowledged that suicide is a problem.
- We now have a well-conceived plan involving multi-sectoral collaborations, because the only way a strategy would work would be to involve various sectors.
- The strategy should now be passed on to the States for them to develop locally relevant action plans; and then cascade to the district, primary health and community levels.
Why suicide is such a big issue?
- More youth committing: For the youth of the country (15-29 years), among whom 1/3rd of all suicides take place.
- Performance pressure: Data suggests that one student dies by suicide every 55 minutes, and 1,129 suicides among children below 18 years of age in 2020 were due to failure in examinations.
- Farm distress: This is followed by farmer’s suicide and the gendered variance observed these days.
- Gendered variances: More women are committing suicides these days.
Way forward
- Holistic approach: Promoting national and sectoral research into the reasons for suicide mortality and its rise, and making culturally and economically appropriate suggestions to help mitigate the problem is critical.
- Counselling by mass-media: During times of distress, media must promote health-seeking behaviour, correct information and counter the possible myths related to suicide.
- Evidence-based interventions: Keep in mind the needs of the most vulnerable and marginalized populations, like women and young individuals, providing the required support systems can reduce the number of lives lost and build a healthier response system.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Is India a Diabetes capital of the world?
From UPSC perspective, the following things are important :
Prelims level : Basics-Diabetes, Insulin, glucose. etc
Mains level : India's Diabetes stress, Measures
Context
- India is often referred to as the ‘Diabetes Capital of the World as it accounts for 17%percent of the total number of diabetes patients in the world. There are currently close to 80 million people with diabetes in India and this number is expected to increase to 135 million by 2045. World Diabetes day is observed on 14 November.
What is Diabetes?
- Diabetes is a chronic (long-lasting) health condition that affects how our body turns food into energy.
- Diabetes is a metabolic disorder in which the body has high sugar levels for prolonged periods of time.
- The lack of insulin causes a form of diabetes.
- Type-I Diabetes: It is a medical condition that is caused due to insufficient production and secretion of insulin from the pancreas. Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1
- Type-2 diabetes: With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2.
Type-2 diabetes in brief
- Long term Condition: It is long-term (chronic) condition which results in too much sugar circulating in the bloodstreams and poor response of insulin. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems. Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. It is a defective response of Insulin
- More common in adults: Type 2 is more common in older adults, but the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.
- Slow signs and symptoms: Signs and symptoms of type 2 diabetes often develop slowly. Symptoms include, Increased thirst, Frequent urination, Increased hunger, Unintended weight loss, Fatigue, Blurred vision, Slow-healing sores, Frequent infections etc. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults).
- Cure for Type-2: There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.
What is insulin?
- Insulin is a hormone produced by the pancreas.
- Insulin regulates the movement of sugar into your cells.
- Blood glucose levels tightly controlled by insulin.
- When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level
The prevalence of diabetes in India
- People living with Diabetes in India: There are an estimated 77 million people with diabetes in India. Which means one in every 10 adults in India has diabetes. Half of those who have high blood sugar levels are unaware. Even among those who have been diagnosed with diabetes, only half of them have their blood sugar level under control.
- Rapid increase in younger population: According ICMR report, the prevalence of diabetes in India has increased by 64 percent over the quarter-century. prevalence among the younger population has also increased above 10%.
- Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.
- Projected Estimation: About 98 million Indians could have diabetes by 2030, these projections come from the International Diabetes Federation and the Global Burden of Disease project.
- Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.
Why Indians are more prone to diabetes?
- Lifestyle changes: The current exponential rise of diabetes in India is mainly attributed to lifestyle changes. The rapid change in dietary patterns, physical inactivity, and increased body weight, especially the accumulation of abdominal fat, are some of the primary reasons for increased prevalence.
- Ethnically more prone: Ethnically, Indians seem to be more prone to diabetes as compared to the Caucasians, although the precise mechanisms are not well known. we Indians have a greater degree of insulin resistance which means our cells do not respond to the hormone insulin. And when compared to Europeans, our blood insulin levels also tend to rise higher and more persistently when we eat carbohydrates.
- Greater genetic predisposition: The epidemic increase in diabetes in India along with various studies on migrant and native Indians clearly indicate that Indians have an increased predilection to diabetes which could well be due to a greater genetic predisposition to diabetes in Indians.
- Decrease in traditional diets: At the same time, the increased ‘westernization’, especially in the metros and the larger cities, has led to a drastic change in our dietary pattens. Indian diets have always been carbohydrate-heavy and now the reliance on refined sugars, processed food in the form of quick bites and fuss-free cooking and trans fatty acids are creating havoc.
- Mechanization of day-to-day work: With the increasing availability of machines to do our work, there’s also a substantial drop in day-to-day activities.
- Consumption of high calorie food and lack of physical activities: Obesity, especially central obesity and increased visceral fat due to physical inactivity, and consumption of a high-calorie/high-fat and high sugar diets, thus become major contributing factors.
- Rapid urbanization: Currently, India is undergoing a rapid epidemiological transition with increased urbanization. The current urbanization rate is 35% compared to 15% in the 1950’s and this could have major implications on the present and future disease patterns in India with particular reference to diabetes and coronary artery disease.
- Rural-urban migration: The rural migration to urban areas and associated stress plays a significant role in lifestyle change.
Ways to manage Increasing Diabetes in India
- Aggressive Screening procedures: Indians need an upstream approach or prioritizing protection of the population as a whole, beginning with women and children. This can be done with aggressive screening procedures. “Anybody above 18, with a clear-cut risk like family history, weight issues and young women with polycystic ovarian syndrome (PCOS) should be tested. All Indians above 30 should be screened.
- Timely diagnosis and right management: Medical experts feel that timely detection and right management can go a long way in helping patients lead a normal life.
- Diet discipline for children: For children, Doctors recommends a serious diet discipline. “Only healthy meals are the option that remains. Tutor the tastebuds of the young and stop their access to fast foods. There can be supportive policy measures making healthy fruits and vegetables accessible in a cost-effective manner to all instead of plain carbs. The mid-day meal or tiffin needs to be looked at thoughtfully and to make it healthy.
- Promoting physical activities: “The overall decline in physical activity has had devastating impacts on our metabolism,” while agreeing with the 30-minute a day exercise and activity schedule, sounds a note of caution. The recent scientific evidence suggests even five minutes of walk after any meal provides some protection.
- Adopting healthy Lifestyle: Though a chronic medical condition, Diabetes can be curbed at the initial level by introducing lifestyle changes. Experts suggests, reduce stress; sleep on time and for minimum of seven hours, maintaining ideal body weight, regular physical activity stop smoking, stopping/ minimum alcohol intake and get early treatment for any pre-existing or co-morbid health condition such as hypertension.
- Regular check-ups: Regular visits to the doctor are important to assess sugar control and assessment/ prevention of complications related to the disease.
Conclusion
- With the country having the highest number of diabetic patients in the world, the sugar disease is posing an enormous health problem to our country today. According to a World Health Organization (WHO) fact sheet on diabetes, an estimated 3.4 million deaths are caused due to high blood sugar in the world.
Mains Question
Q. Diabetes is increasing alarmingly across all age groups in India. Discuss the reasons and suggest measures to manage epidemic of diabetes if it is not curable?
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Role of Private Sector in Ayushman Bharat Digital Mission
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat Digital Mission
Mains level : Issues with interoperability of Private Sector under Ayushman Bharat Digital Mission
Context
- On 27 September, 2021, Prime Minister Narendra Modi announced the rollout of the Ayushman Bharat Digital Mission with the aim of integrating the different and disparate digital health systems that exist into a National Digital Health Ecosystem.
What is Ayushman Bharat Digital Mission (ABDM)?
- The ABDM currently has five main components:
- Ayushman Bharat Health Account (ABHA) number: A unique health identification number,
- Healthcare Professionals Registry (HPR): A repository of healthcare professionals across both modern and traditional systems of medicine,
- Health Facility Registry (HFR): A repository of both public and private health facilities, including hospitals, clinics, diagnostic laboratories, and pharmacies,
- Unified Health Interface (UHI): An open protocol for digital health services linking patients with healthcare providers,
- ABHA Mobile App: An app allowing an individual to carry electronic health records.
Analyzing the future of India’s health care system
- Digitization push of Government: To achieve the Sustainable Development Goals and targets of universal health coverage, the Indian government has expended significant efforts to promote the digitization of the healthcare sector to make health accessible, affordable, and equitably distributed.
- Citizens and doctors can access the health registry: The two registries would ostensibly create a database of India’s healthcare institutions and professionals that citizens would be able to access.
- Digital health card: The ABHA number and the application allow citizens to securely identify themselves and carry their health records to any healthcare facility.
- Targeted health care services: And lastly, the UHI would facilitate greater access to and delivery of healthcare services.
- Huge data for research: All of this activity has and will generate a tremendous quantity of data, which will be crucial for research, innovation, and policymaking.
Importance of private sector in health sector
- Mixed health care system: India has a mixed healthcare system, which means that it has both public and private healthcare providers. Without significant participation from the private healthcare providers, the ABDM’s ability to achieve its objectives will be limited.
- 81% doctors are private: This is because private healthcare infrastructure accounts for nearly 62 per cent of all of India’s health infrastructure and the private sector also provides 81 per cent of the doctors in India.
- Preference to private healthcare: Both rural and urban population in India seem to prefer seeking treatment from the private sector. Only 33 per cent of the rural and 26 per cent of the urban population depend on the public sector for healthcare.
Why Private health care are opting out of ABDM?
- Voluntary participation in ABDM: The voluntary nature of participation in the ABDM has led to a significant portion of private healthcare providers opting to not participate in the universal programme nor integrate into the UHI.
- High cost for digital records: Small healthcare providers like charitable hospitals, clinics, diagnostic labs, pharmacies, or nursing homes are less inclined to participate because of the significant costs involved.
- Requirement of manpower for digitization: The cost to these healthcare providers, who are most likely in various stages of digitisation, is the number of man hours required to digitise their health records and other data.
- Financial cost of digitization: The actual financial cost of upgrading or altering their digital health systems to meet basic required standards to participate in the ABDM and the UHI.
Impact of non-participation by private players
- A lack of participation from the private sector will negatively impact the objectives of the ABDM in major way:
- Limited success for UHI: Considering the concentration of private healthcare providers in urban areas, a lack of their participation and integration would limit the UHI’s ability to bring previously inaccessible services to the rural population who would otherwise have to travel to access them.
- Incomplete data and ineffective policy: The data generated by the ABDM and use of the UHI would be incomplete, which in turn would significantly limit the effectiveness of policy planning and programme delivery.
Conclusion
- It is unclear whether the government intends to achieve private sector participation through incentives or mandates. Without either approach, it seems that the ABDM will see little participation from smaller private healthcare providers, though how this will play out remains to be seen.
Mains Question
Q. What is the significance of Private Players in health care system of India? Explain the crucial role of Private health care in Ayushman Bharat digital Mission.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Centre opposes petition in HC against provisions of Surrogacy Law
From UPSC perspective, the following things are important :
Prelims level : Surrogacy (Regulation) Act, 2021
Mains level : Not Much
The Centre has opposed before the Delhi HC a petition challenging certain provisions of the surrogacy laws, including the Assisted Reproductive Technology (Regulation) Act, 2021, and the Surrogacy (Regulation) Act, 2021.
What is the case?
- The provisions challenged includes the exclusion of a single man and a married woman having a child from the benefit of surrogacy as a reproductive choice.
- It challenged the ban on commercial surrogacy.
- In their plea, the petitioners have stated that commercial surrogacy is the only option available to them.
Invoking Article 21
- The personal decision of a single person about the birth of a baby through surrogacy, that is, the right of reproductive autonomy is a facet of the right to privacy guaranteed under Article 21 of the Constitution.
- Thus, the right affecting a decision to bear or beget a child through surrogacy cannot be taken away, the petition said.
What rules say?
- Under the Surrogacy (Regulation) Act, 2021, a married couple can opt for surrogacy only on medical grounds.
- The law defines a couple as a married Indian “man and woman” and also prescribes an age-criteria with the woman being in the age of 23 years to 50 years and the man between 26 years to 55 years.
- The couple should not have a child of their own.
- Though the law allows single women to resort to surrogacy, she has to be a widow or a divorcee between the age of 35 and 45 years.
- The law does not allow single men to go for surrogacy.
Distinct features of the Surrogacy (Regulation) Act, 2021
- Definition of surrogacy: It defines surrogacy as a practice where a woman gives birth to a child for an intending couple with the intention to hand over the child after the birth to the intending couple.
- Regulation of surrogacy: It prohibits commercial surrogacy, but allows altruistic surrogacy which involves no monetary compensation to the surrogate mother other than the medical expenses and insurance.
- Purposes for which surrogacy is permitted: Surrogacy is permitted when it is: (i) for intending couples who suffer from proven infertility; (ii) altruistic; (iii) not for commercial purposes; (iv) not for producing children for sale, prostitution or other forms of exploitation; and (v) for any condition or disease specified through regulations.
- Eligibility criteria: The intending couple should have a ‘certificate of essentiality’ and a ‘certificate of eligibility’ issued by the appropriate authority ex. District Medical Board.
Eligibility criteria for surrogate mother:
- To obtain a certificate of eligibility from the appropriate authority, the surrogate mother has to be:
- A close relative of the intending couple;
- A married woman having a child of her own;
- 25 to 35 years old;
- A surrogate only once in her lifetime; and
- Possess a certificate of medical and psychological fitness for surrogacy.
- Further, the surrogate mother cannot provide her own gametes for surrogacy.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Recognizing “ASHA”: The real hope
From UPSC perspective, the following things are important :
Prelims level : Basics of ASHA workers
Mains level : Strengthening ASHA and basic medical facilities
Context
- One of the biggest issues facing rural health services is lack of information. ASHA workers are the first respondents even when there is lack of access to medical aid are threatened with violence and abused on the number of occasions while handlining the prospected patients in COVID19 pandemic.
Evolution of “ASHA” you may want to know
- The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
- The ASHA was to be a local resident, looking after 200 households.
- The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health.
- Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.
Who are ASHA workers?
- ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.
- The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
- They act as a bridge connecting marginalized communities with facilities such as primary health centers, sub-centers and district hospitals.
Qualifications for ASHA Workers
- ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community.
- They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.
What role do the ASHA Workers play?
- Involved in Awareness programs: They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They also counsel women about contraceptives and sexually transmitted infections.
- Ensures Mother and child health: They focus primarily on ensuring that pregnant women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children.
- Actively involved in Immunization programs: ASHA workers are also tasked with ensuring and motivating children to get immunized.
- Providing medicines and therapies: Other than mother and childcare, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anemia etc.
- Tasked with Screening tests: They are also tasked with screening for infections like malaria during the season. They also get people tested and get their reports for non-communicable diseases. They were tasked to quarantine the covid 19 infected patients in the pandemic.
- Informing the birth and death in respective areas: The health volunteers are also tasked with informing their respective primary health center about any births or deaths in their designated areas.
What are the challenges that ASHA workers face?
- Lack of communication threating the job of ASHA Workers: One of the biggest issues facing rural health services is lack of information.
- Lack of resources burdening the ASHA works job: Another area of concern is the lack of resources. Over the years, with the closest hospital being 9 km away and ambulances taking hours to respond, ASHA workers had to take multiple women in labour to the hospital in auto rickshaws.
- Poor medical health facilities: Medical facilities are understaffed and lack adequate equipment for various basic procedures like deliveries. Simple tests, like for sickle cell anemia and HIV, cannot be conducted in no of respective areas of ASHA workers.
- Low wages according to the job they do: The initial payment used to be paid was Rs 250 a month in 2009. Since ASHA’s unionized and agitated for a living wage. Thirteen years on, they earn around Rs 4,000 a month. It is simply not enough to sustain a family of four.
- Covid 19 disruptions added to the existing problems: Low wages forcing ASHA’s to work two or more jobs. In the pandemic, no of women lost their husband or the means of earnings and had to revert to farming. Weather fluctuations disrupting the farm produce leaving no of ASHA’s the sole earner for the family. Those who don’t have land are living in miserable conditions.
- Delayed payments reduce the morale: Payments are also delayed by months, Desperation for work leaves us unable to focus on the groundwork we do.
What can be done to improve the work conditions of ASHA workers?
- Improving the communication channels: Channels of communication between the government and the rural population need to be robust. A deadly pandemic makes the value of these channels obvious but in order to get people on board, information needs to be sent out much more effectively and in a hands-on manner. ASHA workers play a crucial role in aiding this effort. ASHA’s can’t do this alone. They need new systems to ensure the dissemination of life-saving information in remote areas.
- ASHA’s should have fixed income: ASHA’s should have a fixed income, giving them the stability in a job where they spend between eight to twelve hours daily.
- Role needs to be formalized ensuring the dignity: ASHA’s are recognized as “volunteers” currently. Their role needs to be formalized. Recognizing them as workers provides dignity and protection, and helps them to be taken seriously, by the state, the gram panchayat responsible for the disbursal of funds, and patients.
- Recognizing and awarding their role will empower and motivate ASHA’s further: For people in villages, ASHA’s have become lifelines. They have led innumerable immunization drives and are everybody’s first call in a medical emergency. They have labored to build trust and serve as a bridge with the state. Examples shows recognition gives some leverage to circumvent the system and seek funds for people in my community.
Conclusion
- ASHA’s are lifelines of rural primary healthcare, they are playing critical role on no of fronts ensuring the basic health of India. A better, stronger India is possible if ASHA’s are enabled to serve people. Giving them due recognition would serve this end, along with making rural India’s needs medical or otherwise a priority.
Mains Question
Q. For the villagers, ASHA has been a lifeline in the last few years. Acknowledge the problems they face on a daily basis and suggest solutions to raise their morale for the primary health of the village community and the nation as a whole.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Physical Inactivity, Neglected Burden on Economy
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Physical and mental health and economy
Context
- Global status report on physical activity is WHO’s first dedicated global assessment of global progress on country implementation of policy recommendations of the Global Action Plan on Physical Activity (GAPPA) 2018-2030.
What are the findings of the report?
- Poor physical activity standards: Over 80 per cent adolescents and 27 per cent adults do not meet the physical activity standards set by the World Health Organization (WHO), according to a new report.
- developing non-communicable diseases: This will lead to 500 million additional people developing non-communicable diseases from 2020-2030 and cost the global economy $27 billion annually, it added.
How physical Inactivity impacts health and Economy?
- Changing lifestyles: Sedentary lifestyle of a large share of the global population has been linked to rising prevalence of heart diseases, obesity, diabetes or other noncommunicable diseases.
- Increasing Hypertension and depression: Of the 500 million new cases projected, nearly half will be attributed to hypertension and 43 per cent to depression, the authors of the report said.
- A strain on the health systems: The report quantified the economic burden of not being able to meet the GAPPA target. The sharp rise in non-communicable diseases will also put a strain on the health systems in every country.
- Rising cost of treatment: If the current prevalence of physical inactivity doesn’t change, the world will incur treatment costs of just over $300 billion till 2030, the report mentioned.
- 70 per cent of health-care expenditure: The largest economic cost is set to occur among high-income countries, according to the analysis. This will account for 70 per cent of health-care expenditure on treating illness resulting from physical inactivity, it showed. Around 75 per cent of the cases will occur in low- and middle-income countries, it added.
What are the government efforts to address the physical inactivity menace?
- National physical activity policy: Less than half the countries in the world have any national physical activity policy, showed the analysis of 194 countries by WHO published October 19, 2022.
- National policies are in operation: Less than 40 per cent of the existing national policies are in operation, the United Nations health agency noted in the Global status report on physical activity 2022.
- Monitor physical activity among adolescents: As many as 75 per cent of countries monitor physical activity among adolescents, and less than 30 per cent monitor physical activity in children under 5 years.
- Addressing lack of public Infrastructure: The report highlighted that data regarding progress on certain policy actions is missing. These include provision of public open space, provision of walking and cycling infrastructure, provision of sport and physical education in schools.
- National physical activity guidelines: only 30 per cent of countries have national physical activity guidelines for all age groups, according to the findings of the report.
What are the Recommendations of WHO?
- Exercise benefits mental and physical health: Light exercise and even walking has proven benefits for mental and physical health, studies have shown.
- Infrastructural changes by governments: Citizens cannot make healthier lifestyle choices without infrastructural changes by governments such as safe walking and cycling lanes. “In policy areas that could encourage active and sustainable transport, only just over 40% of countries have road design standards that make walking and cycling safer,” the WHO analysts found.
- Five ways to address the policy gaps:
- Strengthen whole-of-government ownership and political leadership
- Integrate physical activity into relevant policies and support policy implementation with practical tools and guidance
- Strengthen partnerships, engage communities and build capacity in people
- Reinforce data systems, monitoring, and knowledge translation
- Secure sustainable funding and align with national policy commitments
- Four areas of policy intervention:
- Active societies,
- active environments,
- active people and
- active systems.
Government of India’s efforts to promote physical activity
- FIT India Movement: FIT INDIA Movement was launched on 29th August 2019 by Honorable Prime Minister with a view to make fitness an integral part of our daily lives. The mission of the Movement is to bring about behavioral changes and move towards a more physically active lifestyle.
- Objectives of Fit India: Fit India proposes to undertake various initiatives and conduct events to achieve the following objectives:
- To promote fitness as easy, fun and free.
- To spread awareness on fitness and various physical activities that promote fitness through focused campaigns.
- To encourage indigenous sports.
- To make fitness reach every school, college/university, panchayat/village, etc.
- To create a platform for citizens of India to share information, drive awareness and encourage sharing of personal fitness stories.
Conclusion
- Physical inactivity is silent poison, killing the future of the citizens. Work from home, remote working has increased the physical inactivity among the working populations. Indoor games, mobile addictions, e-learning have reduced the physical activity of children. It’s a collective responsibility of parents, society and government to promote and encourage the physical activity among citizens.
Mains Question Q.
What are the ill effects of physical inactivity on health and economy? What are the policies of government India to promote healthy life style?
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Reality check on India’s Population policy
From UPSC perspective, the following things are important :
Prelims level : Population prospectus,NFHS report
Mains level : Declining fertility,Population prospectus and development
Context
- Earlier this year, the United Nations published data to show that India would surpass China as the world’s most populous country by 2023.According to the 2018-19Economic Survey, India’s demographic dividend will peak around2041, when the share of the working age population is expected to hit 59%.
What is the Present status of India’s population?
- Declining Total fertility rate (TFR): The Total fertility rate (TFR) has declined from 2.2 (reported in 2015-16) to 2.0 at the all- India level, according to the latest National Family Health Survey of India OR NFHS- 5 (phase 2) released by Union Health Ministry.1.6 in urban areas2.1 in Rural area and 2.0 all India.
- Sex ratio: There are 1,020 women per 1,000 men in India according to the recently released Fifth Edition (NFHS-5). Such a sex ratio has not been recorded in any of the previous four editions of the NFHS.
Need for population control measures
- At present, India hosts 16% of the world’s population with only 2.45% of the global surface area and 4% of water resources.
- The ecosystem assessments also pointed out the human population’s role in driving other species into extinction and precipitating a resource crunch.
- So, the population explosion would irreversibly impact India’s environment and natural resource base and limit the next generation’s entitlement and progress. Therefore, the government should take measures to control the population.
What will be the Impact of declining fertility?
- Implications on Political economy: It’s not just the economic implications that we need to think about but also the implications of the political economy.
- Spatial difference: India’s fertility fell below 2.1 births for certain States 10 years ago. In four other States, it’s just declining. So, not only is the fertility falling, the proportion of the population that will be living in various States is also changing.
- North-south imbalance: The future of India lies in the youth living in U.P., Bihar, M.P. If we don’t support these States in ensuring that their young people are well educated, poised to enter the labour market and have sufficient skills, they will become an economic liability.
How India can take advantage of its demographic dividend?
- Investing In literacy: If China hadn’t invested in literacy and good health systems, it would not have been able to lower its fertility rates. In any case, we have much to learn from China about what not to do.
- Planning for elderly: Especially in the case of the elderly, where the estimates show that12% of India’s total population by 2025 is going to be the elderly. Every fifth Indian by 2050 will be over the age of 65. So, planning for this segment merits equal consideration.
- Focusing on gendered dimension: India certainly has the capacity to invest in its youth population. But we don’t recognise the gender dimension of some of these challenges. Fertility decline has tremendous gender implications.
- Lowering the Burdon on women: What it means is that women have lower burden on them. But it also has a flip side. Ageing is also a gender issue as two thirds of the elderly are women, because women tend to live longer than men do. Unless we recognise the gender dimension, it will be very difficult for us to tap into these changes.
- Educating the young girls: So, what do we need to do? India has done a good job of ensuring educational opportunities to girls. Next, we need to improve employment opportunities for young women and increase the female employment rate. Elderly women need economic and social support networks.
Do we really need the population policy?
- Existing policy is right: India has a very good population policy, which was designed in 2000. And States also have their population policies. We just need to tweak these and add ageing to our population policy focus. But otherwise, the national population policy is the right policy.
- Reproductive health is important: What we need is a policy that supports reproductive health for individuals. We also need to start focusing on other challenges that go along with enhancing reproductive health, which is not just the provision of family planning services.
- Avoiding the stigma: We need to change our discourse around the population policy. Although we use the term population policy, population control still remains a part of our dialogue. We need to maybe call it a policy that enhances the population as resource for India’s development, and change the mindset to focus on ensuring that the population is happy, healthy, productive
- Thinking beyond two child policy: Our arguments and discussions have not gone beyond the two-child norm. The two-child norm indicates a coercive approach to primarily one community. And there are too many myths and misconceptions around population issues, which lead to this discourse, which takes away attentions of from real issues.
Way forward
- Family welfare approach: We need to move from a family planning approach to a family welfare approach. We should be focusing on empowering men and women in being able to make informed choices about their fertility, health and wellbeing.
- Thinking about automation: As fertility drops and life spans rise globally, the world is ageing at a significant pace. Can increasing automation counteract the negative effects of an ageing population or will an ageing population inevitably end up causing a slowdown in economic growth? We need to look at all of that.
- Changing the mindset: We are where we are, so let’s plan for the wellbeing of our population instead of hiding behind the excuse that we don’t have good schooling or health because there are too many people. That mindset is counterproductive.
- Skill development and making population productive: It is not about whether the population is large or small; it is about whether it is healthy, skilled and productive. Thomas Malthus had said as the population grows, productivity will not be able to keep pace with this growth, and we will see famines, higher mortality, wars, etc. Luckily, he proved to be wrong.
- Adhering to the Cairo consensus: Cairo International Conference on Population and Development in 1994 stressed population. The Cairo Consensus called for the promotion of reproductive rights, empowering women, universal education, maternal and infant health to untangle the knotty issue of poverty and high fertility. The consensus also demands an increase in the rate of modern contraceptive prevalence, male contraception. States instead of releasing population control measures can start to adhere to implementing the Cairo consensus.
- Adopting Women-Centric Approach: Population stabilisation is not only about controlling population growth, but also entails gender parity. So, states need to incentivize later marriages and childbirth, promoting women’s labor force participation, etc.
- Seeing Population as a Resource rather than Burden:
- As the Economic Survey, 2018-19, points out that India is set to witness a sharp slowdown in population growth in the next two decades.
- Further, population estimates also predict a generational divide between India’s north and south, Fifteen years from now.
- So instead of population control policies at the state level, India needs a universal policy to utilize population in a better way.
Conclusion
- We have the capacity to tap into the potential of our youth population. There is a brief window of opportunity, which is only there for the next few decades. We need to invest in adolescent wellbeing right away, if we want to reap the benefits. Otherwise, our demographic dividend could turn easily into a demographic disaster.
Mains Question
Q.Why India’s fertility rate is declining? How India can convert its demography into opportunity by investing in gendered based population policy?
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Mental health in India
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Mental healthcare in India
10th October, yesterday was observed as World Mental Health Day.
What is the news?
- The Lancet released a new report calling for radical action to end stigma and discrimination in mental health.
- It stated that 90% of people living with mental health conditions feel negatively impacted by stigma and discrimination.
Mental Illness in India
- Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990.
- In 2017, an estimation of the burden of mental health conditions for the states across India revealed that as many as 197.3 million people required care for mental health conditions.
- This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders.
- The situation has been exacerbated due to the Covid-19 pandemic, making it a serious concern the world over.
Reasons for Persistence of Mental Illness
- Stigma to seek help: The staggering figures are void of millions of others directly, or indirectly impacted by the challenge and those who face deep-rooted stigma, many times rendering them unable to seek help.
- Lack of awareness: This growing challenge in dealing with mental health issues is further compounded by a lack of information and awareness, self-diagnosis, and stigma.
- Psycho-social factors: Institutions like gender, race, and ethnicity, are also responsible for mental health conditions.
- Post-Treatment gap: There is a need for proper rehabilitation of mentally ill persons post/her treatment which is currently not present.
- Rise in Severity: Mental health problems tend to increase during economic downturns, therefore special attention is needed during times of economic distress.
Need for immediate intervention
- Neglected Area: Mental health which forms the core of our personhood is often neglected which impeded the development of an individual to full potential.
- Disproportionate impact: It is the poor, dispossessed and marginalised who bear the greatest burden of mental health problems, but historically their sufferings are dismissed as a natural extension of their social and economic conditions.
- Vulnerability of the ills: Mentally ill patients are vulnerable to and usually suffer from drug abuse, wrongful confinement, even at homes and mental healthcare facilities which is a cause of concern and a gross human right violation.
- Suicidal tendencies: Suicidal behavior was found to have relation with female gender, working condition, independent decision making, premarital sex, physical abuse and sexual abuse.
- Gendered nature: Females are more predisposed to mental disorders due to rapid social change, gender discrimination, social exclusion, gender disadvantage like marrying at young age, concern about the husband’s substance misuse habits, and domestic violence.
Policy initiatives
- National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the NMHP since 1982.
- Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
- Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in the society
- Manodarpan Initiative: An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.
Way Forward
- Policy boost: Mental health situation in India demands active policy interventions and resource allocation by the government.
- Public sensitization: To reduce the stigma around mental health, we need measures to train and sensitize the community/society.
- Awareness: People should be made aware of the significance of mental health, as much as that of physical health.
- Destigmatising: Sharing one’s story about mental health (through media campaigns) is the most effective strategy to reduce stigma attached with mental illness
- Community Approach: There is need to deploy community health workers who, with appropriate training and supervision, effectively deliver psychosocial interventions for the needy
- Broadening the scope: Mental health care must embrace the diversity of experiences and strategies which work, well beyond the narrow confines of traditional biomedicine with its emphasis on “doctors, diagnoses, and drugs”.
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Ayushman Bharat scheme
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat
Mains level : Success of India's health policies
India has completed four years of Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY), the world’s largest public health insurance programme.
What is Ayushman Bharat?
- 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.
- It was launched in September 2018 by the Ministry of Health and Family Welfare.
- It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
- It has subsumed the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
Features of the scheme
- It will have a defined benefit cover of Rs. 5 lakh per family per year.
- Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
- It will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
- The beneficiaries can avail benefits in both public and empanelled private facilities.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
India’s health expenditure post Ayushman Bharat
Ans. India’s public healthcare spending is still among the lowest in the world.
- Total health expenditure declined to 3.2% of GDP in 2018-19 from 3.3% in 2017-18, while the government’s health expenditure (centre and state) as a percentage of GDP fell from 1.35% to 1.28% in the same period.
- National health estimates showed the Centre’s share decreasing to 34.3% in 2018-19 from 40.8% in the previous year, while that of states rose from 59.2% to 65.7%.
- Out-of-pocket spending as a percentage of total health expenditure declined to 48.2% in 2018-19, though it is significantly higher than the world average of 18.1% in 2019
What about health insurance penetration?
Ans. Retail health insurance covers a meagre 3.2% of the country’s population.
- With a population of 1.36 billion, India is the world’s second most populous country, and is expected to surpass China soon.
- Launched in 2018 to provide universal health coverage, AB-PMJAY, takes care of the bottom 50% of the population of approximately 700 million individuals.
- The top 20% of the population is covered through social and private health insurance.
- Therefore, about 30% of the population, or about 400 million, is “the missing middle”— they don’t have any financial protection for health emergencies.
Why is sound healthcare important for the economy?
- Covid-19 exposed the economic consequences of poor healthcare. Higher out-of-pocket healthcare spending hits savings and consumption.
- In the work space, poor health impacts physical and mental abilities, increase turnover and lead to lower productivity.
- Data shows that 7% of India’s population is pushed into poverty every year due to healthcare costs.
Way forward
- Healthcare management and disease prevention should be the focus, along with an all-encompassing healthcare system, including OPD.
- The government also needs to pay attention on healthcare cover for “the missing middle” population.
- As a pilot, states may allow the authority already implementing the AB-PMJAY scheme in the state to cover the missing middle.
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Congenital Heart Disease
From UPSC perspective, the following things are important :
Prelims level : Heart, and Heart Diseases
Mains level : Health
Context
- Congenital Heart Disease (CHD), which the Centre for Disease Control and Prevention(CDC), Atlanta, U.S., acknowledges to be the most common congenital disorder, is responsible for 28% of all congenital birth defects, and accounts for 6%-10 % of all the infant deaths in India. 29 September is celebrated as world heart day.
What is Congenital Heart Disease (CHD)?
- Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. The term “congenital” means the condition is present from birth.
What is paediatric cardiac care?
- Paediatric cardiologists diagnose, treat, and manage heart problems in children, including. “Congenital heart disease” (heart differences children are born with), such as holes between chambers of the heart, valve problems, and abnormal blood vessels
What is the Present situation of Congenital Heart Disease In India?
- It is estimated that over 1,00,000 children keep getting added to the existing pool of children awaiting surgery.
- According to the Paediatric Cardiac Society of India (PCSI), the prevalence of congenital cardiac anomalies is one in every 100 live births; or an estimated 2,00,000 children are born with CHD every year. Only 15,000 of them receive treatment.
- At least 30% of infants who have complex defects require surgical intervention to survive their first birthday but only 2,500operations can be performed each year. A case in point is the premier All India Institute of Medical Sciences (AIIMS), where infants are waitlisted till 2026 for cardiac surgery.
What are the Reasons behind this worrisome situation?
- Lack of money: There has been more neglect and little improvement in child health care because creating a comprehensive paediatric cardiology care service is usually considered economically unviable — it is resource intensive and requires infrastructure investment that politicians and policy makers choose to evade.
- Infrastructure: There are 22 hospitals and less than 50 centres in India with infant and neonatal cardiac services.
- Uneven distribution: Geographically, these centres are not well distributed either. 2018 cardiology department report of AIIMS, highlighted how South India accounted for 70% of these centres; most centres are located in regions with a lower burden of CHD. For instance, Kerala has eight centres offering neonatal cardiac surgeries for an estimated 4.5 lakh annual childbirths. Populous Uttar Pradesh and Bihar, with an estimated annual childbirth of 48 and 27 lakh births per annum, respectively (Census of India, 2012), do not have a centre capable of performing neonatal cardiac surgery.
- Non-priority: A 2018 article by the Department of Cardiothoracic Cardiology, AIIMS, states, “paediatric cardiology is not a priority area in the face of competing demands for the resources
What are the problems in treating congenital Heart Disease?
- Doctor population ratio: For 600 districts with a 1.4 billion population, there are only 250 paediatric cardiologists available. The doctor to patient ratio is an abysmal one for half-a-crore population. According to the Annals of Paediatric Cardiology journal, the United States had 2,966 paediatric cardiologists in 2019, ratio of one per 29,196population.
- Poverty: Poverty is another barrier before treatment. Transporting sick neonates from States with little or no cardiac care facilities to faraway centres for accurate diagnosis and treatment burdens parents financially.
- Medical devices: In addition, there is the non-availability of crucial equipment that is essential for diagnosis of heart diseases in the unborn. Accentuating the problem is the general lack of awareness about early symptoms of CHD among parents.
What should be approach for the treatment of Congenital Heart Disease?
- Timely treatment: Paediatricians say timely medical intervention can save 75% of these children and give them normal lives.
- National policy: The lack of a national policy for the treatment of cardiovascular diseases in children keeps a huge number outside the ambit of treatment.
- Echocardiography: The Child Heart Foundation, a non-governmental organisation working in Siliguri (WestBengal), Jalandhar (Punjab) and Delhi, with underprivileged children with CHD, has been flagging the need for fatal echocardiography.
- Hridayam: There are programmes worth emulating such as Kerala’s ‘Hridayam (for little hearts)’,aimed at early detection, management and support to children with CHD or the Tamilnadu Chief Minister’s Comprehensive Health Insurance Scheme offering free specialised surgeries.
- Ayushman Bharat: The National Health Protection Scheme (Ayushman Bharat), is expected to financially assist 10 crore poor families but has still to takeoff. So far, Maharashtra, Karnataka, Gujarat and Andhra Pradesh have apparently got going.
Conclusion
- India’s performance in neo natal care is very regrettable. India can drastically reduce its infant mortality by investing in paediatric cardiac care. Sooner we realize this better will be the future of India.
Mains Question
Q.Infant mortality India out of congenital Heart Disease is because of negligence and non-priority. Acknowledge the problems and suggest solutions.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Rising number of Rabies case
From UPSC perspective, the following things are important :
Prelims level : particulars of virus
Mains level : Human health
Context
- The death of a 12-year-old girl in Pathanamthitta has sharpened the focus on the rising number of rabies cases and the growing population of stray dogs in Kerala
What is rabies?
- The rabies virus attacks the central nervous system of the host, and in humans, it can cause a range of debilitating symptoms including states of anxiety and confusion, partial paralysis, agitation, hallucinations, and, in its final phases, a symptom called “hydrophobia,” or a fear of water.
What are rabies caused by?
- Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system of mammals, ultimately causing disease in the brain and death.
Can rabies person survive?
- Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. Less than 20 cases of human survival from clinical rabies have been documented.
How long can a human live with rabies?
- Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.
Facts on rabies
- What animal has the most rabies?
- Bats
- Wild animals accounted for 92.7% of reported cases of rabies in 2018. Bats were the most frequently reported rabid wildlife species (33% of all animal cases during 2018), followed by raccoons (30.3%), skunks (20.3%), and foxes (7.2%).
What is the issue?
- There is a blame game over the rising rabies cases: With the rabies deaths causing panic and reports of residents killing stray dogs through poisoning and strangulation, there is a blame game over the rising canine population and rabies cases. Some legal experts blame it on conflicts in the Prevention of Cruelty to Animals Act, 1960 and the Animal Birth Control (Dogs) Rules, 2001; others point to the flawed implementation of birth control measures.
- Legal battle over the issue in the Supreme Court: Canine culling campaigners and advocates of animal rights are also engaged in a protracted legal battle over the issue in the Supreme Court. V.K. Biju, a lawyer of the Supreme Court, who brought the issue of the “stray dog menace” before the apex court, contends that the root cause is the enactment of the Rules, which according to him, were passed in contravention of the parent Act, the Prevention of Cruelty to Animals Act.
- Existence of stray dogs has adversely affected the fundamental rights of citizens: Biju says that while the Act stands for the “destruction” of stray dogs, the rules are against the “destruction” of stray dogs, including the rabies affected ones, besides providing specific protection of stray dogs. In his submission before the Supreme Court, he argues that the existence of stray dogs has adversely affected the fundamental rights of citizens, i.e. the right to life and free movement.
- The quashing of the Rules to make India free of stray dogs: In his writ petition filed before the apex court, Biju has sought orders for the strict implementation of the Act and the quashing of the Rules to make India free of stray dogs.
- Animal rights campaigners are apprehensive: In the light of this, animal rights campaigners are apprehensive over the campaign to cull dogs to check rabies.
How can we prevent rabies in animals?
- First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.
- Second, maintain control of your pets by keeping cats and ferrets indoors and keeping dogs under direct supervision.
- Third, spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly.
- Finally, call animal control to remove all stray animals from your neighbourhood since these animals may be unvaccinated or ill.
How can we prevent rabies in humans?
- Leave all wildlife alone.
- Know the risk: contact with infected bats is the leading cause of rabies deaths in people followed by exposure to rabid dogs while traveling internationally.
- Wash animal bites or scratches immediately with soap and water.
- If you are bitten, scratched, or unsure, talk to a healthcare provider about whether you need postexposure prophylaxis. Rabies in people is 100% preventable through prompt appropriate medical care.
- Vaccinate your pets to protect them and your family.
Initiatives by Government to curb Neglected Tropical Diseases
National Rabies Control Programme: This programme is being restructured as Integrated National Rabies Control Programme under ‘One Health Approach’, with a aim to provide vaccination to stray dogs and free vaccines through Government hospitals.
Way forward
- Think globally, act locally. Study and adopt global ‘best-practices’ after customising them to local needs.
- Apply integrated approach. Follow a holistic strategy.
- Ensure efficient and effective collaboration across various government departments.
- Partner with Civil Society Organisations (especially with WASH – Water, Sanitation and Hygiene – sector) for ground-level implementation and monitoring.
Mains question
Q. What is rabies? What ethical challenges are involved in culling of stray dogs? Explain the control measures for the same.
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Fighting anaemia
From UPSC perspective, the following things are important :
Prelims level : iron fortification
Mains level : women health
Context
- The recent National Family Health Survey (NFHS-5) data shows anaemia rates increased from 53 per cent to 57 per cent in women and 58 per cent to 67 per cent in children in 2019-21.
Definition of anaemia
- The WHO defines anaemia as a condition where the number of red blood cells or the haemoglobin concentration within them is lower than normal. This compromises immunity and impedes cognitive development.
Why anaemia is a concern?
- Adverse effects of anaemia affect all age groups lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
- Anaemia among adolescent girls (59.1 per cent) advances to maternal anaemiaand is a major cause of maternal and infant mortality and general morbidity and ill health in a community.
What causes anaemia?
- Imbalanced diet: Cereal-centric diets, with relatively less consumption of iron-rich food groups like meat, fish, eggs, and dark green leafy vegetables (DGLF), can be associated with higher levels of anaemia.
- Underlying factors: High levels of anaemia are also often associated with underlying factors like poor water quality and sanitation conditions that can adversely impact iron absorption in the body.
- Iron deficiency is major cause: A diet that does not contain enough iron, folic acid, or vitamin B12 is a common cause of anaemia.
- Some other conditions: That may lead to anaemia include pregnancy, heavy periods, blood disorders or cancer, inherited disorders, and infectious diseases.
Why is anaemia so high in the country?
- Low vitamin intake: Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
- High population and nutrition deprivation: Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
- Overemphasis on cereals: Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.
What is Iron fortification?
- Iron fortification of food is a methodology utilized worldwide to address iron deficiency. Iron fortification programs usually involve mandatory, centralized mass fortification of staple foods, such as wheat flour.
Why need iron fortification?
- Iron deficiency anaemia is due to insufficient iron.
- Without enough iron, the body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (haemoglobin).
- Severe anaemia during pregnancy increases risk of premature birth, having a low birth weight baby and postpartum depression. Some studies also show an increased risk of infant death immediately before or after birth.
Success story / value addition
- Nepal’s success story to improve maternal anaemia by national action plan .
Anaemia Mukt Bharat
- The scheme aims to reduce the prevalence of anaemia in India.
- It provides bi weekly iron Folic acid supplementation to all under five children through Asha workers.
- Also, it provides biannual Deworming for children and adolescents. The scheme also establishes institutional mechanisms for advanced research in anaemia.
- It also focuses on non-nutritional causes of anaemia.
We need to focus on the following interventions
- Prophylactic Iron and Folic Acid supplementation.
- Intensified year-round Behaviour Change Communication Campaign (Solid Body, Smart Mind).
- Appropriate infant and young child feeding practices.
- Increase in intake of iron-rich food through diet diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available resources.
- Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents
- Mandatory provision of Iron and Folic Acid fortified foods in government-funded public health programmes
Way forward
- India’s nutrition programmes must undergo a periodic review.
- The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.
- The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.
Conclusion
- When a person is anaemic, the capacity of his blood cells to carry oxygen decreases. This reduces the productivity of the person which in turn affects the economy of the country. Therefore, it is highly important to cover Anaemia under National Health Mission.
Mains question
Q. “Every second adolescent girl has anaemia. Every second woman of reproductive age is anaemic”. In this context do you think Women’s empowerment will not have any meaning without tackling anaemia? Discuss.
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Public health should be led by doctor alone
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : Health care sector reforms
Context
- Doctor shortages are creating hurdles in health emergency response
What is the crux of the article in simple words?
- Medical qualification and expertise is necessary to deliver quality health services by medical professionals unlike by general health care workers who lack competency.
What is public health?
- Public health has been defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.
Why there is need of qualification?
- Lack of training: Health workers have no training in public health; they are grassroots-level service providers. Asking them to be part of public health cadre trivialises the profession of public health.
- Separate profession: It is important to understand that public health is a separate profession with a specific set of competencies.
What are 4 pillars of public health?
- Academics: Academics refers to a good understanding of evidence generation and synthesis by having a good grounding in epidemiology and biostatistics. These competencies are also critical for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
- Activism: Public health is inherently linked to ‘social change’ and an element of activism is core to public health. Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc. This requires grounding in social and behavioural sciences.
- Administration: Administration refers to administering health systems at different levels from a primary health centre to the district, State, and national level. This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc. It includes microplanning of programme delivery, team building, leadership as well as financial management to some extent.
- Advocacy: In public health, there is little that one can do at an individual level; there must be communication with key stakeholders to change the status quo at different levels of government. This requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation. Good communication and negotiation skills are critical to perform this function. The related subjects are health policy, health economics, health advocacy and global health.
What are the hurdles in absorbing others as public health professionals?
- Lack of skill: Many doctors and other health professionals work at the grassroots level and develop a good sense of public health due to their inclination. But they do not become public health professionals as they may not have the necessary skills. Nevertheless, they are valuable.
- Lack of critical expertise: Clinicians with training in epidemiology and biostatistics would not qualify to be public health professionals as they lack not only other essential and critical expertise but also an appropriate perspective.
- Compromise on quality:
Current challenges faced by public healthcare in India
- Deficiency: The doctor-patient ratio of 1:1655 in India as against WHO norm of 1:1000 clearly shows the deficit of MBBS. While the government is working towards a solution and targeting to reach the required ratio, there is a need to relook at the overall medical education.
- Post pandemic scenario: The lag in formal medical education has come up evidently post-pandemic when the nation saw the medical fraternity struggling to fill the doctor deficit.
- Limited government seats: The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
- Lack of skills: Though the institutes are managing to hire professors and lecturers, there is a lack of technical skills. Finding faculties in clinical and non-clinical disciplines is difficult and there are very few faculty development programs for upskilling the existing lot.
- Lack of infrastructure: The gap in digital learning infrastructure is currently the biggest challenge the sector is facing. There is an urgent need to adopt technology and have resources available to facilitate e-learning.
- Lack of research and innovation: The medical research and innovation needs an added push as there haven’t been many ground-breaking research here. The education system needs to focus more on increasing the quality of research. Additionally since industry academia partnership is not available, hence innovation also takes a back-seat.
Conclusion
- By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to public health as separate profession. This will attract the best and the brightest people into this discipline, which is very important for the nation’s health. This is one lesson that we should learn from the pandemic.
Mains question
Q. What do you understand by public health? Do you think it is a separate profession requiring a specific set of competencies? Examine.
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Global pandemic treaty to avert future mishap
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : future preparedness for pandemics
Context
- The outline of an essential global pandemic treaty.
Purpose of the treaty
- A pandemic treaty under the umbrella of the World Health Organization would build coherence and avoid fragmentation of response.
Severity of this pandemic demands such treaty
- COVID-19 would count as being among some of the most severe pandemics the world has seen in the last 100 years. An estimated 18 million people may have died from COVID-19, according various credible estimates, a scale of loss not seen since the Second World War.
- Further, with over 120 million people pushed into extreme poverty, and a massive global recession, no single government or institution has been able to address this emergency singlehandedly.
- This has given us a larger perspective of how nobody is safe until everybody is safe.
Catchy line for value addition
Nobody is safe until everybody is safe
There is widespread inequity in healthcare
- Gross inequity in distribution: Health-care systems have been stretched beyond their capacity and gross health inequity has been observed in the distribution of vaccines, diagnostics, and therapeutics across the world.
- Irreversible consequences: While high-income economies are still recovering from the aftereffects, the socioeconomic consequences of the novel coronavirus pandemic are irreversible in low and low middle-income countries.
- The monopolies: Held by pharma majors such as Pfizer, BioNTech, and Moderna created at least nine new billionaires since the beginning of the COVID-19 pandemic and made over $1,000 a second in profits, even as fewer of their vaccines reached people in low-income countries.
- Skewed distribution: As of March 2022, only 3% of people in low-income countries had been vaccinated with at least one dose, compared to 60.18% in high-income countries. The international target to vaccinate 70% of the world’s population against COVID-19 by mid-2022 was missed because poorer countries were at the “back of the queue” when vaccines were rolled out.
India’s lead role
- Dynamic response: India’s response to the COVID-19 pandemic and reinstating global equity by leveraging its own potential has set an example to legislators worldwide.
- Vaccine diplomacy: India produces nearly 60% of the world’s vaccines and is said to account for 60%-80% of the United Nations’ annual vaccine procurement “vaccine diplomacy” or “vaccine maitri” with a commitment against health inequity.
- We lead by example: India was unfettered in its resolve to continue the shipment of vaccines and other diagnostics even when it was experiencing a vaccine shortage for domestic use. There was only a brief period of weeks during the peak of the second wave in India when the vaccine mission was halted.
- A classic example of global cooperation: As of 2021, India shipped 594.35 lakh doses of ‘Made-in-India’ COVID-19 vaccines to 72 countries a classic example of global cooperation. Among these, 81.25 lakh doses were gifts, 339.67 lakh doses were commercially distributed and 173.43 lakh doses were delivered via the Covax programme under the aegis of Gavi, the Vaccine Alliance.
Why the treaty is needed for?
- Data sharing: A treaty should cover crucial aspects such as data sharing and genome sequencing of emerging viruses.
- Rapid response mechanism: It should formally commit governments and parliaments to implement an early warning system and a properly funded rapid response mechanism.
- Health investments: Further, it should mobilise nation states to agree on a set of common metrics that are related to health investments and a return on those investments. These investments should aim to reduce the public-private sector gap.
Conclusion
- A global pandemic treaty will not only reduce socioeconomic inequalities across nation states but also enhance a global pandemic preparedness for future health emergencies. India must take the lead in this.
Mains question
Q. Nobody is safe until everybody is safe. What do you understand by this? Why there is need of global pandemic treaty?.
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Mental Health in india
From UPSC perspective, the following things are important :
Prelims level : manodarpan initiative
Mains level : mental health
Context
- How to deal with mental wellness challenges in the uniformed forces
What is stress?
- Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stress is your body’s reaction to a challenge or demand.
What is mental wellness?
- Mental wellness encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behaviour. It also determines how an individual handles stress, interpersonal relationships, and decision-making.
Why is Mental Health Important?
- Mental health is more important now than ever before; it impacts every area of our lives. The importance of good mental health ripples into everything we do, think, or say.
Reasons for Persistence of Mental Illness
- Stigma to seek help: The staggering figures are void of millions of others directly, or indirectly impacted by the challenge and those who face deep-rooted stigma, many times rendering them unable to seek help.
- Lack of awareness: This growing challenge in dealing with mental health issues is further compounded by a lack of information and awareness, self-diagnosis, and stigma.
- Psycho-social factors: Institutions like gender, race and ethnicity, are also responsible for mental health conditions.
- Post-Treatment gap: There is a need for proper rehabilitation of the mentally ill persons post/her treatment which is currently not present.
- Rise in Severity: Mental health problems tend to increase during economic downturns, therefore special attention is needed during times of economic distress.
Ongoing challenges in mental wellness regime
- There is a need to expand understanding of the full scope of what uniformed Services and other mental health experts can achieve.
- Stigma regarding mental health both domestically and around the world remains strong.
- There is a lack of trained personnel and healthcare and public health systems in many areas of the world.
- Training needs are broad and reach beyond direct patient care, especially regarding cultural competence, crisis communication, and consultation.
- There is a need for expanded support for the value of multi-professional and multi-organizational integration and collaboration.
Government Policy initiatives
- National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the NMHP since 1982.
- Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
- Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in the society
- Manodarpan Initiative: An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.
What needs to be done?
- Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance. This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
- Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
- Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.
Conclusion
- Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.
Mains question
Q. Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. Examine.
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Bhang, Ganja, and criminality in the NDPS Act
From UPSC perspective, the following things are important :
Prelims level : NDPS Act
Mains level : Issues with NDPS Act
While granting bail to a man arrested on June 1 for possessing 29 kg of bhang and 400 g of ganja, Karnataka High Court recently observed that nowhere in the Narcotic Drugs and Psychotropic Substances (NDPS) Act is bhang referred to as a prohibited drink or prohibited drug.
What is Bhang?
- Bhang is the edible preparation made from the leaves of the cannabis plant, often incorporated into drinks such as thandai and lassi, along with various foods.
- Bhang has been consumed in the Indian subcontinent for centuries, and is frequently consumed during the festivals of Holi and Mahashivratri.
- Its widespread use caught the attention of Europeans, with Garcia da Orta, a Portuguese physician who arrived in Goa in the 16th century, noting that, “Bhang is so generally used and by such a number of people that there is no mystery about it”.
Bhang and the law
- Enacted in 1985, the NDPS Act is the main legislation that deals with drugs and their trafficking.
- Various provisions of the Act punish production, manufacture, sale, possession, consumption, purchase, transport, and use of banned drugs, except for medical and scientific purposes.
- The NDPS Act defines cannabis (hemp) as a narcotic drug based on the parts of the plant that come under its purview. The Act lists these parts as:
- Charas: “The separated resin, in whatever form, whether crude or purified, obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish.”
- Ganja: “The flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops), by whatever name they be known or designated.”
- “Any mixture, with or without any neutral material, of any of the above forms of cannabis or any drink prepared therefrom.”
- The Act, in its definition, excludes seeds and leaves “when not accompanied by the tops”.
- Bhang, which is made with the leaves of the plant, is not mentioned in the NDPS Act.
Cannabis and criminal liability
- Section 20 of the NDPS Act lays out the punishment for the production, manufacture, sale, purchase, import and inter-state export of cannabis, as defined in the Act.
- The prescribed punishment is based on the amount of drugs seized.
- Contravention that involves a small quantity (100 g of charas/hashish or 1 kg of ganja), will result in rigorous imprisonment for a term that may extend to one year and/or a fine which may extend to Rs 10,000.
- For a commercial quantity (1 kg charas/ hashish or 20 kg ganja), rigorous imprisonment of not less than 10 years, which may extend to 20 years, including a fine that is not less than Rs 1,00,000 but may extend to Rs 2,00,000.
- Where the contravention involves quantity less than commercial, but greater than small quantity, rigorous imprisonment up to 10 years is prescribed, along with a fine which may extend to Rs 1,00,000.
Also read:
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National Digital Health Mission
From UPSC perspective, the following things are important :
Prelims level : Digital health id
Mains level : National digital health mission
Context
- The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models and embrace the digital health transformation of the sector.
Definition of digital health care
- Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise.
Digital Health: A Backgrounder
- The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
- A Digital Health ID was proposed to reduce the risk of preventable medical errors and significantly increase the quality of care.
- It recognised the need to establish a specialised ecosystem, called the National Digital Health Mission (NDHM).
The National Digital Health Mission
- The NDHM is a digital health ecosystem under which every Indian citizen will now have unique health IDs, digitized health records with identifiers for doctors and health facilities.
- The mission will significantly improve the efficiency, effectiveness, and transparency of health service delivery and will be a major step towards the achievement of the UN Sustainable Development Goal 3.8 of Universal Health Coverage, including financial risk protection.
Significance of digital health
- Prioritizing patients: Say, mortality from Covid-19 is significantly increased by comorbidities or the presence of other underlying conditions like hypertension or diabetes.With digital health records, doctors can prioritise patients based on their test results.
- Portability of health records: Portability of records fairly eases in a patient with the first hospital visit, or her/his most frequently visited hospital. If she/he wishes to change a healthcare provider for cost or quality reasons, she can access her health records without carrying pieces of paper prescriptions and test reports. People will able to access their lab reports, x-rays and prescriptions irrespective of where they were generated, and share them with doctors or family members — with consent.
- Easy facilitation: This initiative will allow patients to access healthcare facilities remotely through e-pharmacies, online appointments, teleconsultation, and other health benefits. Besides, as all the medical history of the patient is recorded in the Health ID card, it will help the doctor to understand the case better, and improved medication can be offered.
- Technology impetus in policymaking: Meanwhile, it is also not just individuals who could emerge beneficiaries of the scheme. With large swathes of data being made available, the government too can form policies based on geographical, demographical, and risk-factor based monitoring of health.
Critical point to remember
In the case of lung cancer, only 18.5 % of patients survive five or more years once diagnosed. These are threats that data-led technology will help address.
Major privacy issues involved
- Informed Consent:The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
- Data leakages issue:Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
- Digital divide:Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
- Data Migration:The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.
Other challenges
- Existing digitalization is yet incomplete:India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
- Lack of healthcare facilities:The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
- Lack of finance:With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.
Conclusion
- With an enabling ecosystem, supported by effective policies for digital healthcare and increased innovation, the promise of digital solutions in healthcare is immense. It’s not long before precision healthcare becomes central to the health and well-being of every citizen.
Mains question
Q. The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models. In this context discuss challenges and opportunities of digital health ecosystem in India.
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Equitable education and health care needed for better future
From UPSC perspective, the following things are important :
Prelims level : NA
Mains level : equitable health and education
Context
- To create the foundation for the next century, we need to invest in equitable education and health care in the next 25 years not just for the elite, but for all.
What is current status of education?
- Expenditure on Education: The expenses on education as a percentage to GDP, India lags behind some developed/ developing nations.
- Infrastructure deficit: Dilapidated structures, single-room schools, lack of drinking water facilities, separate toilets and other educational infrastructure is a grave problem.
- Student-teacher ratio: Another challenge for improving the Indian education system is to improve the student teacher ratio.
What is current status of healthcare?
- Weak delivery: Current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
- Unpreparedness: Public health experts believe that India is ill-equipped to handle emergencies.
- Technical glitches in urban areas: It is not prepared to tackle health epidemics, particularly given its urban congestion.
A systemic approach to reforming education system in the country needs
- Dynamic pedagogy: Academic interventions involve the adoption of grade competence framework instead of just syllabus completion.
- Directional efforts: Effective delivery of remedial education for weaker students like after-school coaching, audio-video based education.
- Administrative reforms: that enable and incentivize teachers to perform better through data-driven insights, training, and recognition. Example: Performance based increments in Salary.
A systemic approach to reforming healthcare system in the country needs
- Universal health coverage: Access to healthcare in India is not equitable—the rich and the middle class would survive the COVID-19 or any other crisis but not the poor.
- Increasing healthcare professionals in numbers: India has handled the COVID-19 pandemic exceptionally well. However, India is in dire need of more medical staff and amenities.
- Revamping medical education: If the government wants to stay successful in fighting the COVID-19 pandemic, it needs to rapidly build medical institutions and increase the number of doctors.
- Cross-subsidization of health-care: How the poor managed without, or even with, any government insurance scheme is a big question. They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.
Recent initiatives
- PLI scheme: In view of these challenges, the government announced various policies like PLI scheme for domestic manufacturing of active pharmaceutical ingredients (APIs).
- National Digital Health Mission: It also announced the National Digital Health Mission.
Way forward
- India’s healthcare system is too small for such a large population.
- There seems to be a long battle ahead. The public healthcare system cannot be improved overnight.
- The country needs all hands on deck during and after this crisis—both public and private sectors must work together and deliver universal health coverage for all citizens.
Conclusion
- Providing expanded access to high quality education and healthcare supports—particularly for those young people who today lack such access—will not only expand economic opportunity for those individuals, but will also likely do more to strengthen the overall state economy.
Mains question
Q. To create the foundation for the next century, we need to invest in education and health in the next 25 years not just for the elite, but for all. Critically examine
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Govt. to enumerate Sanitation Workers
From UPSC perspective, the following things are important :
Prelims level : Rashtriya Garima Abhiyan
Mains level : Plight of sanitation workers in India
The Ministry of Social Justice and Empowerment (MoSJ&E) is now preparing to undertake a nationwide survey to enumerate all people engaged in the hazardous cleaning of sewers and septic tanks.
Why such move?
- Cleaning of sewers and septic tanks has led to at least 351 deaths since 2017.
Various initiatives for sanitation workers
- The ministry now has proper distinction between sanitation work and manual scavenging.
- The practice of manual scavenging no longer takes place in the country as all manual scavengers had been accounted for and enrolled into the rehabilitation scheme, said the ministry.
- The enumeration of sanitization workers is soon to be conducted across 500 AMRUT (Atal Mission for Rejuvenation and Urban Transformation) cities, as a part of National Action Plan for Mechanised Sanitation Ecosystem (NAMASTE).
- The NAMASTE scheme aims to eradicate unsafe sewer and septic tank cleaning practices.
Manual Scavenging in India
- Manual scavenging is the practice of removing human excreta by hand from sewers or septic tanks.
- India banned the practice under the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 (PEMSR).
- The Act bans the use of any individual for manually cleaning, carrying, disposing of or otherwise handling in any manner, human excreta till its disposal.
- In 2013, the definition of manual scavengers was also broadened to include people employed to clean septic tanks, ditches, or railway tracks.
- The Act recognizes manual scavenging as a “dehumanizing practice,” and cites a need to “correct the historical injustice and indignity suffered by the manual scavengers.”
Why is it still prevalent in India?
- Low awareness: Manual scavenging is mostly done by the marginalized section of the society and they are generally not aware about their rights.
- Enforcement issues: The lack of enforcement of the Act and exploitation of unskilled labourers are the reasons why the practice is still prevalent in India.
- High cost of automated: The Mumbai civic body charges anywhere between Rs 20,000 and Rs 30,000 to clean septic tanks.
- Cheaper availability: The unskilled labourers, meanwhile, are much cheaper to hire and contractors illegally employ them at a daily wage of Rs 300-500.
- Caste dynamics: Caste hierarchy still exists and it reinforces the caste’s relation with occupation. Almost all the manual scavengers belong to lower castes.
Various policy initiatives
- Prohibition of Employment as Manual Scavengers and their Rehabilitation (Amendment) Bill, 2020: It proposes to completely mechanise sewer cleaning, introduce ways for ‘on-site’ protection and provide compensation to manual scavengers in case of sewer deaths.
- Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013: Superseding the 1993 Act, the 2013 Act goes beyond prohibitions on dry latrines, and outlaws all manual excrement cleaning of insanitary latrines, open drains, or pits.
- Rashtriya Garima Abhiyan: It started national wide march “Maila Mukti Yatra” for total eradication of manual scavenging from 30th November 2012 from Bhopal.
- Prevention of Atrocities Act: In 1989, the Prevention of Atrocities Act became an integrated guard for sanitation workers since majority of the manual scavengers belonged to the Scheduled Caste.
- Compensation: As per the Prohibition of Employment of Manual Scavengers and their Rehabilitation (PEMSR) Act, 2013 and the Supreme Court’s decision in the Safai Karamchari Andolan vs Union of India case, a compensation of Rs 10 lakh is awarded to the victims family.
- National Commission for Safai Karamcharis (NCSK): It is currently a temporary non-statutory body that investigates the conditions of Safai Karamcharis (waste collectors) in India and makes recommendations to the Government.
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Drugs shortage haunts HIV-positive community
From UPSC perspective, the following things are important :
Prelims level : ART therapy
Mains level : Not Much
People living with HIV are facing an acute shortage of life-saving drugs, say protesters who have been camping outside the National AIDS Control Organisation (NACO) office.
What is NACO?
- The NACO established in 1992 is a division of India’s Ministry of Health and Family Welfare.
- It provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies.
- It is the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India.
Functions of NACO
- Along with drug control authorities and NACO provides joint surveillance of Blood Bank licensing, Blood Donation activities and Transfusion Transmitted infection testing and reporting.
- NACO also undertakes HIV estimations biennially (every 2 years) in collaboration with the Indian Council of Medical Research (ICMR) – National Institute of Medical Statistics (NIMS).
- The first round of HIV estimation in India was done in 1998, while the last round was done in 2017.
Why in news?
- Activists allege rationing of medicines, arbitrary change in the drug regimen and even complete deprivation of life-saving paediatric drugs.
- They fear that treatment will be interrupted, leading to drug resistance and deaths from AIDS.
NACO stand
- The protesters noted that the NACO, in its public communication, had claimed that 95% of the recipients had not faced any shortage.
- Going by the figure, 5% of 14.5 lakh, or 72,500 people, are being affected by the current shortage and stock-out.
- The impact is severe and far-reaching.
What drugs are protestors talking about?
- Protestors are for a stock-out of ART (antiretroviral) drugs such as Dolutegravir 50 mg, Lopinavir/Ritonavir (adult and child doses), and Abacavir in several states.
What is ART?
- The medicines that treat HIV are called antiretroviral drugs.
- There are more than two dozen of them, and they fall into seven main types.
- Each drug fights the virus in your body in a slightly different way.
- Research shows that a combination, or “cocktail,” of drugs is the best way to control HIV and lower the chances that the virus will become resistant to treatment.
Back2Basics: HIV/AIDS
- HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.
- First identified in 1981, HIV is the cause of one of humanity’s deadliest and most persistent epidemics.
- It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex, or through sharing injection drug equipment.
- If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).
- The human body can’t get rid of HIV and no effective HIV cure exists.
Treating HIV
- However, by taking HIV medicine (called antiretroviral therapy or ART), people with HIV can live long and healthy lives and prevent transmitting HIV to their sexual partners.
- In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
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What rules govern Disposal of Seized Narcotics?
From UPSC perspective, the following things are important :
Prelims level : Disposal of Seized Narcotics
Mains level : Not Much
The Narcotics Control Bureau (NCB) has destroyed 30,000 kg of seized drugs at four locations – Kolkata, Chennai, Delhi and Guwahati — in the virtual presence of Union Home Minister.
Destruction of Seized Narcotic Drugs
- Section 52-A of the Narcotics Drugs and Psychotropic Substances (NDPS) Act, 1985 allows probe agencies to destroy seized substances after collecting required samples.
- Officials concerned must make a detailed inventory of the substance to be destroyed.
- A five-member committee comprising the area SSP, director/superintendent or the representative of the area NCB, a local magistrate and two others linked to law enforcement and legal fraternity is constituted.
- The substance is then destroyed in an incinerator or burnt completely leaving behind not any trace of the substance.
Exact procedure that is followed
- The agency first obtains permission from a local court to dispose of the seized narcotic substances.
- These substances are then taken to the designated place of destruction under a strict vigil.
- The presiding officer tallies the inventory made at the storeroom with that material brought to the spot.
- The entire process is videographed and photographed.
- Then one by one, all the packets/gunny bags of the substance/s are put in the incinerator.
- As per rules, committee members cannot leave the place until the seized drugs have been completely destroyed.
Which agency is authorized to carry out such an exercise?
- Every law enforcement agency competent to seize drugs is authorized to destroy them after taking prior permission of the area magistrate.
- These include state police forces, the CBI and the NCB among others.
Why destroy seized drugs?
- The hazardous nature of narcotic drugs or psychotropic substances, their vulnerability to theft, substitution, and constraints of proper storage space are among the reasons that make agencies destroy them.
- There have been instances when seized narcotics were pilfered from the storeroom.
- To prevent such instances, authorities try to destroy seized drugs immediately after collecting the required samples out of the seized substances.
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Monkeypox outbreak: It’s time to act, not panic
From UPSC perspective, the following things are important :
Prelims level : Monkeypox
Mains level : Paper 2-Challenges of zoonotic diseases
Context
Monkeypox was previously limited to the local spread in central and west Africa, close to tropical rainforests, but has recently been seen in various urban areas and now in more than 50 countries.
About monkeypox
- A virus belonging to the poxviruses family causes a rare contagious rash illness known as monkeypox.
- This zoonotic viral disease (a disease transmitted from animals to humans) has hosts that include rodents and primates.
- It is a self-limiting disease with symptoms lasting two to four weeks and a case fatality rate of 3-6 per cent.
- Symptoms: A skin rash on any part of the body could be the only presenting symptom.
- Swollen lymph nodes are another distinguishing feature. Aside from these, other symptoms of a viral illness include fever, chills, headache, muscle or back aches, and weakness.
- Mode of transmission: Touching skin lesions, bodily fluids, or clothing or linens that have been in contact with an infected person can result in transmission.
- It’s also worth noting that monkeypox does not spread from person to person through everyday activities like walking next to or having a casual conversation with an infected person.
- Treatment: Monkeypox is mostly treated by managing symptoms and preventing complications if it is diagnosed.
- In the minor proportion who are immunocompromised, complications can occur; pulmonary failure was the most common complication with a high mortality rate.
Containment Measures
- Because symptoms usually appear 5-21 days after exposure, people with rashes, sores in the mouth, rash, eye irritation or redness, or swollen lymph nodes should be monitored.
- When symptoms appear, it is critical to isolate the infected from other people and pets, cover their lesions, and contact the nearest healthcare provider.
- It is also critical to avoid close physical contact with others until instructed to do so by our healthcare provider.
- It is preferable to use home isolation whenever possible.
- Priority should be given to educating grassroots workers about symptoms, specimen collection, disease detection, acquiring sample collection equipment, and maintaining cold storage of specimens.
- Increased surveillance and detection of monkeypox cases are critical for controlling the disease’s spread and understanding the changing epidemiology of this resurging disease.
- Preventive health measures, such as avoiding infected animal or human contact and practising good hand hygiene, are the best option.
Vaccines and drugs
- In the US, pre exposure vaccination with JYNNEOS® is available to healthcare workers and lab workers exposed to this group of poxviruses.
- The smallpox vaccine is 85 percent effective against the disease.
- Another vaccine, ACAM2000, is a live vaccinia virus vaccine that is otherwise recommended for smallpox immunisation and can also be used for high-risk individuals during monkeypox outbreaks.
- In addition, Tecovirimat, an antiviral drug used to treat smallpox, is recommended for monkeypox.
- Challenges: Smallpox vaccination programmes have been discontinued for the past 50 years, resulting in a scarcity of effective vaccines.
- There are approved drugs and vaccines, but they are not widely available to scale up controlling monkeypox.
Why WHO declared it as international concern?
- The increase in monkeypox cases in a short span of time in many countries necessitated the declaration of public health emergency of international concern (PHEIC) and additional research studies.
- It is unclear whether the recent sudden outbreaks in multiple countries result from genotypic mutations that alter virus transmissibility. SARS-CoV-2 and monkeypox virus co-infection can alter infectivity patterns, severity, management, and response to vaccination against either or both diseases.
- As a result, there is a need to improve diagnostic test efficiency.
Way forward
- Plan for pandemic preparedness: This is not the last such difficulty we will face, as the world is still witnessing more such public health crises.
- Zoonotic diseases are caused by various factors, including unchecked deforestation, climate coupled with a failure to prioritise public health, poverty, and climate change.
- Instead, a robust plan for pandemic preparedness should be accelerated, guided by a single health agenda.
- The world is yet to recognise emerging and re-emerging infectious diseases as a genuine threat.
- The immediate priority is to strengthen the surveillance infrastructure, including hiring public health professionals and field workers who can participate in outbreak detection and response during many future PHEICs.
Conclusion
Without prioritising public health strengthening, the threat of new and re-emerging infectious diseases, as well as the enormous social and economic challenges that accompany them, is real and grave.
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[pib] NAMASTE scheme
From UPSC perspective, the following things are important :
Prelims level : NAMASTE Scheme
Mains level : Sanitation workers and their upliftment
The Government has formulated a National Action Plan for Mechanized Sanitation Ecosystem- NAMASTE scheme for cleaning of sewers and septic tank.
NAMASTE Scheme
- The scheme is a joint venture of Department of Drinking Water and Sanitation, Ministry of Social Justice and Empowerment and the Ministry of Housing and Urban Affairs.
- It aims to achieve outcomes like:
- Zero fatalities in sanitation work in India
- No sanitation workers come in direct contact with human faecal matter
- All Sewer and Septic tank sanitation workers have access to alternative livelihoods
- The Ministry has shortlisted type of machineries and core equipments required for maintenance works, safety gear for Safai Mitras.
Why such move?
Ans. Prevalence of manual scavenging in India
What is Manual Scavenging?
- Manual scavenging is the practice of removing human excreta by hand from sewers or septic tanks.
- India banned the practice under the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 (PEMSR).
- The Act bans the use of any individual for manually cleaning, carrying, disposing of or otherwise handling in any manner, human excreta till its disposal.
- In 2013, the definition of manual scavengers was also broadened to include people employed to clean septic tanks, ditches, or railway tracks.
- The Act recognizes manual scavenging as a “dehumanizing practice,” and cites a need to “correct the historical injustice and indignity suffered by the manual scavengers.”
Why is it still prevalent in India?
- Low awareness: Manual scavenging is mostly done by the marginalized section of the society and they are generally not aware about their rights.
- Enforcement issues: The lack of enforcement of the Act and exploitation of unskilled labourers are the reasons why the practice is still prevalent in India.
- High cost of automated: The Mumbai civic body charges anywhere between Rs 20,000 and Rs 30,000 to clean septic tanks.
- Cheaper availability: The unskilled labourers, meanwhile, are much cheaper to hire and contractors illegally employ them at a daily wage of Rs 300-500.
- Caste dynamics: Caste hierarchy still exists and it reinforces the caste’s relation with occupation. Almost all the manual scavengers belong to lower castes.
Various policy initiatives
- Prohibition of Employment as Manual Scavengers and their Rehabilitation (Amendment) Bill, 2020: It proposes to completely mechanise sewer cleaning, introduce ways for ‘on-site’ protection and provide compensation to manual scavengers in case of sewer deaths.
- Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013: Superseding the 1993 Act, the 2013 Act goes beyond prohibitions on dry latrines, and outlaws all manual excrement cleaning of insanitary latrines, open drains, or pits.
- Rashtriya Garima Abhiyan: It started national wide march “Maila Mukti Yatra” for total eradication of manual scavenging from 30th November 2012 from Bhopal.
- Prevention of Atrocities Act: In 1989, the Prevention of Atrocities Act became an integrated guard for sanitation workers since majority of the manual scavengers belonged to the Scheduled Caste.
- Compensation: As per the Prohibition of Employment of Manual Scavengers and their Rehabilitation (PEMSR) Act, 2013 and the Supreme Court’s decision in the Safai Karamchari Andolan vs Union of India case, a compensation of Rs 10 lakh is awarded to the victims family.
Way forward
- Regular surveys and social audits must be conducted against the involvement of manual scavengers by public and local authorities.
- There must be proper identification and capacity building of manual scavengers for alternate sources of livelihood.
- Creating awareness about the legal protection of manual scavengers is necessary.
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Kerala reports India’s first Monkeypox Case
From UPSC perspective, the following things are important :
Prelims level : Monkeypox
Mains level : Rise in zoonotic diseases
The first known lab-confirmed case of monkeypox in India has been reported in a 35-year-old man in Kerala.
What is Monkeypox?
- The monkeypox virus is an orthopoxvirus, which is a genus of viruses that also includes the variola virus, which causes smallpox, and vaccinia virus, which was used in the smallpox vaccine.
- It causes symptoms similar to smallpox, although they are less severe.
- While vaccination eradicated smallpox worldwide in 1980, monkeypox continues to occur in a swathe of countries in Central and West Africa, and has on occasion showed up elsewhere.
- According to the WHO, two distinct clade are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.
Its origin
- Monkeypox is a zoonosis, that is, a disease that is transmitted from infected animals to humans.
- Monkeypox virus infection has been detected in squirrels, Gambian poached rats, dormice, and some species of monkeys.
- According to the WHO, cases occur close to tropical rainforests inhabited by animals that carry the virus.
Symptoms and treatment
- Monkeypox begins with a fever, headache, muscle aches, back ache, and exhaustion.
- It also causes the lymph nodes to swell (lymphadenopathy), which smallpox does not.
- The WHO underlines that it is important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
- The incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days.
- There is no safe, proven treatment for monkeypox yet.
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Typhi: A more drug-resistant Typhoid
From UPSC perspective, the following things are important :
Prelims level : Salmonella Typhi
Mains level : Not Much
The bacteria causing typhoid fever is becoming increasingly resistant to some of the most important antibiotics for human health.
What is the news?
- The largest genome analysis of Salmonella Typhi (S. Typhi) also shows that resistant strains — almost all originating in South Asia — have spread to other countries nearly 200 times since 1990.
- The researchers noted that typhoid fever is a global public health concern, causing 11 million infections and more than 1,00,000 deaths per year.
- Antibiotics can be used to successfully treat typhoid fever infections, but their effectiveness is threatened by the emergence of resistant S. Typhi strains.
What is Salmonella Typhi?
- Salmonella Typhi (S. Typhi) are bacteria that infect the intestinal tract and the blood.
- It is usually spread through contaminated food or water.
- Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream.
- The disease is referred to as typhoid fever. S. Paratyphi bacteria cause a similar, but milder illness, which comes under the same title.
- Paratyphoid has a shorter duration, generally, than typhoid.
- Typhi and S. Paratyphi are common in many developing countries where sewage and water treatment systems are poor.
How does it spread?
- Salmonella Typhi lives only in humans.
- Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract.
- Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea.
- Some patients may have a rash. Severe cases may lead to serious complications or even death.
- Typhoid fever can be confirmed through blood testing.
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Managing Type 1 Diabetes
From UPSC perspective, the following things are important :
Prelims level : Diabetes , its types
Mains level : Not Much
Last week, the Indian Council of Medical Research (IMCR) released guidelines for the diagnosis, treatment, and management for type-1 diabetes.
Why such move?
- India is considered the diabetes capital of the world, and the pandemic disproportionately affected those living with the disease.
- Type 1 or childhood diabetes, however, is less talked about, although it can turn fatal without proper insulin therapy.
- Type 1 diabetes is rarer than type 2. Only 2% of all hospital cases of diabetes in the country are type 1.
What is Diabetes?
- Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy.
- Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream.
- When your blood sugar goes up, it signals your pancreas to release insulin.
What is Type 1 Diabetes?
- Type 1 diabetes is a condition where the pancreas completely stops producing insulin.
- Insulin is the hormone responsible for controlling the level of glucose in blood by increasing or decreasing absorption to the liver, fat, and other cells of the body.
- This is unlike type 2 diabetes — which accounts for over 90% of all diabetes cases in the country — where the body’s insulin production either goes down or the cells become resistant to the insulin.
How lethal diabetes is?
- Type 1 diabetes is predominantly diagnosed in children and adolescents.
- Although the prevalence is less, it is much more severe than type 2.
- Unlike type 2 diabetes where the body produces some insulin and which can be managed using various pills, if a person with type 1 diabetes stops taking their insulin, they die within weeks.
How rare is it?
- There are over 10 lakh children and adolescents living with type 1 diabetes in the world, with India accounting for the highest number.
- Of the 2.5 lakh people living with type 1 diabetes in India, 90,000 to 1 lakh are under the age of 14 years.
- For context, the total number of people in India living with diabetes was 7.7 crore in 2019.
- Among individuals who develop diabetes under the age of 25 years, 25.3% have type 2.
Who is at risk of type 1 diabetes?
- The exact cause of type 1 diabetes is unknown, but it is thought to be an auto-immune condition where the body’s immune system destroys the islets cells on the pancreas that produce insulin.
- Genetic factors play a role in determining whether a person will get type-1 diabetes.
- The risk of the disease in a child is 3% when the mother has it, 5% when the father has it, and 8% when a sibling has it.
- The presence of certain genes is also strongly associated with the disease.
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CoWIN as a repurposed digital platform
From UPSC perspective, the following things are important :
Prelims level : CoWIN
Mains level : Paper 2- CoWIN platform
Context
Seeing its success, other nations have also expressed interest in availing CoWIN and using it as a bridge for erecting their digital health systems. Responding to this incoming interest, our prime minister has offered CoWIN as a digital public good, free of cost, for all nations globally to adopt.
About CoWIN
- In late 2020, even before the Covid-19 vaccines had arrived, the Government of India had commenced preparations for launching the world’s largest vaccination drive.
- This led to the beginning of the CoWIN journey in January 2021.
- Scalability, modularity, and interoperability: CoWIN, or the Covid-19 Vaccine Intelligence Network, was developed in a record time, with consideration given to scalability, modularity, and interoperability.
- The platform has been made available in English and 11 regional languages to allow citizens across multiple states to access the platform with ease.
- To circumvent the lack of digital access, the platform allows for up to six members to be registered under one mobile-number linked account.
- CoWIN has scaled every 100 million milestone faster than any other platform.
- It reached the coveted one billion registered user mark which only a handful of platforms have been able to achieve globally, and none in such a short time.
- A key feature of the platform has been its modularity and evolvability.
- The CoWIN team has been adept at keeping pace with the changing policy environment and scientific research and developments in the administration of vaccines.
- It was never that CoWIN became the bottleneck or delayed the implementation of our vaccination policies or drive.
- Time and again, CoWIN has proved itself as one of the most secure and robust platforms with minimal data input and zero risk of personal data hacks.
Major phases of CoWIN
- The journey of CoWIN was staggered across three major phases, with multiple additions subsequently.
- In phase 1, the registration process went online where healthcare workers and frontline workers were sent system-generated notifications about their vaccination schedule.
- In subsequent phases, beneficiaries were allowed both walk-in and online vaccination registration, along with the choice of location and time slot as per their convenience.
- An assisted mode was also made available through the 240,000+ Common Service Centres (CSCs) and a helpline number.
- After ensuring successful orchestration using scalability and agile features of the platform to vaccinate individuals over 45 years of age, the APIs of the platform were made available to private players at the beginning of Phase III of the vaccination drive.
- Once access to its services was opened through APIs, more than 100 applications integrated with CoWIN for providing search, booking and certification facilities to their users.
Way ahead
- The inevitable question is what will we do with CoWIN when no further Covid-19 vaccines are to be administered?
- Repurpose the platform: The decision is to repurpose the platform as a universal immunisation platform.
- The credentialing service of DIVOC, used in CoWIN, has proven to be a game-changer in the world of digital certificates.
- CoWIN service is being implemented in five other countries after India and receiving global acceptance for its veracity and sound architecture.
- There is a proposal for opening the credentialing service for more use cases in health.
Conclusion
The story of CoWIN has truly been one of national impact and importance. And while the story started during the pandemic, it won’t end with the pandemic: it will segue into a repurposed digital platform for more health use-cases.
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Thailand becomes first Asian country to legalize Marijuana
From UPSC perspective, the following things are important :
Prelims level : Marijuana
Mains level : Substance abuse in India
Thailand has officially legalized the growing and consumption of marijuana in food and drinks, becoming the first Asian country to do so.
Films like ‘Udta Punjab’ have graphically portrayed the crisis faced by the society and its youth with regard to the drug menace.
What is Marijuana?
- Cannabis, also known as marijuana among other names, is a psychoactive drug from the Cannabis plant used primarily for medical or recreational purposes.
- The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, including cannabidiol (CBD).
- It is used by smoking, vaporizing, within the food, or as an extract.
Prospects of legalizing Marijuana
(1) Health benefits
- The cannabinoids found in Cannabis is a great healer and has found mention in the Ayurveda.
- It can be used to treat a number of medical conditions like multiple sclerosis, arthritis, epilepsy, insomnia, HIV/AIDS treatment, cancer.
(2) Ecological benefits
- The cannabis plant and seeds apart from being labeled a ‘super-foods’ as per studies is also a super-industrial carbon negative raw material.
- Each part of the plant can be used for some industry. Hemp currently is also being used to make bio-fuel, bio-plastics and even construction material in certain countries. The cosmetic industry has also embraced Hemp seeds.
(3) Marijuana is addiction-free
- An epidemiological study showed that only 9% of those who use marijuana end up being clinically dependent on it.
- The ‘comparable rates’ for tobacco, alcohol and cocaine stood at 32%, 15% and 16% respectively.
(4) Good source of Revenue
- By legalizing and taxing marijuana, the government will stand to earn huge amounts of revenue that will otherwise go to the Italian and Israeli drug cartels.
- In an open letter to US President George Bush, around 500 economists, led by Nobel Prize winner Milton Friedman, called for marijuana to be “legal but taxed and regulated like other goods”.
(5) A potential cash crop
- The cannabis plant is something natural to India, especially the northern hilly regions. It has the potential of becoming a cash crop for poor marginal farmers.
- If proper research is done and the cultivation of marijuana encouraged at an official level, it can gradually become a source of income for poor people with small landholdings.
(6) Prohibition was ineffective
- In India, the consumption of synthetic drugs like cocaine has increased since marijuana was banned, while it has decreased in the US since it was legalized in certain states.
- Moreover, these days, it is pretty easy to buy marijuana in India and its consumption is widespread among the youth. So it is fair to say that prohibition has failed to curb the ‘problem’.
(7) Marijuana is less harmful
- Marijuana consumption was never regarded as a socially deviant behaviour any more than drinking alcohol was. In fact, keeping it legal was considered as an ‘enlightened view’.
- It is now medically proven that marijuana is less harmful than alcohol.
Risks of Legalizing Cannabis
(1) Health risks continue to persist
- There are many misconceptions about cannabis. First, it is not accurate that cannabis is harmless.
- Its immediate effects include impairments in memory and in mental processes, including ones that are critical for driving.
- Long-term use of cannabis may lead to the development of addiction of the substance, persistent cognitive deficits, and of mental health problems like schizophrenia, depression and anxiety.
- Exposure to cannabis in adolescence can alter brain development.
(2) A new ‘tobacco’ under casualization
- A second myth is that if cannabis is legalized and regulated, its harms can be minimized.
- With legalization comes commercialization. Cannabis is often incorrectly advertised as being “natural” and “healthier than alcohol and tobacco”.
- Tobacco, too, was initially touted as a natural and harmless plant that had been “safely” used in religious ceremonies for centuries.
(3) Unconvincing Advocacy
- Advocates for legalization rarely make a convincing case. To hear some supporters tell it, the drug cures all diseases while promoting creativity, open-mindedness, moral progression.
- Too much trivialization of Cannabis use could lead to its mass cultivation and a silent economy wreaking havoc through a new culture of substance abuse in India.
Way forward
- For Cannabis/ Marijuana, it’s important to make a distinction between legalization, decriminalization and commercialization.
- We must ensure that there are enough protections for children, the young, and those with severe mental illnesses, who are most vulnerable to its effects.
- Hence, laws should be made to suit people so that they do not break the law to maintain their lifestyle.
- Laws should weave around an existing lifestyle, not obstruct it. Or else laws will be broken.
Conclusion
- The debate on the legalization of marijuana in India has been consistent on social media and other noted platforms.
- As with alcohol and tobacco products, the use of cannabis needs to be regulated, taxed and monitored.
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Healthcare in India is ailing. Here is how to fix it
From UPSC perspective, the following things are important :
Prelims level : National Health Mission
Mains level : Paper 2- Reforms in healthcare
Context
The lesson emerging from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus.
Need for institutional reforms in the health sector
- The importance of public health has been known for decades with every expert committee underscoring it.
- Ideas ranged from instituting a central public health management cadre like the IAS to adopting an institutionalised approach to diverse public health concerns — from healthy cities, enforcing road safety to immunising newborns, treating infectious diseases and promoting wellness.
- Covid has shifted the policy dialogue from health budgets and medical colleges towards much-needed institutional reform.
About National Health Mission (NHM)
- The National Health Mission (NHM) seeks to provide universal access to equitable, affordable and quality health care which is accountable, at the same time responsive, to the needs of the people, reduction of child and maternal deaths as well as population stabilization, gender and demographic balance.
- The Framework for Implementation of NUHM has been approved by the Cabinet on May 1, 2013.
- NHM encompasses two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
- The National Rural Health Mission (NRHM) was launched in 2005 with a view to bringing about dramatic improvement in the health system and the health status of the people, especially those who live in the rural areas of the country.
Learning from the failure of National Health Mission (NHM)
- The National Health Mission (NHM) has been in existence for about 15 years now and the health budget has trebled— though not as a proportion of the GDP.
- Despite this less than 10 per cent of the health facilities below the district level can attain the grossly minimal Indian public health standards.
- Clearly, the three-tier model of subcentres with paramedics, primary health centres with MBBS doctors and community health centres (CHC) with four to six specialists has failed.
- Lack of accountability framework: The model’s weakness is the absence of an accountability framework.
- The facilities are designed to be passive — treating those seeking care.
Suggestions
- 1] FHT: Instead of passive design of NHM, we need Family Health Teams (FHT) like in Brazil, accountable for the health and wellbeing of a dedicated population, say 2,000 families.
- The FHTs must consist of a doctor with a diploma in family medicine and a dozen trained personnel to reflect the skill base required for the 12 guaranteed services under the Ayushman Bharat scheme.
- A baseline survey of these families will provide information about those needing attention.
- Family as a unit: The team ensures a continuum of care by taking the family as a unit and ensuring its well-being over a period.
- Nudging these families to adopt lifestyle changes, following up on referrals for medical interventions and post-operative care through home visits for nursing and physiotherapy services would be their mandate.
- 2] Health cadre: The implication of and central to the success of such a reset lies in creating appropriate cadres.
- 3] Clarity to nomenclatures: There is also a need to declutter policy dialogue and provide clarity to the nomenclatures.
- Currently, public health, family medicine and public health management are used interchangeably.
- While the family doctor cures one who is sick, the public health expert prevents one from falling sick.
- The public health management specialist holds specialisation in health economics, procurement systems, inventory control, electronic data analysis and monitoring, motivational skills and team-building capabilities, public communication and time management, besides, coordinating with the various stakeholders in the field.
- 4] Move beyond doctor-led systems: India needs to move beyond the doctor-led system and paramedicalise several functions.
- Instead of wasting gynaecologists in CHCs midwives (nurses with a BSc degree and two years of training in midwifery) can provide equally good services except surgical, and can be positioned in all CHCs and PHCs.
- This will help reduce C Sections, maternal and infant mortality and out of pocket expenses.
- 5] Counsellors and physiotherapists at PHC: Lay counsellors for mental health, physiotherapists and public health nurses are critically required for addressing the multiple needs of primary health care at the family and community levels.
- 6] Review of existing system: Bringing such a transformative health system will require a comprehensive review of the existing training institutions, standardising curricula and the qualifying criteria.
- Increase spending on training: Spending on pre-service and in-service training needs to increase from the current level of about 1 per cent.
- 7] Redefining of functions: A comprehensive redefinition of functions of all personnel is required to weed out redundancies and redeploy the rewired ones.
Conclusion
Resetting the system to current day realities requires strong political leadership to go beyond the inertia of the techno-administrative status quoist structures. We can.
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ASHA Program
From UPSC perspective, the following things are important :
Prelims level : ASHA program
Mains level : Paper 2- Strengthening ASHA
Context
India’s one million Accredited Social Health Activists (ASHA) volunteers have received World Health Organization’s Global Health Leaders Awards 2022.
Background of the ASHA program
- In 1975, a WHO monograph titled ‘Health by the people’ and then in 1978, an international conference on primary health care in Alma Ata (in the then USSR and now in Kazakhstan), gave emphasis for countries recruiting community health workers to strengthen primary health-care services that were participatory and people centric.
- Soon after, many countries launched community health worker programmes under different names.
- India launched the ASHA programme in 2005-06 as part of the National Rural Health Mission.
- The biggest inspiration for designing the ASHA programme came from the Mitanin (meaning ‘a female friend’ in Chhattisgarhi) initiative of Chhattisgarh, which had started in May 2002.
- The core of the ASHA programme has been an intention to build the capacity of community members in taking care of their own health and being partners in health services.
- Each of these women-only volunteers work with a population of nearly 1,000 people in rural and 2,000 people in urban areas, with flexibility for local adjustments.
A well thought through and deliberated program
- The ASHA programme was well thought through and deliberated with public health specialists and community-based organisations from the beginning.
- 1] Key village stakeholders selected: The ASHA selection involved key village stakeholders to ensure community ownership for the initiatives and forge a partnership.
- 2] Ensure familiarity: ASHAs coming from the same village where they worked had an aim to ensure familiarity, better community connect and acceptance.
- 3] Community’s representative: The idea of having activists in their name was to reflect that they were/are the community’s representative in the health system, and not the lowest-rung government functionary in the community.
- 4] Avoiding the slow process of government recruitment: Calling them volunteers was partly to avoid a painfully slow process for government recruitment and to allow an opportunity to implement performance-based incentives in the hope that this approach would bring about some accountability.
Contribution of ASHA
- It is important to note that even before the COVID-19 pandemic, ASHAs have made extraordinary contributions towards enabling increased access to primary health-care services; i.e. maternal and child health including immunisation and treatment for hypertension, diabetes and tuberculosis, etc., for both rural and urban populations, with special focus on difficult-to-reach habitations.
- Over the years, ASHAs have played an outstanding role in making India polio free, increasing routine immunisation coverage; reducing maternal mortality; improving new-born survival and in greater access to treatment for common illnesses.
Challenges
- Linkages with AWW and ANM: When newly-appointed ASHAs struggled to find their way and coordinate things within villages and with the health system, their linkage with two existing health and nutrition system functionaries — Anganwadi workers (AWW) and Auxiliary Nurse Midwife (ANM) as well as with panchayat representatives and influential community members at the village level — was facilitated.
- This resulted in an all-women partnership, or A-A-A: ASHA, AWW and ANM, of three frontline functionaries at the village level, that worked together to facilitate health and nutrition service delivery to the community.
- No fixed salary to ASHAs: Among the A-A-A, ASHAs are the only ones who do not have a fixed salary; they do not have opportunity for career progression.
- These issues have resulted in dissatisfaction, regular agitations and protests by ASHAs in many States of India.
Way forward
- The global recognition for ASHAs should be used as an opportunity to review the programme afresh, from a solution perspective.
- 1] Higher remuneration: Indian States need to develop mechanisms for higher remuneration for ASHAs.
- 2] Avenues for career progression: It is time that in-built institutional mechanisms are created for capacity-building and avenues for career progression for ASHAs to move to other cadres such as ANM, public health nurse and community health officers are opened.
- 3] Extend the benefits of social sector services: Extending the benefits of social sector services including health insurance (for ASHAs and their families) should be considered.
- 4] Independent and external review: While the ASHA programme has benefitted from many internal and regular reviews by the Government, an independent and external review of the programme needs to be given urgent and priority consideration.
- 5] Regularisation of temporary posts: There are arguments for the regularisation of many temporary posts in the National Health Mission and making ASHAs permanent government employees.
Conclusion
The WHO award for ASHA volunteers is a proud moment and also a recognition of every health functionary working for the poor and the underserved in India. It is a reminder and an opportunity to further strengthen the ASHA programme for a stronger and community-oriented primary health-care system.
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Malnutrition in India is a worry in a modern scenario
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Malnutrition challenge
Context
The country’s response to its burden of malnutrition and growing anaemia has to be practical and innovative.
What is malnutrition?
- Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
- The term malnutrition covers 2 broad groups of conditions.
- One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
- The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).
What are the root causes of malnutrition in India?
The following three deficits are the root cause of malnutrition in India.
1) Dietary deficit
- There is a large dietary deficit among at least 40 per cent of our population of all age groups, shown in— the National Nutrition Monitoring Bureau’s Third Repeat Survey (2012), NFHS 4, 2015-16, the NNMB Technical Report Number 27, 2017.
- Our current interventions are not being able to bridge this protein-calorie-micronutrient deficit.
- The NHHS-4 and NFHS-5 surveys reveal an acute dietary deficit among infants below two years, and considerable stunting and wasting of infants below six months.
- Unless this maternal/infant dietary deficit is addressed, we will not see rapid improvement in our nutritional indicators.
2) Information deficit at household level
- We do not have a national IEC (information, education and communication) programme that reaches targeted households to bring about the required behavioural change regarding some basic but critical facts.
- For example, IEC tells about the importance of balanced diets in low-income household budgets, proper maternal, child and adolescent nutrition and healthcare.
3) Inequitable market conditions
- The largest deficit, which is a major cause of dietary deficiency and India’s chronic malnutrition, pertains to inequitable market conditions.
- Such market conditions deny affordable and energy-fortified food to children, adolescents and adults in lower-income families.
- The market has stacks of expensive fortified energy food and beverages for higher income groups, but nothing affordable for low-income groups.
The vicious cycle of malnutrition
- Link with mother: A child’s nutritional status is directly linked to their mother.
- Poor nutrition among pregnant women affects the nutritional status of the child and has a greater chance to affect future generations.
- Impact on studies: Undernourished children are at risk of under-performing in studies and have limited job prospects.
- Impact on development of the country: This vicious cycle restrains the development of the country, whose workforce, affected mentally and physically, has reduced work capacity.
Marginal improvement on Stunting and Wasting
- The National Family Health Survey (NFHS-5) has shown marginal improvement in different nutrition indicators, indicating that the pace of progress is slow.
- This is despite declining rates of poverty, increased self-sufficiency in food production, and the implementation of a range of government programmes.
- Children in several States are more undernourished now than they were five years ago.
- Increased stunting in some states: Stunting is defined as low height-for-age.
- While there was some reduction in stunting rates (35.5% from 38.4% in NFHS-4) 13 States or Union Territories have seen an increase in stunted children since NFHS-4.
- This includes Gujarat, Maharashtra, West Bengal and Kerala.
- Wasting remains stagnant: Wasting is defined as low weight-for-height.
- Malnutrition trends across NFHS surveys show that wasting, the most visible and life-threatening form of malnutrition, has either risen or has remained stagnant over the years.
Prevalence of anaemia in India
- What is it? Anaemia is defined as the condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
- Consequences: Anaemia has major consequences in terms of human health and development.
- It reduces the work capacity of individuals, in turn impacting the economy and overall national growth.
- Developing countries lose up to 4.05% in GDP per annum due to iron deficiency anaemia; India loses up to 1.18% of GDP annually.
- The NFHS-5 survey indicates that more than 57% of women (15-49 years) and over 67% children (six-59 months) suffer from anaemia.
Way forward
1] Increase investment:
- There is a greater need now to increase investment in women and children’s health and nutrition to ensure their sustainable development and improved quality of life.
- Saksham Anganwadi and the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) 2.0 programme have seen only a marginal increase in budgetary allocation this year (₹20,263 crore from ₹20,105 crore in 2021-22).
- Additionally, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilised.
2] Adopt outcome oriented approach on the nutrition programme
- India must adopt an outcome-oriented approach on nutrition programmes.
- It is crucial that parliamentarians begin monitoring needs and interventions in their constituencies and raise awareness on the issues, impact, and solutions to address the challenges at the local level.
- Direct engagement: There has to be direct engagement with nutritionally vulnerable groups and ensuring last-mile delivery of key nutrition services and interventions.
- This will ensure greater awareness and proper planning and implementation of programmes.
- This can then be replicated at the district and national levels.
3] Increase awareness and mother’s education
- With basic education and general awareness, every individual is informed, takes initiatives at the personal level and can become an agent of change.
- Various studies highlight a strong link between mothers’ education and improved access and compliance with nutrition interventions among children.
4] Monitoring
- There should be a process to monitor and evaluate programmes and address systemic and on the ground challenges.
- A new or existing committee or the relevant standing committees meet and deliberate over effective policy decisions, monitor the implementation of schemes, and review nutritional status across States.
Conclusion
We must ensure our young population has a competitive advantage; nutrition and health are foundational to that outcome.
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Accessible India Campaign
From UPSC perspective, the following things are important :
Prelims level : Accessible India Campaign
Mains level : Facilitating PWDs
With its deadline of June 2022 almost up, the status of targets under the Accessible India Campaign (AIC) is likely to be discussed during a meeting of the Central Advisory Board on Disability.
What is Accessible India Campaign?
- Accessible India Campaign or Sugamya Bharat Abhiyan is a program that is launched to serve the differently-able community of the country.
- The flagship program has been launched on 3 December 2015, the International Day of People with Disabilities.
- The program comes with an index to measure the design of disabled-friendly buildings and human resource policies.
- The initiative also in line with Article 9 of the (UN Convention on the Rights of Persons with Disabilities) which India is a signatory since 2007.
- The scheme also comes under the Persons with Disabilities Act, 1995 for equal Opportunities and protection of rights which provides non-discrimination in Transport to Persons with Disabilities.
Recent developments
- The Central Public Works Department (CPWD) released the Harmonised Guidelines and Standards for Universal Accessibility in India 2021.
- Drafted by a team of the IIT-Roorkee and the National Institute of Urban Affairs of the MoHUA, the revised guidelines aim to give a holistic approach.
- Earlier, the guidelines were for creating a barrier-free environment, but now they are focusing on universal accessibility.
Key highlights
- Ramps: The guidelines provide the gradient and length of ramps — for example, for a length of six metres, the gradient should be 1:12. The minimum clear width of a ramp should be 1,200 mm.
- Beyond PwDs: While making public buildings and transport fully accessible for wheelchair users is covered in the guidelines, other users who may experience temporary problems have also been considered. For instance, a parent pushing a child’s pram while carrying groceries or other bags, and women wearing saris.
- Women friendly: Built environment needs for accessibility for women should consider diverse age groups, diverse cultural contexts and diverse life situations in which women operate. Diverse forms of clothing (saris, salwar-kameez, etc.) and footwear (heels, kolhapuri chappals, etc.) require a certain orientations.
- Accessibility symbols: The guidelines call for accessibility symbols for PwD, family-friendly facilities and transgender to be inclusively incorporated among the symbols for other user groups.
- Targeted authorities: The guidelines are meant for State governments, government departments and the private sector, as well as for reference by architecture and planning institutes.
Policy measures for PwDs
- India is a signatory to the UN Convention the Right of Persons with Disabilities, which came into force in 2007.
- The Union Minister for Social justice and Empowerment has also launched the “Sugamya Bharat App” to complain for ease accessibility for PwDs.
- India has its dedicated the Rights of Persons with Disabilities Act, 2016, which is the principal and comprehensive legislation concerning persons with disabilities.
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What is the West Nile Virus?
From UPSC perspective, the following things are important :
Prelims level : West Nile Virus
Mains level : Vector borne diseases
The Kerala health department is on alert after the death occurred due to the West Nile Virus.
West Nile Virus
- The West Nile Virus is a mosquito-borne, single-stranded RNA virus.
- According to the WHO, it is a member of the flavivirus genus and belongs to the Japanese Encephalitis antigenic complex of the family Flaviviridae.
How does it spread?
- Culex species of mosquitoes act as the principal vectors for transmission.
- It is transmitted by infected mosquitoes between and among humans and animals, including birds, which are the reservoir host of the virus.
- Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days.
- The virus eventually gets into the mosquito’s salivary glands.
- During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness.
- WNV can also spread through blood transfusion, from an infected mother to her child, or through exposure to the virus in laboratories.
- It is not known to spread by contact with infected humans or animals.
Symptoms of WNV infection
- The disease is asymptomatic in 80% of the infected people.
- The rest develop what is called the West Nile fever or severe West Nile disease.
- In these 20% cases, the symptoms include fever, headache, fatigue, body aches, nausea, rash, and swollen glands.
- Severe infection can lead to encephalitis, meningitis, paralysis, and even death.
- It is estimated that approximately 1 in 150 persons infected with the West Nile Virus will develop a more severe form of the disease.
- Recovery from severe illness might take several weeks or months.
- It usually turns fatal in persons with co-morbidities and immuno-compromised persons (such as transplant patients).
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Monkeypox Virus: Origins and Outbreaks
From UPSC perspective, the following things are important :
Prelims level : Monkey Pox
Mains level : Rise in zoonotic diseases
With cases being reported from across the world, monkeypox has caught everyone’s attention.
What is Monkeypox?
- Monkeypox is not a new virus.
- The virus, belonging to the poxvirus family of viruses, was first identified in monkeys way back in 1958, and therefore the name.
- The first human case was described in 1970 from the Democratic Republic of Congo.
- Many sporadic outbreaks of animal to human as well as human to human transmission has occurred in Central and West Africa in the past with significant mortality.
- After the elimination of smallpox, monkeypox has become one of the dominant poxviruses in humans, with cases increasing over years along with a consequent reduction in the age-group affected.
How is it transmitted?
- Since the transmission occurs only with close contact, the outbreaks have been in many cases self-limiting.
- Since in the majority of affected people, the incubation period ranges from five to 21 days and is often mild or self-limiting, asymptomatic cases could transmit the disease unknowingly.
- The outbreaks in Central Africa are thought to have been contributed by close contact with animals in regions adjoining forests.
- While monkeys are possibly only incidental hosts, the reservoir is not known.
- It is believed that rodents and non-human primates could be potential reservoirs.
Does the virus mutate?
- Monkeypox virus is a DNA virus with a quite large genome of around 2,00,000 nucleotide bases.
- While being a DNA virus, the rate of mutations in the monkeypox virus is significantly lower (~1-2 mutations per year) compared to RNA viruses like SARS-CoV-2.
- The low rate of mutation therefore limits the wide application of genomic surveillance in providing detailed clues to the networks of transmission for monkeypox.
- A number of genome sequences in recent years from Africa and across the world suggest that there are two distinct clades of the virus — the Congo Basin/Central African clade and the West African clade.
- Each of the clades further have many lineages.
What do the genomes say?
- With over a dozen genome sequences of monkeypox, it is reassuring that the sequences are quite identical to each other suggesting that only a few introductions resulted in the present spread of cases.
- Additionally, almost all genomes have come from the West African clade, which has much lesser fatality compared to the Central African one.
- This also roughly corroborates with the epidemiological understanding that major congregations in the recent past contributed to the widespread transmission across different countries.
Does it have an effective vaccine?
- It is reassuring that we know quite a lot more about the virus and its transmission patterns.
- We also have effective ways of preventing the spread, including a vaccine.
- Smallpox/vaccinia vaccine provides protection.
- While the vaccine has been discontinued in 1980 following the eradication of smallpox, emergency stockpiles of the vaccines are maintained by many countries.
- Younger individuals are unlikely to have received the vaccine and are therefore potentially susceptible to monkeypox which could partly explain its emergence in younger individuals.
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ASHA workers earn WHO’s global plaudits
From UPSC perspective, the following things are important :
Prelims level : ASHA
Mains level : Contribution of ASHAs in primary healthcare in rural areas
The country’s frontline health workers or ASHAs (accredited social health activists) were one of the six recipients of the WHO’s Global Health Leaders Award 2022 which recognises leadership, contribution to the advance of global health and commitment to regional health issues.
Who are ASHA workers?
- ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.
- The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
- They act as a bridge connecting marginalised communities with facilities such as primary health centres, sub-centres and district hospitals.
Genesis & evolution
- The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
- The ASHA was to be a local resident, looking after 200 households.
- The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health.
- Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.
Qualifications for ASHA Workers
- ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community.
- They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.
How many ASHAs are there across the country?
- The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.
- There are around 10.4 lakh ASHA workers across the country, with the largest workforces in states with high populations – Uttar Pradesh (1.63 lakh), Bihar (89,437), and Madhya Pradesh (77,531).
- Goa is the only state with no such workers, as per the latest National Health Mission data available from September 2019.
What do ASHA workers do?
- They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available.
- They focus primarily on ensuring that pregnant women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children.
- They also counsel women about contraceptives and sexually transmitted infections.
- ASHA workers are also tasked with ensuring and motivating children to get immunised.
- Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme.
- They are also tasked with screening for infections like malaria during the season.
- They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anaemia etc.
- Now, they also get people tested and get their reports for non-communicable diseases.
- The health volunteers are also tasked with informing their respective primary health centre about any births or deaths in their designated areas.
How much are ASHA workers paid?
- Since they are considered “volunteers/activists”, governments are not obligated to pay them a salary. And, most states don’t.
- Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunised.
- All this adds up to only between Rs 6,000 to Rs 8,000 a month.
- Her work is so tailored that it does not interfere with her normal livelihood.
Success of the ASHAs
- It is a programme that has done well across the country.
- In a way, it became a programme that allowed a local woman to develop into a skilled health worker.
- Overall, it created a new cadre of incrementally skilled local health workers who were paid based on performance.
- The ASHAs are widely respected as they brought basic health services to the doorstep of households.
- Since then ASHA continues to enjoy the confidence of the community.
Challenges to ASHAs
- The ASHAs faced a range of challenges: Where to stay in a hospital? How to manage mobility? How to tackle safety issues?
- There have been challenges with regard to the performance-based compensation. In many states, the payout is low, and often delayed.
- It has a problem of responsibility and accountability without fair compensation.
- There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation.
- Ideally, an ASHA should be able to make more than the salary of a government employee, with opportunities for moving up the skill ladder in the formal primary health care system as an ANM/ GNM or a Public Health Nurse.
Way forward
- The incremental development of a local resident woman is an important factor in human resource engagement in community-linked sectors.
- It is equally important to ensure that compensation for performance is timely and adequate.
- Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living while serving the community.
- Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programmes will contribute to ASHAs emerging as even stronger agents of change.
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India Hypertension Control Initiative (IHCI)
From UPSC perspective, the following things are important :
Prelims level : IHCI, hypertension
Mains level : Burden of NCDs in India
The IHCI project has demonstrated that blood pressure treatment and control are feasible in primary care settings in diverse health systems across various States in India.
India Hypertension Control Initiative (IHCI)
- It is a multi-partner initiative involving the Indian Council of Medical Research, WHO-India, Ministry of Health and Family Welfare, and State governments.
- It aims to improve blood pressure control for people with hypertension.
- The project initiated in 26 districts in 2018 has expanded to more than 100 districts by 2022.
- More than two million patients were started on treatment and tracked to see whether they achieved BP control.
The project was built on five scalable strategies:
- Simple treatment protocol with three drugs was selected in consultation with the experts and non-communicable disease programme managers.
- Supply chain was strengthened to ensure the availability of adequate antihypertensive drugs.
- Patient-centric approaches were followed, such as refills for at least 30 days and assigning the patients to the closest primary health centre or health wellness centre to make follow-up easier.
- The focus was on building capacity of all health staff and sharing tasks such as BP measurement, documentation, and follow-up.
- There was minimal documentation using either paper-based or digital tools to track follow-up and BP control.
Prevalence of hypertension in India
- Cardiovascular diseases (CVD) are the leading cause of death among adults in India.
- One of the major drivers of heart attack and stroke is untreated high blood pressure or hypertension.
- Hypertension is a silent killer as most patients do not have any symptoms.
- India has more than 200 million people with hypertension, and only 14.5% of individuals with hypertension are on treatment.
Success of IHCI
- Blood pressure treatment and control were feasibly controlled in primary care settings in diverse health systems across various States in India.
- Before IHCI, many patients travelled to higher-level facilities such as community health centres (block level) or district hospitals in the public sector for hypertension treatment.
- Over three years, all levels of health staff at the primary health centres and health wellness centres were trained to provide treatment and follow-up services for hypertension.
- Nearly half (47%) of the patients under care achieved blood pressure control.
- The BP control among people enrolled in treatment was 48% at primary health centres and 55% at the health wellness centres.
Contributing to its success: A data-driven approach
- One of the unique contributions of the project was a data-driven approach to improving care and overall programme management.
- The list of people who did not return for treatment was generated through a digital system or on paper by the nurse/health workers.
- Patients were reminded either over the phone or by home visit (if feasible).
- This strategy motivated a large number of patients to continue treatment.
- In addition, programme managers reviewed aggregate data at the district and State levels to assess the performance of facilities in terms of follow-up and BP control.
- Patients were provided generic antihypertensive drugs costing only ₹200 per year.
- In addition, E-Sanjeevani, a telemedicine initiative, facilitated teleconsultations.
Back2Basics: Hypertension
- Hypertension also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
- High blood pressure usually does not cause symptoms.
- Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.
- High blood pressure is classified as primary (essential) hypertension or secondary hypertension.
- For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.
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Bridging the health policy to execution chasm
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Public health and management cadre
Context
In April this year, the Union government released a guidance document on the setting up of a ‘public health and management cadre’ (PHMC) as well as revised editions of the Indian Public Health Standards (IPHS) — for ensuring quality health care in government facilities.
Background
- The need for a public health cadre and services in India rarely got any policy attention.
- Limited understanding: The reason was that even among policymakers, there was limited understanding on the roles and the functions of public health specialists and the relevance of such cadres, especially at the district and sub-district levels.
- However, the last decade and a half was eventful.
- The initial threat of avian flu in 2005-06, the Swine flu pandemic of 2009-10; five more public health emergencies of international concern between years 2009-19; the increasing risks and regular emergence and re-emergence of of new viruses and diseases (Zika, Ebola, Crimean-Congo Hemorrhagic fever, Nipah viruses, etc.) in animals and humans, resulted in increased attention on public health.
- National Public health Act: In 2017, India’s National Health Policy 2017 proposed the formation of a public health cadre and enacting a National Public Health Act.
- The COVID-19 pandemic changed the status quo.
- In the absence of trained public health professionals at the policy and decision making levels, India’s pandemic response ended up becoming bureaucrat steered and clinician led.
Different cadres and its implications
- Lack of career progression opportunities: At present, most Indian States (with exceptions such as Tamil Nadu and Odisha) have a teaching cadre (of medical college faculty members) and a specialist cadre of doctors involved in clinical services.
- This structure does not provide similar career progression opportunities for professionals trained in public health.
- Limited interest: It is one of the reasons for limited interest by health-care professionals to opt for public health as a career choice.
- The outcome has been costly for society: a perennial shortage of trained public health workforce.
Public health cadre
- The proposed public health cadre and the health management cadre have the potential to address some of these challenges.
- With the release of guidance documents, the States have been advised to formulate an action plan, identify the cadre strengths, and fill up the vacant posts in the next six months to a year.
- A public health workforce has a role even beyond epidemics and pandemics.
- A trained public health workforce ensures that people receive holistic health care, of preventive and promotive services (largely in the domain of public health) as well as curative and diagnostic services (as part of medical care).
Revised version of IPHS and significance
- This is the second revision in the IPHS, which were first released in 2007 and then revised in 2012.
- The regular need for a revision in the IPHS is a recognition of the fact that to be meaningful, quality improvement has to be an ongoing process.
- The development of the IPHS itself was a major step.
- The revised IPHS is an important development but not an end itself.
- In the 15 years since the first release of the IPHS, only a small proportion — around 15% to 20% — of government health-care facilities meets these standards. .
- If the pace of achieving IPHS is any criteria, there is a need for more accelerated interventions.
- Opportunities such as a revision of the IPHS should also be used for an independent assessment on how the IPHS has improved the quality of health services.
Implementation challenges
- The effective part of implementation is interplay: policy formulation, financial allocation, and the availability of a trained workforce.
- In this case, policy has been formulated.
- Financial allocations: Then, though the Government’s spending on health in India is low and has increased only marginally in the last two decades; however, in the last two years, there have been a few additional — small but assured — sources of funding for public health services have become available.
- The Fifteenth Finance Commission grant for the five-year period of 2021- 26 and the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) allocations are available for strengthening public health services and could be used as States embark upon implementing the PHMC and a revised IPHS.
- Availability of trained workforce: The third aspect of effective implementation, the availability of trained workforce, is the most critical.
- As States develop plans for setting up the PHMC, all potential challenges in securing a trained workforce should be identified and actions initiated.
Conclusion
The public health and management cadres and the revised IPHS can help India to make progress towards the NHP goal. To ensure that, State governments need to act urgently and immediately.
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Back2Basics: Indian Public Health Standards (IPHS)
- IPHS are a set of uniform standards envisaged to improve the quality of health care delivery in the country.
- The IPHS documents have been revised keeping in view the changing protocols of the existing programmes and introduction of new programmes especially for Non-Communicable Diseases.
- Flexibility is allowed to suit the diverse needs of the States and regions.
- These IPHS guidelines will act as the main driver for continuous improvement in quality and serve as the bench mark for assessing the functional status of health facilities.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Ensuring a sustainable vaccination programme
From UPSC perspective, the following things are important :
Prelims level : Gavi
Mains level : Paper 2- Future pandemic preparedness
Context
COVID-19, which disrupted supply chains across countries and in India too, marks an inflection point in the trajectory of immunisation programmes.
UIP: Showcasing India’s strength in managing large scale vaccination
- India’s Universal Immunisation Programme (UIP), launched in 1985 to deliver routine immunisation, showcased its strengths in managing large-scale vaccine delivery.
- This programme targets close to 2.67 crore newborns and 2.9 crore pregnant women annually.
- Full immunisation: To strengthen the programme’s outcomes, in 2014, Mission Indradhanush was introduced to achieve full immunisation coverage of all children and pregnant women at a rapid pace — a commendable initiative.
- India’s UIP comprises upwards of 27,000 functional cold chain points of which 750 (3%) are located at the district level and above; the remaining 95% are located below the district level.
- The COVID-19 vaccination efforts relied on the cold chain infrastructure established under the UIP to cover 87 crore people with two doses of the vaccine and over 100 crore with at least a single dose.
Why strong service delivery network is essential?
- While we have, over the years, set up a strong service delivery network, the pandemic showed us that there were weak links in the chain, especially in the cold chain.
- Nearly half the vaccines distributed around the world go to waste, in large part due to a failure to properly control storage temperatures.
- In India, close to 20% of temperature-sensitive healthcare products arrive damaged or degraded because of broken or insufficient cold chains, including a quarter of vaccines.
- Wastage has cost implications and can delay the achievement of immunisation targets.
Measures and initiatives in strengthening vaccine supply chains
- The Health Ministry has been digitising the vaccine supply chain network in recent years through the use of cloud technology, such as with the Electronic Vaccine Intelligence Network (eVIN).
- Developed with support from Gavi, the Vaccine Alliance, and implemented by the UN Development Programme through a smartphone-based app, the platform digitises information on vaccine stocks and temperatures across the country.
- This supports healthcare workers in the last mile in supervising and maintaining the efficiency of the vaccine cold chain.
Way forward
- Electrification: There is a need to improve electrification, especially in the last mile, for which the potential of solar-driven technology must be explored to integrate sustainable development.
- For instance, in Chhattisgarh, 72% of the functioning health centres have been solarised to tackle the issue of regular power outages.
- This has significantly reduced disruption in service provision and increased the uptake of services.
Conclusion
India has pioneered many approaches to ensure access to public health services at a scale never seen before. Robust cold chain systems are an investment in India’s future pandemic preparedness; by taking steps towards actionable policies that improve the cold chain, we have an opportunity to lead the way in building back better and stronger.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Public health engineering
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Focusing on public health engineering
Context
As we confront the public health challenges emerging out of environmental concerns, expanding the scope of public health/environmental engineering science becomes pivotal.
Why does India need a specialised cadre of public health engineers
- Achieving SDGs and growing demand for water consumption: For India to achieve its sustainable development goals of clean water and sanitation and to address the growing demands for water consumption and preservation of both surface water bodies and groundwater resources, it is essential to find and implement innovative ways of treating wastewater.
- It is in this context why the specialised cadre of public health engineers, also known as sanitation engineers or environmental engineers, is best suited to provide the growing urban and rural water supply and to manage solid waste and wastewater.
- Limited capacity: The availability of systemic information and programmes focusing on teaching, training, and capacity building for this specialty cadre is currently limited.
- Currently in India, civil engineering incorporates a course or two on environmental engineering for students to learn about wastewater management as a part of their pre-service and in-service training.
- However, the nexus between wastewater and solid waste management and public health issues is not brought out clearly.
- India aims to supply 55 litres of water per person per day by 2024 under its Jal Jeevan Mission to install functional household tap connections.
- The goal of reaching every rural household with functional tap water can be achieved in a sustainable and resilient manner only if the cadre of public health engineers is expanded and strengthened.
- Different from the international trend: In India, public health engineering is executed by the Public Works Department or by health officials. This differs from international trends.
Way forward
- Introducing public health engineering as a two-year structured master’s degree programme or through diploma programmes for professionals working in this field must be considered to meet the need of increased human resource in this field.
- Interdisciplinary field: Furthermore, public health engineering should be developed as an interdisciplinary field.
- Engineers can significantly contribute to public health in defining what is possible, identifying limitations, and shaping workable solutions with a problem-solving approach.
- Public health engineering’s combination of engineering and public health skills can also enable contextualised decision-making regarding water management in India.
Conclusion
Diseases cannot be contained unless we provide good quality and adequate quantity of water. Most of the world’s diseases can be prevented by considering this. Training our young minds towards creating sustainable water management systems would be the first step.
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India Hypertension Control Initiative (IHCI)
From UPSC perspective, the following things are important :
Prelims level : India Hypertension Control Initiative (IHCI)
Mains level : Non-communicable diseases burden on India
A project called the India Hypertension Control Initiative (IHCI) finds that nearly 23% out of 2.1 million Indians have uncontrolled blood pressure.
What is the IHCI?
- Recognizing that hypertension is a serious, and growing, health issue in India, the Health Ministry, the ICMR, State Governments, and WHO-India began a five-year initiative to monitor and treat hypertension.
- The programme was launched in November 2017.
- In the first year, IHCI covered 26 districts across five States — Punjab, Kerala, Madhya Pradesh, Telangana, and Maharashtra.
- By December 2020, IHCI was expanded to 52 districts across ten States — Andhra Pradesh (1), Chhattisgarh (2), Karnataka (2), Kerala (4), Madhya Pradesh (6), Maharashtra (13), Punjab (5), Tamil Nadu (1), Telangana (13) and West Bengal (5).
What is Hypertension?
- Hypertension is defined as having systolic blood pressure level greater than or equal to 140 mmHg or diastolic blood pressure level greater than or equal to 90 mmHg.
- The definition also assumes taking anti-hypertensive medication to lower his/her blood pressure.
Why need IHCI?
- India has committed to a “25 by 25” goal, which aims to reduce premature mortality due to non-communicable diseases (NCDs) by 25% by 2025.
- To achieve India’s target of a 25%, approximately 4.5 crore additional people with hypertension need to get their BP under control by 2025.
What has the IHCI found so far?
- Its most important discovery so far is that nearly one-fourth of (23%) patients under the programme had uncontrolled blood pressure, and 27% did not return for a follow-up in the first quarter of 2021.
- There were an estimated 20 crore adults with hypertension in the country.
- There weren’t enough validated high-quality digital blood pressure monitors in several health facilities, which affected accuracy of hypertension diagnosis.
How prevalent is the problem of hypertension?
- About one-fourth of women and men aged 40 to 49 years have hypertension.
- Southern States have a higher prevalence of hypertension than the national average, according to the latest edition of the National Family Health Survey.
- While 21.3% of women and 24% of men aged above 15 have hypertension in the country, the prevalence is the highest in Kerala where 32.8% men and 30.9% women have been diagnosed with hypertension.
- Kerala is followed by Telangana where the prevalence is 31.4% in men and 26.1% in women.
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What is Monkeypox?
From UPSC perspective, the following things are important :
Prelims level : Monkey Pox
Mains level : Zoonotic Diseases
The UK health authorities have confirmed a case of Monkeypox, which is a virus passed from infected animals such as rodents to humans, in someone with a recent travel history to Nigeria where they are believed to have caught it.
What is Monkeypox?
- The monkeypox virus is an orthopoxvirus, which is a genus of viruses that also includes the variola virus, which causes smallpox, and vaccinia virus, which was used in the smallpox vaccine.
- It causes symptoms similar to smallpox, although they are less severe.
- While vaccination eradicated smallpox worldwide in 1980, monkeypox continues to occur in a swathe of countries in Central and West Africa, and has on occasion showed up elsewhere.
- According to the WHO, two distinct clade are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.
Its origin
- Monkeypox is a zoonosis, that is, a disease that is transmitted from infected animals to humans.
- Monkeypox virus infection has been detected in squirrels, Gambian poached rats, dormice, and some species of monkeys.
- According to the WHO, cases occur close to tropical rainforests inhabited by animals that carry the virus.
Symptoms and treatment
- Monkeypox begins with a fever, headache, muscle aches, back ache, and exhaustion.
- It also causes the lymph nodes to swell (lymphadenopathy), which smallpox does not.
- The WHO underlines that it is important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
- The incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days.
- There is no safe, proven treatment for monkeypox yet.
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Highlights of the National Family Health Survey (NFHS) 5 Part: II
From UPSC perspective, the following things are important :
Prelims level : NFHS and other survey mentioned
Mains level : Read the attached story
The Total Fertility Rate (TFR), the average number of children per woman, has further declined from 2.2 to 2.0 at the national level between National Family Health Survey (NFHS) 4 and 5.
What is NFHS?
- The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
- The IIPS is the nodal agency, responsible for providing coordination and technical guidance for the NFHS.
- NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF).
- The First National Family Health Survey (NFHS-1) was conducted in 1992-93.
Objectives of the NFHS
The survey provides state and national information for India on:
- Fertility
- Infant and child mortality
- The practice of family planning
- Maternal and child health
- Reproductive health
- Nutrition
- Anaemia
- Utilization and quality of health and family planning services
Modifications in NFHS 5
NFHS-5 includes new focal areas that will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention. The areas are:
- Expanded domains of child immunization
- Components of micro-nutrients to children
- Menstrual hygiene
- Frequency of alcohol and tobacco use
- Additional components of non-communicable diseases (NCDs)
- Expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above.
Highlights of the NFHS 5 Part-II
(a) Fertility Rate
- There are only five States — Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) Manipur (2.17) —which are above replacement level of fertility of 2.1.
(b) Institutional Births
- The institutional births increased from 79% to 89% across India and in rural areas around 87% births being delivered in institutions and the same is 94% in urban areas.
- As per results of the NFHS-5, more than three-fourths (77%) children aged between 12 and 23 months were fully immunised, compared with 62% in NFHS-4.
- The level of stunting among children under five years has marginally declined from 38% to 36% in the country since the last four years.
- Stunting is higher among children in rural areas (37%) than urban areas (30%) in 2019-21.
(c) Decision making
- The extent to which married women usually participate in three household decisions (about health care for herself; making major household purchases; visit to her family or relatives) indicates that their participation in decision-making is high, ranging from 80% in Ladakh to 99% in Nagaland and Mizoram.
- Rural (77%) and urban (81%) differences are found to be marginal.
- The prevalence of women having a bank or savings account has increased from 53% to 79% in the last four years.
(d) Rise in obesity
- Compared with NFHS-4, the prevalence of overweight or obesity has increased in most States/UTs in NFHS-5.
- At the national level, it increased from 21% to 24% among women and 19% to 23% among men.
- More than a third of women in Kerala, Andaman and Nicobar Islands, AP, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh and Lakshadweep (34-46 %) are overweight or obese.
Also read
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Loudspeaker Crackdown: Court orders and Govt directives
From UPSC perspective, the following things are important :
Prelims level : Noise Pollution
Mains level : Crackdown on noise pollution
Illegal and unauthorized loudspeakers had been taken down across the Uttar Pradesh and their loudness had been capped, under “an existing government order of 2018, and set rules for sound decibel limits and court directions”.
What is the news?
- The UP state authorities have taken action since the loudspeaker crackdown began in our country.
- Notices were served to alleged violators by local police stations citing the order of Allahabad High Court of 2017, and centre’s the Noise Pollution Rules, 2000.
- The recent UP order asked officials to remove illegal loudspeakers after dialogue and coordination with religious leaders, and to ensure that decibel levels are kept within laid down limits.
Legal basis of loudspeaker crackdowns
(a) Orders of 2022, 2018
- The April 23 order said that two earlier orders passed by the government in 2018 were not being followed, and the situation needed to be rectified.
- Those earlier orders had been passed to ensure implementation of The Noise Pollution (Regulation and Control) Rules, 2000.
- However, it had come to knowledge that many religious institutions are violating the standard decibel norms and are using loudspeakers in large numbers.
(b) The Noise Pollution Rules, 2000
- The 2000 Rules define “Ambient Air Quality Standards in Respect of Noise”, i.e., Industrial, Commercial, Residential, and Silence Zones.
- It asked officials to demarcate these areas and to ensure that the correct norms were followed.
- Each police station has been asked to prepare a list of religious institutions using loudspeakers under their jurisdiction.
What is noise pollution?
- Noise is defined as unwanted sound. A sound might be unwanted because it is loud, distracting, or annoying.
- Noise pollution is manmade sound in the environment that may be harmful to humans or animals.
Objective of the NPR, 2000: To regulate and control noise producing and generating sources with the objective of maintaining the ambient air quality standards in respect of noise
Important compliance’s under NPR, 2000
- What are the restrictions on using loud speaker or musical system at night?
: A person cannot play a loud speaker, public address system, sound producing instrument, musical instrument or a sound amplifier at night time except in closed premises like auditorium, conference rooms, community halls or banquet halls. - What is the noise level for using loudspeakers or the public address?
: The persons using loudspeakers or public address shall maintain the noise level and restrain it from exceeding 10 dB (A) above the ambient noise standards for the area specified or 75 dB (A) whichever is lower. - What is the Noise level for a private sound system?
: The persons owning a private sound system or a sound producing instrument shall not, exceed the noise above 5 dB (A) the noise standards specified for the area in which it is used. - What are the prohibitions on violating the silence zone areas?
A person shall not do the following acts in silence zone- Playing any music or uses any sound amplifiers,
- A drum or tom-tom or blows a horn either musical or pressure, or trumpet or beats or sounds any instrument, or
- Playing any musical or other performance of a to attract crowd
- Bursting sound-emitting firecrackers
- Using a loudspeaker or a public address system.
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Autism Support Network to give Specialised Care in Rural India
From UPSC perspective, the following things are important :
Prelims level : Autism
Mains level : Mental healthcare in India
The Centre for Autism and Other Disabilities Rehabilitation Research and Education (CADRRE), a not-for-profit organization will launch “Pay Autention — a different mind is a gifted mind”, India’s first bridgital autism support network.
Pay ‘Autention’
- The initiative shall pave the way for small towns and rural India to access specialised care and support and help create an auxiliary network of champions for the differently-abled.
- This platform shall also enable mentoring, skilling and meaningful livelihoods for people with autism.
- In the first phase, the initiative will primarily focus on supporting children with autism, and subsequently, in the second stage, it will focus on young adults, empowering them with life skills and career readiness.
- The content is designed and delivered in collaboration with specialists from CADRRE who have expertise in training children with autism.
- The project aims to create a network of grassroots champions, enable early identification, first-level care, teach social skills, ways to ease activities of daily living, hold workshops for sensory and motor development.
- It also focuses on art and craft, dance, music therapy, physical and mental fitness, communication skills and enable support for academics.
What is Autism?
- Autism, also called autism spectrum disorder (ASD), is a complicated condition that includes problems with communication and behaviour.
- It can involve a wide range of symptoms and skills.
- ASD can be a minor problem or a disability that needs full-time care in a special facility.
- People with autism have trouble with communication. They have trouble understanding what other people think and feel.
- This makes it hard for them to express themselves, either with words or through gestures, facial expressions, and touch.
- People with autism might have problems with learning. Their skills might develop unevenly.
- For example, they could have trouble communicating but be unusually good at art, music, math, or memory.
What are the signs of Autism?
Symptoms of autism usually appear before a child turns 3. Some people show signs from birth. Common symptoms of autism include:
- A lack of eye contact
- A narrow range of interests or intense interest in certain topics
- Doing something over and over, like repeating words or phrases, rocking back and forth, or flipping a lever
- High sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
- Not looking at or listening to other people
- Not looking at things when another person points at them
- Not wanting to be held or cuddled
- Problems understanding or using speech, gestures, facial expressions, or tone of voice
- Talking in a sing-song, flat, or robotic voice
- Trouble adapting to changes in routine
What causes Autism?
- Exactly why autism happens isn’t clear. It could stem from problems in parts of your brain that interpret sensory input and process language.
- Autism is four times more common in boys than in girls. It can happen in people of any race, ethnicity, or social background.
- Family income, lifestyle, or educational level doesn’t affect a child’s risk of autism. But there are some risk factors:
- Autism runs in families, so certain combinations of genes may increase a child’s risk.
- A child with an older parent has a higher risk of autism.
- Pregnant women who are exposed to certain drugs or chemicals, like alcohol or anti-seizure medications, are more likely to have autistic children
- Other risk factors include maternal metabolic conditions such as diabetes and obesity.
Prevalence of Autism in India
- Prevalence and incidence statistics about autism in India is 1 in 500 or 0.20% or more than 2,160,000 people.
- According to a study, an estimated three million people live with autistic spectrum disorder (ASD) on the Indian subcontinent.
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Why are vaccines administered into the upper arm?
From UPSC perspective, the following things are important :
Prelims level : Vaccination
Mains level : NA
Almost everyone vaccinated for Covid-19 over the last 16 months will remember that he or she received a quick prick in the upper arm.
Why vaccines are generally administered into muscle?
- This is because most vaccines, including those for Covid-19, are most effective when administered through the intramuscular route into the upper arm muscle, known as the deltoid.
- There are several reasons, but the most important one is that the muscles have a rich blood supply network.
- This means whenever a vaccine carrying an antigen is injected into it, the muscle releases the antigen, which gets dispersed by the muscular vasculature, or the arrangement of blood vessels in the muscle.
- The antigen then gets picked up by a type of immune cells called dendritic cells, which function by showing antigens on their surface to other cells of the immune system.
- The dendritic cells carry the antigen through the lymphatic fluid to the lymph node.
Role of T Cells
- T Cells also called T lymphocyte, type of leukocyte (white blood cell) that is an essential part of the immune system.
- T cells are one of two primary types of lymphocytes—B cells being the second type—that determine the specificity of the immune response to antigens (foreign substances) in the body.
- Through the course of research over the years, it is understood that the lymph nodes have T cells and B cells — the body’s primary protector cells.
- Once this antigen gets flagged and is given to the T cells and B cells that is how we start developing an immune response against a particular virus.
- It could be any of the new viruses like SARS-CoV-2, the virus that causes Covid-19, or the previous viruses which we have been running vaccination programs for.
Other options for vaccination
- Conversely, if the vaccine is administered into the subcutaneous fat tissue [between the skin and the muscle], which has a poor blood supply, absorption of the antigen vaccine is poor and therefore one may have failed immune response.
- Similarly, the additives which could be toxic, could cause a local reaction.
- The same thing could happen when the vaccine is administered intradermally (just below the outermost skin layer, the epidermis).
- Hence, the route chosen now for most vaccines is intramuscular.
- Also, compared to the skin or subcutaneous tissue, the muscles have fewer pain receptors, and so an intramuscular injection does not hurt as much as a subcutaneous or an intradermal injection.
But why the upper arm muscle in particular?
- In some vaccines, such as that for rabies, the immunogenicity — the ability of any cell or tissue to provoke an immune response — increases when it is administered in the arm.
- If administered in subcutaneous fat tissues located at the thigh or hips, these vaccines show a lower immunogenicity and thus there is a chance of vaccine failure.
Why not administer the vaccine directly into the vein?
- This is to ensure the ‘depot effect’, or release of medication slowly over time to enable longer effectiveness.
- When given intravenously, the vaccine is quickly absorbed into the circulation.
- The intramuscular method takes some time to absorb the vaccine.
- Wherever a vaccination programme is carried out, it is carried out for the masses.
- To deposit the vaccine, the easiest route would be the oral route (like the polio vaccine).
- However, for other vaccines that need to be administered intravenously or intramuscularly (enabling wider field-based administration), the intramuscular route is chosen from a public health perspective over the intravenous route.
Which vaccines are administered through other routes?
- One of the oldest vaccines that for smallpox, was given by scarification of the skin.
- However, with time, doctors realised there are better ways to vaccinate beneficiaries.
- These included the intradermal route, the subcutaneous route, the intramuscular route, oral, and nasal routes.
- There are only two exceptions that continue to be administered through the intradermal route.
- These are the vaccines for BCG (Bacillus Calmette–Guérin) and for tuberculosis because these two vaccines continue to work empirically well when administered through the intradermal route.
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Noise Pollution in India
From UPSC perspective, the following things are important :
Prelims level : Noise Pollution
Mains level : Not Much
The city of Moradabad in Uttar Pradesh is the second-most noise polluted city globally, according to a recent report title Frontier 2022 by the United Nations Environment Programme (UNEP).
What is Noise Pollution?
- Noise pollution, also known as environmental noise or sound pollution, is the propagation of noise with ranging impacts on the activity of human or animal life, most of them harmful to a degree.
- It is generally defined as regular exposure to elevated sound levels that may lead to adverse effects in humans or other living organisms.
- The source of outdoor noise worldwide is mainly caused by machines, transport, and propagation systems.
- Poor urban planning may give rise to noise disintegration or pollution, side-by-side industrial and residential buildings can result in noise pollution in the residential areas.
- Some of the main sources of noise in residential areas include loud music, transportation (traffic, rail, airplanes, etc.), maintenance, construction, electrical generators, wind turbines, explosions, and people etc.
Defining Noise Pollution
- Sounds with a frequency over 70 db are considered harmful to health.
- The World Health Organization (WHO) had recommended a 55 db standard for residential areas in the 1999 guidelines, while for traffic and business sectors, the limit was 70 db.
- The WHO set the limit of noise pollution on the road at 53 db in 2018, taking into account health safety.
Noise Pollution in India
- The report identifies 13 noise polluted cities in south Asia. Five of these, including Moradabad, are in India, which have recorded alarming levels of noise pollution:
- Kolkata (89 db)
- Asansol (89 db)
- Jaipur (84 db)
- Delhi (83 db)
- The noise pollution figures given in the report relate to daytime traffic or vehicles.
- Moradabad has recorded noise pollution of a maximum of 114 decibels (db). The Frontier 2022 report mentions a total of 61 cities.
Case in the neighborhood
- The highest noise pollution of 119 db has been recorded in Dhaka, the capital of Bangladesh.
- At third place is Pakistan’s capital Islamabad, where the noise pollution level has been recorded at 105 db.
Hazards created
- High levels of noise pollution affect human health and well-being by having an effect on sleep.
- This has a bad effect on the communication of many animal species living in the area and their ability to hear.
- Regular exposure for eight hours a day to 85 decibels of sound can permanently eliminate the ability to hear.
- Not only that, exposure to relatively low noise pollution for long periods in cities can harm physical and mental health.
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Need for integrated approach to power sector
From UPSC perspective, the following things are important :
Prelims level : COP26
Mains level : Paper 2- Integration of development sector and electricity
Context
Electricity and development sectors need a more integrated approach to achieve the vision set forth in instruments such as the Union Budget that guide policy implementation at other administrative levels.
Reduction in allocation
- While the health sector witnessed a 16% increase in estimated Budget allocations from last year, medical and public health spending was reduced by 45% for 2022-23.
- Budget estimates demonstrate intent, but the proof of the pudding lies in the actual expenditure which reiterates the need for greater attention to be paid to our health and education sectors.
- While the health sector was allocated ₹74,602 crore in 2021-22, the Government exceeded its spending by over ₹5,000 crore more (₹80,026 crore) on health, signalling a spike in demand, likely propelled by the ongoing COVID-19 pandemic.
- Given this scenario, a less than ₹1,000 crore increase in the Budget Estimate (₹86,606 crore) in 2022-23 when compared with last year’s Revised Estimates (₹85,915 crore) appears incongruent with the Government’s aim of providing quality public health care at scale.
Role of reliable energy
- It is widely recognised that the availability of reliable electricity supply can improve the delivery of health and education services.
- 74% of the targets of the Sustainable Development Goals are interlinked with universal access to reliable energy.
- Its reliability in terms of the number of hours that electricity is available steadily without any voltage fluctuations also plays a significant role in delivering services.
- Sometimes, multiple policies can complement each other to achieve the larger sectoral objectives.
- For example, in Assam, the Energy Vision document that lays out the electricity and development outcomes is to be applied in tandem with the Solar Energy Policy 2017 that operationalises this vision via an action plan.
Reasons for lack of integration of electrification in the development sector
- The lack of integration of electrification requirements in development sector policy documents may be partly due to lack of information about electricity and development linkages, poor coordination mechanisms between the sectors and departments, and poor access to appropriate finance.
- Even while electricity is considered, it is to the limited extent of being a one-time civil infrastructure activity rather than a continuous feature necessary for the day-to-day operations of these services.
Way forward
- To successfully integrate electricity provisioning and maintenance, policy frameworks should include innovative coordination and financing mechanisms.
- These mechanisms, while developing clear compliance mandates, must also allow sufficient room for flexibility to respond to local contexts.
- Providing reliable electricity for health centres and schools should be the responsibility of centralised decision-making entities at the State or national level.
- As India has witnessed with other cross-sectoral and centralised statistical, planning, and implementation data governance, diverse contexts must support oversight mechanisms that ensure data credibility.
- Finance is largely unavailable to ensure reliable electricity supply to schools and health facilities.
- Some directives, such as those governing the use of untied funds, need to be more flexible in allowing these facilities to prioritise providing reliable and sustainable electricity.
Conclusion
A successful policy outcome might be dependent on several invisible aspects that do not get the attention and funding necessary to aid in successful policy delivery. Electricity is one of them.
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A miracle cure against HIV
From UPSC perspective, the following things are important :
Prelims level : HIV/AIDS
Mains level : Communicable diseases burden on India
There is considerable excitement in the world of medicine after scientists reported that a woman living with HIV (Human Immunodeficiency Virus) and administered an experimental treatment is likely ‘cured’.
What is HIV/AIDS?
- HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.
- First identified in 1981, HIV is the cause of one of humanity’s deadliest and most persistent epidemics.
- It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex, or through sharing injection drug equipment.
- If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).
- The human body can’t get rid of HIV and no effective HIV cure exists.
Treating HIV
- However, by taking HIV medicine (called antiretroviral therapy or ART), people with HIV can live long and healthy lives and prevent transmitting HIV to their sexual partners.
- In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
What is the new breakthrough?
- US researchers have described the case of a 60-year-old African American woman who was diagnosed with an HIV infection in 2013.
- She was started on the standard HIV treatment regimen of anti-retroviral treatment (ART) therapy consisting of tenofovir, emtricitabine, and raltegravir.
- She was given cord blood, or embryonic stem cells, from a donor with a rare mutation that naturally blocks the HIV virus from infecting cells.
- She was also given blood stem cells, or adult stem cells, from a relative.
What actually worked?
- The adult stem cells boosted the patient’s immunity and possibly helped the cord blood cells fully integrate with the lady’s immune system.
- Now she has no sign of HIV in her blood and also has no detectable antibodies to the virus.
- Embryonic stem cells are potentially able to grow into any kind of cell and hence their appeal as therapy, though there is no explanation for why this mode of treatment appeared to be more effective.
Is this treatment the long-sought cure for AIDS?
- Not at all. While this approach is certainly a welcome addition to the arsenal of treatments, stem cell therapy is a cumbersome exercise and barely accessible to most HIV patients in the world.
- Moreover, this requires stem cells from that rare group of individuals with the beneficial mutation.
- Anti-retroviral therapy, through the years, has now ensured that HIV/AIDS isn’t always a death sentence and many with access to proper treatment have lifespans comparable to those without HIV.
- A vaccine for HIV or a drug that eliminates the virus is still elusive and would be the long-sought ‘cure’ for HIV/AIDS.
What is the prevalence of HIV/AIDS in India?
- As per the India HIV Estimation 2019 report, the estimated adult (15 to 49 years) HIV prevalence trend has been declining in India since the epidemic’s peak in the year 2000 and has been stabilizing in recent years.
- In 2019, HIV prevalence among adult males (15–49 years) was estimated at 0.24% and among adult females at 0.20% of the population.
- There were 23.48 lakh Indians living with HIV in 2019.
- Maharashtra had the maximum at 3.96 lakh followed by Andhra Pradesh (3.14 lakh) and Karnataka.
- ART is freely available to all those who require and there are deputed centers across the country where they can be availed from.
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Weighing in on a health data retention plan
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat Digital Mission
Mains level : Paper 2- Privacy centric health data retention policy
Context
The National Health Authority (NHA) — the body responsible for administering the Ayushman Bharat Digital Mission (ABDM) — has initiated a consultation process on the retention of health data by healthcare providers in India. The consultation paper asks for feedback on what data is to be retained, and for how long.
Issues with the policy for healthcare data retention
- Risk of over-collection: A simple classification system, as suggested in the consultation paper, exposes individuals to harms arising from over-collection and retention of unnecessary data.
- At the same time, this kind of one-size-fits-all system can also lead to the under-retention of data that is genuinely required for research or public policy needs.
- Instead, we should seek to classify data based on its use.
Do we need a policy for the mandatory retention of health data?
- Currently, service providers can compete on how they handle the data of individuals or health records, in theory, each of us can choose a provider whose data policies we are comfortable with.
- Whether the state should mandate a retention period at all is an open question.
- Given the landscape of healthcare access in India, including through informal providers, many patients may not think about this factor in practice.
- Nonetheless, the decision to take the choice out of the individual’s hands should not be taken lightly.
Balancing the policy for public health data retention with the right to privacy
- Four-part test for privacy: The Supreme Court of India has clarified that privacy is a fundamental right, and any interference into the right must pass a four-part test: legality; legitimate aim; proportionality, and appropriate safeguards.
- Health data and privacy: The mandatory retention of health data is one such form of interference with the right to privacy.
- 1] Legality: In this context, the question of legality becomes a question about the legal standing and authority of the NHA.
- Since the NHA is not a sector-wide regulator, it has no legal basis for formulating guidelines for healthcare providers in general.
- 2]Legitimate aim: The aim of data retention is described in terms of benefits to the individual and the public at large.
- Benefits to the individuals: Individuals benefit through greater convenience and choice, created through portability of health records.
- The broader public benefits through research and innovation, driven by the availability of more and better data to analyse.
- Risk involved: Globally, legal systems consider health data particularly sensitive, and recognise that improper disclosure of this data can expose a person to a range of significant harms.
- Benefits must be clearly defined: As per Indian law, if an individual’s rights are to be curtailed due to anticipated benefits, such benefits cannot be potential or speculatory: they must be clearly defined and identifiable.
- 3] Proportionality: This is the difference between saying that data on patients with heart conditions will help us better understand cardiac health — a vague explanation — and being able to identify a specific study that will include data from that patient.
- It would further mean demonstrating that the study requires personally identifiable information, rather than just an anonymous record — the latter flowing from the principle of proportionality, which requires choosing the least intrusive option available.
- 4] Safeguard: Standards for anonymisation are still developing.
- We are not yet able to rule out the possibility of anonymised data still being linked back to specific individuals.
- In other words, even anonymisation may not be the least intrusive solution to safeguarding patients’ rights in all scenarios.
Way forward
- Clear and specific case for retention: The test for retaining data should be that a clear and specific case has been identified for such retention, following a rigorous process run by suitable authorities.
- Anonymise data: A second safeguard would be to anonymise data that is being retained for research purposes — again, unless a specific case is made for keeping personally identifiable information.
- If neither of these is true, the data should be deleted.
- Express and informed consent: An alternate basis for retaining data can be the express and informed consent of the individual in question.
- User-based classification process: Health-care service providers — and everyone else — will have to comply with the data protection law, once it is adopted by Parliament.
- The current Bill already requires purpose limitation for collecting, processing, sharing, or retaining data; a use-based classification process would thus bring the ABDM ecosystem actors in compliance with this law as well.
Consider the question “What are the advantages and concerns with the retention of public health data? Suggest the ways to ensure the privacy-centric public health data retention policy.”
Conclusion
A privacy-centric process is needed to determine what data to retain and for how long.
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How the Budget can push India’s health system transformation
From UPSC perspective, the following things are important :
Prelims level : National Health Authority
Mains level : Paper 2- Health system transformation
Context
After decades of low government expenditure on health, the Covid pandemic created a societal consensus on the need to strengthen our health system.
Steps to strengthen our health system
- The Fifteenth Finance Commission recommended greater investment in rural and urban primary care, a nationwide disease surveillance system extending from the block-level to national institutes, a larger health workforce and the augmentation of critical care capacity of hospitals.
- The Union budget of 2021 reflected these priorities in a proposed Pradhan Mantri Aatmanirbhar Swasth Bharat Yojana (PMASBY) to be made operational over six years, with a budget of Rs 64,180 crore.
- Broader vision of health: The Finance Minister also projected a broader vision of health beyond healthcare by merging allocations to water, sanitation, nutrition and air pollution control with the health budget.
- Under the Ayushman Bharat umbrella the Digital Health Mission was launched in September 2021.
- The Health Infrastructure Mission, launched in October 2021, was a renamed and augmented version of the PMASBY.
- These missions join the two other components of Ayushman Bharat launched in 2018.
- The Comprehensive Primary Health Care (CPHC) component is nested in the National Health Mission (NHM) while the Pradhan Mantri Jan Arogya Yojana (PMJAY) is steered by the National Health Authority (NHA).
Way forward
- While much of the following needs to be done by the states, the Centre should incentivise and support such efforts by the states.
- Link synergically: Primary healthcare services under the CPHC and linkage with water, sanitation, nutrition and pollution control programmes will strengthen the capacity of the health system for health promotion and disease prevention.
- The budget of 2022 must not only fund these missions adequately but indicate how they will link synergically while functioning under different administrative agencies.
- Allocate more funds: The NHM received only a 9.6 per cent increase in the 2021 budget.
- PMJAY did not see an increase in allocation last year, because its utilisation for non-Covid care declined sharply in the previous year.
- More importantly, limiting cost coverage to hospitalised care reduces the PMJAY’s capacity to significantly lower out-of-pocket expenditure (OOPE) on health, which is driven mostly by outpatient care and expenditure on medicines.
- Focus on Digital Heath Mission: The Digital Health Mission can enhance efficiency of the health systems in a variety of ways.
- These include better data collection and analysis, improved medical and health records, efficient supply chain management, tele-health services, support for health workforce training, implementation of health insurance programmes, real time monitoring and sharper evaluation of health programme performance along with effective multi-sectoral coordination.
- Improve the skill and number of healthcare workers: We need to increase the numbers and improve the skills of all categories of healthcare providers.
- While training specialist doctors could take time, the training of frontline workers like Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) can be done in a shorter time.
- Upgrade district hospitals: District hospitals need to be upgraded, with greater investment in infrastructure, equipment and staffing.
- In underserved regions, such district hospitals should be upgraded to become training centres for students of medical, nursing and allied health professional courses.
Conclusion
The expanded ambit of health, as defined in last year’s budget, must continue for aligning other sectors to public health objectives. The Union budget of 2022 can add further momentum to our health system transformation.
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National Commission for Safai Karamcharis gets 3-year extension
From UPSC perspective, the following things are important :
Prelims level : NCSK
Mains level : Manual scavenging in India
The Union Cabinet has approved a three-year extension of the tenure of the National Commission for Safai Karamcharis (NCSK) that was set to end on March 31.
About National Commission for Safai Karamcharis
- The commission was set up in 1993 under the NCSK Act 1993 for a period of three years, which has been extended since then.
- The NCSK Act is however ceased to have effect from February 29, 2004.
- After that, the tenure of the NCSK has been extended as a non-statutory body from time to time through resolutions.
Why was NCSK set up?
- The commission helps in coming up with programmes for the welfare of sanitation workers.
- It also monitors the implementation of the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013.
- Till December 31, 2021, 58,098 manual scavengers had been identified.
Need for eliminating Manual Scavenging
- Undignified life (all the 6 Fundamental Rights are compromised, directly or indirectly).
- It directly perpetuates castism.
- Modern, Secular India has no place for such “professions”.
- It no way suits India’s rising global profile – ‘super power’ aspirations.
- Women are mostly disprivileged since most manual scavengers are dalit women.
What else needs to be done?
- Though the government has taken many steps for the upliftment of the safai karamcharis, the deprivation suffered by them in socio-economic and educational terms is still far from being eliminated.
- Although manual scavenging has been almost eradicated, sporadic instances of their deaths do occur.
Way forward
- There is a continued need to monitor the various interventions and initiatives of the government for welfare of safai Karamcharis.
- The govt must strive to achieve the goal of complete mechanization of sewer/septic tanks cleaning in the country and rehabilitation of manual scavengers.
Try this question from CSP 2016:
Q.’Rashtriya Garima Abhiyaan’ is a national campaign to:
(a) rehabilitate the homeless and destitute persons and provide them with suitable sources of livelihood
(b) release the sex workers from their practice and provide them with alternative sources of livelihood
(c) eradicate the practice of manual scavenging and rehabilitate the manual scavengers
(d) release the bonded labourers from their bondage and rehabilitate them
Post your answers here:
Also try this question from our AWE initiative:
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Extinguishing the tobacco industry’s main narrative
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Price and tax measures to reduce demand of tobacco
Context
There is no doubt that tobacco use is highly detrimental to public health. We have to find the ways and the means to reduce the demand for tobacco among existing as well as aspiring users.
Impact of tobacco
- Tobacco is a product that kills more than 13 lakh Indians every year.
- Annual burden: The annual economic burden from tobacco use is estimated to be ₹177,340 crore which is more than 1% of India’s GDP.
- About 27 crore people above the age of 15 years and 8.5% of school-going children in the age group 13-15 years use tobacco in some form in India.
Are price and tax measures effective against tobacco use?
- When tobacco products become more expensive, people either quit using them or use them less, and it incentivises many to not initiate the habit.
- Because it hurts both revenue and profits, the tobacco industry, globally, is always devising tactics and narratives that will pre-empt any kind of tax increases on tobacco products.
- The narrative of “increasing illicit trade” is something the tobacco industry has historically used to pre-empt potential tax increases on tobacco products in most countries around the world.
- The story is no different in India.
- In a recent report by the Tobacco Institute of India, it was said that the illicit cigarette volume in India has grown by 44% from 2011 to 2019 while adding that high and increasing tax rates provide a profitable opportunity for tax evasion and encourage growth in illegal trade.
- A study published in 2018 which used a survey of empty cigarette packs collected from retail outlets across different cities in India estimated that illicit cigarettes constitute 2.7% of the market.
- The second study published in 2020 used tax-gap analysis to estimate that the percentage of illicit cigarettes was 5.1% in 2009-10 and 6.6% in 2016-17.
Are taxes and prices key determinants of illicit trade?
- It is to be noted that taxes and prices are not the key determinants of illicit trade.
- There is sufficient evidence in the literature on illicit trade in cigarettes that shows tax increases only have a minimal impact, if at all, on illicit trade.
- There are several countries where tobacco taxes are quite high and yet have low levels of illicit trade, while there are also countries with high levels of illicit trade despite having relatively low tax rates.
- Several factors such as the quality of tax administration, the strength of the regulatory framework, government commitment to control illicit trade, the strength of governance, social acceptance, and the presence of informal distribution networks are known to play a larger role in determining the scale and the extent of an illicit market.
Way forward
- WHO protocol: Eliminating all forms of illicit trade in tobacco products through a package of measures is one of the major objectives of the Protocol to Eliminate Illicit Trade in Tobacco Products under the World Health Organization’s Framework Convention on Tobacco Control.
- The Protocol provides the tools and the measures to eliminate or minimise illicit trade which includes strong governance, establishing an international track and trace system, and securing supply chains.
- India has already ratified the World Health Organization Protocol and it should now show leadership in implementing these measures to effectively address even the relatively lower levels of illicit trade.
Conclusion
There is no scientific or public health rationale not to increase tax on tobacco products for unfounded fear of increasing illicit trade.
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Worrying trends in nutrition indicators in NFHS-5 data
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Dealing with the nutrition gap
Context
The NFHS-5 factsheets for India and all states and Union territories are now out. At first glance, it appears to be a mixed bag — much to cheer about, but concern areas remain.
Positives from the NFHS-5 survey
- Change in demographic trends: For the first time since the NFHS 1992-93 survey, the sex ratio is slightly higher among the adult population.
- Improvement in sex ratio at birth: For the first time in 15 years that the sex ratio at birth has reached 929 (it was 919 for 1,000 males in 2015-16).
- The total fertility rate has also dropped from 2.2 per cent to a replacement rate of 2 per cent, albeit with not much change in the huge fertility divide between the high and low fertility states.
- Improvement in literacy level of women: There has been an appreciable improvement in general literacy levels and in the percentage of women and men who have completed 10 years or more of schooling, which has reached 41 per cent and 50.2 per cent respectively.
- Improvements in health indicators: The health sector deserves credit for achieving a significant improvement in the percentage of institutional births, antenatal care, and children’s immunisation rates.
- There has also been a consistent drop in neonatal, infant and child mortality rates — a decrease of around 1 per cent per year for neonatal and infant mortality and a 1.6 per cent decrease per year for under five mortality rate.
Nutrition: Area of concern
- Increase in anaemic people: India has become a country with more anaemic people since NFHS-4 (2015-16), with anaemia rates rising significantly across age groups, ranging from children below six years, adolescent girls and boys, pregnant women, and women between 15 to 49 years.
- Why anaemia is a concern? Adverse effects of anaemia affect all age groups — lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
- Further, anaemia among adolescent girls (59.1 per cent) advances to maternal anaemia and is a major cause of maternal and infant mortality and general morbidity and ill health in a community.
- The detailed report will explain why a dedicated programme like Anaemia Mukt Bharat which focused on IFA consumption failed to gain impetus.
- Slow pace of improvement in nutritional indicators: Between NFHS 4 and NFHS 5, the percentage of children below five years who are moderately underweight has reduced from 35.8 per cent to 32.1 per cent.
- Moderately stunted children have fallen from 38.4 per cent to 35.5 per cent, moderately wasted from 21 per cent to 19.3 per cent and severely wasted have increased slightly from 7.5 per cent to 7.7 per cent.
- Inadequate diet: The root cause for this is that the percentage of children below two years receiving an adequate diet is a mere 11.3 per cent, increasing marginally from 9.6 per cent in NFHS-4.
Way forward
- India’s nutrition programmes must undergo a periodic review.
- The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.
Conclusion
The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Put out the data, boost the dose of transparency
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Dealing with Covid
Context
The Government must make COVID-19 data including that for vaccine regulatory approvals and policy available.
Kay decisions
- On December 25, the Prime Minister of India announced two key decisions.
- Vaccination of children: All children in the 15-17 age bracket will be eligible to receive COVID-19 vaccines from January 3, 2022.
- Third shot: All health-care workers, frontline workers and the people aged 60 years and above (with co-morbidities and on the advice of a medical doctor) can get a third shot, or ‘precaution dose’.
- The eligibility for the precaution dose will be on the completion of nine months or 39 weeks after the second dose.
- Teenage children whose birth year is 2007 or before will be eligible for COVID-19 vaccines.
- Children will receive Covaxin, the reason being (according to the note) it is the only emergency use listed (EUL) World Health Organization vaccine available for use in this age group in India.
Issues with the decision
- Lack of scientific evidence: The decision is said to be based on ‘advice of the scientific community’.
- A few members of the National Technical Advisory Group on Immunisation (NTAGI) in India, have written or spoken publicly about not having enough scientific evidence to administer booster doses and vaccinate children in India.
- Successive national and State-level sero-surveys have reported that a majority of children in India had got natural infection, while staying at home and thus developed antibodies.
- The studies have shown that children rarely develop moderate to severe COVID-19 disease.
- Targeted vaccination approach not adopted: Most public health and vaccine experts favour a ‘targeted vaccination approach’ by prioritising high-risk children for COVID-19 vaccination.
- However, such an approach is likely to face an operational challenge in the identification of the eligible children.
- Consultation cost: A majority of the elderly have one or other comorbidities. Of the 14 crore elderly population in India, an estimated 7 to 10 crore people could have co-morbidities.
- If they have to seek advice from a physician, in order to get vaccinated, this essentially means that there would be up to 10 crore of medical consultations, which would come at a cost — all of which is avoidable.
Suggestions
- Do away with prescription: The conditionality of comorbidities and the need for advice/prescription by a doctor for ‘the precaution shot’ in the elderly should be done away with.
- Third dose to all immunocompromised adults: There is scientific evidence and consensus on administering the third dose for immunocompromised adults.
- The Indian government should urgently consider administering a third dose for all immunocompromised adults, irrespective of age.
- Third dose on a different vaccine platform: Studies have found that a heterologous prime-boost approach — third shot on a different vaccine platform — is a better approach.
- Identify policy questions: Various pending policy questions on COVID-19 vaccine need to be identified urgently.
- The technical expert should be given complete access to COVID-19 data for analysis and to find answers to those scientific and policy questions.
- Vaccine supply and stock management: Vaccination for teenage children, exclusively with Covaxin (which means 15 crore doses for this sub-group) has other implications.
- Covaxin will also be needed for people coming for their first shot, returning for their second shot, and then for their ‘precaution dose’ if a third shot of the same vaccine is allowed.
- Focus on primary vaccination: The precaution dose and vaccination for children should not divert attention from the task of primary vaccination, which continues to be an unfinished task in India; 46 crore doses are still needed for the first and second shots.
- Make data public: It is time the Union and State governments in India make COVID-19 data — this includes clinical outcomes, testing, genomic sequencing as well as vaccination — available in the public domain.
- This would help in formulating and updating COVID-19 policy and strategies and also assess the impact of ‘precaution dose’ as well as vaccination of children.
Conclusion
The Indian government urgently needs to make COVID-19 data available, including the one used for regulatory approvals of vaccines and for vaccine policy decisions. This will bring transparency in decision making and increase the trust of the citizen in the process.
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NITI Aayog releases fourth edition of State Health Index
From UPSC perspective, the following things are important :
Prelims level : State Health Index
Mains level : Competitive Federalism
NITI Aayog has released the fourth edition of the State Health Index for 2019–20.
State Health Index
- The State Health Index is an annual tool to assess the performance of states and UTs. It is being compiled and published since 2017.
- The index is part of a report commissioned by the NITI Aayog, the World Bank, and the Union Health and Family Welfare Ministry.
- The reports aim to nudge states/UTs towards building robust health systems and improving service delivery.
Components of the index
- It is a weighted composite index based on 24 indicators grouped under the domains of ‘Health Outcomes’, ‘Governance and Information’, and ‘Key Inputs/Processes’.
- Health outcomes: It includes parameters such as neonatal mortality rate, under-5 mortality rate, and sex ratio at birth.
- Governance: This includes institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
- Key inputs: It consists of the proportion of shortfall in healthcare providers to what is recommended, functional medical facilities, birth, and death registration, and tuberculosis treatment success rate.
Performance of the states
- For the fourth year in a row, Kerala has topped a ranking of States on health indicators. Uttar Pradesh has come in at the bottom.
- Kerala is followed by Tamil Nadu and Telangana, which improved its ranking.
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Issues with Health Surveys in India
From UPSC perspective, the following things are important :
Prelims level : NFHS and other survey mentioned
Mains level : Need for national health data architecture
This article discusses the feasibility of conducting a single comprehensive survey for collecting health-related data in India.
Context
- In a country perennially thirsty for reliable health data, the National Family Health Survey (NFHS) is like an oasis.
- It has a large volume of data that is openly accessible.
- The report of the fifth round of the NFHS was recently released. Since then, we had many articles covering different aspects (malnutrition, fertility, and domestic violence to name a few).
What is NFHS?
- The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
- Three rounds of the survey have been conducted since the first survey in 1992-93.
- Currently, the survey provides district-level information on fertility, child mortality, contraceptive practices, reproductive and child health (RCH), nutrition, and utilization and quality of selected health services.
- The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.
Issues with health surveys in India
- Multiple surveys: The NFHS is not the only survey. In the last five years, there has been the National NCD Monitoring Survey (NNMS), the National Mental Health Survey (NMHS) etc.
- Huge cost: Each survey funding for different rounds of NFHS costs upto ₹250 crore.
- Huge chunk of data: The size of the survey has obvious implications for data quality.
- Different estimates: Multiple surveys also raise the problem of differing estimates, as is likely, due to sampling differences in the surveys.
- Limited respondents: The respondents are largely women in the reproductive age group (15-49 years) with husbands included.
- Global obligations: Some of these surveys are done to meet the global commitments on targets (NCDs, tobacco, etc.).
- Undefined purpose The health surveys have confusing research with programme monitoring and surveillance needs. Ex. Questions on domestic violence in NFHS.
Need of the hour
- Alignment of purpose: There have been previous attempts to align these surveys but they have failed as different advocates have different “demands” and push for inclusion of their set of questions.
- Regularity of surveys: NFHS is the only major survey that India has a record of doing regularly. One does not know if and when the other surveys will be repeated.
One-stop solution
- National health data architecture: With diverse aspects of health, there is a need to plan the public health data infrastructure for the country.
- Budgetary outlay: We also need to ensure that these data are collected in an orderly and regular manner with appropriate budgetary allocation.
- Purpose definition: This requires clarity of purpose and a hard-nosed approach to the issue that randomized activities.
- National-level indicators: We have to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.
How should surveys be done?
- There should be three national surveys done every three to five years in a staggered manner:
- NFHS focuses on Reproductive and Child Health (RCH) issues
- Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviors) and
- Nutrition-Biological Survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)
We need to look at alternate models and choose what suits us best.
Way forward
- Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
- States have to become active partners including providing financial contributions to these surveys.
- It is also very important to ensure that the data arising from these surveys are in the public domain.
Conclusion
- We are ready to establish public health data architecture for our complexity of needs.
- We have the technical capacity to do so.
- All it requires now is the political will.
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Extending outpatient health care coverage
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Extending coverage to OP care
Context
Over the past two decades, initiatives announced to extend health care coverage to the indigent sections have come under criticism due to their near-exclusive focus on hospitalisation (inpatient, IP) care.
Significance of outpatient health care
- What is outpatient health care: Outpatient (OP) health care, mainly comprising doctor consultations, drugs, and tests, can be called ‘the elephant in the room’ of Indian public health care policy.
- OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health.
Why do we need to extend OP care coverage?
- How IP care differs from OP care? IP care comprises high-impact and unavoidable episodes that are less prone to misuse than OP care, for which demand is considerably more sensitive to price and is thus more prone to overuse under health insurance.
- IP insurance prioritised: This logic, among other reasons, has led to IP insurance schemes being prioritised.
- [1] OP care and preventive care is neglected: While a price-sensitive demand for OP care entails that it could be misused under insurance, it also means that OP care is the first to come under the knife when there is no insurance.
- In India, where there are many public IP insurance schemes but no OP coverage, this incentive is further amplified.
- The mantra of ‘prevention is better than cure’ thus goes for a toss.
- [2] Against economic sense: It defies economic sense to prioritise IP care over OP care for public funds.
- Preventive and primary care services which often come with externalities, elicit little felt need and demand, and must therefore be the primary recipients of public investment.
- Not conducive to epidemiological profile: Greater investments in IP care today translate to even greater IP care investments in future, further reduction in primary care spending, and ultimately lesser ‘health’ for the money invested.
- None of these are conducive to the epidemiological profile that characterises this country.
Issues with using private commercial insurance to extend OP care coverage nationwide
- Some recent policy pronouncements by the Centre have conveyed an inclination to expand healthcare coverage with little fiscal implications for the government.
- Challenges:
- [1] The OP practices are under-regulated and there is a lack of standards.
- [2] The difficulty to monitor OP clinical and prescribing behaviours and the concomitant higher likelihood of malpractices.
- [3] Low public awareness of insurance products and a low ability to discern entitlements and exclusions.
- [4] Add to it the inexperience that a still under-developed private OP insurance sector brings.
- All these entail tremendous and largely wasteful costs and administrative complexity, and it would be of little help even if the government was to step in with considerable subsidies.
Suggestion
- Need for fiscal and time commitment: Significant improvements in healthcare are implausible without significant fiscal and time commitments.
- No perfect model: There is no ‘perfect’ model of expanding healthcare — the emphasis must be on finding the best fit.
- Implementing even such a best fit could involve adopting certain modalities with known drawbacks.
- Expand public spending: The focus must be on expanding public OP care facilities and services financed mainly by tax revenues.
- For India, wisdom immediately points to successful countries that are (or were, at one point) much closer to its socioeconomic fabric, such as Thailand, than countries like the U.S. which we currently look to emulate.
- Now, the sparse number and distribution of public facilities offers various modes of rationing care, and their expansion is likely to result in a considerable spike in demand.
- Contracting with private players: Contracting with private players based on objective and transparent criteria would also be called for, with just enough centralised supervision to deter corruption while preserving local autonomy.
- To deter supply-side malpractices, low-powered modes of provider payment, such as capitation, may be considered for private providers wherever possible.
Conclusion
There are several compelling reasons for extending outpatient health care coverage even though there are several challenges to overcome to achieve this.
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How lack of public data on pandemic could harm us
From UPSC perspective, the following things are important :
Prelims level : Omicron variant
Mains level : Paper 2- Importance of data in dealing with pandemic
Context
Questions are being asked about India’s preparedness as the cases with the Omicron variant of the Coronavirus has been on the rise in the country.
Where does India stand?
[1] The Positives
- Addressing oxygen shortage: The extreme shortages of oxygen that we saw barely six months ago will hopefully not be a feature of a third wave.
- Vaccinated population: We have now vaccinated more than 50% of the adult population with both doses of vaccine, and approximately 85% have received one or two doses.
- Ramping up testing to deal with a spike should not require an increase in capacity.
- More vaccine doses: We have more vaccine doses than in May 2021 and the potential for oral antiviral therapy in the near future.
[2] The negatives
- Lack of data: An urgent and important one is the lack of publicly available data on the pandemic from Government sources, particularly in regard to testing, but also in terms of being able to correlate disease severity with age, prior medical conditions, locations and other variables.
- Data from the Indian Council of Medical Research (ICMR), India’s premier medical research agency, remains inaccessible.
- The National Centre for Disease Control (NCDC) has not responded.
- The CoWIN data contains valuable information but it is of little value for future planning and prediction unless it can be tied to testing data and clinical information at the level of individuals.
- ICMR data not correlated to CoWIN platform data: The Indian Council of Medical Research holds data on every COVID-19 test conducted in India.
- However, these data are not correlated to the vaccine data in the CoWIN platform.
- Data with States is inaccessible: Data on hospitalisations, etc. are apparently available at the State level, but seem inaccessible.
What we can know from the data about pandemic
- Infer the probability of reinfection: If we knew that a person had tested positive on successive tests separated by, say four months or more, with a negative test in-between, that would suggest a reinfection.
- We could then infer the probability of such a reinfection.
- Probability of vaccine breakthrough infection: With information about testing and vaccination status, we could compute the probability of a vaccine breakthrough event.
- To know the efficacy of single vaccine dose: By checking to see whether the positive test happened after the first but before the second dose of vaccine, or after the second dose, the relative efficacy of such single vaccine doses at preventing disease could be derived.
- Effect of the vaccine on disease severity: By examining symptoms reported after a vaccine breakthrough event, we could understand the extent to which vaccines reduce disease severity.
- Impact of new variant: Add to this a layer of sequence information, and we could study the impact of new variants.
Role of the volunteer organisation
- The most trustworthy and granular data on cases in India have resulted from the remarkable and public-spirited work of a volunteer organisation, Covid19India.org.
- Their work has now been taken over by several other voluntary groups, all operating on the same broad principles of data accessibility: covid19bharat.org, incovid19.org and covid19tracker.in.
Way forward
- Commitment towards data accessibility: We need to stress on data availability because this is the one area where a swift realignment is possible.
- The more widely data are shared, the greater the likelihood of integration of the rapidly shifting scientific frontier with clinical practice.
- Learning from the experience of South Africa: With the advantages of a relatively high-quality surveillance system among low- and middle-income countries (LMIC) countries, bolstered by a commitment towards transparency and data accessibility, South Africa’s rapid sharing allowed the world to prepare swiftly for the appearance of the highly mutated Omicron variant.
- It is clear that pre-emptive decisions on vaccination and other measures could be made faster and better if more integrated data were available.
Consider the question “Why availability and accessibility of data is important in dealing with the Covid-19 pandemic? What are the challenges facing health data accessibility in India?”
Conclusion
Now, more than ever before is the time for us to urgently reassess our attitude towards data for public health purposes and the role of national health agencies in sharing data, generated with public funds, with scientists in India and across the world.
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Amendment to the NDPS Act
From UPSC perspective, the following things are important :
Prelims level : NDPS Act
Mains level : Narcotics crime in India
The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2021 was passed by Lok Sabha.
Must read:
About NDPS Act
- The Narcotic Drugs and Psychotropic Substances Act, commonly referred to as the NDPS Act was promulgated in 1985.
- It prohibits a person from the production/manufacturing/cultivation, possession, sale, purchasing, transport, storage, and/or consumption of any narcotic drug or psychotropic substance
What is the 2021 amendment?
- The 2021 Bill amends the Narcotic Drugs and Psychotropic Substances Act, 1985 and seeks to rectify a drafting “anomaly” created by a 2014 amendment to the parent legislation.
- It contains a legislative declaration about what one section refers to.
- It says Section 2 clause viii(a) corresponds to clause viii(b) in Section 27, since 2014 when the provision was first brought in.
- Section 27A of the NDPS Act, 1985, prescribes the punishment for financing illicit traffic and harbouring offenders.
Earlier amendment in 2014
- In 2014, a substantial amendment was made to the NDPS Act to allow for better medical access to narcotic drugs.
- It defined “essential drugs”; under Section 9 and allowed the manufacture, possession, transport, import inter-State, export inter-State, sale, purchase, consumption and use of essential narcotic drugs.
- But before the 2014 amendment, a Section 2(viii)a already existed and contained a catalogue of offences for which the punishment is prescribed in Section 27A.
What is Section 21A?
- Section 27A reads: Whoever indulges in financing, directly or indirectly or harbours any person engaged in any of the aforementioned activities, shall be punishable with rigorous imprisonment.
- The term shall not be less than ten years and may extend to twenty years.
- The accused shall also be liable to fine which shall not be less than one lakh rupees but which may extend to two lakh rupees.
What was the drafting “anomaly”?
- While defining “essential drugs” in 2014, the legislation re-numbered Section 2.
- The catalogue of offences, originally listed under Section 2(viii)a, was now under Section 2(viii)b.
- In the amendment, Section 2(viii)a defined essential narcotic drugs.
- However, the drafters missed amending the enabling provision in Section 27A to change Section 2(viii)a to Section 2(viii)b.
What was the result of the drafting error?
- Section 27A punished offences mentioned under Section 2(viiia) sub-clauses i-v.
- However, Section 2 (viiia) sub-clauses i-v, which were supposed to be the catalogue of offences, does not exist after the 2014 amendment. It is now Section 2(viiib).
- This error in the text meant since 2014, Section 27A was inoperable.
When was the error noticed?
- In June this year, the Tripura High Court, while hearing a reference made by the district court, flagged the drafting error, urging the Centre to bring in an amendment and rectify it.
- In 2016, an accused had sought bail before a special judge in West Tripura in Agartala, citing this omission in drafting.
Why can’t it be applied retrospectively?
- Article 20(1) of the Constitution says that no person shall be convicted of any offence except for violation of the law in force at the time of the commission.
- The person shall not be subjected to a penalty greater than that which might have been inflicted under the law in force at the time of the commission of the offence.
- This protection means that a person cannot be prosecuted for an offence that was not a “crime” under the law when it was committed.
Does the latest amendment make it retrospective?
- In September, the government brought in an ordinance to rectify the drafting error, which Lok Sabha. “It shall be deemed to have come into force on the 1st day of May 2014,” the Bill reads.
- Retrospective application is permitted in clarificatory amendments.
- This 2021 amendment is not a substantive one, that is why the retrospective is allowed.
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Tobacco Consumption in India
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Cancer related fatality in India
Tobacco use is known to be a major risk factor for several non-communicable diseases in India.
Tobacco abuse in India
- In India, 28.6% of adults above 15 years and 8.5% of students aged 13-15 years use tobacco in some form or the other.
- This makes the country the second-largest consumer of tobacco in the world.
Concern: No action against Tobacco
- India bears an annual economic burden of over ₹1, 77,340 crores on account of tobacco use.
- There has been no major increase in taxation of tobacco products to discourage the consumption of tobacco in the past four years since the introduction of GST.
- Only in 2020-21, the Union Budget had the effect of increasing the average price of cigarettes by about 5%.
- Yet, the excise duty on tobacco in India continues to remain extremely low.
A worrying trend
- No increase in tax: The absence of an increase in tax means more profits for the tobacco industry and more tax revenue foregone for the government.
- Revenue losses: This revenue could have easily been utilized during the COVID-19 pandemic.
- Losses due to GST: There has been a 3% real decline in GST revenues from tobacco products in each of the past two financial years.
Present governance of Tobacco
- GST slab: Tobacco at present is a highly taxed commodity. It is kept in the 28% GST slab (other than for tobacco leaves which is taxed at 5%).
- Heavy cess: Tobacco and its various forms are also subject to a heavy burden of cess, given that the commodity is seen as a sin good.
- Statutory warning: The government also uses pictures of cancer patients on the packages of cigarettes to discourage its use.
Federal issues
- Excise taxes on many tobacco products used to be regularly raised in the annual Union Budgets before the GST.
- Similarly, several State governments used to regularly raise value-added tax (VAT) on tobacco products.
- During the five years before the introduction of the GST, most State governments had moved from having a low VAT regime on tobacco products to having a high VAT regime.
Implication of such policies
- Increased consumption: The lack of tax increases in post-GST years might mean that some current smokers smoke more now and some non-smokers have started smoking.
- Reverse trend in decline: This could potentially lead to a reversal of the declining trend in prevalence.
- Affordability: Tobacco products are more affordable post-GST as shown in recent literature from India.
- Missing up national target: This might jeopardise India’s commitment to achieving 30% tobacco use prevalence reduction by 2025 as envisaged in the National Health Policy of 2017.
Way forward
- Several countries in the world have high excise taxes along with GST or sales tax and they are continuously being revised.
- We must adhere to the WHO recommendation for a uniform tax burden of at least 75% for each tobacco product.
- The Union government should take a considerate view of public health and significantly increase excise taxes — either basic excise duty or NCCD — on all tobacco products.
- Taxation should achieve a significant reduction in the affordability of tobacco products to reduce tobacco use prevalence and facilitate India’s march towards sustainable development goals.
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Global Health Security Index, 2021
From UPSC perspective, the following things are important :
Prelims level : Global Health Security Index, 2021
Mains level : Health security
Countries across all income levels remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security (GHS) Index.
About GHS Index
- The GHS Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations.
- It is a project of the Johns Hopkins Centre for Health Security, the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU) and was first launched in October 2019.
- It assesses countries across 6 categories, 37 indicators, and 171 questions using publicly available information.
- It benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader strength of the health system, and country adherence to global norms.
Parameters assessed
The report is based on a questionnaire of 140 questions, organized across 6 categories, 34 indicators, and 85 sub-indicators. The six categories are:
- Prevention: Prevention of the emergence or release of pathogens
- Detection and Reporting: Early detection and reporting for epidemics of potential international concern
- Rapid Response: Rapid response to and mitigation of the spread of an epidemic
- Health System: Sufficient and robust health system to treat the sick and protect health workers
- Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
- Risk Environment: Overall risk environment and country vulnerability to biological threats
Global performance
- In 2021, no country scored in the top tier of rankings and no country scored above 75.9, the report showed.
- The world’s overall performance on the GHS Index score slipped to 38.9 (out of 100) in 2021, from a score of 40.2 in the GHS Index, 2019.
- This, even as infectious diseases are expected to have the greatest impact on the global economy in the next decade.
- Some 101 countries high-, middle- and low-income countries, including India, have slipped in performance since 2019.
Indian scenario
- India, with a score of 42.8 (out of 100) too, has slipped by 0.8 points since 2019.
- Three neighboring countries — Bangladesh, Sri Lanka and Maldives — have improved their score by 1-1.2 points.
Conclusion
- Health emergencies demand a robust public health infrastructure with effective governance.
- The trust in government, which has been a key factor associated with success in countries’ responses to COVID-19, is low and decreasing, the index noted.
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Need for closer scrutiny of reduced out-of-pocket expenditure on health
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Scrutinising reduced out-of-pocket expenditure on health
Context
The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.
India’s total public spending on health
- One of the lowest in the world: India’s total public spending on health as a percentage of GDP or in per capita terms has been one of the lowest in the world.
- Majority spent by the States: The Union government traditionally spends around a third of the total government spending whereas the majority is borne by the States.
- There has been a policy consensus for more than a decade now that public spending has to increase to at least 2.5% of GDP.
- However, there has not been any significant increase so far.
- Despite several pronouncements, it has continued to hover around 1%-1.2% of GDP.
Why NHA report is being celebrated?
- The National Health Accounts (NHA) report capture spending on health by various sources, and track the schemes through which these funds are channelised to various providers in a given time period for a given geography.
- The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.
- The increase shown in NHA 2017-18 is largely due to increase in Union government expenditure.
- Increase in Centre’s share: For 2017-18, the Centre’s share in total public spending on health has jumped to 40.8%.
- However, if we study the spending pattern of the Ministry of Health and Family Welfare and the Ministry of AYUSH, we see that expenditure increased to 0.32% of GDP from 0.27% in 2016-17 — insufficient to explain the overall jump.
Issues with NHA report
- Expenditure of DMS included: Much of this increase has actually happened on account of a tripling of expenditure of the Defence Medical Services (DMS).
- Compared to an expenditure of ₹10,485 in 2016-17, it increased to ₹32,118 crore.
- Though the increasing spending for the health of defence personnel is a good thing, such spending does not benefit the general population.
- Within government expenditure, the share of current health expenditure has come down to 71.9% compared to 77.9% a year ago.
- Capital expenditure included: This essentially means, capital expenditure has increased, and specifically in defence.
- There is a problem in accounting capital expenditure within the NHA framework.
- Why capital expenditure needs to be left out: Equipment brought or a hospital that is built serves people for many years, so the expenditure incurred is used for the lifetime of the capital created and use does not get limited to that particular year in which expenditure is incurred.
- The World Health Organization proposes to leave out capital expenditure from health accounts estimates, instead focus on current health expenditure.
- Incomparable to other countries: In NHA estimates in India, in order to show higher public investment, capital expenditure is included; thus, Indian estimates become incomparable to other countries.
- The NHA estimate also shows that out-of-pocket expenditure as a share of GDP has reduced to less than half of the total health expenditure.
- NSSO 2017-18 data suggest that during this time period, utilisation of hospitalisation care has declined compared to 2014 NSSO estimates for almost all States and for various sections of society.
- Sign of distress: The decline in out-of-pocket expenditure is essentially due to a decline in utilisation of care rather than greater financial protection.
- Actually, the NSSO survey happened just after six months of demonetisation and almost at the same time when the Goods and Services Tax was introduced.
- The disastrous consequences of the dual blow of demonetisation and GST on the purchasing power of people are quite well documented.
- Another plausible explanation is linked to limitations in NSSO estimates. The NSSO fails to capture the spending pattern of the richest 5% of the population (who incur a large part of the health expenditure).
- Thus, out-of-pocket expenditure measured from the NSSO could be an under-estimate as it fails to take into account the expenditure of the richest sections.
Conclusion
The reduction of out-of-pocket expenditure is a sign of distress and a result of methodological limitations of the NSSO, rather than a sign of increased financial protection.
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What the latest NFHS data says about the New Welfarism
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- What findings of NHFS-5 imply
Context
The second and final phase of NFHS-5 was released which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population.
Major findings
[1] Success of New Welfarism
- Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women.
- The improvements are as striking as they were based on the performance of the phase 1 states.
- In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.
[2] Child-related outcomes
- India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade.
- For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021.
- On diarrhoea too, adding the new data reverses the earlier finding.
- However, on anaemia and acute respiratory illness, there seems to have been deterioration.
- The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states.
- The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.
[3] Catch up by the laggard states
- If the new child stunting numbers are right, a different picture of India emerges.
- Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh!
- On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.
- Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021.
Conclusion
When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics.
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National Health Accounts Estimates: 2017-18
From UPSC perspective, the following things are important :
Prelims level : National Health Accounts Estimates: 2017-18
Mains level : Health expenditure in India
Out-of-pocket expenditure (OOPE) as a share of total health expenditure and foreign aid for health has both come down as per the findings of the National Health Accounts (NHA) estimates for India for 2017-18.
What is National Health Accounts (NHA)?
- The NHA estimates are prepared by using an accounting framework based on internationally accepted System of Health Accounts 2011, provided by the World Health Organization (WHO).
- It is released by Ministry of Health & Family Welfare.
- It describes health expenditures and flow of funds in the country’s health system over a financial year of India.
- It answers important policy questions such as what are the sources of healthcare expenditures, who manages these, who provides health care services, and which services are utilized.
- It is a practice to describe the health expenditure estimates according to a global standard framework, System of Health Accounts 2011 (SHA 2011), to facilitate comparison of estimates across countries.
Objective of the NHA
- To describe the Current Health Expenditures (CHE).
The details of CHE are presented according to
- Revenues of healthcare financing schemes: – entities that provide resources to spend for health goods and services in the health system;
- Healthcare financing schemes: entities receiving and managing funds from financing sources to pay for or to purchase health goods and services;
- Healthcare providers: entities receiving finances to produce/ provide health goods and services;
- Healthcare functions: It describes the use of funds across various health care services.
About NHA (2017-2018)
- The 2017-18 NHA estimates shows government expenditure on health exhibiting an increasing trend and growing trust in public health care system.
- With the present estimate of NHA 2017-18, India has a continuous Time Series on NHA estimates for both government and private sources for five years since 2013-14.
- These estimates are not only comparable internationally, but also enable the policy makers to monitor progress towards universal health coverage as envisaged in the National Health Policy, 2017.
Key Highlights
Increase in GDP share: The NHA estimates for 2017-18 clearly show that there has been an increase in the share of government health expenditure in the total GDP from 1.15% in 2013-14 to 1.35% in 2017-18.
Increase in govt share in expenditures: In 2017-18, the share of government expenditure was 40.8%, which is much higher than 28.6% in 2013-14.
Per-Capita increase in expenditure: In per capita terms, the government health expenditure has increased from Rs 1042 to Rs.1753 between 2013-14 to 2017-18.
Focus on total healthcare: The primary and secondary care accounts for more than 80% of the current Government health expenditure.
Social security expenditure: The share of social security expenditure on health, which includes the social health insurance program, Government financed health insurance schemes, and medical reimbursements made to Government employees, has increased.
Decline in foreign aid: The findings also depict that the foreign aid for health has come down to 0.5%, showcasing India’s economic self-reliance.
Decline in OOPE: The government’s efforts to improve public health care are evident with out-of-pocket expenditure (OOPE) as a share of total health expenditure coming down to 48.8% in 2017-18 from 64.2% in 2013-14.
Way forward
- After 18 months of Covid-19, financial year 2017-18 appears to be from another era.
- However, learnings from that year’s NHA help us to plan for health system strengthening in the post-Covid years.
- The special financing packages for Covid emergency response, announced by the central government in 2020 and 2021, represent an extraordinary situation.
- The resolve to increase public financing for health must remain strong even after Covid.
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Key Demographic Transitions captured by 5th round of NFHS
From UPSC perspective, the following things are important :
Prelims level : National Family Health Survey
Mains level : Read the attached story
The Union health ministry released the summary findings of the fifth round of the National Family and Health Survey (NFHS-5), conducted in two phases between 2019 and 2021.
About NFHS
- The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
- The previous four rounds of the NFHS were conducted in 1992-93, 1998-99, 2005-06 and 2015-16.
- The survey provides state and national information for India on:
Fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services etc.
Objectives of the survey
Each successive round of the NFHS has had two specific goals:
- To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes
- To provide information on important emerging health and family welfare issues.
Key highlights of the NFHS-5
[1] Women outnumbering men
- NFHS-5 data shows that there were 1,020 women for 1000 men in the country in 2019-2021.
- This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.
- To be sure, in the 2005-06 NFHS, the sex ratio was 1,000 or women and men were equal in number.
[2] Fertility has decreased
- The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to replace itself from one generation to next.
- TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1. To be sure, in rural areas, the TFR is still 2.1.
- In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.
[3] Population is ageing
- A decline in TFR, which implies that lower number of children are being born, also entails that India’s population would become older.
- Sure enough, the survey shows that the share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.
[4] Children’s nutrition has improved
- The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.
- However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.
- The share of overweight children has increased from 2.1% to 3.4%.
[5] Nutrition problem for adults
- For children and their mothers, there are at least government schemes such as Integrated Child Development Services (ICDS) that seek to address the nutritional needs at the time of childbirth and infancy.
- However, there is a need to address the nutritional needs of adults too.
- The survey has shown that though India might have achieved food security, 60% of Indians cannot afford nutritious diets.
- While the share of women and men with below-normal Body Mass Index (BMI) has decreased, the share of overweight and obese (those with above-normal BMI) and the share of anaemic has increased.
[6] Basic sanitation challenges
- Availability of basic amenities such as improved sanitation facilities clean fuel for cooking, or menstrual hygiene products can improve health outcomes.
- There has been an improvement on indicators for all three since the last NFHS. However, the degree of improvement might be less than claimed by the government.
- For example, only 70% population had access to an improved sanitation facility.
- While not exactly an indicator of open defecation, it means that the remaining 30% of the population has a flush or pour-flush toilet not connected to a sewer, septic tank or pit latrine.
[7] Use of clean fuel
- The share of households that use clean cooking fuel is also just 59%.
[8] Financial inclusion
- The share of women having a bank account that they themselves use has increased from 53% to 79%.
- Households’ coverage by health insurance or financing scheme also has increased 1.4 times to 41%, a clear indication of the impact of the government’s health insurance scheme.
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HomoSEP: Robot for cleaning Septic Tanks
From UPSC perspective, the following things are important :
Prelims level : HomoSEP
Mains level : Manual scavenging in India
IIT Madras has developed a robot that can, if deployed extensively, put an end to this practice of sending people into septic tanks.
HomoSEP
- HomoSEP stands for “homogenizer of septic tanks”.
- It has a shaft attached to blades that can open like an inverted umbrella when introduced into a septic tank.
- This is helpful as the openings of the septic tanks are small and the tank interiors are bigger.
- The sludge inside a septic tank contains faecal matter that has thickened like hard clay and settled at the bottom.
- This needs to be shredded and homogenized so that it can be sucked out and the septic tank cleaned. The whirring blades of the robot achieve precisely this.
Manual scavenging deaths in India
- A statement by the Social Justice and Empowerment Ministry conveyed that in the five years till December 31, 2020, there have been 340 deaths due to manual scavenging.
- Uttar Pradesh (52), Tamil Nadu (43) and Delhi (36) leads in the list. Maharashtra had 34 and Gujarat and Haryana had 31 each.
- This is despite bans and prohibitory orders.
Various policy initiatives
- Prohibition of Employment as Manual Scavengers and their Rehabilitation (Amendment) Bill, 2020: It proposes to completely mechanise sewer cleaning, introduce ways for ‘on-site’ protection and provide compensation to manual scavengers in case of sewer deaths.
- Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013: Superseding the 1993 Act, the 2013 Act goes beyond prohibitions on dry latrines, and outlaws all manual excrement cleaning of insanitary latrines, open drains, or pits.
- Rashtriya Garima Abhiyan: It started national wide march “Maila Mukti Yatra” for total eradication of manual scavenging from 30th November 2012 from Bhopal.
- Prevention of Atrocities Act: In 1989, the Prevention of Atrocities Act became an integrated guard for sanitation workers since majority of the manual scavengers belonged to the Scheduled Caste.
- Judicial intervention: In 2014, a Supreme Court order made it mandatory for the government to identify all those who died in sewage work since 1993 and provide Rs. 10 lakh each as compensation to their families.
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Health Care Equity in Urban India
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Healthcare scenario in urban areas
The report on ‘Health Care Equity in Urban India’ exploring health vulnerabilities and inequalities in cities in India was recently released.
About the report
- The report is released recently by Azim Premji University in collaboration with 17 regional NGOs across India.
- It notes that a third of India’s people now live in urban areas, with this segment seeing rapid growth from about 18% (1960) to 28.53% (2001) to 34% (in 2019).
- The study draws insights from data collected through detailed interactions with civil society organizations in major cities and towns.
- This also included an analysis of the National Family and Health Surveys (NHFS), the Census of India, and inputs from State-level health officials on the provision of health care.
- It also looks at the availability, accessibility, and cost of healthcare facilities, and possibilities in future-proofing services in the next decade.
Key highlights of the report
- Urban poverty on rise: Close to 30% of people living in urban areas are poor.
- Declining life expectancy: Life expectancy among the poorest is lower by 9.1 years and 6.2 years among men and women, respectively, compared to the richest in urban areas.
- Chaotic health governance: The report, besides finding disproportionate disease burden on the poor, also pointed to a chaotic urban health governance.
- Multiplicity and non-coordination: The multiplicity of healthcare providers both within and outside the government without coordination challenges to urban health governance.
- Lack of political attention: Urban healthcare has received relatively less research and policy attention.
Major recommendations
The report calls for:
- Strengthening community participation and governance
- Building a comprehensive and dynamic database on the health and nutrition status, including co-morbidities of the diverse, vulnerable populations
- Strengthening healthcare provisioning through the National Urban Health Mission, especially for primary healthcare services
- Putting in place policy measures to reduce the financial burden of the poor
- A better mechanism for coordinated public healthcare services and better governed private healthcare institutions
Conclusion
- As urbanization is happening rapidly, the number of the urban poor is only expected to increase.
- A well-functioning, better coordinated, and governed health care system is crucial at this point.
- The pandemic has brought to attention the need for a robust and resourced healthcare system.
- Addressing this will benefit the most vulnerable and offer critical services to city dwellers across income groups.
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More a private sector primer than health-care pathway
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- UHC and challenges
Context
NITI Aayog recently published a road map document entitled “Health Insurance for India’s Missing Middle”.
About missing middle and provision in the NITI Aayog report
- The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), aims to extend hospitalisation cover of up to ₹5 lakh per family per annum to a poor and vulnerable population of nearly 50 crore people.
- Left out segment: Covering the left out segment of the population, commonly termed the ‘missing middle’ sandwiched between the poor and the affluent, has been discussed by the Government recently.
- Towards this, NITI Aayog recently published a road map document entitled “Health Insurance for India’s Missing Middle”.
- Primary role for private commercial health insurer: The report proposes voluntary, contributory health insurance dispensed mainly by private commercial health insurers as the prime instrument for extending health insurance to the ‘missing middle’.
Issues with the provision in the NITI Aayog report
- Narrow coverage: Government subsidies, if any at all, will be reserved for the very poor within the ‘missing middle’ and only at a later stage of development of voluntary contributory insurance.
- This is a major swerve from the vision espoused by the high-level expert group on UHC a decade ago, which was sceptical about such a health insurance model.
- No country has ever achieved UHC by relying predominantly on private sources of financing health care.
- Contributory insurance not best way: Evidence shows that in developing countries such as India, with a gargantuan informal sector, contributory health insurance is not the best way forward and can be replete with problems.
- Issues with low premium model: For hospitalisation insurance, the report proposes a model similar to the Arogya Sanjeevani scheme, albeit with lower projected premiums of around ₹4,000-₹6,000 per family per annum.
- This model is a little different from commercial private insurance, except for somewhat lower premiums.
- Low premiums are achieved by reducing administrative costs of insurers through an array of measures, including private use of government infrastructure.
- This model is vulnerable to nearly every vice that characterises conventional private insurance.
- Insufficient measures to deal with adverse selection: The report suggests enrolment in groups as a means to counter adverse selection.
- The prevailing per capita expenditure on hospital care is used to reflect affordability of hospital insurance, and thereby, a possible willingness to pay for insurance.
- Both these notions are likely to be far-fetched in practice, and the model is likely to be characterised by widespread adverse selection notwithstanding.
- OPD insurance on a subscription basis: The report proposes an OPD insurance with an insured sum of ₹5,000 per family per annum, and again uses average per capita OPD spending to justify the ability to pay.
- However, the OPD insurance is envisaged on a subscription basis, which means that insured families would need to pay nearly the entire insured sum in advance to obtain the benefits.
- Clearly, this route is unlikely to result in any significant reduction of out-of-pocket expenditure on OPD care.
- Role of government:The NITI report defies the universally accepted logic that UHC invariably entails a strong and overarching role for the Government in health care, particularly in developing countries.
Consider the question “What are the challenges in achieving universal health coverage? What are the issues with private sources financing health care to achieve UHC?”
Conclusion
The National Health Policy 2017 envisaged increasing public health spending to 2.5% of GDP by 2025. Let us not contradict ourselves so early and at this crucial juncture of an unprecedented pandemic.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Strengthening healthcare through ABHIM
From UPSC perspective, the following things are important :
Prelims level : ABHIM
Mains level : Paper 2- ABHIM
Context
The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM), announced recently, seeks to realise greater investment in the health system as proposed in the Budget, implement the Fifteenth Finance Commission recommendations such as strengthening of urban and rural primary care, stronger surveillance systems and laboratory capacity.
Measures of ABHIM
- It will support infrastructure development of 17,788 rural health and wellness centres (HWCs) in seven high-focus States and three north-eastern States.
- In addition, 11,044 urban HWCs will be established in close collaboration with Urban Local Bodies.
- The various measures of this scheme will extend primary healthcare services across India.
- Areas like hypertension, diabetes and mental health will be covered, in addition to existing services.
- Support for 3,382 block public health units (BPHUs) in 11 high-focus States and establishment of integrated district public health laboratories in all 730 districts will strengthen capacity for information technology-enabled disease surveillance.
- To enhance the capabilities for microbial surveillance, a National Platform for One Health will be established.
- Four Regional National Institutes of Virology will be established.
- Laboratory capacity under the National Centre for Disease Control, the Indian Council of Medical Research and national research institutions will be strengthened.
- Fifteen bio-safety level III labs will augment the capacity for infectious disease control and bio-security.
Way forward
- There is a need to train and deploy a larger and better skilled health workforce.
- We must scale up institutional capacity for training public health professionals.
- Private sector participation in service delivery may be invited by States, as per need and availability.
- ABHIM, if financed and implemented efficiently, can strengthen India’s health system by augmenting capacity in several areas and creating a framework for coordinated functioning at district, state and national levels.
- Many independently functioning programmes will have to work with a common purpose by leaping across boundaries of separate budget lines and reporting structures.
- That calls for a change of bureaucratic mindsets and a cultural shift in Centre-State relations.
Conclusion
The ABHIM can fix the weaknesses in India’s healthcare system.
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Preparing for outbreaks
From UPSC perspective, the following things are important :
Prelims level : ABHIM
Mains level : Paper 2- ABHIM
Context
Prime Minister Narendra Modi launched the Ayushman Bharat Health Infrastructure Mission, one of the largest pan-India schemes for strengthening healthcare infrastructure, in his parliamentary constituency Varanasi in Uttar Pradesh.
Aims of Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) and how it seeks to achieve it
- This was launched with an outlay of ₹64,180 crore over a period of five years.
- In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment, including critical care services.
- The latter goal would be met with the establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts.
- Laboratories and their preparedness: The government will be establishing integrated district public health labs in 730 districts to provide comprehensive laboratory services.
- Research: ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
- One health approach: The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
- Surveillance labs: A network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.
- Local capacities in urban areas: A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
- The services from the existing urban primary health centres will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres and polyclinics or specialist clinics.
Conclusion
The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) is another addition to the arsenal we have to prepare for such oubreaks in the future.
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Ayushman Bharat Health Infrastructure Mission
From UPSC perspective, the following things are important :
Prelims level : AB- Health Infrastructure Mission
Mains level : Not Much
PM has launched the Ayushman Bharat Health Infrastructure Mission (AB-HIM), one of the largest pan-India schemes for strengthening healthcare infrastructure.
AB- Health Infrastructure Mission
- AB-HIM is being rolled out as India’s largest scheme to scale up health infrastructure.
- It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.
Key features
- Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
- Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
- Integrated public health labs: will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
- Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
- Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.
Why is the scheme significant?
- India has long been in need of a ubiquitous healthcare system.
- A 2019 study has highlighted how access to public health care remained elusive to those living on the margins.
- The study found that 70 per cent of the locations have public healthcare services.
- However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
- In 45 per cent of the surveyed locations, people could access healthcare services by walking, whereas in 43 per cent of the locations they needed to use transport.
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On Digital Health ID, proceed with caution
From UPSC perspective, the following things are important :
Prelims level : DHID
Mains level : Issues with ABDM
Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.
Good intents of the DHID
- The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
- The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.
Why need DHID?
(a) Record maintenance
- The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
- A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
- It met with limited success, despite the strong positives.
- With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.
(b) Better tracking of medical history
- The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
- As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
- That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.
(c) Better Diagnosis
- DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
- Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
- The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.
(d) Promoting medical research
- Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
- Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
- This storehouse of patient data can be valuable for clinical and operational research.
Given our population, would this be an idealistic expectation?
- We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
- While technology helps smoothen processes and enhance patient experience, there is a cost attached.
- Investments have to be made upfront and results should not be expected overnight.
Issues with DHID
(a) A costly affair
- In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
- Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
- Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.
(b) Privacy concerns
- Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
- The possibility of privacy being violated increases with the centralisation of all information.
- Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
- How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
- So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.
Ground situation in India
- Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
- Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
- Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
- Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
- Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
- Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
- Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.
Plugging the existing gaps
- Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
- Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
- But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
- Continuity of care is central to good outcomes in inpatient management of chronic diseases.
- The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
- Technology can be of little use in the absence of doctors and basic infrastructure.
Way forward
- What is needed is building very robust firewalls and trust.
- Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
- For this reason, instead of a big bang approach, it is better to go slow and steady.
- That’s the only way to ensure that a good policy does not die along the way due to poor implementation.
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What are the concerns of digital health mission?
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat Digital Mission
Mains level : Ayushman Bharat Digital Mission
The Ayushman Bharat Digital Mission (ABDM), was recently launched by the PM.
About Ayushman Bharat Digital Mission
- The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
- The mission will enable access and exchange of longitudinal health records of citizens with their consent.
- This will ensure ease of doing business for doctors and hospitals and healthcare service providers.
The key components of the project include
- Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
- Healthcare Professionals Registry (HPR)
- Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine
How will it work?
- In order to be a part of the ABDM, citizens will have to create a unique health ID – a randomly generated 14-digit identification number.
- The ID will give the user unique identification, authentication and will be a repository of all health records of a person.
- The ID can also be made by self-registration on the portal, downloading the ABMD Health Records app on one’s mobile or at a participating health facility.
- The beneficiary will also set up a Personal Health Records (PHR) address for the issue of consent, and for future sharing of health records.
Major privacy issues involved
- Informed Consent: The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
- Data leakages issue: Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
- Digital divide: Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
- Data Migration: The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.
Other challenges
- Existing digitalization is yet incomplete: India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
- Lack of healthcare facilities: The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
- Lack of finance: With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Antimalarial drug resistance in India
From UPSC perspective, the following things are important :
Prelims level : Malaria and it vaccines
Mains level : Non-communicable diseases burden on India
In recent years there is increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.
What is Malaria?
- Malaria is caused by the bite of the female Anopheles mosquito if the mosquito itself is infected with a malarial parasite.
- There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
- Therefore, to say that someone has contracted the Plasmodium ovale type of malaria means that the person has been infected by that particular parasite.
Burden of Malaria in India
- In 2018, the National Vector-borne Disease Control Programme (NVBDCP) estimated that approximately 5 lakh people suffered from malaria.
- 63% of the cases were of Plasmodium falciparum.
- The recent World Malaria Report 2020 said cases in India dropped from about 20 million in 2000 to about 5.6 million in 2019.
Treatment of Malaria
- Malaria is treated with prescription drugs to kill the parasite. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug.
- In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment.
- This is especially against Plasmodium falciparum parasite which is responsible for almost all malaria-related deaths in the world.
Why in news now?
- There are reports of artemisinin resistance in East Africa and is a matter of great concern as this is the only drug that has saved several lives across the globe.
- In India, after the failure of chloroquine to treat P. falciparum malaria successfully, artemisinin-based combination therapy was initially introduced in 2008.
- Currently, several combinations of artemisinin derivatives are registered in India.
Artemisinin-based combination therapy failure in India
- In 2019, a report from Eastern India indicated the presence of two mutations in P. falciparum cases treated with artemisinin that linked to its presence of resistance.
- Again in 2021, artemisinin-based combination therapy failure was reported from Central India where the partner drug SP showed triple mutations with artemisinin wild type.
- This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. Here it is needed to change the partner drug as has been done in NE states in 2013.
History of drug resistance
- In the 1950s chloroquine resistance came to light.
- Both chloroquine and pyrimethamine resistance originated from Southeast Asia following their migration to India and then on to Africa with disastrous consequences.
- Similarly, artemisinin resistance developed from the six Southeast Asian countries and migrated to other continents, as is reported in India and Africa.
- It would not be out of context that artemisinin is following the same path as has been seen with chloroquine.
- Now, the time has come to carry out Molecular Malaria Surveillance to find out the drug-resistant variants so that corrective measures can be undertaken in time to avert any consequences.
- Some experts even advocate using triple artemisinin-based combination therapies where the partner drug is less effective.
Try this PYQ:
Widespread resistance of malarial parasite to drugs like chloroquine has prompted attempts to develop a malarial vaccine to combat malaria.
Why is it difficult to develop an effective malaria vaccine?
(a) Malaria is caused by several species of Plasmodium
(b) Man does not develop immunity to malaria during natural infection
(c) Vaccines can be developed only against bacteria
(d) Man is only an intermediate host and not the definitive host
Post your answers here.
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Explained: Digital Health ID
From UPSC perspective, the following things are important :
Prelims level : Various facts related to digital health ID
Mains level : Features of the ABDM
The PM has recently launched the flagship Ayushman Bharat Digital Mission (ABDM) which involves the creation not just a unique digital health ID for every citizen.
What is the unique health ID?
- If a person wants to be part of the ABDM, she must create a health ID, which is a randomly generated 14-digit number.
- The ID will be broadly used for three purposes: unique identification, authentication, and threading of the beneficiary’s health records, only with their informed consent, across multiple systems and stakeholders.
Why is this initiative significant?
- The initiative has the potential to “increase the ease of living” along with “simplifying the procedures in hospitals”.
- At present, the use of digital health ID in hospitals is currently limited to only one hospital or to a single group, and mostly concentrated in large private chains.
- The new initiative will bring the entire ecosystem on a single platform.
- The system also makes it easier to find doctors and specialists nearest to you.
- Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest.
- Also, labs and drug stores will be easily identified for better tests using the new platform.
How can one get it?
- One can get a health ID by self-registration on the portal or by downloading the ABMD Health Records app on one’s mobile.
- Additionally, one can also request the creation of a health ID at a participating health facility.
- Health facilities may include government or private hospitals, community health centres, and wellness centres of the government across India.
- The beneficiary will also have to set up a Personal Health Records (PHR) address for consent management, and for future sharing of health records.
What is a PHR address?
- It is a simple self-declared username, which the beneficiary is required to sign into a Health Information Exchange and Consent Manager (HIE-CM).
- Each health ID will require linkage to a consent manager to enable sharing of health records data.
- An HIE-CM is an application that enables sharing and linking of personal health records for a user.
- At present, one can use the health ID to sign up on the HIE-CM; the National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from in the near future.
What does one need to register for a health ID?
- Currently, ABDM supports health ID creation via mobile or Aadhaar.
- The official website states that ABDM will soon roll out features that will support health ID creation with a PAN card or a driving licence.
- For health ID creation through mobile or Aadhaar, the beneficiary will be asked to share details on name, year of birth, gender, address, mobile number/Aadhaar.
Is Aadhaar mandatory?
Ans. No, it is voluntary.
- One can use one’s mobile number for registration, without Aadhaar.
- If the beneficiary chooses the option of using her Aadhaar number, an OTP will be sent to the mobile number linked to the Aadhaar.
- However, if she has not linked it to her mobile, the beneficiary has to visit the nearest facility and opt for biometric authentication using Aadhaar number.
- After successful authentication, she will get her health ID at the participating facility.
Are personal health records secure?
- The NHA says ABDM does not store any of the beneficiary health records.
- The records are stored with healthcare information providers as per their “retention policies”.
- They are “shared” over the ABDM network “with encryption mechanisms” only after the beneficiary express consent.
Can one delete my health ID and exit the platform?
Ans. Yes, the NHA says ABDM, supports such a feature. Two options are available: a user can permanently delete or temporarily deactivate her health ID.
- On deletion, the unique health ID will be permanently deleted, along with all demographic details.
- The beneficiary will not be able to retrieve any information tagged to that health ID in the future, and will never be able to access ABDM applications or any health records over the ABDM network with the deleted ID.
- On deactivation, the beneficiary will lose access to all ABDM applications only for the period of deactivation.
- Until she reactivates her health ID, she will not be able to share the ID at any health facility or share health records over the ABDM network.
What facilities are available to beneficiaries?
- Users can access personal digital health records right from admission through treatment and discharge.
- One can access and link his/her personal health records with your health ID to create a longitudinal health history.
What other features will be rolled out?
- Upcoming new features will enable access to verified doctors across the country.
- The beneficiary can create a health ID for her child, and digital health records right from birth.
- Third, she can add a nominee to access her health ID and view or help manage the personal health records.
- Also, there will be much inclusive access, with the health ID available to people who don’t have phones, using assisted methods.
How do private players get associated with a government digital ID?
- The NHA has launched the NDHM Sandbox: a digital architecture that allows helps private players to be part of the National Digital Health Ecosystem as health information providers or health information users.
- The private player sends a request to NHA to test its system with the Sandbox environment.
- The NHA then gives the private player a key to access the Sandbox environment and the health ID application programming interface (API).
- The private player then has to create a Sandbox health ID, integrate its software with the API; and register the software to test link records and process health data consent requests.
- Once the system is tested, the system will ask for a demo to the NHA to move forward. After a successful demo, the NHA certifies and empanels the private hospital.
Now try this PYQ:
Consider the following statements:
- Aadhaar metadata cannot be stored for more than three months.
- State cannot enter into any contract with private corporations for sharing of Aadhaar data.
- Aadhaar is mandatory for obtaining insurance products.
- Aadhaar is mandatory for getting benefits funded out of the Consolidated Fund of India.
Which of the statements given above is/are correct?
(a) 1 and 4 only
(b) 2 and 4 only
(c) 3 only
(d) 1, 2 and 3 only
Post your answers here.
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What is Meningitis?
From UPSC perspective, the following things are important :
Prelims level : Meningitis
Mains level : NA
The World Health Organization (WHO) has launched the first-ever global strategy to defeat meningitis, a debilitating disease that kills hundreds of thousands of people each year.
What is Meningitis?
- Meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord.
- People of any age can get meningitis.
What Causes Meningitis?
- Most cases are caused by bacteria or viruses, but some can be due to certain medicines or illnesses.
- Meningitis is usually caused by a viral infection but can also be bacterial or fungal.
- Both kinds of meningitis spread like most other common infections do — someone who’s infected touches, kisses, or coughs or sneezes on someone who isn’t infected.
- Bacterial meningitis is rare, but is usually serious and can be life-threatening if not treated right away.
- Viral meningitis (also called aseptic meningitis) is more common than bacterial meningitis and usually less serious.
- Many of the viruses that cause meningitis are common, such as those that cause colds, diarrhea, cold sores, and the flu.
What Are the Signs & Symptoms of Meningitis?
- Meningitis symptoms vary, depending on the person’s age and the cause of the infection.
- The first symptoms can come on quickly or start several days after someone has had a cold, diarrhea, vomiting, or other signs of an infection.
Common symptoms include:
- fever
- lack of energy
- irritability
- headache
- sensitivity to light
- stiff neck
- skin rash
Treatment
- Several vaccines protect against meningitis, including meningococcal, Haemophilus influenzae type b and pneumococcal vaccines.
- If dealt with quickly, meningitis can be treated successfully.
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Ayushman Bharat Digital Mission
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat Digital Mission
Mains level : Features of the ABDM
The PM has launched the Ayushman Bharat Digital Mission to provide a digital Health ID to people which will contain their health records.
Ayushman Bharat Digital Mission
- The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
- The mission will enable access and exchange of longitudinal health records of citizens with their consent.
- This will ensure ease of doing business for doctors and hospitals and healthcare service providers.
The key components of the project include
- Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
- Healthcare Professionals Registry (HPR)
- Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine
What makes this special?
- The mission will create integration within the digital health ecosystem, similar to the role played by the Unified Payments Interface (UPI) in revolutionising payments.
- Citizens will only be a click-away from accessing healthcare facilities.
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Disease surveillance system
From UPSC perspective, the following things are important :
Prelims level : Integrated disease surveillance project
Mains level : Paper 2- Disease surveillance
Context
A well-functioning system can reduce the impact of diseases and outbreaks.
Importance of disease surveillance system
- Successful tackling of cholera in 1854 in London by use of the health statistics and death registration data from the General Registrar Office (GRO) started the beginning of a new era in epidemiology.
- Importance of data: The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
- This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
- Subsequently, the high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
- Then, in the second half of the Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
- These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.
Surveillance in India
- The Government of India launched the National Surveillance Programme for Communicable Diseases in 1997.
- However, this initiative remained rudimentary.
- In wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
- The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.
Issues with surveillance: Interstate variation
- Variation among states: The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
- In the fourth round of serosurvey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected.
- This points towards a weak disease surveillance system.
- In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.
- While Kerala is picking the maximum COVID-19 cases; it could pick the first case of the Nipah virus in early September 2021.
- On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.
Way forward
- A review of the IDSP in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems.
- These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
- Increase allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
- Trained workforce: The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
- The vacancies of surveillance staff at all levels need to be urgently filled in.
- Capacity increase: The laboratory capacity for COVID-19 needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
- The interconnectedness of human and animal health: The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.
- The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
- Strengthening registration system: There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of death (MCCD).
- Coordination: It is also time to ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
- The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.
Consider the question “Examine the measure for disease surveillance in India? How it can help reduce the impact of the diseases?”
Conclusion
We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with the application of principles of epidemiology, we can reduce their impact.
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What is Serotype 2 Dengue?
From UPSC perspective, the following things are important :
Prelims level : Dengue
Mains level : NA
The Union Health Ministry has flagged the emerging challenge in 11 States across India of serotype 2 dengue, which it said is associated with “more cases and more complications” than other forms of the disease.
Try this PYQ from CSP 2015:
Q. Consider the following statements:
- In tropical regions, Zika virus disease is transmitted by the same mosquito that transmits dengue.
- Sexual transmission of Zika virus disease is possible.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2
Post your answers here!
What is Dengue?
- Dengue is a mosquito-borne viral infection, found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
- It is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus.
- These mosquitoes are also vectors of chikungunya, yellow fever and Zika viruses.
- Dengue is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature, relative humidity and unplanned rapid urbanization.
Its transmission
- The virus is transmitted to humans through the bites of infected female mosquitoes, primarily the Aedes aegypti
- Other species within the Aedes genus can also act as vectors, but their contribution is secondary to Aedes aegypti.
- Mosquitoes can become infected from people who are viremic with dengue.
Various serotypes
- Dengue is caused by a virus of the Flaviviridae family and there are four distinct, but closely related, serotypes of the virus that cause dengue (DENV-1, DENV-2, DENV-3 and DENV-4).
- Recovery from infection is believed to provide lifelong immunity against that serotype.
- However, cross-immunity to the other serotypes after recovery is only partial and temporary.
- Subsequent infections (secondary infection) by other serotypes increase the risk of developing severe dengue.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Outpatient Opioid Assisted Treatment Centres
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Drug rehabiliation
The state government in Punjab is banking on Outpatient Opioid Assisted Treatment Centres (OOAT) to curb the drug menace in the state.
What are the OOAT Centres?
- The move to set up OOAT centres in Punjab began in October 2017.
- The centres administer de-addiction medicine, a combination of buprenorphine and naloxone, to the opioid-dependent people registering there.
- Administered in the form of a pill, the treatment is primarily for addicts of opioid drugs, including heroin, poppy husk and opium.
- There are such private and state-run centres in Punjab.
Why is the Punjab government planning?
- Punjab is planning to open OOAT linked extension centres and clinics in rural areas to broaden the outreach of this treatment.
- The idea is that patients get medicine nearer their place of residence.
- It will also reduce pressure on existing OOAT centres which cater to patients from far-off places.
Administering medicine at OOAT Centres
The patients are broadly put into three categories or phases.
- In the induction phase, the newly-registered patients are administered medicine at the OOAT centres for a week or two to manage withdrawal symptoms in the presence of the doctor and counselor.
- In the second, stabilization, phase, which extends between two to four months.
- The patient is put on watch for taking any opioid-based “super-imposed” illicit drug and accordingly maximum tolerated dose is administered to nullify the kick of the “super-imposed” drug.
- In the third, maintenance, phase, the patient is given take-home medicine and it continues for a year and a half before an assessment is done to see whether the medicine can be tapered off.
Why is Punjab banking so much on OOAT therapy?
There are two major approaches to wean away opioid-dependent persons.
- One is the abstinence approach and another alternate medication approach.
- There are more chances of relapse in an abstinence-based approach as compared to alternate medication for de-addiction.
- In the abstinence approach, it would have taken years to rehabilitate patients by admitting them to facilities and there would have been increased chances of relapse.
- On the other hand, the alternate medication approach has been acknowledged as better in various scientific studies worldwide.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Why India needs an NHS-like healthcare model
From UPSC perspective, the following things are important :
Prelims level : India's expenditure on health
Mains level : Paper 2- India needs NHS like healthcare model
Context
Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.
About NHS
- Every year, Britain’s legendary health network National Health Service (NHS) cures 15 million patients with chronic ailments, at a fraction of the cost spent by the US.
- The NHS funded by direct taxes is also the fifth largest employer in the world, after McDonalds and Walmart.
- One of every 20 British workers is employed as a doctor, nurse, catering and technical personnel.
Public healthcare in India
- Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.
- In contrast, China invests around 3 per cent, Britain 7 per cent and the United States 17 per cent of GDP.
- So, 62 per cent of health expenses in India are paid for by patients themselves
- This is one of the main reasons for families falling into poverty especially during the pandemic.
- In India, hospitals are beleaguered with absentee staff.
- As per a Niti Aayog database, in the worst state of Bihar in 2017-18, positions for 60 per cent of midwives, 50 per cent of staff nurses, 34 per cent of medical officers and 60 per cent of specialist doctors were vacant.
- Those on the job, despite being handsomely paid, are chronically overworked.
Conclusion
In the 21st century, not much has improved in India’s public hospitals. Still, in India doctors are often equated with gods. What India needs in NHS like healthcare model.
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Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Issues related to people with disabilities
From UPSC perspective, the following things are important :
Prelims level : CRPD
Mains level : Paper 2- Ensuring the dignity of persons with disability
Context
Twenty years ago on August 6 in Erwadi in Tamil Nadu’s Ramanathapuram, a fire broke out in a thatched shelter, engulfing 43 chained people who had psychosocial disabilities.
Legal provision for the persons with disabilities
- India ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007.
- The Rights of Persons with Disabilities Act was enacted in 2016.
- The Mental Healthcare Act (MHCA) was enacted in 2017.
Failure of the states
- Sates have failed to uphold the human rights of people with disabilities in general and those with psychosocial and intellectual disabilities in particular.
- Only eight states/UTs — Karnataka, Andhra Pradesh, Uttar Pradesh, Jammu & Kashmir, Maharashtra, Odisha, Kerala, and West Bengal — have framed rules for implementation of MHCA.
- Unless we implement the law in letter and spirit, the Global Mental Health Movement will remain a mere buzzword and the CRPD-reliant MHCA will remain a law only on paper.
Violations of rights in private asylums
- Private asylums survive because of their close proximity to faith-based healing centres.
- Because mental health conditions carry a high stigma, caregivers flock to these faith-based facilities in the hopes of finding a cure.
- Private players take advantage of their vulnerabilities, forcing such persons with psychosocial issues to be grouped together and chained in these shelters.
- Chaining in any way or form is outlawed under Section 95 of the MHCA.
Way forward
- Human right approach: We must work to ensure that the human rights approach to disability is integrated into mental health systems, education, law, and bureaucracy.
- We move away from pathologisation, segregation, and a charity-based approach.
Conclusion
Implementation of rights of the persons with disability needs implementation in letter and spirit and human rights based approach.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
India’s technical education: Issues and Suggestions
From UPSC perspective, the following things are important :
Prelims level : AICTE
Mains level : Paper 2- Issues of technical education in India
Context
This year, AICTE approved the closure of 63 engineering colleges across the country.
Deterioration of quality
- Tweaking with curriculum: Private entrepreneurs took the lead to meet the growing demand of the country in technical education in the mid-Eighties, but with little idea of the subject.
- Subjects like materials, applied physics and thermodynamics which forms the building blocks of engineering became dispensable.
- Because they were both tough to teach for the teachers and tough to pass for the students.
- Expansion: This softening of subjects coupled with unfettered expansion in the early and mid-2000s, resulted in real dilution of the overall standards in the country.
- Lack of adequate number of teachers, lack of quality in those available, inability of the management to make adequate investments in a dynamic environment, lack of employment opportunities, shelf life of skills coming down with every technology-related intervention and a constant experimentation with curriculum have all been the bane of quality in technical education.
Issues
- Engineering education suffers from regulatory gaps, poor infrastructure, lack of qualified faculty and the non-existent industry linkage that contributed to the abysmal employability of graduates from most of these institutes.
- No linkage with Industry: Not a single industry body, be it CII, FICCI or ASSOCHAM has managed to effectively inform the education planners on the growth in different employment sectors.
- No independent body to suggest AICTEC: The government also has not taken any tangible steps to set up an independent body to advise AICTE on this vital aspect.
- Excessive changes: A constant fiddling with the curriculum, reducing total credits, giving multiple choices in the name of flexibility, dispensing with mathematics and physics at the qualification level, teaching in local languages may all be good arguments, but one must assess their utility and their effect on technical education in the long run.
Way forward
- Proactive: Rather than being reactive, institutions must proactively define the practicing elements of education.
- Investment in teaching: The corrective measures for these shortfalls are technology intensive, are experiential, and need investments in teaching.
- Quality assurance body: The ultimate measure of performance is embedded in quality assurance.
- The need of the hour is to create a truly autonomous quality assurance body at an arms-length from the government, manned by eminent persons both from the industry as well as academia.
Conclusion
The education paradigm is staring at a large shift and technical education cannot remain immune to that change.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Organ Transplantation in India
From UPSC perspective, the following things are important :
Prelims level : NOTP
Mains level : Organ transplantation in India
The Government of India is implementing National Organ Transplant Programme (NOTP) to promote organ donation and transplantation across all States/Union Territories (UTs).
National Organ Transplant Programme (NOTP)
- In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
- Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.
Types of Organ Donations
- The law allows both deceased and living donors to donate their organs.
- It also identifies brain death as a form of death.
- Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.
(1) Deceased donors:
- They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
- Uterus transplant is also performed, but it is not regarded as a life-saving organ.
- Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
- Brainstem death is also recognized as a form of death in India, as in many other countries.
- After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs
(2) Living donors:
They are permitted to donate the following:
- one of their kidneys
- portion of pancreas
- part of the liver
Features of the NOTP
- Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
- Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio- material centre.
- As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.
More moves for facilitation: Green Corridors
- Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
- Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
- A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.
About NOTTO
National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.
- National Human Organ and Tissue Removal and Storage Network
- National Biomaterial Centre (National Tissue Bank)
[I] National Human Organ and Tissue Removal and Storage Network
- This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
- The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
- Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
- It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.
[II] National Biomaterial Centre (National Tissue Bank)
- The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
- It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
- The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.
The centre will take care of the following Tissue allografts:
- Bone and bone products
- Skin graft
- Cornea
- Heart valves and vessels
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
A cardinal omission in the COVID-19 package
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Importance of medical workforce in making the healthcare system robust
Context
On July 8, 2021, the Union government announced the “India COVID-19 Emergency Response and Health Systems Preparedness Package: Phase II”. But it lacks provision for the medical workforce.
Objectives of the package
- The stated purpose of the package is to boost health infrastructure and prepare for a possible third wave of COVID-19.
- There is plan to increase COVID-19 beds, improve the oxygen availability and supply, create buffer stocks of essential medicines; purchase equipment and strengthen paediatric beds.
What is lacking in the package?
- Workforce shortage: The package barely has any attention on improving the availability of health human resources.
- As reported in rural health statistics and the national health profile there are vacancies for staff in government health facilities, which range from 30% to 80% depending upon the sub-group of medical officers, specialist doctors to nurses, laboratory technicians, pharmacists and radiographers, amongst others.
- Interstate variation: In addition, there are wide inter-State variations, with States that have poor health indicators with the highest vacancies.
Way forward
- Package for filling the existing vacancies: The COVID-19 package II needs to be urgently supplemented by another plan and a similar financial package (with shared Union and State government funding) to fill the existing vacancies of health staff at all levels.
- An objective approach to assess the mid-term health human resource needs could be the Indian Public Health Standards (IPHS).
- IPHS prescribes the human resources and infrastructure needed to make various types of government health facilities functional.
- The pandemic should be used as an opportunity to prepare India’s health system for the future.
- Scrutiny of the progress on policy decision: The progress on key policy decisions, for the last few years, to strengthen India’s health system, including those in India’s national health policy of 2017, need to be objectively scrutinised.
- These two sets of policy decisions should be reviewed and progress monitored, through a meeting of the Central Council of Health and Family Welfare, of which the Health Ministers of the States are members.
Conclusion
India’s health system will not benefit from ad hoc and a patchwork of one or other small packages. It essentially needs some transformational changes.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Mental health care in India
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Shift in mental health care system needed
Context
Recently, a High Court suggested that homeless persons with health conditions be branded with a permanent tattoo, when vaccinated against COVID-19.
Issue
- In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison.
- On the other hand, many persons with mental health issues live and even die alone on the streets.
- Three losses dominate the mental health systems narrative: dignity, agency and personhood.
- Issues with the laws: Far-sighted changes in policy and laws have often not taken root and many laws fail to meet international human rights standards.
- Many also do not account for cultural, social and political contexts resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
- There is also the social legacy of the asylum, and of psychiatry and mental illness itself, that guides our imagination in how care is organised.
Way forward: A responsive care system
- We must understand mental health conditions for what they are and for how they are associated with disadvantage.
- These situations are linked, but not always so, therefore, not all distress can be medicalised.
- Adopt WHO guidelines: Follow the Guidance on Community Mental Health Services recently launched by the World Health Organization.
- The Guidance, which includes three models from India, addresses the issue from ‘the same side’ as the mental health service user and focuses on the co-production of knowledge and on good practices.
- Drawn from 22 countries, these models balance care and support with rights and participation.
- Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance.
- This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
- Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
- Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.
- Small emergency care and recovery centres for those who need crisis support instead of larger hospitals, and long-term inclusive living options in an environment that values diversity and celebrates social mixing, will reframe the archaic narrative of how mental health care is to be provided.
Conclusion
Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
NITI Aayog releases study on ‘Not-for-Profit’ hospital model
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : India's healthcare system and its limitations
NITI Aayog has released a comprehensive study on the not-for-profit hospital model in the country, in a step towards closing the information gap on such institutions and facilitating robust policymaking in this area.
‘Not-for-Profit’ hospitals
- The “Not-for-Profit” Hospital Sector has the reputation of providing affordable and accessible healthcare for many years.
- This sector provides not only curative healthcare, but also preventive healthcare, and links healthcare with social reform, community engagement, and education.
- They utilize the resources and grants provided to them by the Government to provide cost-effective healthcare to the population without being overly concerned about profits.
- However, this sector remains largely understudied, with a lack of awareness about its services in the public domain.
Significance for India
- As per the NITI Aayog’s report, the not-for-profit hospitals account for only 1.1% of treated ailments as of June 2018.
- The report further revealed that for-profit hospitals account for 55.3% of in-patients, while not-for-profit hospitals account for only 2.7% of in-patients in the country.
- The cumulative cost of care at not-for-profit hospitals is lesser than for-profit hospitals by about one-fourth in the in-patient department.
- This is reckoned by the package component of cost, which is approximately 20% lower, the doctor’s or surgeon’s charges, which are approximately 36% lower and the major aspect being the bed charges, which are approximately 44% lower than the for-profit hospitals.
NITI Aayog’s approach
- Categorization of the prominent not-for-profit hospitals based on the premise of services and their ownership
- Understanding the business model of the hospitals i.e. the financial viability, and their dependence on donations and grants
- Understanding the challenges faced by these hospitals
- Formulation of recommendations for policy interventions to promote the sector
Categories of such hospitals
Using the above-mentioned approach and secondary research, the following four categories were defined for the not-for-profit hospitals:
- Faith-based Hospitals
- Community-based Hospitals
- Cooperative Hospitals
- Private Trust Hospitals
Why need such hospitals?
- There has been relatively low investment in the expansion of the health sector in the private domain.
- The not-for-profit hospital sector provides not only curative but also preventive healthcare.
- It links healthcare with social reform, community engagement, and education.
- It uses government resources and grants to provide cost-effective healthcare to people without being concerned about profits.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Centre must make way for states in Covid fight
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Role of the States in health crisis
The States are better equipped to deal with the health emergencies and the Centre needs to augment them in their efforts. The article deals with this issue.
Role of the States in health crisis
- Covid-19 pandemic is a national crisis calling for concerted efforts by both, the Government of India (GoI) and state governments.
- Health is a state subject, and the states have been pioneering many health programmes on their own, some with support and funding from the GoI, for a very long time.
- The number of employees in the health wing of the GoI is negligible as compared to that in any state government.
- The GoI must help them, motivate them to do better and assist them in their task.
- Also, the GoI must and can play a major role is in vaccination.
Role of the Central government
- It must try to augment supplies by encouraging companies to produce more and through imports/gifts.
- However, whatever it procures must be allotted to states in proportion to their eligible population.
- State governments must be involved in this policy.
- The vaccination policy may be left to the state governments based on the allocation.
- The GoI must also augment supplies of critical medical goods through imports and donations from friendly nations in view of their acute shortage.
- It must distribute them to the needy states transparently and equitably.
Steps that need to be taken
- Lockdowns need to be lifted in a calibrated manner depending on local conditions.
- Lockdowns are not the solution, they just buy breathing time which can be used by governments to ramp up capacity.
- State governments must set up efficient and well-functioning control rooms and telemedicine centres to guide people on home treatment and timely admission to hospitals.
- The private sector can also be fully involved in these efforts.
- Bed capacity must be increased in both private and public sectors, with all necessary requirements such as oxygen, medicines, and health workers.
- It is also important to put in place a standard guidance protocol for health workers and control rooms to guide patients through the disease.
- Enforcement of masks and distancing in public places must go on till the country is fully vaccinated.
- The measures suggested above require hard work and efficient management by state governments, by a team of reputed professionals and civil servants.
- Daily briefing by a professional, not a politician, is the need of the hour at both the Centre and state level, giving some confidence and assurance to the public.
Consider the question “In dealing with the health crisis the Union Government and the State governments are better placed for certain roles. In light of this, examine the important role of the States in dealing with the Covid pandemic and how the Union government can complement it.”
Conclusion
The central government must realise that states are on the forefront in this war, and therefore, play a supporting and proactive role. It has only a minor, behind-the-scenes role in the health sector.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
A place for disruptive technology in India’s health sector
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Use of disruptive technologies in medical sector
The adoption of technologies such as AI and blockchain has the potential to transform the medical sector.
How new technologies can play important role in medical sector
1) Blockchain technology
- Blockchain technology can help in addressing the interoperability challenges that health information and technology systems face.
- The health blockchain would contain a complete indexed history of all medical data, including formal medical records and health data from mobile applications and wearable sensors.
- This can also be stored in a secure network and authenticated, besides helping in seamless medical attention.
2) Big data analytics
- Big data analytics can help improve patient-based services tremendously such as early disease detection.
- AI and the Internet of Medical Things, or IoMT are shaping healthcare applications.
- IoMT is defined as a connected infrastructure of medical devices, software applications, and health systems and services.
3) Medical autonomous system
- Medical autonomous systems can also improve health delivery to a great extent and their applications are focused on supporting medical care delivery in dispersed and complex environments with the help of futuristic technologies.
- This system may also include autonomous critical care system, autonomous intubation, autonomous cricothyrotomy and other autonomous interventional procedures.
4) Cloud computing
- Cloud computing is another application facilitating collaboration and data exchanges between doctors, departments, and even institutions and medical providers to enable best treatment.
Challenges
- The possible constraints in this effort are standardisation of health data, organisational silos, data security and data privacy, and also high investments.
Using technology for Universal Health Coverage
- According to the World Health Organization, Universal health coverage (UHC) is a powerful social equalizer and the ultimate expression of fairness.
- Studies by WHO show that weakly coordinated steps may lead to stand-alone information and communication technology solutions.
- India needs to own its digital health strategy that works and leads towards universal health coverage and person-centred care.
- Such a strategy should emphasise the ethical appropriateness of digital technologies, cross the digital divide, and ensure inclusion across the economy.
- ‘Ayushman Bharat’ and tools such as Information and Communication Technology could be be fine-tuned with this strategy to promote ways to protect populations.
- Online consultation should be a key part of such a strategy.
Using local knowledge
- In addition to effective national policies and robust health systems, an effective national response must also draw upon local knowledge.
- Primary health centres in India could examine local/traditional knowledge and experience and then use it along with modern technology.
Way forward
- Initial efforts in this direction should involve synchronisation and integration, developing a template for sharing data, and reengineering many of the institutional and structural arrangements in the medical sector.
- Big data applications in the health sector should help hospitals provide the best facilities and at less cost, provide a level playing field for all sectors, and foster competition.
Consider the question “Examine the role technologies such as AI and data analytics could play in the medical sector. What are the challenges in the adoption of such technologies?”
Conclusion
The above-discussed aspects highlight the potential benefits of the adoption of disruptive technologies in the healthcare system. India should embrace it while addressing the concerns with such technologies.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
China to allow couples for third child
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : One-Child Policy
China will for the first time allow couples to have a third child in a further relaxation of family planning rules five years after a “two-child policy” largely failed to boost birth rates.
Do you think that the One-Child Policy would be effective for population control in India?
What was the One-Child Policy?
- China embarked upon its one-child policy in 1980 when the Communist Party was concerned that the country’s growing population, which at the time was approaching one billion, would impede economic progress.
- The policy was implemented more effectively in urban areas.
- It was enforced through several means, including incentivizing families financially to have one child, making contraceptives widely available, and imposing sanctions against those who violated the policy.
How well did the policy fare?
- Chinese authorities have long hailed the policy as a success, claiming that it helped the country avert severe food and water shortages by preventing up to 40 crore people from being born.
- However, the policy was also a source of discontent, as the state used brutal tactics such as forced abortions and sterilizations.
- It also met criticism and remained controversial for violating human rights, and for being unfair to poorer Chinese since the richer ones could afford to pay economic sanctions if they violated the policy.
- Additionally, China’s rulers have been accused of enforcing reproductive limits as a tool for social control.
- The Uighur Muslim ethnic minority, for example, has been forced to have fewer children to restrict the growth of their population.
Demographic changes due to the policy
- Due to the policy, while the birth rate fell, the sex ratio became skewed towards males.
- This happened because of a traditional preference for male children in the country, due to which abortion of female fetuses rose and so did the number of girls who were placed in orphanages or abandoned.
- Experts have also blamed the policy for making China’s population age faster than other countries, impacting the country’s growth potential.
- It is also suggested that because of the long-lingering impact of the policy, China would be unable to reap the full benefits of its economic growth and will need other ways to support it.
Skeptics of the new move
- Experts say relaxing limits on reproductive rights alone cannot go a long way in averting an unwanted demographic shift.
- The main factors behind fewer children being born, they say, are rising costs of living, education, and supporting aging parents.
- The problem is made worse by the country’s pervasive culture of long working hours.
- There has also been a cultural shift during the decades in which the one-child policy remained in force, with many couples believing that one child is enough, and some expressing no interest in having children.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
What are Neglected Tropical Diseases (NTD)?
From UPSC perspective, the following things are important :
Prelims level : Neglected Tropical Diseases
Mains level : Burden of NTD in India
The ongoing World Health Assembly has declared January 30 as ‘World Neglected Tropical Diseases (NTD) Day’.
Neglected Tropical Diseases
- NTDs are a group of infections that are most common among marginalized communities in the developing regions of Africa, Asia, and the Americas.
- They are caused by a variety of pathogens such as viruses, bacteria, protozoa, and parasitic worms.
- These diseases generally receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
- Some examples of NTDs include snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease.
Significance of global recognition
- NTDs affect more than a billion people globally, according to the WHO. They are preventable and treatable.
- However, these diseases and their intricate interrelationships with poverty and ecological systems — continue to cause devastating health, social and economic consequences.
- A major milestone in the movement to recognize the global burden of these diseases was the London Declaration on NTDs that was adopted January 30, 2012.
- The first World NTD Day was celebrated informally in 2020. This year, the new NTD road map was launched.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
WHO BioHub: Global Facility for Pathogen Storage
From UPSC perspective, the following things are important :
Prelims level : WHO BioHub and its purpose
Mains level : Not Much
The World Health Organization (WHO) and Switzerland have signed an MoU to launch a BioHub facility that will allow rapid sharing of pathogens between laboratories and partners to facilitate better analysis and preparedness against them.
WHO BioHub
- The BioHub will enable member states to share biological materials with and via the BioHub under pre-agreed conditions, including biosafety, biosecurity, and other applicable regulations.
- The facility will help in the safe reception, sequencing, storage, and preparation of biological materials for distribution to other laboratories, so as to facilitate global preparedness against these pathogens.
- It would be based in Spiez, Switzerland.
- Pathogens are presently shared bilaterally between countries: A process that can be sluggish and deny the benefits to some.
Its significance
- This will ensure timeliness and predictability in response activities.
- The move is significant in the view of the novel coronavirus disease (COVID-19) pandemic and the need to underline the importance of sharing pathogen information to assess risks and launch countermeasures.
- The move will help contribute to the establishment of an international exchange system for novel coronavirus SARS-CoV-2 and other emerging pathogens.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
The fault line of poor health infrastructure
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Poor public health infrastructure in India and its consequences
The poor public health infrastructure in India hits the poor hard. The article examines the factors responsible for poor public health infrastructure and suggests the measures to deal with it.
Poor state of health infrastructure
- World Bank data reveal the poor state of India’s health infrastructure.
- It reveals that India had 85.7 physicians per 1,00,000 people in 2017.
- In contrast, it is 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan.
- India had 53 beds per 1,00,000 people.
- It is 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan.
- India had172.7 nurses and midwives per 1,00,000 people in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan.
What are the factors responsible for poor health infrastructure?
- Stagnant expenditure: Analysis by the Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that health expenditure has been stagnant for years.
- Lack of expertise with states: Despite health being a state subject, the main bodies with technical expertise are under central control.
- The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
- Inter-State variation: States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.
- Kerala and Delhi have been close to top in years from 2011 to 2019-20.
- Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in the same years.
Out-of-pocket expenditure and its impact on the poor
- Due to low levels of public health provision, the World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
- Some of the poorest States, Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha, have a high ratio of OOP expenditures in total health expenditure.
- Impact on the poor: High ratio of OOP means that the poor in the poorest States, the most vulnerable sections, are the worst victims of a health emergency.
Way forward
1) Coordinated national plan
- The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
- The Centre already tightly controls major decisions, including additional resources raised specifically for pandemic relief, e.g. the PM CARES Fund.
- The need for a coordinated strategy on essential supplies of oxygen and vaccines is acute.
- The Centre can bargain for a good price from vaccine manufacturers in its capacity as a single large buyer like the European Union did for its member states.
- Centre will also benefit from the economies of scale in transportation of vaccines into the country.
- Once the vaccines arrive in India, these could be distributed across States equitably in a needs-based and transparent manner.
- Another benefit of central coordination is that distribution of constrained resources like medical supplies, financial resources can internalise the existing disparities in health infrastructure across States.
2) Form Pandemic Preparedness Unit
- There is a need for the creation of a “Pandemic Preparedness Unit” (PPU) by the central government.
- PPU would streamline disease surveillance and reporting systems; coordinate public health management and policy responses across all levels of government.
- It will also formulate policies to mitigate economic and social costs, and communicate effectively about the health crisis.
Consider the question “India has among the highest out-of-pocket expenditure in the world, which is the result of poor public health infrastructure. Examine the factors responsible for poor public health infrastructure and suggest the ways to deal with it.”
Conclusion
As and when we emerge on the other side of the pandemic, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Medicine from the Sky Project
From UPSC perspective, the following things are important :
Prelims level : Medicine from the Sky Project
Mains level : Innovation in healthcare services
The Telangana government has selected 16 primary healthcare centres (PHCs) spread around Vikarabad area hospital for pilot testing the ambitious ‘Medicine from the sky’, the first-of-its-kind project involving delivery of medicines through multiple drones.
Medicine from the Sky Project
- A consortium of seven operators headed by Blue Dart Med-Express had been selected for the project to be launched in the VLOS range of 500 metres initially and will be scaled up gradually to a 9 km range.
- The selected PHCs are both within the Visual Line of Sight (VLOS) and Beyond Visual Line of Sight (BVLOS) range.
- The project would be launched in three waves starting with a pilot followed by mapping the route network for the operation of drones for delivering vaccine/medicine in the desired community health centres and PHCs.
- The project is being launched following the approval granted by the Civil Aviation Ministry to the request made by the State to grant conditional exemption from the Unmanned Aircraft System Rules 2021.
Benefits of the project
- The project is aimed at assessing alternative logistics route in providing safe, accurate and reliable pickup and delivery of health care items like medicines, vaccines, units of blood and other lifesaving equipment from the distribution centre to a specific location and back.
- The model, once successful, would enable deliveries from district medical stores and blood banks to PHCs, CHCs and further from PHCs/CHCs to central diagnostic laboratories.
Back2Basics: What is VLOS (Visual Line of Sight)?
- Visual Line of Sight (‘VLOS’) operations are a type of operation in which the remote pilot maintains continuous, unaided visual contact with the unmanned aircraft. In its simplest term, the aircraft must always be visible to the pilot.
- This allows the remote pilot to control the flight path of the unmanned aircraft in relation to other aircraft, people, and obstacles for the purpose of avoiding collisions.
- Extended Visual Line of Sight operations (‘EVLOS’) allows flight Beyond Visual Line of Sight of the Remote Pilot by using ‘trained observers’.
- Trained observers are used to comply with the separation and collision avoidance responsibilities of the operator.
- ‘Beyond Visual Line of Sight’ operations is where the flying of a drone is without a pilot maintaining a visual line of sight on the aircraft at all times.
- Instead, the pilot operates the UAV using Remote Pilot Station (RPS) / Ground Control Station (GCS) instruments.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Brain drain of India’s health worker
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- India's health worker brain drain
The article highlights the issue of shortage of healthcare workers in India even as it exports its healthcare workers to other countries.
India as an exporter of healthcare workers
- For several decades, India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council countries, Europe and other English-speaking countries.
- As per OECD data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017.
- In these four countries, 56,000 Indian-trained nurses were working in the same year.
- There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.
- There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.
Shortage of nurses and doctors
- The migration of healthcare workers is part of the reason for the shortage in nurses and doctors.
- If we look at the figures for countries where we export our healthcare workers, we see just how big the difference is between the sending and the receiving countries.
- As per government reports, India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1,404.
- This is well below the WHO norm of 3 nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
- But, this does not convey the entire problem.
- The distribution of doctors and nurses is heavily skewed against some regions.
- Moreover, there is high concentration in some urban pockets.
Factors driving migration
- There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries.
- However, there are strong push factors that often drive these workers to migrate abroad.
- The low wages in private sector outfits along with reduced opportunities in the public sector plays a big role in them seeking employment opportunities outside the country.
- The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration.
Measures to check brain drain and issues with it
- Over the years, the government has taken measures to check the brain drain of healthcare workers with little or no success.
- In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US.
- The NORI certificate is a US government requirement for doctors who migrate to America on a J1 visa and seek to extend their stay beyond three years.
- The non-issuance of the NORI would ensure that the doctors will have to return to India at the end of the three-year period.
- The government has included nurses in the Emigration Check Required (ECR) category.
- This move was taken to bring about transparency in nursing recruitment and reduce the exploitation of nurses in the destination countries.
- The government’s policies to check brain drain are restrictive in nature and do not give us a real long-term solution to the problem.
Way forward
- We require systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to workers and building an overall environment to motivate them to stay in the country.
- The government should focus on framing policies that promote circular migration and return migration — policies that incentivise healthcare workers to return home after the completion of their training or studies.
- It could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.
- The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world.
- Increased investment in healthcare, especially in the public sector, is thus the need of the hour.
- This would, in turn, increase employment opportunities for health workers.
Consider the question “What are the factors driving the migration of healthcare workers from India? Suggest the measure to stem their migration.”
Conclusion
India needs systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to health workers and building an overall environment that could prove to be beneficial for them and motivate them to stay in the country.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Risk of mucormycosis in Covid-19 patients
From UPSC perspective, the following things are important :
Prelims level : Mucormycosis
Mains level : Paper 2- Mucormycosis infection risk in Covid-19 patients
About mucormycosis
- Mucormycosis is a fungal infection that has a high mortality rate of 50 per cent.
- An increasing number of Covid-19 patients have been developing this infection while still at the hospital or after discharge.
- The disease often manifests in the skin and also affects the lungs and the brain.
- Some of the common symptoms include sinusitis, blackish nasal discharge, facial pain, headaches, and pain around the eyes.
Who is at risk
- Patients who have been hospitalised for Covid-19 and particularly those who require oxygen therapy during Covid-19 illness are at a much higher risk of mucormycosis.
- However, there are some cases of mucormycosis in patients with asymptomatic Covid-19 infection.
- Before the pandemic, patients with uncontrolled diabetes were at a higher risk of mucormycosis.
- The risk of mucormycosis rises for these patients for two reasons.
- First is that Covid-19 further impairs their immune system.
- Second, they are given corticosteroids for their treatment it leads to a rise in their blood sugar level thus increasing their risk of mucormycosis.
Treatment
- Today, we have a number of drugs and anti-fungal medicines that can treat mucormycosis.
- These are given by IV or taken orally.
- Surgery is needed to remove the affected dead tissues along with antifungal therapy.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Digital Technologies and Inequalities
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Growing inequality in access to health and education
Impact of pandemic
- The novel coronavirus pandemic has accelerated the use of digital technologies in India, even for essential services such as health and education, where access to them might be poor.
- Economic inequality has increased: people whose jobs and salaries are protected, face no economic fallout.
- Well-recognised channels of economic and social mobility — education and health — are getting rejigged in ways that make access more inequitable in an already unequal society.
Growing inequality in access to education
- According to National Sample Survey data from 2017, only 6% rural households and 25% urban households have a computer.
- Access to Internet facilities is not universal either: 17% in rural areas and 42% in urban areas.
- Surveys by the National Council of Educational Research and Training (NCERT), the Azim Premji Foundation, ASER and Oxfam suggest that between 27% and 60% could not access online classes for a range of reasons: lack of devices, shared devices, inability to buy “data packs”, etc.
- Further, lack of stable connectivity jeopardises their evaluations.
- Besides this, many lack a learning environment at home.
- Peer learning has also suffered.
Inequality in access to health care
- India’s public spending on health is barely 1% of GDP.
- Partly as a result, the share of ‘out of pocket’ (OOP) health expenditure (of total health spending) in India was over 60% in 2018.
- Even in a highly privatised health system such as the United States, OOP was merely 10%.
- Moreover, the private health sector in India is poorly regulated in practice.
- Both put the poor at a disadvantage in accessing good health care.
- Right now, the focus is on the shortage of essentials: drugs, hospital beds, oxygen, vaccines.
- In several instances, developing an app is being seen as a solution for allocation of various health services.
- Digital “solutions” create additional bureaucracy for all sick persons in search of these services without disciplining the culprits.
- Platform- and app-based solutions can exclude the poor entirely, or squeeze their access to scarce health services further.
- In other spheres (e.g., vaccination) too, digital technologies are creating extra hurdles.
- The use of CoWIN to book a slot makes it that much harder for those without phones, computers and the Internet.
Issues with the creation of centralised database
- The digital health ID project is being pushed during the pandemic when its merits cannot be adequately debated.
- Electronic and interoperable health records are the purported benefits.
- For patients, interoperability i.e., you do not have to lug your x-rays, past medication and investigations can be achieved by decentralising digital storage say, on smart cards as France and Taiwan have done.
- Given that we lack a data privacy law in India, it is very likely that our health records will end up with private entities without our consent, even weaponised against us.
- For example, a private insurance companies may use health record to deny poor people an insurance policy or charge a higher premium.
- There are worries that the government is using the vaccination drive to populate the digital health ID database.
Way forward
- Unless health expenditure on basic health services (ward staff, nurses, doctors, laboratory technicians, medicines, beds, oxygen, ventilators) is increased, apps such as Aarogya Setu, Aadhaar and digital health IDs can improve little.
- Unless laws against medical malpractices are enforced strictly, digital solutions will obfuscate and distract us from the real problem.
- We need political, not technocratic, solutions.
Conclusion
Today, there is greater understanding that the harms from Aadhaar and its cousins fall disproportionately on the vulnerable. Hopefully, the pandemic will teach us to be more discerning about which digital technologies we embrace.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
A ‘One Health’ approach that targets people, animals
From UPSC perspective, the following things are important :
Prelims level : Zoonotic diseases
Mains level : Paper 2- 'One Health' approach to deal with infections diseases
The article highlights the need for a holistic approach to animal and human health as more than two-thirds of existing and emerging infectious diseases are zoonotic.
Need to document the link between environment animal and human health
- Studies indicate that more than two-thirds of existing and emerging infectious diseases are zoonotic, or can be transferred between animals and humans, and vice versa.
- Another category of diseases, anthropozoonotic infections, gets transferred from humans to animals.
- The transboundary impact of viral outbreaks in recent years such as the Nipah virus, Ebola, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) has reinforced the need for us to consistently document the linkages between the environment, animals, and human health.
India’s ‘One Health’ vision
- India’s ‘One Health’ vision derives its blueprint from the agreement between the tripartite-plus alliance.
- The alliance comprises the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), the World Health Organization (WHO) and the United Nations Environment Programme (UNEP) — a global initiative supported by the United Nations Children’s Fund (UNICEF) and the World Bank under the overarching goal of contributing to ‘One World, One Health’.
- In keeping with the long-term objectives, India established a National Standing Committee on Zoonoses as far back as the 1980s.
- This year, funds were sanctioned for setting up a ‘Centre for One Health’ at Nagpur.
- Further, the Department of Animal Husbandry and Dairying (DAHD) has launched several schemes to mitigate the prevalence of animal diseases since 2015.
- Hence, under the National Animal Disease Control Programme, ₹13,343 crore have been sanctioned for Foot and Mouth disease and Brucellosis control.
- In addition, DAHD will soon establish a ‘One Health’ unit within the Ministry.
- Additionally, the government is working to revamp programmes that focus on capacity building for veterinarians such as Assistance to States for Control of Animal Diseases (ASCAD).
- There is increased focus on vaccination against livestock diseases and backyard poultry.
- DAHD has partnered with the Ministry of Health and Family Welfare in the National Action Plan for Eliminating Dog Mediated Rabies.
Need for coordination
- There are more than 1.7 million viruses circulating in wildlife, and many of them are likely to be zoonotic.
- Therefore, unless there is timely detection, India risks facing many more pandemics in times to come.
- There is need to address challenges pertaining to veterinary manpower shortages, the lack of information sharing between human and animal health institutions, and inadequate coordination on food safety at slaughter.
- These issues can be remedied by consolidating existing animal health and disease surveillance systems — e.g., the Information Network for Animal Productivity and Health, and the National Animal Disease Reporting System.
Conclusion
As we battle yet another wave of a deadly zoonotic disease (COVID-19), awareness generation, and increased investments toward meeting ‘One Health’ targets is the need of the hour.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
[pib] MANAS Platform
From UPSC perspective, the following things are important :
Prelims level : MANAS Platform
Mains level : Not Much
The MANAS App to promote wellbeing across age groups was recently launched.
Name, acronym and the purpose; thats all. The rest of the theory is of less importance.
MANAS Platform
- MANAS is an acronym for Mental Health and Normalcy Augmentation System.
- It is a comprehensive, scalable, and national digital wellbeing platform and an app developed to augment the mental well-being of Indian citizens.
- MANAS was initiated by the Office of the Principal Scientific Adviser to the Government of India and jointly executed by NIMHANS Bengaluru, AFMC Pune and C-DAC Bengaluru.
- It was endorsed as a national program by the Prime Minister’s Science, Technology, and Innovation Advisory Council (PM-STIAC).
- It integrates the health and wellness efforts of various government ministries, scientifically validated indigenous tools with gamified interfaces developed/researched by various national bodies and research institutions.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
NCAHP Bill 2020
From UPSC perspective, the following things are important :
Prelims level : National Commission for Allied and Healthcare Professions Bill 2020
Mains level : Paper 2- NCAHP Bill 2020
The article highlights the key aspects of NCAHP Bill 2020 which recognises the allied healthcare professionals and seeks to regulate and set the standards of education.
Regulating allied health professions
- The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAHP) was passed by Parliament in March.
- Global evidence demonstrates the vital role of allied professionals in the delivery of healthcare services.
- They are the first to recognise the problems of the patients and serve as safety nets.
- Their awareness of patient care accountability adds tremendous value to the healthcare team in both the public and private sectors.
- The passage of this Bill has the potential to overhaul the entire allied health workforce by establishing institutes of excellence and regulating the scope of practice by focusing on task shifting and task-re distribution.
What the Bill provides for
- This legislation provides for regulation and maintenance of standards of education and services by allied and healthcare professionals and the maintenance of a central register of such professionals.
- It recognises over 50 professions such as physiotherapists, optometrists, nutritionists, medical laboratory professionals, radiotherapy technology professionals, which had hitherto lacked a comprehensive regulatory mechanism.
- This Bill classifies allied professionals using the International System of Classification of Occupations (ISCO code).
- This facilitates global mobility and enables better opportunities for such professionals.
- The Act aims to establish a central statutory body as a National Commission for Allied and Healthcare Professions.
- The Bill has the provision for state councils to execute major functions through autonomous boards.
Shift in perception and policy in healthcare delivery
- There has been a paradigm shift in perception, policy, and programmatic interventions in healthcare delivery in India since 2017.
- In the past, curative healthcare received substantially greater attention than preventive and promotive aspects.
- Ayushman Bharat as a programmatic intervention, with its two pillars of Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY), operationalised certain critical recommendations of the National Health Policy, 2017, emphasising wellness in healthcare.
- With PMJAY, the neediest are protected from catastrophic expenditure and India took the first step towards delivering comprehensive primary healthcare with HWCs.
Conclusion
Caring for patients with mental conditions, the elderly, those in need of palliative services, and enabling professional services for lifestyle change related to physical activity and diets, all require a trained, allied health workforce. The NCAHP is not only timely but critical to this changing paradigm.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
[pib] ‘Anamaya’ Initiative
From UPSC perspective, the following things are important :
Prelims level : ‘Anamaya’ Initiative
Mains level : Not Much
Anamaya, the Tribal Health Collaborative was recently launched.
Simply keep in mind, the name and purpose.
‘Anamaya’ Initiative
- The Collaborative is a multi-stakeholder initiative of the Tribal Affairs Ministry supported by Piramal Foundation and Bill and Melinda Gates Foundation (BMGF).
- It aims to build a sustainable, high-performing health eco-system to address the key health challenges faced by the tribal population of India.
- It will converge efforts of various Government agencies and organisations to enhance the health and nutrition status of the tribal communities of India.
- This collaborative is a unique initiative bringing together governments, philanthropists, national and international foundations, NGOs/CBOs to end all preventable deaths among the tribal communities of India.
Terms of references
- It will begin its operations with 50 tribal, Aspirational Districts (with more than 20% ST population) across 6 high tribal population states.
- Over a 10-year period, the work of the THC will be extended to 177 tribal Districts as recognised by the Ministry of Tribal Affairs.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Integrated Health Information Platform (IHIP)
From UPSC perspective, the following things are important :
Prelims level : IHIP
Mains level : Digital health mission
The Union Minister of Health & Family Welfare has launched the Integrated Health Information Platform (IHIP).
About IHIP
- The new version of IHIP will house the data entry and management for India’s disease surveillance program.
- In addition to tracking 33 diseases now as compared to the earlier 18 diseases, it shall ensure near-real-time data in digital mode, having done away with the paper mode of working.
Various functions
- IHIP will provide a health information system developed for real-time, case-based information, integrated analytics, advanced visualization capability.
- It will provide analyzed reports on mobile or other electronic devices. In addition, outbreak investigation activities can be initiated and monitored electronically.
- It can easily be integrated with another ongoing surveillance program while having the feature of the addition of special surveillance modules.
Unique features
- This is the world’s biggest online disease surveillance platform.
- It is in sync with the National Digital Health Mission and fully compatible with the other digital information systems presently being used in India.
- The refined IHIP with automated -data will help in a big way in real-time data collection, aggregation & further analysis of data that will aid and enable evidence-based policymaking.
- With IHIP, the collection of authentic data will become easy as it comes directly from the village/block level; the last mile from the country.
- With its implementation, we are fast marching towards AtmaNirbhar Bharat in healthcare through the use of technology.
Also read:
[Burning Issue] Rolling-out of National Digital Health Mission
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
N K Singh bats for moving Health Sector to Concurrent List
From UPSC perspective, the following things are important :
Prelims level : Concurrent List
Mains level : India's healthcare
Health should be shifted to the Concurrent list under the Constitution, and a developmental finance institution (DFI) dedicated to healthcare investments set up, Fifteenth Finance Commission Chairman N.K. Singh has said.
Other key recommendations
- Bringing health into the Concurrent list would give the Centre greater flexibility to enact regulatory changes and reinforce the obligation of all stakeholders towards providing better healthcare.
- He has urged the government spending to enhance expenditure on health to 2.5% of GDP by 2025.
- He said primary healthcare should be a fundamental commitment of all States in particular and should be allocated at least two-thirds of such spending.
The Concurrent List or List-III (of Seventh Schedule) is a list of 52 items (though the last subjects are numbered 47) given in the Seventh Schedule to the Constitution of India.
What is the Seventh Schedule?
- This Schedule of the Indian Constitution deals with the division of powers between the Union government and State governments.
- It defines and specifies the allocation of powers and functions between Union & States. It contains three lists; i.e. 1) Union List, 2) State List and 3) Concurrent List.
The Union List
- It is a list of 98 (Originally 97) numbered items as provided in the Seventh Schedule.
- The Union Government or Parliament of India has exclusive power to legislate on matters relating to these items.
The State List
- It is a list of 59 (Originally 66) items.
- The respective state governments have exclusive power to legislate on matters relating to these items.
The Concurrent List
- There are 52 (Originally 47) items currently in the list.
- This includes items which are under the joint domain of the Union as well as the respective States.
Must read
[Burning Issue] India’s Ailing Health Sector and Coronavirus
Healthcare in India
- The Indian Constitution has incorporated the responsibility of the state in ensuring basic nutrition, basic standard of living, public health, protection of workers, special provisions for disabled persons, and other health standards, which were described under Articles 39, 41, 42, and 47 in the DPSP.
- Article 21 of the Constitution of India provides for the right to life and personal liberty and is a fundamental right.
- Public Health comes under the state list.
- India’s expenditure on healthcare has shot up substantially in the past few years; it is still very low in comparison to the peer nations (at approx. 1.28% of GDP).
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
ACT-Accelerator Coalition
From UPSC perspective, the following things are important :
Prelims level : ACT-Accelerator
Mains level : Coronovirus outbreak
ACT-Accelerator, a global coalition formed in April 2020 to fight the novel coronavirus disease (COVID-19) is facing a severe fund crunch to meet its goals for 2020-21.
ACT-Accelerator
- The Access to COVID-19 Tools Accelerator (ACT Accelerator) is a G20 initiative announced on 24 April 2020.
- A call to action was published simultaneously by the World Health Organization (WHO).
- The ACT Accelerator is a cross-discipline support structure to enable partners to share resources and knowledge.
- It comprises four pillars, each managed by two to three collaborating partners:
- Vaccines (also called “COVAX”)
- Diagnostics
- Therapeutics
- Health Systems Connector
- India is an active donor in this alliance.
Try this PYQ based on a global coalition:
Q.Consider the following statements:
- Climate and Clean Air Coalition (CCAC) to Reduce Short Lived Climate Pollutants is a unique initiative of G20 group of countries.
- The CCAC focuses on methane, black carbon and Hydrofluorocarbons.
Which of the above statements is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
What we must consider before digitising India’s healthcare
From UPSC perspective, the following things are important :
Prelims level : National Digital Health Mission
Mains level : Paper 2- Issues to consider in digitising health infrastructure
As India seeks to create digital health infrastructure, it must consider several issues.
Integrated digital health infrastructure
- The National Digital Health Mission aims to develop the backbone needed for the integrated digital health infrastructure of India.
- This can help not only with diagnostics and management of health episodes, but also with broader public health monitoring, socio-economic studies, epidemiology, research, prioritising resource allocation and policy interventions.
- However, before we start designing databases and APIs and drafting laws, we must be mindful of certain considerations for design choices and policies to achieve the desired social objectives.
Factors to be considered
1) Carefully developing pathway to public good
- There must be a careful examination of how exactly digitisation may facilitate better diagnosis and management, and an understanding of the data structures required for effective epidemiology.
- We must articulate how we may use digitisation and data to understand and alleviate health problems such as malnutrition and child stunting.
- We need the precise data we require to better understand crucial maternal- and childcare-related problems.
2) Balancing between public good and individual rights
- The potential tensions between public good and individual rights must be examined, as must the suitable ways to navigate them.
- Moreover, for the balancing to be sound and for determining the level of due diligence required, it is imperative to clearly define the operational standards for privacy management.
- Conflating privacy with security, as is typical in careless approaches, will invariably lead to problematic solutions.
- In fact, most attempts at building health data infrastructures worldwide — including in the UK, Sweden, Australia, the US and several other countries — have led to serious privacy-related controversies and have not yet been completely successful.
3) Managing the sector specific identities
- Even if we define and use a sector-specific identity, the question of when and how to link it with that of other sectors remains.
- For example, with banking or insurance for financial transactions, or with welfare and education for transactions and analytics.
- Indiscriminate linking may break silos and create a digital panopticon, whereas not linking at all will result in not realising the full powers of data analytics and inference.
4) Working out the operational requirement of data infrastructure
- We need to work out the operational requirements of the data infrastructure in ways that are informed by, and consonant with, the previous points.
- In other words, the design of the operationalisation elements must follow the deliberations on above points, and not run ahead of them.
- This requires identifying the diverse data sources and their complexity — which may include immunisation records, birth and death records, informal health care workers, dispensaries etc.
- It also requires an understanding of their frequency of generation, error models, access rights, interoperability, sharing and other operational requirements.
- There also are the complex issues of research and non-profit uses of data, and of data economics for private sector medical research.
5) Issue of due process
- Finally, “due process” has always been a weak point in India, particularly for technological interventions.
- Building an effective system that can engender people’s trust not only requires managing the floor of the Parliament and passing a just and proportional law, but also building a transparent process of design and refinement through openness and public consultations.
- In particular, technologists and technocrats should take care to not define “public good” as what they can conveniently deliver, and instead understand what is actually required.
- While we can understand the urge to move forward quickly, given the urgent need to improve health outcomes in the country, deliberate care is needed.
Consider the question “While seeking to develop digital health infrastructure through the National Digital Health Mission, we should be mindful of certain considerations for design choices and policies to achieve the desired social objectives. Comment.”
Conclusion
Developing a comprehensive understanding of the considerations related to health data infrastructure may also inform the general concerns of e-governance and administrative digitisation in India, which have not been all smooth sailing.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
What are Non-Alcoholic Fatty Liver Diseases (NAFLD)?
From UPSC perspective, the following things are important :
Prelims level : NAFLD
Mains level : Health threats posed by Fats
The Union Govt has integrated the Non-alcoholic fatty liver disease (NAFLD) in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.
Try this MCQ:
Q.A Company marketing food products advertises that its items do not contain trans-fats. What does this campaign signify to the customers?
- The food products are not made out of hydrogenated oils.
- The food products are not made out of animal fats/oils.
- The oils used are not likely to damage the cardiovascular health of the consumers.
Which of the statements given above is/are correct?
(a) Only 1
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
NAFLD
- NAFLD is the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver, such as harmful alcohol use, viral hepatitis, or medications.
- According to doctors, it is a serious health concern as it encompasses a spectrum of liver abnormalities.
- It can cause non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer.
Why such a move?
- NAFLD is emerging as an important cause of liver disease in India.
- Epidemiological studies suggest the prevalence of NAFLD is around 9% to 32% of the general population in India with a higher prevalence in those with overweight or obesity and those with diabetes or prediabetes.
- Researchers have found NAFLD in 40% to 80 % of people who have type 2 diabetes and in 30% to 90% of people who are obese.
- Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease.
- Cardiovascular disease is the most common cause of death in NAFLD.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
vaccine hesitancy
From UPSC perspective, the following things are important :
Prelims level : Not much
Mains level : Paper 2- Dealing with vaccine hesitancy
Reluctance to take the vaccine has several implications. The misinformation around the vaccines needs to be fought through several measures.
Understanding vaccine hesitancy
- According to the World Health Organization, vaccine hesitancy is defined as a reluctance or refusal to vaccinate despite the availability of vaccine services.
- To date, two vaccines have been approved for inoculation in India: Pune-based Serum Institute’s Covishield and Hyderabad-based Bharat Biotech’s Covaxin.
- An adequate supply of vaccines is in place at least for the first phase, but the trickier part is to persuade the population for vaccination.
- Like Western nations, vaccine hesitancy has been a cause of concern in the past in India as well.
- Social media has seen a rising number of self-proclaimed experts who have been making unsubstantiated claims.
- The debates around hesitancy for COVID-19 vaccines include concerns over safety, efficacy, and side effects due to the record-breaking timelines of the vaccines, competition among several companies, misinformation, and religious taboos.
Need to adopt libertarian paternalism
- It is suggested that we adopt the idea of libertarian paternalism, which says it is possible and legitimate to steer people’s behaviour towards vaccination while still respecting their freedom of choice.
- Vaccine hesitancy has a different manifestation in India, unlike in the West.
- According to the World Economic Forum/Ipsos global survey, COVID-19 vaccination intent in India, at 87%, exceeds the global 15-country average of 73%.
Way forward
- Instead of anti-vaxxers, the target audience must be the swing population i.e., people who are sceptical but can be persuaded through scientific facts and proper communication.
- The second measure is to pause before you share any ‘news’ from social media.
- It becomes crucial to inculcate the habit of inquisitive temper to fact-check any news related to COVID-19 vaccines.
- The third measure is to use the celebrity effect — the ability of prominent personalities to influence others to take vaccines.
- Celebrities can add glamour and an element of credibility to mass vaccinations both on the ground and on social media.
Consider the question “What is vaccine hesitancy? Suggest the measures to deal with it”
Conclusion
The infodemic around vaccines can be tackled only by actively debunking myths, misinformation and fake news on COVID-19 vaccines.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
First steps in India’s journey to universal health care
From UPSC perspective, the following things are important :
Prelims level : PM-JAY
Mains level : Paper 2- Achieving universal health coverage
The article highlights the issues with India’s approach in achieving universal health care and issues with it.
Learning from the experience of Thailand
- About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
- What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
- This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
- This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.
Budgetary allocations for health
- The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
- Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
- ₹13,192 crore has been allocated as a Finance Commission grant.
- These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.
Two important and prominent arms of universal health coverage in India merit discussion here
1) Insurance route for achieving universal health coverage and issues with it
- The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
- Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
- However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
- Beyond low allocations, poor budget reliability merits attention.
- Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
- Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
- Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
- Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
- Finally, even high actual coverage should not be equated with effective financial protection.
- For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.
2) Comprehensive primary care
- Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
- Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
- Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
- Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
- This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
- This offers huge cost projections.
- The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
- Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
- Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
- Two untoward implications could result from under-investing and spreading funds too thinly.
- Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
- Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.
Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?”
Conclusion
COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
The unmet health challenge
From UPSC perspective, the following things are important :
Prelims level : PMANSY
Mains level : Paper 2- Allocation in Budget for health
The article analyses the allocation for the health sector in the Budget and highlights the need for more allocations.
Need to increase spending on health
- The Economic Survey argues for the need to increase public spending on healthcare to 2.5-3 per cent of the GDP — it’s about 1.5 per cent currently.
- The Survey points out that there is not much difference in terms of outcomes and quality between healthcare services in the private sector and such services in public centres.
- The Economic Survey, therefore, calls for strengthening the National Health Mission (NHM) along with Ayushman Bharat.
- NHM was initiated in 2005-06 to strengthen public health services.
- The Ayushman Bharat provide social insurance, thereby financing private sector services with public funds.
- The Economic Survey makes a strong pitch for greater regulation of health services in the private sector.
Break-up of allocation in Budget on health (and well being)
- The finance minister described “health and well-being” as one of the pillars of the budget in her budget speech and announcing a 137 per cent increase in allocations for it.
- She placed healthcare, water and sanitation and nutrition as the key components of this pillar.
- However, the figures in the budget documents reveal a different story.
- There is an absolute increase of 9.6 per cent in allocations for the Department of Health and Family Welfare that includes NHM and Ayushman Bharat.
- A 26.8 per cent increase for the Department of Health Research and 40 per cent increase for the AYUSH Ministry do not add up to much since each of them are only 3-4 per cent of the total health budget.
- A Finance Commission grant of Rs 13,000-crore and Rs 35,000-crore for COVID-19 vaccination are one-time allocations and, therefore, do not strengthen the overall system.
- The core health service and research ministries (H&FW and AYUSH) have together received only an 11 per cent increase.
- Even in COVID times, the health services get only 2.21 per cent of the total central budget — down from 2.27 per cent in the 2020-21 budget.
- Computing for inflation, the increase in allocation for health services alone disappears and actually becomes negative.
- Water and sanitation received a 179 per cent increase from Rs 21,518 crore to Rs 60,030 crore already earmarked for the flagship schemes, Swachh Bharat and Jal Jeevan Mission.
- But allocation for nutrition decreased by 27 per cent, with the “new” Poshan 2.0 merely combining the poorly performing Supplementary Nutrition Programme and Poshan project.
- Added together, health, water and sanitation and nutrition make up the claimed 137 per cent increase in allocation to “health” services — with a real decline in healthcare and nutrition.
Pradhan Mantri Atma Nirbhar Swasthya Yojana (PMANSY)
- Finance Minister also announced a new scheme, the Pradhan Mantri Atma Nirbhar Swasthya Yojana, to support the almost 29,000 health and wellness centres in the country.
- The scheme also envisages the creation of public health laboratories and critical care hospital blocks and virology institutes.
Concerns with PMANSY
- PMANSY has an announced allocation of Rs 64,180 crore over six years, but it does not find a place in the present budget documents.
- But these additional activities could have been slotted in the NHM.
- Since 2014, the allocation for NHM has been on the wane.
- Therefore, even the marginal 1.33 per cent increase (from Rs 27,039 crore to Rs 30,100 crore) is a demonstration of the government’s realisation that public services do matter.
- The allocations of about Rs 10,000-Rs 11,000 crore each year for the PMANSY is not enough for making the public services capable of “universal health coverage”.
- The High-Level Expert Group on Universal Health Coverage had estimated that by 2020, we need a 114 per cent increase in sub-centres and primary health centres, 179 per cent increase in community health centres and a 230 per cent increase in sub-district and district hospitals.
- Getting anywhere close to this requires doubling of real allocations every year over a five-year period to reach something like 10 per cent of the budget.
- In the present budget, it declines to a mere 2.21 per cent.
Way forward
- If such public provisioning for universal health coverage can’t be done, then effective low-cost rationalised service system options have to be designed.
- Insurance schemes only create the mirage of affordability of health services while adding to peoples’ expenses.
- Community and public services are indisputably the most cost-effective for any society.
Consider the question “Examine the benefits of the idea of health and well being under which health, water and sanitation and nutrition are clubbed together.”
Conclusion
Water and sanitation are meaningful for health, but not if it only inflates the allocation to “Health and Wellbeing”. What we need is the real increase in spending on health.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Building a robust healthcare system
From UPSC perspective, the following things are important :
Prelims level : Maternal Mortality Rate, Infant Morality Rate
Mains level : Paper 2- Disparity among states in health parameters
The article focuses on the wide variation across the state in terms of the important health parameters and suggests prioritising health.
Variation across the states
- The efficacy of the public health system varies widely across the country since it is a State subject.
- Public health system can be judged just by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate.
- In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala. In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63.
- The northern States are performing very poorly in these vital health parameters.
- The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
- Since health is a State subject, the primary onus lies with the State governments.
- Each State government must focus on public health and aim to improve the health indicators mentioned above.
- Unless all the States perform well, there will be no dramatic improvement in the health system.
Steps needed to be taken
- The governments — both at the Centre and the Empowered Action Group States — should realise that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.
- The Government of India has a vital role to play.
- Public and preventive health should be his focus by holding the Empowered Action Group States accountable to the SDGs.
- They must be asked to reach the levels of the southern States within three to five years.
- An important measure that can make a difference is a public health set-up in these States that addresses primary and preventive health.
Conclusion
Unless we invest in human capital, FDI will not help. Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
Ayushman Bharat for CAPFs
From UPSC perspective, the following things are important :
Prelims level : Ayushman Bharat
Mains level : Universal health coverage
Union Home Minister has rolled out the ‘Ayushman CAPF’ scheme, extending the benefit of the central health insurance programme to the personnel of all Central Armed Police Forces (CAPFs) in the country.
Who are the CAPFs?
- The CAPFs refers to uniform nomenclature of five security forces in India under the authority of the Ministry of Home Affairs.
- Their role is to defend the national interest mainly against the internal threats.
- They are the Border Security Force (BSF), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), Indo-Tibetan Border Police (ITBP), Sashastra Seema Bal (SSB)
Ayushman CAPF
- Under this scheme, around 28 lakh personnel of CAPF, Assam Rifles and National Security Guard (NSG) and their families will be covered by ‘Ayushman Bharat: PM Jan Arogya Yojana’ (AB PM-JAY).
- For the CAPF, the existing health coverage was not comprehensive as compared to other military forces.
Do you know?
The goal of universal health coverage (UHC) as stated in the UN Sustainable Development Goals (SDGs no. 3) is one of the most significant commitments to equitable quality healthcare for all.
About Ayushman Bharat
- PM-JAY aims to provide free access to healthcare for 40% of people in the country.
- It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
- It was launched in September 2018 by the Ministry of Health and Family Welfare.
- The ministry has later established the National Health Authority as an organization to administer the program.
Key features:
- Providing health coverage for 10 crores households or 50 crores Indians.
- It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
- Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
- Using criteria from the Socio-Economic and Caste Census 2011 to determine eligibility for benefits.
- There is no restriction on family size, age or gender.
- All previous medical conditions are covered under the scheme.
- It covers 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostic care and expenses on medicines.
- The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.
Note these features. They cannot be memorized all of sudden but can be recognized if a tricky MCQ comes in the prelims.