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

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

Regulating the Private Health Sector to Eliminate COVID-19op-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Regulation of private sector to deal with the COVID-19.


Context

The current COVID-19 crisis that India is battling has brought into sharp focus the public health system’s inadequacy to cope with it.

Contradictory scenario between public and private healthcare delivery

  • The contrast between public and private: Hospitals with state-of-the-art equipment rivalling five-star hotels in their facilities are mushrooming mostly in cities even as the overburdened public hospitals are valiantly fighting to cope. 
  • Dismal picture in rural areas: As far as the rural areas are concerned, the community health centres and primary health centres and sub-centres present an even more dismal picture in terms of availability of medicine stock, trained para-medical staff, and doctors and nurses.
  • However, it is not as if urban hospitals offer patients excellent care. A common and widely held general misperception is that the private healthcare system is better than the public one.
  • Why private is not always better? Complaints of non-transparent billing, demanding exorbitant sums in advance even in a medical emergency, and cutting corners in services are all too familiar, as are cases of the denial of services.
  • In semi-rural areas and towns, the private sector is not necessarily similar to hospitals in cities.
  • The private hospitals in these areas are small and have basic infrastructure and limited medical and non-medical staff. Unlike the cities, the power and water supply in these areas also constitute a problem to the functioning of these hospitals.

Problems in the public healthcare system

  • Within the public sector health system, there are a number of trends again that add to the dismal picture.
  • A high number of patients: Doctors in the public hospitals deal with an overwhelming number of patients majorly from the poor and marginalised sections.
  • Issue of contractual staff: Health activists have also pointed out that the growing trend of contractual hiring of paramedical and allied staff leads to an insecurity among them, and thus affects overall caregiving to patients.
  • Consequently, the poor patients’ families, frustrated by the lack of infrastructure and services, turn their anger upon the doctors and nurses.
  • What are the implications? The constant vilification of the public hospital staff coupled with starving these hospitals of resources has led to the view that the private hospitals are “much better” despite their exorbitant rates.

State-wise variation in healthcare

  • States subject: Health is a state subject, and it is well known that the health delivery systems are not uniform across states.
  • Kerala a role model: Kerala is often held up as a role model generally, and even now in the manner in which it has dealt with the COVID-19 crisis.
  • The dismal system in North India: As it is, certain states in North India have abysmal healthcare systems, and a couple does not have any testing facilities, the media has reported.

Getting the private sector involved in COVID-19 testing

  • Undoubtedly, at present, the private sector must be involved in screening, tests and treatment for COVID-19.
  • The highly trained professionals in this sector can contribute enormously by helping scale up the testing efforts.
  • Importance of large-scale testing: In South Korea too, it was large-scale testing that was instrumental in reducing mortality rates.
  • The pricing issue: Services across sectors must not be priced differently at a time like this. The media has reported that there is a difference of opinion between the government and private sector on the price of COVID-19 tests flowing from the prices of test kits.
  • Need for the protocol: A clear and non-negotiable protocol for the private sector must be established regarding the present crisis and how the government is going to help financially and otherwise in dealing with it.

Way forward

  • Regulate the testing, screening and treatment facilities: The experience with the government offering subsidies to hospitals, especially in urban areas in terms of land and other concessions, has not borne out desired objectives such as better care for the poor.
  • Taking a cue from this, the testing, screening, and treatment facilities must be regulated in terms of pricing and quality.
  • Focus on strengthening the public health system: The Supreme Court has held healthcare to be a fundamental right under Article 21. The biggest lesson of the current crisis is that political will must focus on strengthening the public health system.

Conclusion

The finance minister has announced a package of `1.7 lakh crore to deal with this catastrophic situation. This is welcome, but long-term resource allocation to invigorate the public health system must be a continual and parallel process.

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

Sodium Hypochlorite as Coronavirus disinfectantPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Sodium hypochlorite, Bleaching Powder

Mains level : Coronovirus outbreak and its mitigation


In Uttar Pradesh, migrant workers travelling to their home states, or their belongings, were sprayed with a disinfectant, apparently to sanitise them.  The chemical in the spray was a sodium hypochlorite solution.

Sodium hypochlorite

  • Sodium hypochlorite is commonly used as a bleaching agent, and also to sanitise swimming pools.
  • As a common bleaching agent, sodium hypochlorite is used for a variety of cleaning and disinfecting purposes.
  • It releases chlorine, which is a disinfectant. Large quantities of chlorine can be harmful.
  • The concentration of the chemical in the solution varies according to the purpose it is meant for.
  • A normal household bleach usually is a 2-10% sodium hypochlorite solution.
  • At a much lower 0.25-0.5%, this chemical is used to treat skin wounds like cuts or scrapes. An even weaker solution (0.05%) is sometimes used as a handwash.

Note: The common bleaching powder is chemically referred to as Calcium hypochlorite and not Sodium hypochlorite.

Is the chemical safe?

  • Sodium hypochlorite is corrosive and is meant largely to clean hard surfaces.
  • It is not recommended to be used on human beings, certainly not as a spray or shower. Even a 0.05% solution could be very harmful for the eyes.
  • A 1% solution can cause damage to the skin of anyone who comes in contact with it.
  • If it gets inside the body, it can cause serious harm to lungs.

Does the chemical get rid of the novel coronavirus?

  • The WHO recommends homemade bleach solutions of about 2-10% concentration to clean hard surfaces to clear them of any presence of the novel coronavirus.
  • Cleaning hard surfaces with this solution can disinfect them not just from novel coronavirus but also help prevent flu, food born illnesses, and more.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

PM-CARES FundPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PM-CARES Fund

Mains level : Not Much


Our PM has called for donations to the newly instituted PM-CARES Fund which has been formed on popular demand to help fight the novel coronavirus.

PM-CARES Fund

  • The fund will be a public charitable trust under the name of ‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’.
  • The PM is Chairman of this trust and members include the Defence Minister, Home Minister and Finance Minister.
  • Contributions to the fund will qualify as corporate social responsibility (CSR) spending that companies are mandated to make.
  • The Fund accepts micro-donations as well.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] National Teleconsultation Centre (CoNTeC)PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Teleconsultation Centre (CoNTeC)

Mains level : Telemedicine and its effectiveness


The Union Ministry of Health & Family Welfare has launched the National Teleconsultation Centre (CoNTeC).

 About CoNTeC

  • The CoNTeC is a Telemedicine Hub established by AIIMS, New Delhi, wherein expert doctors from various clinical domains will be available 24×7 to answer the multifaceted questions from specialists from all over the country.
  • It is a multi-modal telecommunications hub through which 2 way audio-video and text communications can be undertaken from any part of the country as well as the world at large.
  • The modes of communication will include simple mobile telephony as well as two way video communications, using WhatsApp, Skype and Google Duo.
  • The CoNTeC is also fully integrated with the National Medical College Network (NMCN) to conduct a full fledged Video Conference (VC) between the 50 Medical Colleges.

How to Contact the CoNTeC?

  • A single mobile number (+91 9115444155) can be dialled from anywhere in the coutnry/world by COVID-19 treating doctors to reach the CoNTeC which has six lines that can be used simultaneously at present.
  • This number of lines can be increased in future if needed.
  • The incoming calls will be picked up by the CoNTeC Managers, who will then handover the call to the appropriate expert doctors from the clinical domains as desired by the calling specialists managing the COVID-19 cases anywhere in the country.
  • The Managers will guide the callers in establishing a two way video call using the WhatsApp, Skype or Google Duo as preferred by the caller.
  • The callers from the NMCN network can connect anytime using the Telemedicine infrastructure at their end.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Indian Scientists’ Response to CoViD-19 (ISRC) GroupPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Indian Scientists’ Response to CoViD-19 (ISRC)

Mains level : Not Much


Several Indian scientists have come together to form a Google group to address some of the concerns that the COVID-19 outbreak has thrown up.

Indian Scientists’ Response to CoViD-19 (ISRC)

  • It is a voluntary group of scientists who regularly discuss the rapidly evolving situation with its dire need for science communication.
  • With nearly 200 members, the group has scientists from institutions such as the NCBS, the IISc, the TIFR, the IITs, the IISERs and many others.
  • The group aims to study existing and available data to bring out analyses that will support the Central, State and local governments in carrying out their tasks.

Self-assigned tasks

  • Several working groups have been formed by scientists.
  • They include one on hoax busting to address disinformation spreading with respect to the coronavirus and one on science popularization to develop material that explains concepts such as home quarantine.
  • Other groups work on resources in Indian languages, mathematical models and apps.

Why such a group?

  • The scientific community has realized their social and democratic responsibility in the current situation, both in terms of analysing the situation and reaching out to the public.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Serological test for COVID-19Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : COVID 19 diagnosis

Mains level : Coronovirus outbreak and its mitigation


The ICMR invited bids for an estimated 10 lakh antibody kits (for serological tests) for the diagnosis of COVID-19.

What are serological tests?

  • Viral infections are mainly identified by two kinds of tests– genetic and serological.
  • Genetic tests can identify infections that are active but cannot be used to detect past infections.
  • To trace how infections like the novel coronavirus have spread so far, it is important to detect people who contracted the disease in the past and have recovered.
  • This is what serological tests seek to determine.

How are the two different?

  • The genetic test is conducted on a swab collected from the back of the throat, a liquid sample from the lower respiratory tract, or a simple saliva sample.
  • For SARS-COV-2, the virus’s RNA is first converted into DNA.
  • By a process called polymerase chain reaction (PCR), DNA fragments in the sample are copied exponentially — one is copied into two, the two are copied into four, and so on.
  • Unlike genetic tests, which look for RNA in swab samples, serological tests work on antibodies in blood samples. Hence, they are also called ‘antibody tests’.

How serological tests work?

  • Antibodies, or protective proteins produced by the immune system to neutralize pathogens such as bacteria and viruses, are present in one’s bloodstream for a considerable period of time after the infection has gone.
  • To disable a pathogen, the antibody latches to a unique protein molecule on pathogen’s surface, called an antigen.
  • Serological tests use antigen molecules to detect the presence of antibodies relevant to the infection.
  • Generally, a blood sample is placed in a test tube that is lined with antigens on the inside. If the relevant antibodies are present, they latch on to the antigens.
  • Such tests are relatively inexpensive, and can display results within a few minutes.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

‘Contact tracing’ and its significance to control disease outbreaksPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : ‘Contact tracing’ and its significance to control disease outbreaks


As the number of coronavirus cases in India increases, authorities in different states are relying on contact tracing, a concept in epidemiology that involves tracing the number of people an infected person comes in contact with.

The idea behind contact tracing is to stop the outbreak by breaking the transmission chains.

What is Contact Tracing?

  • Contact tracing is not a novel concept and has been used as a method to track cases of the Ebola virus in Africa.
  • It is one of the methods of detecting an outbreak and the number of infected people.
  • In 2014, when the first Ebola cases began to be reported in Sierra Leone, a contact tracing mechanism was devised.
  • According to the Centre for Disease Control (CDC), the system in the district was able to identify 13 Ebola cases, which would have been overlooked otherwise.

Various steps involved

According to WHO contact tracing can be broken down into three steps:

1) Contact identification:

  • This involves identifying the contacts of the infected person by asking about the person’s activities and those of people around them since the onset of illness.
  • In the case of the first positive COVID-19 patient from Chandigarh for instance, a chain of 119 people was traced directly or indirectly to the patient.

2) Contact listing:

  • This means listing all those people who came in contact with the infected person.
  • Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms.
  • In some areas across India, authorities are releasing lists of those who are quarantined and are identifying their houses by putting quarantine posters in front of their houses.

3) Contact follow-up:

  • This step involves regular follow-ups with all the contacts to monitor for symptoms and test for signs of infection.

Limitations of Contact Tracing

  • Since everyone has many contacts, contact tracing is useful when there are only a few cases.
  • At this point, in many countries, we have so many cases that everyone would be contacted. This is essentially the lockdown — everybody isolates.
  • However, while a fifth of the world’s population is currently isolated and under lockdown, it may not be feasible to trace contacts of all the infected patients given the scale of the current outbreak.

Way forward

  • While contact tracing is an important step during a disease outbreak, it is insufficient alone in controlling it, requiring other interventions.
  • Rapid and effective contact tracing can reduce the initial number of cases, which would make the outbreak easier to control overall.
  • Effective contact tracing and isolation could contribute to reducing the overall size of an outbreak or bringing it under control over a longer time period.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Why need a 21-day lockdown period?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : COVID 19

Mains level : Coronovirus outbreak and its mitigation


Amid diverse opinions on nationwide lockdown, there is a public health/epidemiological significance to the 21-day lockdown period announced by PM.

What led PM to impose 21-day lockdown?

  • It seems that rich scientific data has fed this decision to announce a 21-day lockdown period.
  • In fact, 21-day quarantines have been discussed elaborately in the context of Ebola and the calculations are based on the estimated incubation period of the virus in a human host.
  • The 21-day quarantine value is derived from interpretations of outbreak data, past and present, public health experts said.

Median incubation period

  • In epidemiological terms, the logic is that we have arrived at an incubation period of 14 days.
  • Give another week for the residual infection to die out, for the tail end, to be entirely safe, and you arrive at 21 days.
  • This being a new coronavirus, they have estimated that the median incubation period (the time between the entry of the virus to the onset of symptoms/ disease) falls within this period.

Significance

  • This is the most effective way of preventing the spread of the infection from those already infected into the community.
  • In fact, for infections that are transmitted in this manner, this is the one thing to prevent the rapid spread of infection within the community.
  • The lockdown or quarantine also creates some breathing space — to convince people of the seriousness of the situation and build positive public opinion, carry out disinfection of all buildings, vehicles and surfaces, and allows hospitals to prepare themselves for the next phase of operations.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

What is Hantavirus?Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Hantavirus

Mains level : Rise in zoonotic diseases and their possible causes


China has reported the death of a person from Yunnan Province who tested positive for the Hantavirus.

What is Hantavirus?

  • The Hantaviruses are a family of viruses spread mainly by rodents. It is contracted by humans from infected rodents.
  • Cases of the Hantavirus in humans occur mostly in rural areas where forests, fields and farms offer suitable habitat for infected rodents.
  • A person can get infected if he/she comes in contact with a rodent that carries the virus.
  • In the US and Canada, for instance, the Hantavirus carried by the deer mouse is responsible for the majority cases of the Hantavirus infection.
  • Like this, there are various other kinds of Hantaviruses that find hosts in rodents, like the white-footed mouse and the cotton rat among others that may lead to infections in humans if transmitted.

Its origin

  • The Hantavirus is not novel and its first case dates back to 1993, according to the US Centre for Disease Control (CDC).
  • In the Americas, the family of viruses is known as ‘New World hantaviruses’.

Symptoms

  • A person infected with the virus may show symptoms within the first to eighth week after they have been exposed to fresh urine, faeces or the saliva of infected rodents.
  • Symptoms may include fever, fatigue, muscle aches, headaches, chills and abdominal problems.
  • Four to ten after being infected, late symptoms of HPS may start to appear, which include coughing and shortness of breath.

Mortality risk

  • It is the cause of Hantavirus pulmonary disease (HPS), a severe respiratory disease. The HPS can be fatal and has a mortality rate of 38 per cent.
  • It remains unclear whether human-to-human transmission of the virus is possible.
  • There have been no reports of human-to-human transmission of Hantavirus in the US.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

What is Section 188 IPC?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Significance of self-imposed curfew


After the Janata Curfew, many other states took the Centre’s advice to enforce a full lockdown in districts to contain the spread of COVID-19. The orders issued to curb the spread of the coronavirus have been framed under the Epidemic Diseases Act, 1897, which lays down punishment as per Section 188 of the Indian Penal Code, 1860.

What is Section 188 of the Indian Penal Code?

  • Section 3 of the Epidemic Diseases Act, 1897, provides penalties for disobeying any regulation or order made under the Act.
  • These are according to Section 188 of the Indian Penal Code (Disobedience to order duly promulgated by public servant).
  • It is not necessary that the offender should intend to produce harm, or contemplate his disobedience as likely to produce harm.
  • It is sufficient that he knows of the order which he disobeys, and that his disobedience produces, or is likely to produce, harm.

What happens if you violate the lockdown orders? 

Under Section 188, there two offences:

1) Disobedience to an order lawfully promulgated by a public servant, If such disobedience causes obstruction, annoyance or injury to persons lawfully employed

Punishment: Simple Imprisonment for 1 month or fine of Rs 200 or both

2) If such disobedience causes danger to human life, health or safety, etc.

Punishment: Simple Imprisonment for 6 months or fine of Rs 1000 or both

According to the First Schedule of the Criminal Procedure Code (CrPC), 1973, both offences are cognizable, bailable, and can be tried by any magistrate.

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

Stages in a COVID-19 Pandemic

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Various stages of a pandemic

Mains level : Coronovirus outbreak and its mitigation


Over the past few weeks, India has been dreading the possibility that the novel coronavirus outbreak will move to the stage of community transmission.

What are the stages of a pandemic?

Stage I

  • In the first stage of a disease epidemic that eventually takes the form of a pandemic sweeping the globe, cases are imported into a country in which the infection did not originate.
  • An infection whose spread is contained within the boundaries of one or a few countries is obviously not a pandemic.

Stage II

  • The second stage is when the virus starts being transmitted locally.
  • Local transmission means that the source of the infection is from within a particular area and the trajectory the virus has taken from one person to the next is clearly established.

Stage III

  • The third stage is that of community transmission. It is usually localised.
  • According to the WHO community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples.
  • In layman terms, it means that the virus is now circulating in the community, and can infect people with no history either of travel to affected areas or of contact with an infected person.
  • If and when community transmission happens, there might arise the need for a full lockdown because in that situation it is theoretically possible for every person, regardless of where they are from and who they have been in contact with, to spread the disease.

Stage IV

  • There is also a fourth stage in every pandemic. It is when the disease, COVID-19 in this case, becomes endemic in some countries.
  • The Indian government’s containment plan takes this possibility into account.
  • Among diseases that are currently endemic in India — meaning they occur round the year across the country — are malaria and dengue.

How does categorising an outbreak in this manner help?

  • The stages of a pandemic are uniform the world over.
  • This is so because, in today’s interconnected world, it is important to have a standardised phraseology that conveys the same thing to every person around the world, and helps countries prepare better.
  • The categorization helps countries take specific actions that are necessary to target just that particular scenario.
  • For example, India imposed travel restrictions to China from very early on as the cases they were all imported from China.
  • Later, as cases started being imported from other European countries, flight and visa restrictions were put in place for those countries.
  • India has now shut itself to individuals coming from all countries — this is because the virus is now confirmed as circulating in at least 177 countries and territories.

Worldwide, in which stage is the COVID-19 pandemic now?

  • The pandemic has spread to nearly every country on the planet. In most, though, it is in the stage of either imported cases or local transmission.
  • Among the countries where community transmission seems to be operating are China, Italy, Iran, South Korea and Japan.
  • China adopted a graded approach in dealing with the infection but the epicentre, Hubei, was in a state of complete lockdown at the peak of the infection.
  • It something that Italy has now effected in a bid to stop the virus from wreaking more havoc, given the country’s ageing population.

How long before India enters community transmission?

  • It is totally unpredictable. Some doctors perceive that community transmission is inevitable; other experts feel it may have already happened.
  • There are some reports of one strain having less mortality. If indeed a milder strain has come to India, it could change the course of the epidemic.
  • There is another theory that all the various viruses circulating in South Asia and the generally lower levels of hygiene may give us some immunity.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

AYUSH Health-Wellness Centres

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AYUSH Health-Wellness Centres

Mains level : Self-care practices and its benefits


The Union Cabinet has approved the inclusion of AYUSH Health and Wellness Centre (AYUSH HWC) component of Ayushman Bharat in the National AYUSH Mission (NAM).

What is the move?

  • A total of 12,500 Ayush health and wellness centres throughout the country will be operationalised within a period of five years.
  • The implementation of the proposal will establish a holistic wellness model based on Ayush principles and practices focusing on preventive promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.

Why such a move?

  • The move is aimed at establishing a holistic wellness model based on AYUSH principles and practices focusing on preventive, promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.
  • The National Health Policy 2017 has advocated mainstreaming the potential of AYUSH systems (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sows-rigpa and Homoeopathy) within a pluralistic system of Integrative healthcare.
  • The vision of the proposal is to establish a holistic wellness model based on AYUSH principles and practices, to empower masses for ‘self care’ to reduce the disease burden and out of pocket expenditure and to provide informed choice of the needy public.

What is National AYUSH Mission (NAM)?

  • Department of AYUSH, Ministry of Health and Family Welfare, Government of India has launched National AYUSH Mission (NAM) during 12th Plan for im­plementing through States/UTs.
  • The basic objective of NAM is to promote AYUSH medical systems through cost effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of ASU &H drugs and sustainable availability of ASU & H raw-materials.
  • It envisages flexibility of implementation of the programmes which will lead to substantial participation of the State Governments/UT.
  • The NAM contemplates establishment of a National Mission as well as corresponding Missions in the State level.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

The strategy of ‘Shelter in Place’

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Janata curfew

Mains level : Social distancing and its significance


As India observed a “janata curfew” from 7 am to 9 pm yesterday refraining from making any non-essential movements, they are implementing a version of what is referred to, most commonly in the United States, as a “shelter in place” order.

What exactly is a “Shelter in Place”?

  • In the context of the US, it is not a precise legal term, and its meaning and implications vary. It conveys the broad idea of a set of restrictions being put into place, but follows not set definition.
  • Broadly, “shelter in place” orders everywhere social distancing, which is the key to “flattening the curve”, that is, spreading out the incidence of infection over a longer time so that healthcare systems are not overwhelmed.
  • Ultimately, the intent of the protocols is to decide what people should and shouldn’t do based on a particular threat to the public.

Indian concept of self-imposed curfew

  • There is no exact definition of a “janata curfew” — the PM has laid down guidelines for what Indians should not do, and authorities have taken steps to ensure compliance through appeals, advisories, and executive action such as invoking prohibitory orders.
  • In the cities, traders’ associations and housing societies have voluntarily put curbs on themselves in response to the PM’s call.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

PCR Test for Diagnosis of the COVID-19Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polymerase Chain Reaction Test

Mains level : Coronovirus outbreak and its mitigation


 

The diagnosis of COVID-19 can be done with the Polymerase Chain Reaction (PCR) Test which is explained as under:

The PCR Test

  • It uses a technique that creates copies of a segment of DNA. ‘Polymerase’ refers to the enzymes that make the copies of DNA.
  • Kary Mullis, the American biochemist who invented the PCR technique, was awarded the Nobel Prize for Chemistry in 1993.
  • The ‘chain reaction’ is how the DNA fragments are copied, exponentially — one is copied into two, the two are copied into four, and so on.
  • However, SARS-COV-2 is a virus made of RNA, which needs to be converted into DNA. For this, the technique includes a process called reverse transcription.
  • A ‘reverse transcriptase’ enzyme converts the RNA into DNA. Copies of the DNA are then made and amplified.
  • A fluorescent DNA binding dye called the “probe” shows the presence of the virus. The test also distinguishes SARS-COV-2 from other viruses.

Various Stages:

1) Collection and transport

  • Testing centre takes swabs from nasal cavities and back of the throat (pharynx), and puts samples in a “virus transport medium”, which contains balanced salts and albumin to prevent the virus from disintegrating.
  • Sample is then transported in cold storage to the testing lab.

2) Extraction of viral RNA

  • Coronaviruses have large single-stranded RNA genomes.
  • Testing lab extracts the RNA from the samples, using commercially available kits.

3) Putting THE RNA in THE PCR mix

  • Extracted RNA is added to a polymerase chain reaction (PCR) mix.
  • This includes the ‘master mix’, which contains a ‘reverse transcriptase’ enzyme that converts the RNA into DNA.
  • Master Mix contains Taq polymerase, the enzyme that creates copies of the DNA, nucleotides, as well as other elements such as magnesium — an ion of which is needed to amplify the DNA.
  • The PCR mix also contains ‘reagents’ such as ‘primers’ and ‘probes’.
  • Primers are particular strands of DNA that are designed to bind with the DNA that is to be copied; probes are used to detect the specific sequence in the DNA sample.
  • Finally, the PCR mix consists of a “housekeeping” gene — a normal human gene (RNAse P) that is used to ensure that samples were properly collected, and RNA extracted.

4) Amplification of the viral DNA

  • Sample, in its PCR mix, is put into tubes or plates, which are then put in a thermal cycler machine that is used to conduct the PCR process.
  • First, the RNA is converted into DNA. Then the process of copying the genes starts.
  • The thermal cycler heats and cools the mixture with the sample, alternating between three temperatures — for melting the DNA to separate the two strands.
  • The thermal cycler runs 30-40 such cycles in order to amplify the DNA to check for the virus.

5) Testing against controls

  • Amplified DNA is tested against a positive control, which usually consists of genes of the virus cloned into plasmid, and a negative control, which is a ‘known’ sample that has tested negative for the virus earlier.
  • RNase P should show amplification, positive control should be positive, negative control should be negative, and then whatever result you get for the specimen, is the correct result.
  • In order for a test to be valid before the result is released, certain ‘validity criteria’ have to be met.
  • If the housekeeping gene (RNase P) is positive, positive control is positive, negative control is negative, and the sample does not show any PCR positive result, the sample is declared negative.
  • If the PCR result is positive, the patient has COVID-19.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Epidemics that have hit India since 1900Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Various diseases mentioned and their vaccines

Mains level : Epidemics and their containment


India has witnessed widespread illnesses and virus outbreaks in parts of the country, including the SARS outbreak between 2002 and 2004. However, statistics show that they were nowhere as widespread as the COVID-19 that has now reached almost every part of the country and almost every country in the world.

What is an Epidemic?

  • The WHO defines epidemics as “the occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy.
  • The community or region and the period in which the cases occur are specified precisely.
  • The number of cases indicating the presence of an epidemic varies according to the agent, size, and type of population exposed, previous experience or lack of exposure to the disease, and time and place of occurrence.
  • Epidemics are characterized by the rapid spread of the specific disease across a large number of people within a short period of time.

Epidemics in India

  • Many Indian citizens born at the start of the 21st century have not fully witnessed or experienced circumstances surrounding the mass outbreak of epidemics.
  • This is not to say however, that as a nation, India is completely unfamiliar with dealing with epidemics and public health crises, some with exceptional success such as:

1915-1926⁠ — Encephalitis lethargica

  • Encephalitis lethargica, also known as ‘lethargic encephalitis’ was a type of epidemic encephalitis that spread around the world between 1915 and 1926.
  • The disease was characterized by increasing languor, apathy, drowsiness and lethargy and by 1919, had spread across Europe, the US, Canada, Central America and India.
  • It was also called encephalitis A and Economo encephalitis or disease.
  • Approximately 1.5 million people are believed to have died due to this disease.

1918-1920 — Spanish flu

  • This epidemic was a viral infectious disease caused due to a deadly strain of avian influenza.
  • The spread of this virus was largely due to World War I which caused mass mobilization of troops whose travels helped spread this infectious disease.
  • In India, approximately 10-20 million people died due to the Spanish flu that was brought to the region a century ago, by Indian soldiers who were part of the war.

1961–1975 — Cholera pandemic

  • Vibrio cholerae, one type of bacterium, has caused seven cholera pandemics since 1817.
  • In 1961, the El Tor strain of the Vibrio cholerae bacterium caused the seventh cholera pandemic when it was identified as having emerged in Makassar, Indonesia.
  • In a span of less than five years, the virus spread to other parts of Southeast Asia and South Asia, having reached Bangladesh in 1963 and India in 1964.

1974 — Smallpox epidemic

  • According to WHO, smallpox was officially eradicated in 1980. The infectious disease was caused by either of the two virus variants Variola major and Variola minor.
  • Although the origins of the disease are unknown, it appears to have existed in the 3rd century BCE.
  • This disease has a history of occurring in outbreaks around the world and it is not clear when it was first observed in India. India was free of smallpox by March 1977.

1994 — Plague in Surat

  • In September 1994, pneumonic plague hit Surat, causing people to flee the city in large numbers. Rumours and misinformation led to people hoarding essential supplies and widespread panic.
  • This mass migration contributed to the spread of the disease to other parts of the country. Within weeks, reports emerged of at least 1,000 cases of patients afflicted with the disease and 50 deaths.

2002-2004 — SARS

  • SARS was the first severe and readily transmissible new disease to have emerged in the 21st century.
  • In April 2003, India recorded its first case of SARS, severe acute respiratory syndrome, that was traced to Foshan, China.
  • Similar to COVID-19, the causative agent of SARS was a type of coronavirus, named SARS CoV that was known for its frequent mutations and spread through close person-to-person contact and through coughing and sneezing by infected people.

2014-2015 — Swine flu outbreak

  • In the last few months of 2014, reports emerged of the outbreak of the H1N1 virus, one type of influenza virus, with states like Gujarat, Rajasthan, Delhi, Maharashtra and Telangana being the worst affected.
  • By March 2015, according to India’s Health Ministry, approximately 33,000 cases had been reported across the country and 2,000 people had died.

2018 — Nipah virus outbreak

  • In May 2018, a viral infection attributed to fruit bats was traced in the state of Kerala, caused by the Nipah virus that had caused illness and deaths.
  • The spread of the outbreak remained largely within the state of Kerala, due to efforts by the local government and various community leaders who worked in collaboration to prevent its spread even inside the state.
  • Between May and June 2018, at least 17 people died of Nipah virus and by June, the outbreak was declared to have been completely contained.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

What is Herd Immunity?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Herd Immunity

Mains level : Coronovirus outbreak and its mitigation


As Europe was declared the epicentre of the novel coronavirus outbreak last week, Britain announced a different strategy to tackle the situation. Officials said that Britain would contain the spread of the virus but would not suppress it completely to build up a degree of ‘herd immunity’.

Herd Immunity

  • Herd immunity is when a large number of people are vaccinated against a disease, lowering the chances of others being infected by it.
  • When a sufficient percentage of a population is vaccinated, it slows the spread of disease.
  • It is also referred to as community immunity or herd protection.
  • The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission.
  • The approach requires those exposed to the virus to build natural immunity and stop the human-to-human transmission. This will subsequently halt its spread.

Can it work?

  • Globally, this strategy has been criticized.
  • COVID-19 is a new virus to which no one has immunity. More people are susceptible to infection.
  • The goal seems to have been delaying urgent action to allow an epidemic to infect large numbers of people.
  • To combat COVID-19, there is an urgent need to implement social distancing and closure policies.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Smart-locking Indiaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Strategies to deal with the COVID-19 pandemic.


Context

Currently, India has entered Stage 2 of the COVID 19 epidemic, but can we do something urgently to halt it before Stages 3 and 4, and prevent it from becoming another China or Italy? Let’s look at what COVID 19 is doing globally and what it has already done in India.

Nature and characteristics of COVID-19

  • It belongs to a simple family of cold viruses: Coronavirus 19, which emerged from China but has now spread globally, belongs to a simple family of common cold viruses which look innocent and harmless, unlike the sinister flu.
  • Footprints of similar epidemics: It has footprints of two similar epidemics: SARS (2002) and MERS (2012) apart from Ebola, which were contained well globally in the last two decades.
  • They are the group of viruses: Coronaviruses are large groups of viruses seen in humans as well as animals like camels, bats, cats, and even cattle, which India should take note of.
    • The current COVID 19 appears to be a bat-originated beta variant of the coronavirus.
    • Who is the most vulnerable? The human COVID disease is fatal predominantly in elderly or vulnerable groups, such as people with a chronic disease like hypertension, diabetes, cancer or people with suppressed immune systems.
  • How it is spread? It is spread via airborne droplets (sneeze or cough) or contact with the surface. It is possible that a person can get COVID-19 by touching a surface or an object that has the virus on it and then touching their own nose, eyes or mouth.

Susceptibility and the measures needed to contain the spread

  • Mode of spread: The way virus spreads creates vulnerability and susceptibility of the spread of the virus through airborne droplets and contact surfaces — which are now, therefore, targets of public hygiene for preventing the spread.
  • Why India is more vulnerable? We are vulnerable due to the large population constantly travelling and working: This needs immediate containment to halt the virus spread. We are a ticking time bomb now with less than 30 days to explode in Stage 3, which will be the virus getting deeper into communities, and which will then be impossible to contain.
  • Poor public hygiene in India: Public hygiene in India is poor despite the “Swachh Bharat (Clean India)” movements. We need to have legislation with a penalty to stop spitting in public as well as private spaces.
  • Past performance: India has done very well to contain both SARS and the novel Nipah viral spread very well.

Should India shut down the cities?

  • From China to global spread: The COVID 19 virus possibly came from the Wuhan epicentre of central China. Subsequent it assumed a large enough proportion to be called a pandemic. It rapidly transitioned across different geographies of the world including Korea, Japan, Iran, Italy and others for the WHO to declare it as a pandemic.
  • Neighbouring countries shutting down the cities: neighbouring countries like Thailand and Singapore shut down their major cities and towns for a few weeks to stop it from moving onto the next stages.
  • Should India shut down the cities? The big question today is, should the Indian government and the state governments stop the virus spread from Stage 2 to 3 by totally shutting down cities and towns when the economy is already fragile and on the brink?
  • From cluster to community spread: India had its first case diagnosed on January 30, from a student who returned from China. Later, it had a very slow spread despite the global transit involved. Such individual cases will become small clusters.
    • These clusters will then spread to communities.
  • We must halt the community-wide spread: Currently, we have just moved from case to clusters, but we must halt the community-wide spread.
  • Biphasic or dual-phase infection: COVID 19 usually follows what is known as a biphasic or dual-phase infection, which means the virus persists and causes a different set of symptoms than observed in the initial bout.
    • Also, sometimes, the recovered person can relapse.
  • The possibility of “super spreader”: Currently, the cases and clusters in India are simple spreaders which means an infected person with normal infectivity.
    • What is it? But COVID 19 can also have a “super spreader”, which means an infected person with high infectivity who can infect hundreds in no time.
  • This was reportedly seen in Wuhan where a fringe group spread the virus via a place of worship in Korea, infecting almost 51 cases.
  • India saw a mini spurt of cases on March 4, and then again between March 10 and 13, when cases jumped from 23 to 35, yet no super spreader was present.
  • We need to halt transition from stage 2 to stage 3: Now we have almost crossed a hundred cases and we must be vigilant.
    • As we enter Stage 2, we will now see a geometric jump in the number of cases which will put us at risk of rapidly transitioning from Stage 2 to 3 like Italy, which we need to halt urgently.

Conclusion

The ICMR has rightly advised the government to go into partial shutdown but is it too little too late now? It’s time to halt COVID 19 by smartly locking the country at home so that we can have a better tomorrow. This needs a political will which we currently have.

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

What is a Pandemic?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Coronovirus outbreak


The World Health Organization (WHO) has declared the COVID-19 outbreak a pandemic.

What is a pandemic?

  • Simply put, a pandemic is a measure of the spread of a disease.
  • When a new disease spreads over a vast geographical area covering several countries and continents, and most people do not have immunity against it, the outbreak is termed a pandemic.
  • It implies a higher level of concern than an epidemic, which the US Centers of Disease and Control Prevention (CDC) define as the spread of a disease in a localised area or country.
  • There is no fixed number of cases or deaths that determine when an outbreak becomes a pandemic.
  • The Ebola virus, which killed thousands in West Africa, is an epidemic as it is yet to mark its presence on other continents.
  • Other outbreaks caused by coronaviruses such as MERS (2012) and SARS (2002), which spread to 27 and 26 countries respectively, were not labelled pandemics because they were eventually contained.

Which outbreaks have been declared pandemics in the past?

  • A major example is the Spanish flu outbreak of 1918, which killed between 20-50 million.
  • Cholera pandemics have been declared multiple times between 1817 and 1975.
  • In 1968, an pandemic was declared for H3N2 that caused about a million deaths.
  • The last pandemic declared by the WHO was in 2009, for H1N1.

Does the declaration change the approach to the disease?

  • Describing the situation as pandemic does not change WHO’s assessment of the risk posed by the virus. However the categorization as a pandemic can lead to more government attention.
  • The categorization by WHO indicates the risk of disease for countries to take preventive measures.
  • It will help improve funding by international organisations to combat coronavirus.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Explained: Epidemic Diseases Act, 1897Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Epidemic Diseases Act, 1897

Mains level : Epedimics and their mitiagtion strategies


Till today, at least 60 COVID-19 cases have been confirmed in India. So it was decided in a Cabinet Secretary meeting that States and UTs should invoke provisions of Section 2 of Epidemic Diseases Act, 1897, so that Health Ministry advisories are enforceable.

History of the 1897 Epidemic Diseases Act

  • The Epidemic Diseases Act is routinely enforced across the country for dealing with outbreaks of diseases such as swine flu, dengue, and cholera.
  • The colonial government introduced the Act to tackle the epidemic of bubonic plague that had spread in the erstwhile Bombay Presidency in the 1890s.
  • Using powers conferred by the Act, colonies authorities would search suspected plague cases in homes and among passengers, with forcible segregations, evacuations, and demolitions of infected places.
  • Historians have criticised the Act for its potential for abuse.
  • In 1897, the year the law was enforced, Lokmanya Tilak was punished with 18 months’ rigorous imprisonment after his newspapers Kesari and Mahratta admonished imperial authorities for their handling of the plague epidemic.

Provisions of the 1897 Epidemic Diseases Act

  • The Act is one of the shortest Acts in India, comprising just four sections. It aims to provide for the better prevention of the spread of Dangerous Epidemic Diseases.
  • The then Governor-General of colonial India had conferred special powers upon the local authorities to implement the measures necessary for the control of epidemics.
  • Although, the act does define or give a description of a “dangerous epidemic disease”.

Its various sections can be summarized as under:

  • The first section describes all the title and extent, the second part explains all the special powers given to the state government and centre to take special measures and regulations to contain the spread of disease.
  • The second section has a special subsection 2A empowers the central government to take steps to prevent the spread of an epidemic, especially allowing the government to inspect any ship arriving or leaving any post and the power to detain any person intending to sail or arriving in the country.
  • The third section describes the penalties for violating the regulations in accordance with Section 188 of the IPC. Section 3 states, “Six months’ imprisonment or 1,000 rupees fine or both could be charged out to the person who disobeys this Act.”
  • The fourth and the last section deals with legal protection to implementing officers acting under the Act.

Examples of implementation

The act has been invoked several times since independence. Few recent incidents include-

  • In 2018, the district collector of Gujarat’s Vadodara issued a notification under the Act declaring a town as cholera-affected.
  • In 2009, to tackle the swine flu outbreak in Pune, Section 2 powers were used to open screening centres in civic hospitals across the city, and swine flu was declared a notifiable disease.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Finding cure for COVID-19Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : COVID 19

Mains level : Global pandemics and their mitiagtion strategies


Scientists across the world are trying to develop a line of treatment and a possible vaccine for COVID-19. However, with the most optimistic timelines we don’t see a line of treatment or vaccine arriving before next year.

Genome sequencing of Coronavirus

  • A global effort is on to collect and analyse the genetic composition of the new virus, which would be key to developing a cure and a vaccine.
  • Genome sequence is the unique code of genetic material of any organism, and determines the characteristic of any organism.
  • Whole genome sequencing is the process of determining the complete DNA sequence of an organism’s genome at a single time.
  • The gene composition of novel coronavirus, for instance, is different from that of the influenza virus. Every organism has a unique genome sequence.
  • Laboratories in various countries have been isolating and sharing the genome sequences of the virus on an international platform.

Why are so many genome sequences being isolated?

  • When viruses multiply, or reproduce, there is a copying mechanism that transfers the gene information to the next generation.
  • However, no copying mechanism is perfect. When the virus multiplies, there will be small changes, which are called mutations.
  • These mutations accumulate over time, and after prolonged periods, are responsible for evolution into new organisms.
  • Within a single reproduction, the changes are extremely minor. More than 95 per cent of the gene structure remains the same.

How it helps scientists?

  • However, the small changes that occur are crucial to understanding the nature and behaviour of the organism.
  • In this case, for example, the small changes could provide scientists with information about the origin, transmission, and impact of the virus on the patient.
  • It could also hold clues to the differing effects the virus could have on patients with different health parameters.

How many genome sequences are required?

  • India has far fewer positive cases compared to China, South Korea, Iran, Italy, or even the US.
  • Patients who have been infected with the virus in similar conditions are unlikely to show any significant changes in the genome sequences.
  • Patients with existing medical conditions could be other candidates from where genome sequences of this virus could be isolated.
  • This could help scientists to look for clues to possible impact of virus amidst those existing medical conditions.

Currently, what is the most effective medication?

  • As of now, there is none such. Right now, drugs are being repurposed, meaning old drugs for similar diseases are being checked for their efficacy against COVID-19.
  • These drugs, if they work, will require clinical trials, and then can be made widely available for people.
  • In most cases, symptomatic treatment for fever, body ache, and cough will be sufficient. More severe cases will require oxygen and respiratory support.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

N95 maskPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : N95 Masks

Mains level : Coronovirus outbreak


In a new mandate to curb unnecessary demand, the Maharashtra Food and Drug Administration said that chemists cannot sell N95 masks without a doctor’s prescription. The FDA also warned that serious action would be taken against those who are found selling masks at high prices or hoarding them.

Why such a move?

  • Personal Protective Equipment (PPE) kits and N95 masks are being sold at very high prices in medical shops. The State has received many complaints about the same.
  • It has also been found that many are making bulk purchases and hording PPE kits and N95 masks.
  • Since the COVID-19 outbreak in China, shortage of PPE gear and masks has been reported from across the world.
  • While the Indian government has currently banned exports of N95 masks, the manufacturers are focussed on making other surgical marks to get good returns from exports.

N95 mask

  • A disposable N95 mask (respirator) is a safety device that covers the nose and mouth and helps protect the wearer from breathing in some hazardous substances.
  • An N95 respirator is designed to achieve a very close facial fit and very efficient filtration of airborne particles.
  • The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles.
  • If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Tracking the big threeop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2-Key areas India needs to focus on to achieve good health and well being.


Context

The article focuses on the top three Sustainable Development Goals (SDGs) of the United Nations, namely poverty elimination, zero hunger, and good health and well-being by 2030.

India’s record on extreme poverty, hunger and health

  • Decline in extreme poverty: The World Bank’s estimates of extreme poverty- measured as $1.9/per capita/per day at purchasing power parity of 2011- show a secular decline in India from 45.9 per cent to 13.4 per cent between 1993 and 2015.
  • Elimination of extreme poverty 2030: If the overall growth process continues as has been the case since, say, 2000 onwards, India may succeed in eliminating extreme poverty by 2030, if not earlier.
  • Zero hunger by 2030: Given the overflowing stock of food grains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90 per cent of its cost to 67 per cent of the population, there is no reason to believe that India can also not attain the goal of zero hunger before 2030.
  • Health- a real challenge: The real challenge for India, is to achieve the third goal of good health and well-being by 2030. India’s performance in this regard, so far, has not been satisfactory. as per the National Family Health Survey (NFHS 2015-16)-
    • In 2015-16, almost 38.4 per cent of India’s children under the age of five years were stunted.
    • 8 per cent were underweight.
    • 21 per cent suffered from wasting (low weight for height).
    • The situation in some states like Bihar, Jharkhand and Uttar Pradesh is even worse.
  • Global Hunger Index ranking of India: No wonder, the Global Hunger Index (GHI) ranks India at 102 out of 117 countries in terms of the severity of hunger in 2019.

What are the various targets set on the nutrition problem?

  • Target on reducing the problems of underweight children: The National Nutrition Strategy, 2017, aims to reduce the prevalence of underweight children (0-3 years) by three percentage points every year by 2022 from NFHS 2015-16 estimates.
    • Why this is an ambitious target? This is an ambitious target given the decadal decline in underweight children from 42.5 per cent in 2005-06 to 35.8 per cent in 2015-16 amounts to less than 1 per cent decline per year.
  • Targets set in National Nutrition Mission: Similar targets have been set by the National Nutrition Mission (renamed as POSHAN Abhiyaan), 2017.
    • To reduce stunting by 2 per cent.
    • Under-nutrition by 2 per cent.
    • Anaemia (among young children, women and adolescent girls) by 3 per cent.
    • Low birth weight by 2 per cent.

Four areas India needs to focus to achieve the set targets

  • India has to focus on four key areas:  If India has to make a significant dent on malnutrition by 2030.
  • First- Mother’s education.
    • Multiplier effect: It is one of the most important factors that have a positive multiplier effect on child care and access to healthcare facilities.
    • Increases awareness: It also increases awareness about the nutrient-rich diet, personal hygiene, etc. This can also help contain the family size in poor, malnourished families.
    • Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way towards tackling this problem.
  • Second- Access to improved sanitation and safe drinking water.
    • The Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.
  • Third-shift in dietary pattern
    • Shift from cereals to more nutritious food: There is a need to shift dietary patterns from cereal dominance to the consumption of nutritious foods such as livestock products, fruits and vegetables, pulses, etc.
    • But they are generally costly and their consumption increases only by higher incomes and better education.
    • Diverting the food subsidy to nutritious foods: Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.
  • Fourth- Adoption of new agricultural technology
    • Adopt bio-fortifying cereals: India must adopt new agricultural technologies of bio-fortifying cereals, such as zinc-rich rice, wheat, iron-rich pearl millet, and so on.
    • The Indian Council of Agricultural Research (ICAR) has to work closely with the Harvest Plus programme of the Consultative Group of International Agricultural Research (CGIAR) to make it a win-win situation for curtailing malnutrition in Indian children at a much faster pace — and, at a much lower cost than would be achieved under a business as usual scenario.

Examples from the world

  • Right public policies make the difference: Global experience shows that with the right public policies focusing on agriculture, improved sanitation, and women’s education, one can have much better health and well-being for its citizens, especially children.
  • China’s example: In China, it was agriculture and economic growth that significantly reduced the rates of stunting and wasting among the population and lifted millions of people out of hunger, poverty and malnutrition.
  • Brazil and Ethiopia example: According to FAO, Brazil and Ethiopia have transformed their food systems: They have targeted their investments in agricultural R&D and social protection programmes to reduce hunger in the country.

Conclusion

Despite India’s improvement in child nutrition rates since 2005-06, it is way behind the progress experienced by China and many other countries. According to the Global Nutrition Report, 2016, at the present rates of decline, India will achieve the current stunting rates of China by 2055. India can certainly do better, but only if it focuses on this issue.

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

State lethargy amidst cough syrup poisoningop-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Need of the policy and standard guidelines for the drug recall.


Context

A few days ago, 12 children died in Udhampur district of Jammu due to poisoned cough syrup (Coldbest-PC).

Fourth mass glycol poisoning

  • What was the cause of the poisoning? A team of doctors at the Post Graduate Institute of Medical Education & Research, Chandigarh, attributed the deaths to the presence of diethylene glycol in the cough syrup.
  • What is Diethylene glycol? It is an anti-freezing agent that causes acute renal failure in the human body followed by paralysis, breathing difficulties and ultimately death.
  • This is the fourth mass glycol poisoning event in India that has been caused due to a pharmaceutical drug.

Measures required and example from the US

  • Preventing further deaths: The immediate concern for doctors, pharmacists and the drug regulators should be to prevent any more deaths.
    • The only way to do so is to account for each and every bottle of the poisoned syrup that has ever been sold in the Indian market and stop patients from consuming this drug any further.
  • The US example in such case: United States Food and Drug Administration (USFDA), in 1937, when the United States faced a similar situation with glycol poisoning.
    • Tracking down every bottle: Entire field force of inspectors and chemists were assigned to the task of tracking down every single bottle of the drug.
    • Even if a patient claimed to have thrown out the bottle, the investigators scoured the street until they found the discarded bottle.
    • This effort was accompanied by a publicity blitz over radio and television.
  • What is being done in India? We do not see such public health measures being undertaken here.
    • Seriousness not communicated to the pubic: Authorities are simply not communicating the seriousness of the issue to the general public.
    • A general statement: At most, the authorities in Himachal Pradesh (H.P.), who are responsible for oversight of the manufacturer of this syrup, have made general statements that they have ordered the withdrawal of the drug from all the other States where it was marketed.
    • Lack of transparency: There is no transparency in the recall process and information about recalls and batch numbers is not being communicated through authoritative channels.
    • No public announcement by the DCGI: There is no public announcement by the Drug Controller General of India (DCGI), which is responsible for overall regulation of the entire Indian market.
    • The suspect product, although manufactured in H.P., has been sold across the country.
    • The website of the DCGI, which is supposed to communicate drug alerts and product recalls, has no mention of Coldbest-PC as being dangerous as of this writing.

Need for the recall policy

  • No rules or binding guidelines on recall: One of the key reasons why the DCGI and state drug authorities have been so sloppy is because unlike other countries, India has not notified any binding guidelines or rules on recalling dangerous drugs from the market.
  • Warnings to the DGCI on lack of framework: The 59th report of the Parliamentary Standing Committee on Health as well as the World Health Organization (in its national regulatory assessment) had warned the DCGI on the lack of a national recall framework in India.
    • A set of recall guidelines was drafted in 2012 but never notified into law.

Conclusion

The drug regulator needs to take the urgent steps to avoid the repeat of such tragedies in the future and formulate a policy on the drug recall at the earliest.

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

[pib] ICoSDiTAUS-2020PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ICoSDiTAUS-2020

Mains level : NA


ICoSDiTAUS-2020 a two-day International Conference on Standardisation of Diagnosis and Terminologies in Ayurveda, Unani and Siddha Systems of Medicine was concluded in New Delhi.

ICoSDiTAUS-2020

  • The conference was jointly organized by the Ministry of AYUSH and the WHO at New Delhi
  • It adopted the “New Delhi Declaration on Collection and Classification of Traditional Medicine (TM) Diagnostic Data”.
  • The New Delhi declaration emphasised the commitment of the countries to Traditional Medicine (TM) as a significant area of health care.
  • It further sought the opportunity for including traditional systems of medicine like Ayurveda, Unani and Siddha in the International Classification of Diseases (ICD) of WHO which is the standard diagnostic tool for health management across the world.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Gearing up to fight the next big viral outbreakop-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Preparing healthcare system for viral outbreaks.


Context

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

No country is adequately prepared

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

Four-point health agenda

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

Thailand’s outstanding example

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

India’s record in past outbreaks

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

Conducting stress tests on health system

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

The partnership between countries and with the private sector

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

Investment in health, education

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

The relation between environmental degradation and health

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

Conclusion

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

 

 

 

 

 

 

 

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

Spontaneous RegressionPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Spontaneous healing/regression

Mains level : Not Much


Patients sometimes make ‘miraculous’ recoveries from severe ailments. This is called spontaneous healing or spontaneous regression.

Spontaneous healing/regression

  • A patient improves unexpectedly from a disease that usually progresses, such as cancer, and at times is even cured.
  • Such cases notwithstanding, the medical fraternity is often sceptical and takes “miraculous” recoveries as flukes.
  • A research explores patterns behind healing illnesses such as the deadliest kinds of cancers, and lays out physical and mental principles associated with recovery.
  • These include physically healing diets and immune systems, and mentally healing stress responses and identities.

How does it occur?

  • The research states that much of our physical reality is created in our minds and perception changes our experiences, sometimes to the point of changing our bodies.
  • Therefore it argues that healing our identities may be a key tool to recovery.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Powering the health-care engine with innovationop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Adoption of innovation in improving the healthcare system in India.


Context

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

Expanding the supply side

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

Transformative solutions

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

Challenges in mainstreaming healthcare innovations

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

Way forward

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

Conclusion

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

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

Explained: One Health ConceptExplained

Note4Students

From UPSC perspective, the following things are important :

Prelims level : One Health Concept

Mains level : Strategies to curb rising incidences of zoonotic diseases


 

The concept of ‘One Health’ is gaining importance as most of the contagious diseases affecting humans are zoonotic (animal to man origin) in nature. It can be effectively implemented for reducing incidence of emerging zoonotic threats like COVID-19.

The One Health concept

  • The World Organization of Animal Health, commonly known as OIE (an abbreviation of its French title), summarizes the One Health concept.
  • It says that as “human health and animal health are interdependent and bound to the health of the ecosystems in which they exist”.
  • Circa 400 BC, Hippocrates in his treatise On Airs, Waters and Places had urged physicians that all aspects of patients’ lives need to be considered including their environment; disease was a result of imbalance between man and environment.
  • So One Health is not a new concept, though it is of late that it has been formalized in health governance systems.

Why accept this model?

  • Of the contagious diseases affecting humans, more than 65% are of zoonotic or animal to man origin.
  • One Health model is a globally accepted model for research on epidemiology, diagnosis and control of zoonotic diseases.
  • One Health model facilitates interdisciplinary approach in disease control so as to control emerging and existing zoonotic threats.
  • Increasing stress on animals due to loss of their habitat would increase scope of zoonotic diseases.

Why corona is so deadly?

  • Current outbreak of COVID-19 still could not find out the actual source of virus.
  • Even though genomics of the virus has been published ambiguity still exists whether it was from bats, snakes, pangolin, etc.

Frequent Outbreaks of Zoonotic Diseases

  • Not so long ago, the widespread prevalence of avian influenza in poultry, or bird flu as it commonly became known, created nationwide panic resulting in the culling of millions of poultry birds.
  • It was concern for human health that prompted the extreme reaction and subsequent establishment of protocols; containment of avian influenza is managed quite effectively now.
  • Similarly in 2003, SARS or Severe Acute Respiratory Syndrome emanated suddenly in China and vanished soon.

Followed by hues and panic

  • These outbreaks culminated emergency response that included extreme measures like travel bans and restrictions.
  • In both cases, panic spread much faster than the virus.
  • Besides drawing a response from governments, these events also brought forth the hitherto forgotten philosophy of One Health.
  • This idea recognizes inter-connectivity among human health, the health of animals, and the environment.

Why rise in zoonotic outbreaks?

  • As human populations expand, it results in greater contact with domestic and wild animals, providing more opportunities for diseases to pass from one to the other.
  • Climate change, deforestation and intensive farming further disrupt environment characteristics, while increased trade and travel result in closer and more frequent interaction, thus increasing the possibility of transmission of diseases.

Need for a robust animal health system

  • Private sector presence in veterinary services is close to being nonexistent.
  • Unlike a physician, a veterinarian is always on a house call on account of the logistic challenge of transporting livestock to the hospital, unless they are domestic pets.
  • There could not be a stronger case for reinventing the entire animal husbandry sector to be able to reach every livestock farmer, not only for disease treatment but for prevention and surveillance to minimize the threat to human health.
  • Early detection at animal source can prevent disease transmission to humans and introduction of pathogens into the food chain. So a robust animal health system is the first and a crucial step in human health.

Conclusion

  • Developing countries like India have a much greater stake in strong One Health systems on account of agricultural systems resulting in uncomfortably close proximity of animals and humans.
  • This builds a strong case for strengthening veterinary institutions and services.
  • Further delay may pave way for emergence of new communicable diseases.

Way Forward

  • The most effective and economical approach is to control zoonotic pathogens at their animal source.
  • It calls not only for close collaboration at local, regional and global levels among veterinary, health and environmental governance, but also for greater investment in animal health infrastructure.
  • Need of the hour is to scale up such a model across the country and to establish meaningful research collaborations across the world.
  • Health, veterinary, agriculture and life science research institutions and universities can play a lead role.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Novel Coronavirus renamed as COVID-19 by WHOPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Coronavirus, Pneumonia

Mains level : Threats posed by coronavirus outbreak


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

COVID-19

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

WHO nomenclature

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

Terms to avoid

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

Terms to include

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

A mix Indian health care can do withoutop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Will allowing participation of private sector in the public healthcare system beneficial for India?


Context

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

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

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

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

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

Conclusion

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

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

Why emergency response units are needed to ensure safety of sanitation workersPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Read the attached story

Mains level : Upliftment of the manual scavengers


  • The Maharashtra government has directed all civic bodies in the state to set up Emergency Response Sanitation Units (ERSUs) to ensure safeguards for sanitation workers who clean manholes and sewers.
  • This move is in response to the multiple cases which were reported of workers dying from suffocation or inhalation of hazardous gases.

PEMSR ACT, 2013

  • The Prohibition of Employment as Manual Scavengers and their Rehabilitation (PEMSR) Act came into force in 2013.
  • The law prohibits employing manual scavengers, manual cleaning of sewers and septic tanks without protective equipment and construction of insanitary latrines.
  • Those violating the law and getting sewers and septic tanks cleaned without protective equipment can face imprisonment of up to two years or a fine of up to Rs 2 lakh, or both.
  • Repeat offenders will face imprisonment of up to five years or a fine of up to Rs 5 lakh, or both.

The Supreme Court judgment

  • While hearing a case on manual scavenging in 2014, the Supreme Court had stated, “If the practice of manual scavenging has to be brought to an end, and also to prevent future generations from the inhuman practice… rehabilitation of manual scavengers will need to include steps to avoid sewer deaths.”
  • The court had said that making a sanitation worker enter sewer lines without safety gear should be a crime even in emergency situations.
  • In such instances, if a sanitation worker died due to the unsafe conditions, a compensation of Rs 10 lakh has to be given to the family of the deceased, stated the court.
  • The court had also directed authorities to identify the family members of sanitation workers who died while cleaning manholes and septic tanks since 1993, and give a compensation of Rs 10 lakh to them.

Directives by National Commission for Scheduled Castes

  • To ensure effective implementation of the law banning manual scavenging, the commission issued various directives.
  • It said workers have to be fully equipped with safety apparatus and oxygen masks in case they have to clean sewers manually.
  • A first information report has to be lodged against officials or contractors responsible for sending a worker to clean sewers manually, without proper gear.
  • The commission also made it mandatory for all municipal corporations to get an insurance policy of Rs 10 lakh per worker, as per the Supreme Court’s directions.
  • The employers, in this case the civic bodies, will have to pay the policy premium.

Emergency Response Sanitation Unit (ERSU)

  • In its directive on the setting up of ERSUs, the state government said the municipal commissioner of the civic body concerned will be the Responsible Sanitation Authority (RSA).
  • The ERSU should be headed by a senior civic officer and other civic officers should be on the ERSU advisory board to decide the standard operating procedure (SoP) for workers who enter manholes for cleaning purposes.
  • The civic body will also have to set up a dedicated toll-free number for the ERSU. The unit will impart training to sanitation workers.
  • Only workers trained and certified by an ERSU will be able to clean sewers, but the priority will be on using machines to get such work done.
  • In case a worker dies while cleaning a sewer, the civic body will have to hold an inquiry and register a police complaint.

Workshop on creating awareness on the issue

  • All civic bodies have been asked to hold workshops to raise awareness on this issue in their respective jurisdictions.
  • The workshops are going to focus on latest technology for cleaning sewers and septic tanks, and the final objective is to find a way to clean septic tanks or manholes with machines.
  • The workshops will have sessions on laws pertaining to sanitation workers, the establishment of ERSUs and their roles, presentations on the latest equipment, machines and protective gear.
  • Sanitation workers, NGOs, social organisations, housing society members and government officials have to participate in the workshops.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Remdesivir: Under-trail vaccine against CoronavirusPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Remdesivir

Mains level : Coronovirus outbreak


The Wuhan Institute of Virology at Wuhan, China has filed for a patent on Remdesivir, an antiviral experimental drug from the US which may help treat the novel coronavirus (nCoV-2019).

Remdesivir

  • It is an experimental drug and has not yet been licensed or approved anywhere globally. It has not been demonstrated to be safe or effective for any use.
  • It is currently being developed for the treatment of Ebola virus infection.
  • Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
  • Chloroquine is a “widely used” anti-malarial and autoimmune disease medicine that has recently come to light as a potential antiviral drug.

Can Remdesivir treat coronavirus?

  • Significantly, Remdesivir has demonstrated in vivo (experimentation using a whole living organism) and in vitro (activity performed in a controlled environment) activity in animal models against viral pathogens that cause MERS and SARS.
  • Even so, the use of the experimental drug has been allowed only as an emergency treatment, which can be administered in the absence of any other approved treatment options.
  • These two diseases are also caused by coronaviruses structurally similar to the nCoV-2019.
  • Additionally, limited clinical data is available from the emergency administration of Remdesivir in patients with Ebola.
  • Even so, it is yet to be seen if Remdesivir and chloroquine can be effective against the novel coronavirus in humans.

How can the novel coronavirus infection be treated?

  • As of now, there is no known treatment for the novel coronavirus, and an appropriate antiviral drug is required for this.
  • Ideally, a vaccine against the infection can also prove to be effective, but such a development does not seem to be in the offing for at least three-four months.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Euthermia: the anomaly of human body temperaturePrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Euthermia

Mains level : Not Much


 

Euthermia refers to normal body temperature. The thermometer reading of 98.6°F has been a gold standard for a century and a half, ever since a German doctor laid it down as the “normal” body temperature.  A new research has found that body temperatures have, in fact, been declining over the last two centuries.

Why we follow 98.6°F?

  • In 1851, Carl Reinhold August Wunderlich pioneered the use of the clinical thermometer.
  • It was a rod a foot long, which he would stick under the armpits of patients at the hospital attached with Leipzig University, and then wait for 15 minutes (some accounts say 20 minutes) for the temperature to register.
  • He took over a million measurements of 25,000 patients, and published his findings in a book in 1868, in which he concluded that the average human body temperature is 98.6°F.
  • Most modern scientists feel Wunderlich’s experiments were flawed, and his equipment inaccurate.
  • Another study concluded that the average human body temperature is closer to 98.2°F, and suggested that the 98.6°F benchmark be discarded.

The body is cooler

  • The Stanford University the researchers confirmed some known trends — body temperature is higher in younger people, in women, in larger bodies and at later times of the day.
  • Additionally, they found that the bodies of men born in the early to mid-1990s is on average 1.06°F cooler than those of men born in the early 1800s.
  • And the body temperature of women born in the early to mid-1990s is on average 0.58°F lower than that of women born in the 1890s.
  • The calculations from the research correspond to a decrease in body temperature of 0.05°F every decade.

Why there’s decrease in body temperature?

  • The researchers have proposed that the decrease in body temperature is the result of changes in the environment over the past 200 years, which have in turn driven physiological changes.
  • The decrease in average body temperature in the US, they said, could be explained by a reduction in metabolic rate, or the amount of energy being used.
  • The environment that we’re living in has changed, including the temperature in our homes, our contact with microorganisms and the food that we have access to.
  • Actually the human body is changing physiologically.

So what’s the normal temperature?

  • The strong influences of age, time of day, and genders determine the healthy body temperature.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Global Report on Medical Data LeakIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level :  Global Report on Medical Data Leak

Mains level : Medical administartion in India and its loopholes


 

Medical details of over 120 million Indian patients have been leaked and made freely available on the Internet, according to a recent report.

 Global Report on Medical Data Leak

  • It is published by Greenbone Sustainable Resilience, a German cybersecurity firm.
  • The first report was published in October 2019 in which Greenbone revealed a widespread data leak of a massive number of records, including images of CT scans, X-rays, MRIs and even pictures of the patients.
  • The follow-up report, which was published, classifies countries in the “good”, “bad” and “ugly” categories based on the action taken by their governments after the first report was made public.
  • India ranks second in the “ugly” category, after the U.S.

Highlights of the report

  • As per the follow-up report, Maharashtra ranks the highest in terms of the number of data troves available online, with 3,08,451 troves offering access to 6,97,89,685 images.
  • The next is Karnataka, with 1,82,865 data troves giving access to 1,37,31,001 images.
  • The number of data troves containing this sensitive data went up by a significant number in the Indian context a month after the initial report was published.
  • It is a notable fact for the systems located in India, that almost 100% of the studies (data troves) allow full access to related images stated the report.

What led to the leaks?

  • Greenbone’s original report says the leak was facilitated by the fact that the Picture Archiving and Communications Systems (PACS) servers, where these details are stored.
  • These servers are not secure and linked to the public Internet without any protection, making them easily accessible to malicious elements.

Impact of leaks

  • The leak is worrying because the affected patients can include anyone from the common working man to politicians and celebrities.
  • In image-driven fields like politics or entertainment, knowledge about certain ailments faced by people from these fields could deal a huge blow to their image.
  • The other concern is of fake identities being created using the details, which can be misused in any possible number of ways.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed of the day] A sneeze, a global cold and testing times for Chinaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Dealing with outbreaks of infectious disease.


Context

The World Health Organization (WHO) has declared the coronavirus outbreak a global emergency, as the outbreak continues to spread outside China.

Coronavirus outbreak and Chinese response

  • What is coronavirus? Normally, coronavirus is a large family of viruses that are often the source of respiratory infections, including the common cold.
    • A small number of common infecting virus: Most of the viruses are common among animals and only a small number of them infect humans.
    • Mutation of animal base virus: Sometimes, an animal-based coronavirus mutates and successfully finds a human host.
  • Dangers of rapid urbanisation: Rapid urbanisation that forces animals and humans into closer proximity (as in the “wet market” in Wuhan) creates a perfect petri dish from where such zoonotic outbreaks can originate.

Concern for India

  • Reported case in Nepal and cause of concern for India: For India, the most critical is cases being reported in Nepal since India and Nepal share an open border though so far.
  • All tests undertaken in India have been negative.
  • A tweet by the Ministry of Health and Family Welfare on January 30 said that one positive case of a novel coronavirus patient

Understanding the new virus

  • The possible mode of transmission: According to the World Health Organization, during previous outbreaks due to other coronavirus, human-to-human transmission occurred through droplets, contact and fomites (objects or materials which are likely to carry infection, such as clothes, utensils, and furniture).
  • This suggests that the transmission mode of the 2019-nCoV can be identical.
  • The transmission even in incubation period: More significant is the new understanding that the virus is contagious even during incubation, that is even before a patient exhibits any symptoms.
    • This characteristic amplifies

Experience from the past outbreaks

  • Comparison with SARS: Comparisons are being drawn the Severe Acute Respiratory Syndrome) outbreak in 2002-03.
    • Zoonotic case: SARS is also a zoonotic case, part of the coronavirus family with clues pointing to horseshoe bats in China as the likely source.
    • Late reporting by China in SARS:
    • The first incidents were reported in Guangdong province in November 2002 but WHO was officially informed only after three months.
  • Different response this time: Comparison with SARS: Comparisons are being drawn the Severe Acute Respiratory Syndrome) outbreak in 2002-03.
    • Zoonotic case: SARS is also a zoonotic case, part of the coronavirus family with clues pointing to horseshoe bats in China as the likely source.
    • Late reporting by China in SARS: The first incidents were reported in Guangdong province in November 2002 but WHO was officially informed only after three months.
    • Different response this time: This time around, the Chinese government has been more open but the question being asked is whether it has been open enough?
    • The difference in time to develop vaccine: For SARS, it took 20 months from the genome sequencing to the first human vaccine trials; for the 2019-nCoV, authorities in the U.S. are working on a deadline of 90 days.

Lessons from Kerala in Nipah outbreak

  • Managing an outbreak with few casualties: Kerala managed to curtail the Nipah outbreak with few casualties.
    • Nipah is also zoonotic and made the jump from fruit bats to humans.
    • Though there were 17 deaths in India, effective quarantine measures by local authorities prevented the spread.
  • Infectious disease on the rise: Infectious diseases including those of the zoonotic variety are on the rise in India.
    • In addition, regions in India suffer from seasonal outbreaks of dengue, malaria and influenza strains.
    • The nation-wide disease surveillance programme needs to be strengthened.

Conclusion

India should brace itself for the possible outbreak of infectious diseases and frame policies to deal with such outbreaks in fast and effective ways.

 

 

 

 

 

 

 

 

 

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

Public Health Emergency of International Concern (PHEIC)IOCRPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PHEIC

Mains level : Global health emergencies


 

The World Health Organization (WHO) has declared the novel Coronavirus infection a Public Health Emergency of International Concern (PHEIC). In the past decade, WHO has declared public health emergencies for outbreaks including swine flu, polio and Ebola.

What is PHEIC?

Definition: Under the International Health Regulations (IHR), a public health emergency is defined as “an extraordinary event which is determined, as provided in these Regulations: to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”.

What criteria does the WHO follow to declare PHEIC?

  • PHEIC is declared in the event of some “serious public health events” that may endanger international public health.
  • The responsibility of declaring an event as an emergency lies with the Director-General of the WHO and requires the convening of a committee of members.

Implications of a PHEIC being declared

  • There are some implications of declaring a PHEIC for the host country, which in the case of the coronavirus is China.
  • Declaring a PHEIC may lead to restrictions on travel and trade.
  • However, several countries have already issued advisories to their citizens to avoid travelling to China, while others are airlifting their citizens from it.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Why China has emerged as the epicentre of global outbreaks of disease?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Zoonotic diseases

Mains level : Threats posed by coronavirus outbreak


Several deadly new viruses in recent years have emerged in China — Severe Acute Respiratory Syndrome (SARS), bird flu, and now the novel Coronavirus (nCOV).

Zoonotic infections

  • Closely packed stalls in busy marketplaces, the Chinese taste for exotic meats, and the high population density of cities create the conditions for the spread of zoonotic infections.
  • The reason could lie in the busy food markets dotting cities across the country — where fruits, vegetables, hairy crabs and butchered meat are often sold next to bamboo rats, snakes, turtles, and palm civets.
  • The relationship between zoonotic pathogens and global pandemics are not new.
  • The WHO estimates that globally, about a billion cases of illness and millions of deaths occur every year from zoonoses, i.e, diseases and infections naturally transmitted between people and vertebrate animals.
  • Some 60% of emerging infectious diseases globally are zoonoses. Of the over 30 new human pathogens detected over the last three decades, 75% originated in animals.

Major cause: Animal markets

  • In animal markets, there are greater chances of transmission of a virus from animals to humans, and its mutation to adapt to the human body.
  • It has happened wherever in the world there is unregulated mixing of humans and animals, either wild or domesticated.
  • The official referred to the Ebola outbreak in Africa there it was wild chimpanzees who had the disease. It came into humans after these were killed and consumed.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Corona Virus (Wuhan Virus)Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Coronavirus, Pneumonia

Mains level : Underlying threats and India's preparedness against the virus


 

Chinese scientists have confirmed can spread between human beings.

Corona Virus

  • Corona viruses are large family of viruses, which cause illnesses to people and also circulate in animals including camels, cats and bats.
  • They cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome.
  • 2019-nCoV is a new strain that has not been previously identified in humans.
  • Much remains to be understood about the new coronavirus, which was first identified in China earlier this month.
  • Not enough is known about 2019-nCoV to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown.

Why is it called the Wuhan Virus?

  • The first cases emerged in Wuhan in central China’s Hubei province.
  • On December 31 last year, authorities confirmed that a large number of patients with unexplained pneumonia were admitted in hospitals in the city.

Symptoms of infection

  • According to the WHO, common signs include fever, cough, and shortness of breath. Serious infections can lead to pneumonia, kidney failure, and death.
  • Although human-to-human transmission has now been confirmed, the WHO says animals are the outbreak’s likely primary source. It is not known yet which animals are responsible.
  • To prevent the spread of all respiratory infections, the WHO in general asks people to cover their mouths and noses when coughing or sneezing, and to frequently wash their hands.
  • Direct contact with farm or wild animals should be avoided — similar outbreaks in the past, like the Severe Acute Respiratory Syndrome (SARS) emerged from markets where people were in contact with live animals.

Why is there concern around the world?

  • People see a similarity with the SARS outbreak that infected over 8,000 people and killed around 775 in more than 35 countries worldwide in 2002-03.
  • SARS too, was caused by a mystery coronavirus, and started in China.
  • The source of the virus remained unknown for 15 years, until Chinese scientists in 2017 traced it back to a colony of horseshoe bats living in remote cave in Yunnan province.
  • The virus was carried by civet cats which are sold in markets in China.
  • Fears that SARS could reappear and memories of China misleading the rest of the world on the extent and seriousness of the outbreak have not gone away.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed of the day] Equity’s weak pulse and commodified medicineop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Lack of coverage of the public health system, Role of private sector and regulation.


Context

As the government tries to overhaul the public health system in India, its time to take into account the advent and the role played by the private sector and its implications.

The advent of the private sector

  • Increase in the role of the private sector in the post-Independence era: Post-Independence, the private sector increased its footprint in India.
    • Perpetual sub-optimal investments in public health allowed the private sector to capitalise, flourish, and increasingly gain the confidence of the masses.
    • The private sector went from having about 1,400 enterprises in 1950 to more than 10 lakh in 2010-11.
    • To doctors, this promised greater professional liberty, lesser restrictions, and higher incomes.
    • After liberalisation, the greater focus shifted to the lucrative tertiary-care sector and led to an onslaught of sophisticated private health care in cities.

The dominance of the private sector and malpractices

  • The scale of dominance: Private sector has over 70% of the health-care workforce and 80% of allopathic doctors, has meant that it is scarcely possible for a health-care provider to function in defiance of its norms.
    • Pervasive malpractices: The pervasiveness of malpractices in this market has come to ensure that few could survive without condoning them.
    • Nexus of the private players: Players in this market, in much of their malpractices, have also learnt to function as a harmonious family.
    • Organised form to safeguard interest: The family plays its role in safeguarding its members, acquainting them with its norms and interests, and leveraging the power of its patriarchs to defend its interests in society.
    • Standards of success dictated by the markets: It is little wonder that the market has also come to dictate the avenues of aggrandisement and yardsticks of professional success for health-care professionals.
    • Benchmark of quality changed: Business finesse and social adroitness rather than clinical excellence and empathy become the touchstones of calibre in this market.

Failure of the government

  • Absence of national system: The larger chunk of Indian health care (and health workforce) could not be brought under a “national system” having some form of overarching state control or involvement.
    • If such a system existed it could avail of essential health care without most people having to rely on a vagarious market, except as a luxury.
    • Example of the UK’s NHS: The National Health Service of the United Kingdom, remains the single largest health-care provider.
    • NHS employs nearly the entire health-care workforce.
    • NHS makes essential health care available to all practically free at the point of service.
  • Consequences of the absence of such system: The absence ensures is that the profit-driven private sector, the minor component, caters mainly to the affluent lot as largely a matter of deliberate choice rather than desperate compulsion.
    • Hopes of benefits of free-market belied: The Indian example, much like the United States’, bespeaks the failure of the idea that a free market will compel players to be more efficient.
    • The exploitation of the loops by the private players: Rather than increasing efficiency, the players have found it expedient to scrupulously exploit the prevailing cracks in the system and employ devious methods in order to maximise profits.

Conclusion

  • Health-care providers, just like others, are moulded by their social surroundings. When necessary controls are loosened, the connatural vices are let loose; when the habitat is conducive to values, the right traits develop.
  • A system that starts off with health care as an overt tradable commodity it threatens the development of virtues in the system.
  • On the other hand, a system founded on the concept of equity cultivates a totally different culture of patient care.

 

 

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

[pib] Novel Corona Virus (nCoV)PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : nCoV

Mains level : Not Much


The Union Ministry of Health and Family Welfare has been closely monitoring the situation after the reports of 41 confirmed cases of novel Corona virus (nCoV) including one death from Wuhan, China, 2020.

About Novel Corona Virus

  • Corona viruses are large family of viruses, which cause illnesses to people and also circulate in animals including camels, cats and bats.
  • They cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome.
  • 2019-nCoV is a new strain that has not been previously identified in humans.
  • Much remains to be understood about the new coronavirus, which was first identified in China earlier this month.
  • Not enough is known about 2019-nCoV to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Yada Yada VirusPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Yada Yada

Mains level : NA


A new virus detected in Australian mosquitoes has been provisionally named the Yada Yada virus (YYV).

Yada Yada

  • It is an alphavirus, a group of viruses that the researchers described as small, single-stranded positive-sense RNA viruses.
  • It includes species important to human and animal health, such as Chikungunya virus and Eastern equine encephalitis virus.
  • They are transmitted primarily by mosquitoes and (are) pathogenic in their vertebrate hosts.
  • Unlike some other alphaviruses, Yada Yada does not pose a threat to human beings.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Policy for the treatment of 450 ‘Rare Diseases’Govt. SchemesPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Rare Diseases

Mains level : Highlights of the saif policy for ‘Rare Diseases’


The Union Ministry of Health and Family Welfare has published a national policy for the treatment of 450 ‘rare diseases’.

About the Policy

  • The Centre first prepared such a policy in 2017 and appointed a committee in 2018 to review it.
  • It was created on the direction of the Delhi High Court to the Ministry of Health and Family Welfare.
  • This was in response to writ petitions for free treatment of such diseases, due to their “prohibitively” high cost of treatment.
  • Hence, a policy was deemed necessary to devise a “multipronged” and “multisectoral” approach to build India’s capacity for tackling such ailments.

Why need such a policy?

  • As per the policy, out of all rare diseases in the world, less than five per cent have therapies available to treat them.
  • In India, roughly 450 rare diseases have been recorded from tertiary hospitals, of which the most common are Haemophilia, Thalassemia, Sickle-cell anemia, auto-immune diseases, Gaucher’s disease, and cystic fibrosis.

Features of the policy

  • While the policy has not yet put down a detailed roadmap of how rare diseases will be treated.
  • It has mentioned some measures, which include creating a patient registry for rare diseases, arriving at a definition for rare diseases that is suited to India, taking legal and other measures to control the prices of their drugs etc.
  • It intends to kickstart a registry of rare diseases, which will be maintained by the Indian Council of Medical Research (ICMR).
  • Under the policy, there are three categories of rare diseases — requiring one-time curative treatment, diseases that require long-term treatment but where the cost is low, and those needing long-term treatments with high cost.
  • Some of the diseases in the first category include osteopetrosis and immune deficiency disorders, among others.
  • As per the policy, the assistance of Rs 15 lakh will be provided to patients suffering from rare diseases that require a one-time curative treatment under the Rashtriya Arogya Nidhi scheme.
  • The treatment will be limited to the beneficiaries of Pradhan Mantri Jan Arogya Yojana.

What are rare diseases?

  • Broadly, a ‘rare disease’ is defined as a health condition of low prevalence that affects a small number of people when compared with other prevalent diseases in the general population. Many cases of rare diseases may be serious, chronic and life-threatening.
  • While a majority of rare diseases are believed to be genetic, many — such as some rare cancers and some autoimmune diseases — are not inherited, as per the NIH.
  • According to the policy, rare diseases include genetic diseases, rare cancers, infectious tropical diseases, and degenerative diseases.

Definition

  • India does not have a definition of rare diseases because there is a lack of epidemiological data on its incidence and prevalence.
  • While there is no universally accepted definition of rare diseases, countries typically arrive at their own descriptions, taking into consideration disease prevalence, its severity and the existence of alternative therapeutic options.
  • In the US, for instance, a rare disease is defined as a condition that affects fewer than 200,000 people.
  • The same definition is used by the National Organisation for Rare Disorders (NORD) in India.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO prequalifies Serum’s low-cost Pneumococcal VaccineIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Pneumococcal Vaccine

Mains level : Not Much


Pneumococcal vaccine developed by the Pune-based Serum Institute of India has been pre-qualified by the World Health Organisation (WHO).

Pneumococcal Vaccine

  • Pneumococcal vaccination is a method of preventing a specific type of lung infection (pneumonia) that is caused by the pneumococcus (Streptococcus pneumonia) bacterium.
  • There are more than 80 different types of pneumococcus bacteria – 23 of them covered by the vaccine.
  • The vaccine is injected into the body to stimulate the normal immune system to produce antibodies that are directed against pneumococcus bacteria.
  • This method of stimulating the normal immune system to be directed against a specific microbe is called immunization.
  • It does not protect against pneumonia caused by microbes other than pneumococcus bacteria, nor does it protect against pneumococcal bacterial strains not included in the vaccine.

About the Vaccine

  • The pneumococcal vaccine PNEUMOSIL is a conjugate vaccine to help produce stronger immune response to a weak antigen.
  • Serum Institute had optimized an efficient conjugate vaccine manufacturing processes for its meningitis A vaccine (MenAfriVac).
  • It was used for manufacturing the pneumococcal vaccine. This helped the company reduce the manufacturing cost of pneumococcal vaccine.

Why?

  • It pneumonia caused 1,27,000 deaths in India in 2018, the second highest number of child mortality under the age of five in the world.
  • In India, pneumonia and diarrhoea cause the most deaths in children under five years.
  • In 2017, pneumococcal conjugate vaccine was included in the under India’s Universal Immunisation Programme (UIP).
  • It has been introduced in a phased manner starting with Himachal Pradesh, parts of Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan.
  • The efficacy of the Serum vaccine was tested against an already approved pneumococcal vaccine (Synflorix).
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Horror in Kotaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2-Issues relating to development and management of Social sector/services relating to health,education, Human resources.


Context

Death of 100 children in the month of December at a Government Hospital in Kota highlights the state of the public health system in India.

Public health as a political agenda

  • After the incident of a large number of children in such a short span, Rajasthan CM appealed not to politicise the issue.
  • But it is high time the issue is in fact politicised.
  • The issue of public health needs to be pushed at the top of the political agenda.
  • Citizens must hold political parties accountable for the state of healthcare in the country.

Poor infrastructure

  • Until the number of deaths crosses a certain threshold the poor state of infrastructure fails to attract the attention of the authorities.
  • This hospital came to light like Gorakhpur Medical college where scores of children had died only after media reports of 963 child deaths.

Conclusion

Every single death in a hospital ought to be seen as a failure that needs to be addressed urgently. For that, the government needs to make public health a priority.

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

2020 as the “Year of the Nurse and Midwife”Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO

Mains level : Role of nurses and midwives , ASHA


The World Health Organisation (WHO) has selected year 2020 as the international “Year of the Nurse and Midwife”.

Year of the Nurse and Midwife

  • It was decided in the honor of 200th birthday of Florence Nightingale.
  • WHO said that nurses and midwives are the people who devote their lives to caring for children and mothers, looking after senior citizens and giving lifesaving immunizations.
  • The declaration will help to strengthen nursing and midwifery for Universal Health Coverage.
  • The declaration will also help to endorse “The NursingNow!” a three-year campaign (2018-2020) to improve health globally by raising the status of nursing.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] For a personal healing touchop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Personalised Health care - importance of family physician


Context

As the Mayo brothers’ initially modest set-up (Mayo Clinic) prolifically expanded into the ‘multispecialty group practice’ in the U.S., concerns that such arrangements would be bereft of the personal touch in patient care were raised.

Organised structures

  • This continued through the evolution of more and more organised structures like Health Maintenance Organisations (HMOs).
  • They were criticised for turning healthcare into a marketable commodity sold by healthcare providers in supermarket-like institutions.
  • U.S. healthcare ended up as one of the most impersonal healthcare systems.

Problematic proposition

  • The NITI Aayog’s 15-year plan for Indian healthcare entitled “Health Systems for a New India: Building Blocks — Potential Pathways to Reform”.
  • The report makes proposals for health system strengthening — including the elimination of informality, merging of fragmented risk pools, and reduction of out-of-pocket health spending.
  • The proposal to consolidate small practices into larger business-like organisations appears problematic on multiple fronts.

Challenges with the proposition

  • Nearly 98% of healthcare providers have less than 10 employees. It is identified as a negative trait.
  • Apart from cost and competition-related concerns, it could portend a commodification of healthcare from the bottom-up. 
  • The report’s bent towards the U.S. HMO model adds to such a foreboding.
  • Loyalty and longitudinality form vital pillars of the patient-physician relationship. 
  • The edifice of these is built upon mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician. 
  • Momentary and haphazardly physician-patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships. 

Family physician

  • The role of a family physician is instrumental.
  • Apart from providing comprehensive care and coordinating referrals, a family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations.
  • It avoids unnecessary clinical hassles and encounters — this reflects in better outcomes and increased patient satisfaction.

Commercialization of care 

  • Widespread commercialisation over the past few decades has entailed that the family physician is a dying breed in India today. 
  • This has a sizeable role in impairing the doctor-patient relationship, manifested through violence against healthcare providers. 
  • In a setting of overcrowded public hospitals, and profiteering healthcare enterprises, mistrust in the healthcare provider and its gruesome implications are not difficult to anticipate.

Advantage of small clinics

  • Studies have demonstrated that healthcare received in small clinics scores higher in terms of patient satisfaction than that received in larger institutions.
  • This increased satisfaction manifests as better compliance with the treatment regimen and regular follow-ups, culminating in improved clinical outcomes. 
  • A meta-analysis of randomised controlled trials has established that patient-clinician relationship has a statistically significant effect on healthcare outcomes.
  • Disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.

The need for empathy

  • A popular myth often floated is that considerations regarding emotive aspects of healthcare such as empathy and trust are disparate from health policy and system design considerations. 
  • In reality, these are entirely amenable to cultivation through careful, evidence-based manipulation of the health system design and its components. 
  • It would necessitate installing an inbuilt family physician ‘gatekeeper’ in the health services system who acts as the first port of call for every registered patient. 
  • NITI Aayog’s long-term plan provides a good opportunity to envisage such long-called-for reforms, but that would require not the U.S. model but the U.K. model to be kept at the forefront for emulation. 
  • A step of sorts is taken in introducing Attitude, Ethics, and Communication (AETCOM) in the revised undergraduate medical curriculum.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Prevalence of Mental disorders in IndiaIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Mental health and associated issues in India


A study by the India State-level Disease Burden Initiative published in The Lancet Psychiatry was recently released.

Highlights of the report

  • The report found that 197.3 million Indians (one in every seven) were suffering from mental disorders in 2017.
  • The study describes the prevalence of mental disorders in Indian states between 1990 and 2017.
  • The 197.3 million in 2017 included 45.7 million cases with depressive disorders and 44.9 million with anxiety disorders.
  • Among the disorders with the highest prevalence, idiopathic developmental intellectual disability affects most Indians, at 4.5 per cent.
  • It is followed by depressive disorders (3.3), anxiety disorders (3.3) and conduct disorders (0.8).

Statewise data

  • Among depressive disorders, the prevalence is the highest in Tamil Nadu (4,796 per 100,000), followed by Andhra Pradesh (4,563), Telangana (4,356), Odisha (4,159) and Kerala (3,897).
  • In case of anxiety disorders, the prevalence is highest in Kerala (4,035), followed by Manipur (3,760), West Bengal (3,480), Himachal Pradesh (3,471) and Andhra Pradesh (3,462).
  • For conduct disorders, Jharkhand and Bihar have the highest prevalence, at 983 and 974 per 100,000 people.
  • At 6,339 and 5,503 per lakh respectively, Bihar and Uttar Pradesh have the highest prevalence of idiopathic developmental intellectual disability.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National guidelines for clinical trials under Gene TherapyPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Prevention of genetic diseases


In a bid to attract the pharmaceutical industry for pooling investments in drugs for treating rare diseases, the Indian Council of Medical Research (ICMR) has come up with national guidelines for gene therapy-related clinical trials.

About the guidelines

  • The document is titled as the “National Guidelines for Gene Therapy Product Development and Clinical Trials”.
  • Treatments for rare genetic diseases have long been neglected by the traditional pharmaceutical industry because of the notion that it will have uncertain or poor commercial outcomes given the smaller affected population size.
  • It aims to ensure that the gene therapies can be introduced in India and their clinical trials can be performed in an ethical, scientific and safe manner. Also, spur innovation and accelerate research for rare diseases.

What are Genetic diseases?

  • Inherited genetic diseases or rare diseases refer to medical conditions that affect a small percentage of the population but has vast, debilitating and often life threatening effects of the patients, many of whom are in the paediatric age group.
  • According to Health ministry approximately 70 million Indians suffer from some form of rare disease.
  • These include haemophilia, thalassemia, sickle-cell anaemia certain forms of muscular dystrophies, retinal dystrophies such as retinitis pigmentosa, corneal dystrophies, primary immunodeficiency (PID) in children, lysosomal storage disorders such as Pompe disease, Gaucher’s disease, haemangioma, cystic fibrosis etc.

Why need such guidelines?

  • Recognizing huge burden of genetic diseases in India there was a need to accelerate the development of advanced therapeutic options.
  • The guidelines will also serve as an important resource and roadmap for those in the field trying to develop gene and cell therapies.
  • There remain many hurdles that the rare disease fields have yet to overcome. These include:
  1. the appropriate and timely diagnosis including genetic testing and genetic counselling
  2. prohibitive costs of such gene therapies
  3. adequate insurance coverage and
  4. management practices among treating physicians

Way Forward

  • While prospects are bleak for many individuals with conditions classified as rare diseases, policies such as that proposed by the ICMR may offer hope.
  • Gene therapy may be a key avenue of research into many disorders where standard medication has shown little effect as the genetic alterations may directly impact the cause of the disorder.
  • However, for progress to be made, research into such conditions must be incentivized through funding and stakeholder support.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Staggering spread: On vaccinesop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Vaccine Hesitancy


Context

The reported measles cases decreased by 59% globally, from 2000 to 2018. At the same time, there has been a spike since 2016. 

Global Measles cases

  • Increase in numbers – There were over 1,32,000 reported cases in 2016. The numbers shot up to over 3,53,000 in 2018. 
  • More than doubled – the numbers in 2018 were more than double the previous year, the numbers in 2019 have already surpassed those of 2018. 
  • By mid-November 2019, over 4,00,000 cases were reported globally. 
  • Cases and deaths – WHO and the Centers for Disease Control and Prevention estimated the number of measles cases and deaths. Based on an updated estimation model, there have been nearly 10 million cases and over 1,42,000 measles deaths in 2018. 
  • Congo – The situation worsened in Congo, with a nearly four-fold increase in cases (from 65,000 in 2018 to 2,50,000 in 2019) and over 5,100 deaths. 

Vaccine Hesitancy

  • Vaccine hesitancy has been highlighted for the staggering spread in cases globally. 
  • The case of Congo – In DR Congo, there is low institutional trust, misinformation, vaccine shortage and even attacks on health-care centers and workers leading to the spread of both measles and Ebola. 
  • Other cases of VH  – The Philippines and the small Pacific island of Samoa serve are textbook cases of the sudden emergence of vaccine hesitancy. 
  • Dengue vaccine – Mass immunization using a newly approved dengue vaccine in the Philippines, before the risks were reported by the manufacturer, shattered public trust in vaccines. Low vaccine coverage led to measles and polio outbreaks.
  • Samoa – In Samoa, an error in preparing the measles, mumps, and rubella (MMR) injection led to the death of two infants. Fear-mongering led to a fall in vaccine uptake, leading to an outbreak of measles. 
  • Religion – In many European countries and the U.S., vaccine hesitancy has been on religious grounds and primarily due to anti-vaccination campaigns spreading fake news about vaccine safety. 

Countering Vaccine Hesitancy

  • Mandatory – About a dozen European countries have introduced laws making vaccination mandatory. 
  • New York City introduced such a law when the U.S. nearly lost its measles elimination status. 
  • Education is the key – Such laws may prove counterproductive in the long run. The only way to increase vaccine uptake is by educating the public.
  • India – 2.3 million children are not vaccinated against measles last year. India has much to do to protect its young citizens.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Taking stock of the anti-AIDS fightop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : UNAIDS

Mains level : AIDS - tackling it


Context

The Sustainable Development Goals (SDG), adopted by the member countries of the United Nations in 2015, set a target of ending the epidemics of AIDS, Tuberculosis and Malaria by 2030 (SDG 3.3). 

HIV/ AIDS

  • The indicator to track progress in achieving the target for HIV-AIDS is “the number of new HIV infections per 1,000 uninfected population, by sex, age and key populations”. 
  • “Key populations” refers to men who have sex with men; people who use injected drugs; people in prisons and other closed settings; sex workers and their clients, and transgender persons.

Bridging gaps

  • To complement the prevention target set by the SDGs, an ambitious treatment target was adopted through UNAIDS.
  • “90-90-90” target – it stated that by 2020, 90% of those living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people on such therapy will have viral suppression.
  • The gaps in detection, initiation of drug therapy and effective viral control were to be bridged to reduce infectivity, severe morbidity and deaths from undetected and inadequately treated persons already infected with HIV.
  • Prevention of new infections was targeted by SDG 3.3.

Progress

  • Much success has been achieved in the past 20 years in the global battle against AIDS.
  • There has been a slowdown in progress of late. 
  • There has to be a fresh surge of high-level political commitment, financial support, health system thrust, public education, civil society engagement and advocacy by affected groups.

High and low points

  • World achieved a reduction in new HIV infections by 37% between 2000 and 2018. 
  • HIV-related deaths fell by 45%, with 13.6 million lives saved due to Antiretroviral Therapy (ART).
  • Effective drugs developed to combat a disease earlier viewed as an inescapable agent of death. They also became widely available due to generic versions generously made available by Indian generic manufacturers.
  • Ignorance and stigma were vigorously combated by coalitions of HIV-affected persons. They were supported by enlightened sections of civil society and the media. 
  • According to a recent report by UNAIDS, of the 38 million persons now living with HIV, 24 million are receiving ART, as compared to only 7 million nine years ago.

Concerns remaining

  • At the end of 2018, while 79% of all persons identified as being infected by HIV were aware of the fact, 62% were on treatment and only 53% had achieved viral suppression. 
  • Due to gaps in service provision, 770,000 HIV-affected persons died in 2018 and 1.7 million persons were newly affected. 
  • There are worryingly high rates of new infection in several parts of the world, especially among young persons. 
  • Only 19 countries are on track to reach the 2030 target. 
  • Central Asia and Eastern Europe have had a setback, with more than 95% of the new infections in those regions occurring among the ‘key populations’. 
  • Risk of acquiring HIV infection is 22 times higher in homosexual men and intravenous drug users, 21 times higher in sex workers and 12 times more in transgender persons.

Complacency, new factors

  • The expanded health agenda in the SDGs stretched the resources of national health systems.
  • Global funding streams started identifying other priorities. 
  • Improved survival rates reduced the fear of what was seen earlier as dreaded death and pushed the disease out of the headlines. 
  • The information dissemination blitz did not continue to pass on the risk-related knowledge and strong messaging on prevention-oriented behaviours to a new generation of young persons. 
  • The vulnerability of adolescent girls to sexual exploitation by older men and domineering male behaviours inflicting HIV infection on unprotected women have been seen as factors contributing to new infections in Africa.

Necessity

  • Even the improved survival rates in persons with HIV bring forth other health problems that demand attention. 
  • Risk factors for cardiovascular disease are high among survivors as they age, with anti-retroviral drugs increase the risk of atherosclerosis. 
  • Other infectious diseases, such as tuberculosis can co-exist and cannot be addressed by a siloed programme. 
  • Mental health disorders are a challenge in persons who are on lifelong therapy for a serious disease that requires constant monitoring and often carries a stigma.

Need for a vigil in India

  • HIV-related deaths declined by 71% between 2005 and 2017. 
  • HIV infection now affects 22 out of 10,000 Indians, compared to 38 out of 10,000 in 2001-03. 
  • India has an estimated 2.14 million persons living with HIV and records 87,000 estimated new infections and 69,000 AIDS-related deaths annually. 
  • Nine states have rated higher than the national prevalence figure. Mizoram leads with 204 out of 10,000 persons affected. 
  • The total number of persons affected in India is estimated to be 21.40 lakh, with females accounting for 8.79 lakh. Assam, Mizoram, Meghalaya and Uttarakhand showed an increase in numbers of annual new infections. 
  • The strength of India’s well established National AIDS Control Programme and a combination of prevention and case management strategies must be preserved.

Drug treatment

  • Drug treatment of HIV is now well-founded with an array of established and new anti-viral drugs. 
  • The success of drug treatment to prevent mother-to-child transmission, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and male circumcision is well-documented. 
  • Development of a vaccine has been highly challenging but a couple of candidates are in early-stage trials. 

Way ahead

  • Mere technical innovations will not win the battle against HIV-AIDS. 
  • Success in our efforts to reach the 2030 target calls for resurrecting the combination of political will, professional skill and wide-ranging pan-society partnerships. 
  • The theme of the World AIDS Day this year – “Ending the HIV/AIDS Epidemic: Community by Community, is a timely reminder for community-wide coalitions.
  • Highly vulnerable sections of the community must be targeted for protection in the next phase of the global response.

Back2Basics

UNAIDS – the lead UN agency that coordinates the battle against HIV.

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

PolydactylyPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polydactyly

Mains level : Social boycott practices in India



A 63-year-old woman in a village in Odisha had been boycotted by the community as a “witch” because she was born with 12 fingers and 20 toes. The woman’s condition is known as polydactyly.

Polydactyly/polydactylism/hyperdactyly

  • It is a birth defect in which humans and animals have supernumerary fingers or toes.
  • In other words, a person suffering from the congenital anomaly of polydactyly will have more than five digits in a particular hand or foot.
  • In most cases, the extra digits can be surgically removed; the procedure gets more challenging if there is bone with the skin and tissue, and most difficult when the bone has a joint.

Causes

  • The defect develops during the sixth or seventh week of gestation, when an irregularity occurs in the splitting of the fingers from the hand or foot, creating an extra digit.
  • Causes are believed to be genetic, in some cases hereditary.

Prevalence

  • It is reported in perhaps one or two children per 1,000 live births, and could be the most common abnormality of development seen in newborns worldwide.
  • The defect is also seen in cats, dogs, cattle, sheep, pigs, chickens, geese, and sometimes horses.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

India Hypertension Control Initiative (IHCI)Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : India Hypertension Control Initiative (IHCI)

Mains level : Read the attached story



  • The India Hypertension Control Initiative (IHCI) launched in four districts of the State has been able to control hypertension in about 35% of the people covered under the initiative.

What is Hypertension?

  • Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
  • Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.
  • High BP often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.
  • Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.

About IHCI

  • The IHCI was launched in Kerala in April 2018 as a multi-partner five-year initiative with the Union Ministry of Health and Family Welfare, Indian Council of Medical Research, State government, and WHO India.
  • The IHCI was also launched in Madhya Pradesh, Telangana, Maharashtra, and Punjab.
  • The results from Kerala had been the most impressive so far because of the infrastructure strength of non-communicable disease clinics across the State.
  • Each patient was given a treatment book and the health card was kept at the hospital.
  • Every month there was a follow-up on the patient by the hospital over the phone or by visit of an Accredited Social Work Activist.
  • With the success of the initiative, the government is considering replicating it in other districts too.

Success of the move

  • A total of 2.23 lakh people — 72,460 in Thiruvananthapuram, 74,909 in Thrissur, 58,818 in Kannur, and 19,009 in Wayanad — were registered for the IHCI.
  • Of 4,530 patients among them, 40% in Thiruvananthapuram, 32% in Thrissur, 37% in Kannur and 24% in Wayanad could better control their health parameters.
  • This study group’s parameters for blood pressure (BP) control were followed up from July to September 2019.

Marked change

  • This is a marked change from the average of 13% of people having control of hypertensive parameters recorded in non-communicable disease (NCD) clinics in the State (data inferred from NCD clinics).
  • In the IHCI study group, those with uncontrolled blood pressure in these districts were put at 43%, 37%, 38% and 27%.
  • In the group, 15%, 31%, 25%, and 49% had also defaulted because of various reasons – change of address, change in treatment system or others.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Lancet report on premature deaths in IndiaDOMR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : DALY,

Mains level : Major causes of deaths in India



An analysis published in The Lancet Global Health, which looked at about 9.7 million deaths in India in 2017, found that every condition that was common in one part of India was uncommon elsewhere.

About the study

  • The study is funded by the Ministry of Heath and Family Welfare.
  • It included authors from the Indian Council of Medical Research, and from the global health research wings of the University of Toronto and University of California, San Francisco.

Highlights

YLLs (years of life lost)

  • By the WHO definition, YLLs, or years of life lost, are calculated from the number of deaths multiplied by a standard life expectancy at the age of death.
  • Premature deaths due to various causes expressed as YLLs, too were unevenly distributed in terms of the burden on the states.
  • For example, liver and alcohol-related YLL rates were high in the northeastern states, Bihar, Karnataka, and Maharashtra, accounting for 18% of national YLLs.

DALYs (disability-adjusted life years)

  • In 2017, India had 486 million DALYs (disability-adjusted life years, a measure of the number of years lost due to ill health or disability).
  • The ratio of DALYs to the 9.7 million deaths was about 50 to 1.
  • More than three quarters of deaths and DALYs occurred in rural areas, and males accounted for 54·3% of all DALYs.
  • At all ages, the DALY rate per 100 000 population was 36,300, but rates were higher among rural residents and among males.
  • DALY rates in rural areas were at least twice those of urban areas for certain conditions.

Deaths due to various reasons

  • The Northeastern states, Uttar Pradesh, Rajasthan, West Bengal, Haryana, Gujarat, Kerala, Karnataka and Madhya Pradesh account for 44% of India’s cancer burden.
  • Suicide YLL rates were highest in the southern states, accounting for 15% of national totals.
  • Road traffic injuries were high in the northern states of UP, Punjab, Uttarakhand, Haryana and Himachal Pradesh, accounting for 33% of national totals.
  • Drowning YLL rates, meanwhile, were highest in the central states of Madhya Pradesh and Chhattisgarh, and in Assam in the Northeast, accounting for 11% of national totals.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

RAAH: A one-stop source of data on mental health centres, professionalsPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : RAAH app

Mains level : Mental health and associated issues in India



  • NIMHANS has compiled a one-stop source online mental health care directory “RAAH”.

RAAH

  • The National Institute of Mental Health and Neuro-Sciences (NIMHANS) has come out with a NIMHANS RAAH app, a mobile application that can be downloaded on Android and iOS platforms.
  • It provides free information to the public on mental health care professionals and mental healthcare centres.
  • The directory can be accessed on http://raah.nimhans.ac.in

How does it work?

  • Mental health professionals and organisations can register and update their information in the directory live for no cost.
  • The online directory and mobile app allows people to search for information about professionals such as psychiatrists, psychologists, psychiatric social workers, special educators and occupational therapists working with government, NGOs, clinics, hospitals, and rehabilitation centres.

Key features

  • The main features of the directory are that people can filter the information according to their search requirements.
  • A user will get two kinds of views in the directory — map and list view — where they can get all the information about the organisation and professionals such as timings, fees details, available services, and years of experience.

About NIMHANS

  • The National Institute of Mental Health and Neuro-Sciences is a premier medical institution located in Bengaluru, India.
  • NIMHANS is the apex centre for mental health and neuroscience education in the country, the institute operates autonomously under the Ministry of Health and Family Welfare.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Chasing the cureop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Alzheimer's

Mains level : New drug and its challenges


Context

For nearly two decades, doctors treating Alzheimer’s patients have been frustrated by the lack of advance in medical research. The most advanced drug that is used to treat the disease was developed in 2003. 

Alzheimer’s

  • It was first identified in 1906 by the German physician, Alois Alzheimer. 
  • Drugs currently in use treat the neurodegenerative disorder symptomatically.
  • They leave doctors almost helpless about elderly patients who may forget familiar facts and even the faces of family members.

Latest news

  • Chinese drug regulator approved medicine that improves cognitive functions in patients with mild to moderate levels of the disease. This is a significant breakthrough.
  • Sugar – The new drug, Oligomannate is a sugar derived from a Chinese seaweed.
  • Gut bacteria – It works by modifying gut bacteria to reduce inflammation in the brain. 
  • Clinical trial – A clinical trial on 818 people “demonstrated solid and consistent cognition improvement among those treated versus a control group”. 
  • Different method – The method adopted by Chinese researchers is a departure from Alzheimer’s drug development. Traditionally, it has focussed on attacking the plaque that forms in the brains of patients; this protein build-up interferes with neural signaling. 

Challenges remain

  • In China, the regulatory agency has asked Green Valley to conduct more research on Oligomannate’s safety. 
  • The complete data on how exactly the cognitive function improved for patients on the drug versus those on placebo — and how meaningful that was in the patients’ lives — is still not known outside select circles in China. 
  • Oligomannate must be tested on diverse groups of people to be affirmed as a panacea for Alzheimer’s globally. 
  • These trials need to include many more than 818 individuals. 
  • If the knowledge on the mode of action of Chinese seaweed spreads among medical researchers worldwide, more potent compounds could be developed to target Alzheimer’s.

Back2Basics

Alzheimer’s disease is a progressive disorder that causes brain cells to waste away and die. Alzheimer’s disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person’s ability to function independently.

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

[op-ed snap] An unwanted booster dose for vaccine hesitancyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Immunisation and its importance


Context

In January, the World Health Organization (WHO) listed “vaccine hesitancy” as among the top 10 threats to global health this year.

Vaccine Hesitancy

  • It is defined as a “reluctance or refusal to vaccinate despite the availability of vaccines”.
  • The repercussions of vaccine hesitancy are playing out globally — as, on October 10, 2019, nearly 4,24,000 children have confirmed measles, as against a figure of 1,73,000 in the whole of 2018.

Vaccination

  • According to WHO, vaccination prevents between two-three million deaths each year.
  • This figure will rise by another 1.5 million if vaccine coverage improves. 
  • A survey of over 1,40,000 people from 140 countries has revealed the striking difference in how people trust vaccines.
    • At 95%, people from South Asia trusted vaccines followed by eastern Africa at 92%. 
    • Western Europe and eastern Europe were just 59% and 52% respectively. 

The Indian perspective

  • Vaccine hesitancy has been a concern in India. 
    • One of the main reasons for the five times low uptake of oral polio vaccine in the early 2000s among poor Muslim communities in Uttar Pradesh was the fear that the polio vaccine caused illness, infertility and was ineffective.
    • In 2016, Muslim communities in two districts in north Kerala reported low uptake of the diphtheria vaccine. One of the reasons was propaganda that the vaccine may contain microbes, chemicals, and animal-derived products which are forbidden by Islamic law.
  • Wrong propaganda – Tamil Nadu and Karnataka have traditionally seen high vaccine acceptance. They witnessed low uptake of the measles-rubella vaccine because of fear, spread through social media, of adverse effects from vaccination.
  • Fear of adverse consequences – A December 2018 study points out that vaccine hesitancy continues to be a huge challenge for India. The study found nearly a quarter of parents did not vaccinate their children out of a fear of adverse events. 
  • Priority districts – This was in 121 high priority districts chosen by the Health Ministry for intensified immunisation drive to increase vaccine coverage.
  • Cultural influence – A yogi in India, Jaggi Vasudev tweeted a dangerous message. “The significance of vaccination against many debilitating diseases should not be played down. It is important it is not overdone, without taking into consideration the many side-effects or negative impacts of vaccinations.”
  • Blaming vaccines – falsely blaming vaccines for unrelated diseases is the bedrock of the anti-vaccination movement across the globe. Even today, the message by British physician Andrew Wakefield, who linked the measles, mumps, and rubella (MMR) vaccine with autism, is used in spreading vaccine doubts and conspiracy theories.

Flu vaccine

  • Children older than six months and younger than five years belong to the high-risk category and are recommended a “vaccination against flu each year”. 
  • WHO too recognises children below five years as a high-risk group and recommends vaccination each year.
  • Influenza should be taken seriously because in the U.S. alone, since 2010, an estimated 7,000-26,000 children younger than five are hospitalised each year. Many end up dying. 
  • It is proven that vaccination offers the best defence against the flu and its potentially serious consequences, reduces flu illnesses, hospitalisations and even deaths.
  • H1N1 (swine flu) became a seasonal flu virus strain in India even during the summer. The uptake of the flu vaccine in India is poor. 
  • Several studies have shown that flu vaccination can reduce the risk of flu illness by 40-60% when there is a good match between the strains used in the vaccine and the circulating virus. 
  • A study in 2017 found that vaccination reduced flu-associated deaths by 65% among healthy children. 
  • The vaccine can also prevent hospitalisation, reduce the severity of illness and “prevent severe, life-threatening complications” in children.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Health Stack (NHS) and National Digital Health Blueprint (NDHB)Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Health Stack (NHS) and National Digital Health Blueprint (NDHB)

Mains level : Need for digital health record



  • The challenge of making quality and affordable healthcare accessible to every one of India’s 135 crore citizens has acquired an altogether new dimension.
  • The report charting out the process for implementing the National Digital Health Blueprint (NDHB) has been completed.

What is the National Health Stack (NHS)?

  • Unveiled by the NITI Aayog last year, NHS is digital infrastructure built with the aim of making the health insurance system more transparent and robust.
  • There are five components of NHS:
  1. Electronic national health registry that would serve as a single source of health data for the nation;
  2. Coverage and claims platform that would serve as the building blocks for large health protection schemes, allow for the horizontal and vertical expansion of schemes like Ayushman Bharat by states, and enable a robust system of fraud detection;
  3. Federated personal health records (PHR) framework that would serve the twin purposes of access to their own health data by patients, and the availability of health data for medical research, which is critical for advancing the understanding of human health;
  4. National health analytics platform that would provide a holistic view combining information on multiple health initiatives, and feed into smart policymaking, for instance, through improved predictive analytics; and
  5. Other horizontal components including a unique digital health ID, health data dictionaries and supply chain management for drugs, payment gateways, etc., shared across all health programmes.

What is the National Digital Health Blueprint (NDHB)?

  • The NDHB is the architectural document for the implementation of the NHS.
  • Its vision is to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, through provision of a wide range of data, information, and infrastructure services.
  • NDHB recognizes the need to establish a specialised organisation, called the National Digital Health Mission (NDHM) that can drive the implementation of the blueprint, and promote and facilitate the evolution of a national digital health ecosystem.

Features

  • The key features of the blueprint include a federated architecture, a set of architectural principles, a five-layered system of architectural building blocks, a unique health ID (UHID), privacy and consent management, national portability, electronic health records, applicable standards and regulations, health analytics.
  • A total of 23 such building blocks have been identified in the blueprint for the NHS to become a viable reality.

Why is the NHS necessary?

  • Currently apart from Ayushman Bharat there are many secondary and tertiary care schemes running in various states.
  • West Bengal has opted out of Ayushman Bharat, and Telangana and Odisha have never been a part of the scheme.
  • Also, there is an urgent need for integration of the two arms of Ayushman Bharat — health and wellness centres which constitute the primary care arm, and PMJAY.
  • This is the secondary and tertiary care arm under which the target is to provide 10.74 crore families with an annual health cover of Rs 5 lakh each.
  • Without integration, the goal of continuum of care cannot be met — and that would mean PMJAY might end up becoming a perpetual drain on resources.
  • Hence, the need for a common digital language for the operationalization and inter-operability of various health schemes, which the NHS seeks to provide.

Is all the data going to be safe/secure?

  • One of the biggest concerns following the high-profile rollout of Ayushman Bharat has been regarding data security and privacy of patients.
  • More than a year after the Justice Srikrishna Committee prepared a draft data privacy law, there has been little meaningful movement on it.
  • Critics have argued that in the backdrop of the Supreme Court’s privacy judgment, the data privacy law should ideally have preceded the implementation of Ayushman Bharat.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Health Profile 2019DOMR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Health Profile 2019

Mains level : Highlights of the study



  • Union Health Minister has released the 14th edition of the National Health Profile 2019.

What is National Health Profile (NHP)?

  • The NHP is an annual stocktaking exercise on the health of the health sector.
  • It provides a comprehensive framework on the socio-economic health status and the status of demographic and health resources in the country.
  • It is prepared by the Central Bureau of Health Intelligence (CBHI).
  • The NHP was first published in 2005. Ever since the profile has been released every year and this year, is its 14th edition.

Utility of NHP

  • The NHP helps the government navigate health needs and issues of the population and devise area-specific program strategies.
  • Good-quality data can enable policymakers to make evidence-based policies and aid the effective implementation of various schemes.

Highlights of the 14th edition of the NHP

Per capita health expenditure

  • In 2016, India’s Domestic general government health expenditure stood at $16 per capita.
  • This is lower than Norway ($6,366), Canada ($3,274), Japan ($3,538), Republic of Korea ($1,209) and Brunei Darussalam ($599).
  • The American system, though, is considered neither ideal nor economical. This data has been sourced from the Global Health Expenditure Database of the World Health Organisation.

Disease profile

  • The NHP also notes the change in disease profile of the country with a shift towards the non-communicable disease from communicable ones.
  • It has been observed that the non-communicable diseases dominate over communicable in the total disease burden of the country.
  • Dengue and Chikungunya, transmitted by Aedes mosquitoes, are a cause of great concern to public health in India.
  • In the same period, disease burden from non-communicable diseases increased from 30 per cent to 55 per cent.
  • DALYs are an international standard of disease burden that measures how much of a normal life span of an individual is taken away by a disease related morbidity of mortality.

Life expectancy

  • Life expectancy in India has increased from 49.7 years in 1970-75 to 68.7 years in 2012-16.
  • For the same period, the life expectancy for females is 70.2 years and 67.4 years for males.
  • For comparison, in last year’s survey, the life expectancy had increased from 49.7 years in 1970-75 to 68.3 years in 2011-15.
  • For the same period, the life expectancy for females is 70 years and 66.9 years for males.

Economically active population

  • On demographics, the survey found the high incidence of the young and economically active population.
  • The survey notes that 27% of the total estimated population of 2016 was below the age of 14 years.
  • Majority (64.7%) of the population were in the age group of 15-59 years i.e. economically active, and 8.5% population were in the age group of 60-85 plus years.

Birth/Death rates

  • There has been a consistent decrease in the birth rate, death rate and natural growth rate in India since 1991 to 2017.
  • As on 2017, India has registered birth rate of 20.2 per population of 1,000 and death rate of 6.3 while the natural growth rate was 13.9 per population of 1,000.
  • The birth rate in rural areas was higher than in the urban.
  • Similarly, the death rate and natural growth rate were also higher in rural areas as compared to the urban.

Sex Ratio

  • As per the NHP, sex ratio (number of females per 1,000 males) in the country has improved from 933 in 2001 to 943 in 2011.
  • In rural areas the sex ratio has increased from 946 to 949.
  • The corresponding increase in urban areas has been of 29 points from 900 to 929.
  • Kerala has recorded the highest sex ratio in respect of total population (1,084), rural population (1,078) and urban (1,091).
  • The lowest sex ratio in rural areas has been recorded in Chandigarh (690).

Dip in IMR

  • The infant mortality rate (IMR) has declined considerably (33 per 1,000 live births in 2016), however differentials of rural (37) and urban (23) are still high.

Various causes of death

  • During the year 2015, 4.13 lakh people lost their life due to accidental injuries and 1.33 lakh people died because of suicide.
  • Suicide rates are increasing significantly among young adults and the maximum number of suicide cases (44,593) is reported between the age group 30-45 years.
  • The total number of cases and deaths due to snake bite are 1.64 lakh and 885, respectively, in 2018.
  • The total number of disabled persons in India is 2.68 crore.

Pollution related illness

  • Air pollution-linked acute respiratory infections contributed 68.47 per cent to the morbidity burden in the country and also to highest mortality rate after pneumonia.
  • Acute diarrhoeal diseases, caused due to drinking contaminated water, caused the second highest morbidity at 21.83 per cent.
  • Cholera cases went up to 651 in 2018 from 508 in 2017, the report showed. Uttar Pradesh followed by Delhi and West Bengal had the highest cases.

Medical education infrastructure

  • The NHP has noted that medical education infrastructure has shown rapid growth over the past few years.
  • The country has 529 medical colleges, 313 Dental Colleges for BDS & 253 Dental Colleges for MDS.
  • The total number of admissions for the academic year 2018-19 in Medical Colleges is 58756.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Indian Human Brain AtlasPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IBA100

Mains level : Brain Atlas



  • The International Institute of Information Technology (IIIT) in Hyderabad has built the first-ever Indian brain atlas.

IBA100

  • This brain atlas was based on the Caucasian brain template. It is named as IBA100. Other brain atlases include Chinese, Korean and Caucasian.
  • The India-specific brain atlas was created by using the MRI scans of 50 individuals of different genders.
  • The Indian atlas was validated against other atlases for various populations.
  • The first digital human brain atlas was created by the Montreal Neurological Institute (MNI).

Indian brain is smaller

  • The researchers in IIIT have also revealed that the Indian brain is smaller compared to others.
  • It is smaller in height, width, and volume compared to the western and eastern populations.

Utility of the atlas

  • This study will help in the early diagnosis of brain diseases like Alzheimer’s.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Pills within reachop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Medicines use in India


Context

The Indian government is planning to allow local retail outlets to sell common drugs. 

Other features

    • As per the proposal, the Centre would let regular shops retail over-the-counter medicines such as paracetamol. 
    • These drugs would contain key information on side effects and the appropriate dosage in local languages.

Benefits

    • Geographical reach – The wide availability of these medicines would offer relief to people living in far-flung areas where pharmacies are few and far between.
    • Issue of self-medication – In India, self-medication is highly prevalent, particularly in rural areas.  If non-prescription drugs can be bought at a local corner shop, it could help lower treatment costs for millions of people who have no chemist closeby.
    • Doctor availability – There aren’t enough qualified doctors in the country. Reports suggest that about two-thirds of all doctors in India cater to urban areas. Going to a doctor proves to be time-consuming and expensive for rural folks.

Challenges

    • Regulation – It is alarming for those who insist on strict regulation of who is allowed to dispense medicines. 
    • Health hazard – The popping of pills without any medical authorization or knowledge could pose an immediate health risk. 
    • Overuse – Easy availability could also result in an overuse of some over-the-counter drugs, compromising people’s health over a longer span of time. This has already happened in the case of antibiotics, whose rampant overuse has turned several strains of disease-causing bacteria resistant to these drugs.
    • Greater concerns – Given the ground conditions in India, the benefits could outweigh those worries.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

IndiGen InitiativePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IndiGen Initiative

Mains level : Applications of Genome Sequencing



  • Anyone looking for a free mapping of their entire genome can sign up for the IndiGen initiative.

IndiGen initiative

  • Under this, the IndiGen mobile application enables participants and clinicians to access clinically actionable information in their genomes.
  • Those who do get their genes mapped this way will get a card and access to an app, which will allow them and doctors to access “clinically actionable information” on their genomes.
  • The programme is a culmination of a six-month project by the CSIR in which 1000 Indians, had their genomes scanned in detail.
  • It is managed by the CSIR-Institute of Genomics and Integrative Biology (IGIB) and the CSIR-Centre for Cellular and Molecular Biology (CCMB).
  • The aim of the exercise was twofold: To test if it’s possible to rapidly and reliably scan several genomes and advise people on health risks that are manifest in their gene and, understand the variation and frequency of certain genes that are known to be linked to disease.

Why such move?

  • A genetic test, which is commercially available at several outlets in the country, usually involves analysing only a portion of the genome that’s known to contain aberrant genes linked to disease.
  • A whole genome sequencing is more involved and expensive — it’s about ₹100,000 and a single person’s scan take a whole day — and generally attempted only for research purposes.
  • The human genome has about 3.2 billion base pairs and just 10 years ago cost about $10,000. Now prices have fallen to a tenth.

Benefits

  • The whole genome data will be important for building the knowhow, baseline data and indigenous capacity in the emerging area of Precision Medicine.
  • The benefits include epidemiology of genetic diseases to enable cost effective genetic tests, carrier screening applications for expectant couples, enabling efficient diagnosis of heritable cancers and pharmacogenetic tests to prevent adverse drug reactions.
  • The outcomes will have applications in a number of areas including predictive and preventive medicine with faster and efficient diagnosis of rare genetic diseases.
  • The outcomes will be utilized towards understanding the genetic diversity on a population scale, make available genetic variant frequencies for clinical applications and enable genetic epidemiology of diseases.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Put away the stickop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Fertility rate

Mains level : Population control - challenges


Context

On Tuesday, the Assam government announced that people with more than two children will not be eligible for government jobs from January 2021. 

Two child norm for jobs

  • Assam will become the fourth state after Maharashtra, Madhya Pradesh and Rajasthan to have a two-child norm in place for government jobs.
  • At least five other states follow this norm for candidates seeking elections to local bodies such as panchayats, municipal corporations and zila parishads. 

Limitations of the two-child norm

  • Measures such as debarring people from holding government office amounts to penalising weaker sections of the population.
  • Women’s reproductive choices are often subject to a variety of constraints. 
  • The two-child policy is discriminatory in nature.
  • Almost all surveys indicate that India’s population growth rate has slowed substantially in the last decade. 
  • According to the NFHS-4, at 2.2, India’s total fertility rate (TFR) is very close to the desired replacement level of 2.1.
  • NFHS-4 figures on contraception point to the unmet need for contraception. It stands at 13% — over 30 million women of reproductive age are not able to access contraception. 

Fertility rate

  • NFHS-4 data confirms that women’s education has a direct bearing on fertility rates.
  • The decadal survey shows that women who have never been to school are likely to bear more than three children while the fertility rate of those who have completed 12 years of schooling is 1.7.

Population growth

  • In spite of the fall in TFR, India’s population has continued to grow.
  • This is because nearly 50% of the people are in the age group of 15-49. 
  • This means that the absolute population will continue to rise even though couples have less children.

What needs to be done

  • Further slowing down of the momentum will require raising the age of marriage, delaying the first pregnancy and ensuring spacing between births. 
  • Dealing with the country’s demographic peculiarity will require investments in health, education, nutrition and employment avenues.

Conclusion

State governments should rethink throttling rights to enforce population control.


Back2Basics

https://www.civilsdaily.com/question/what-is-total-fertility-rate-why-is-the-number-significant-what-challenges-does-india-face-in-achieving-the-replacement-rate-of-fertility-200-words/

 

 

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

Peritoneal dialysisPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Dialysis

Mains level : National Dialysis Programme


  • The Health Ministry has released guidelines for establishing peritoneal dialysis services under the Pradhan Mantri National Dialysis Program (PMNDP).

What is Dialysis?

  • Dialysis is a treatment that filters and purifies the blood using a machine.
  • It is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally.

National Dialysis Programme

  • The PM National Dialysis Programme was rolled out in 2016 as part of the National Health Mission(NHM) for provision of free dialysis services to the poor.
  • The first phase of the programme envisaged setting up of haemodialysis centres in all districts.
  • The Guidelines for National Dialysis Programme envisage provision of dialysis services under NHM in PPP (Public Private Partnership) mode.
  • It covers 2 main types of dialysis:

Hemodialysis (HD, commonly known as blood dialysis)

  • In HD, the blood is filtered through a machine that acts like an artificial kidney and is returned back into the body. HD needs to be performed in a designated dialysis centre.
  • It is usually needed about 3 times per week, with each episode taking about 3-4 hours.

Peritoneal dialysis (PD, commonly known as water dialysis)

  • In PD, the blood is cleaned without being removed from the body.
  • The abdomen sac (lining) acts as a natural filter. A solution (mainly made up of salts and sugars) is injected into the abdomen that encourages filtration such that the waste is transferred from the blood to the solution.

Why such move?

  • The move is aimed at achieving equity in patient access to home-based peritoneal dialysis; reducing the overall cost of care; and bringing in consistency of practice, pricing and a full range of product availability.
  • The guidelines aim to serve as a comprehensive manual to States that intend to set up peritoneal dialysis.
  • This move will instantly benefit the 2 lakh Indians who develop end-stage kidney failure every year in India.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] WHO India Country Cooperation Strategy 2019–2023PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Country Cooperation Strategy

Mains level : Strengthening India's healthcare in line with WHO


  • The Union Ministry for Health & Family Welfare has launched ‘The WHO India Country Cooperation Strategy 2019–2023: A Time of Transition’..

Country Cooperation Strategy

  • The Country Cooperation Strategy (CCS) provides a strategic roadmap for WHO to work with the Government of India towards achieving its health sector goals.
  • It aims in improving the health of its population and bringing in transformative changes in the health sector.
  • The four areas identified for strategic cooperation of WHO with the country encompass:
  1. to accelerate progress on UHC;
  2. to promote health and wellness by addressing determinants of health;
  3. to protect the population better against health emergencies; and
  4. to enhance India’s global leadership in health.

Why need CCS?

  • The CCS builds upon the work that WHO has been carrying out in the last several years.
  • In addition, it identifies current and emerging health needs and challenges such as non-communicable diseases, antimicrobial resistance and air pollution.
  • The implementation of this CCS will build on the remarkable successes in public health that India has demonstrated to the world.
  • It’s a great opportunity to showcase India as a model to the world in initiatives such as digital health, access to quality medicines and medical products, comprehensive hepatitis control program and Ayushman Bharat.

Significance

  • The India CCS is one of the first that fully aligns itself with the newly adopted WHO 13th General Programme of Work and its ‘triple billion’ targets.
  • It captures the work of the United Nations Sustainable Development Framework for 2018–2022.
  • The CCS outlines how WHO can support the Ministry of Health & Family Welfare and other allied Ministries to drive impact at the country level.
  • The strategy document builds on other key strategic policy documents including India’s National Health Policy 2017, the many pathbreaking initiatives India has introduced — from Ayushman Bharat to its National Viral Hepatitis programme and promotion of digital health amongst others.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

World Vision ReportIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the report

Mains level : Economic implications of the Eye impairment


  • The first-ever World Vision Report was recently released by WHO.

Highlights of the report

  • More than a quarter of the world’s population — some 2.2 billion people — suffer from vision impairment.
  • The report warned that population ageing would lead to a dramatic increase in the number of people with vision impairment and blindness.
  • Presbyopia, a condition in which it is difficult to see nearby objects, affects 1.8 billion people. This condition occurs with advancing age.
  • The common refractive error — myopia (a condition in which it is difficult to see objects at a distance) affects 2.6 billion, with 312 million being under the age of 19 years.
  • Cataract (65.2 million), age-related macular degeneration (10.4 million), glaucoma (6.9 million), corneal opacities (4.2 million), diabetic retinopathy (3 million), trachoma (2 million), and other causes (37.1 million) are other common vision impairments listed in the report.
  • Trachoma is caused due to bacterial infection in the eye. Many countries have eliminated it, including India.

India praised

  • There was praise for India in the report for its National Programme for Control of Blindness (NPCB).
  • According to the report, in 2016-17, the NPCB provided cataract surgery to a total 6.5 million people in India, achieving a cataract surgical rate of over 6,000 per million population.
  • During this period, school screening was provided to nearly 32 million children and approximately 750,000 spectacles were distributed, the report said about the NPCB.

Regional and gender distribution

  • The prevalence of vision impairment in low- and middle-income regions was estimated by the report to be four times higher than in high-income regions
  • Three Asian regions alone (representing 51% of the world’s population) account for 62 per cent of the estimated 216.6 million vision-impaired people in the world.
  • South Asia (61.2 million); East Asia (52.9 million); and South-East Asia (20.8 million).
  • Myopia is the highest in high-income countries of the Asia-Pacific region (53.4 per cent), closely followed by East Asia (51.6 per cent).
  • Adolescents in urban areas of China and South Korea have reported rates as high as 67 per cent and 97 per cent, respectively.

Why vision matters?

  • The WHO report said studies had consistently established that vision impairment severely impacted quality of life (QoL) among adult populations.
  • Besides, vision impairment also caused productivity loss and economic burden.
  • The economic burden of uncorrected myopia in the regions of East Asia, South Asia and South-East Asia were reported to be more than twice that of other regions and equivalent to more than one per cent of gross domestic product.

Prevention is possible

  • Out of one billion cases of vision impairment that could have been prevented, 11.9 million suffered from glaucoma, diabetic retinopathy and trachoma that could have been prevented.
  • The estimated costs of preventing the vision impairment in these 11.9 million would have been $5.8 billion.
  • This represented a significant missed opportunity in preventing the substantial personal and societal burden associated with vision impairment and blindness.

Various factors

  • Regarding gender gap, the WHO said no strong association existed between gender and many eye conditions, including glaucoma, age-related macular degeneration, and diabetic retinopathy.
  • However, rates of cataract and trachomatous trichiasis are higher among women, particularly in low- and middle-income countries,” it clarified.
  • Incidence of a rural-urban divide does exist.
  • Rural populations also face greater barriers to accessing eye care due to them having to travel greater distances and poor road quality, among other factors.
  • Lifestyle differences ensured that unlike cataract, higher rates of childhood myopia were found in urban populations of China and Australia since children living in rural areas spent more time outdoors.

Barriers to eye care

  • Accessibility to eye care services and high costs particularly for rural populations are the major drivers of vision impairment.
  • Therefore, the WHO emphasised expanding Universal Healthcare Coverage and making eye care an integral part of it around the world.
  • Direct costs are key barrier to accessing eye care in high-income countries, particularly for people living in rural areas or those with low socio-economic status.
  • Affordability to buy lenses or spectacles was a major stumbling block.
  • The WHO report, as with many other studies, highlighted that there was a gender disparity in accessibility to eye care services, with women standing a lesser chance of availing them.
  • Lack of trained human resources was another factor pushing these ailments further.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] e-DantSevaPIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : e-DantSeva

Mains level : Significance of oral health



  • Union Minister of Health and Family Welfare has launched the e-Dantseva website and mobile application.
  • This is first-ever national digital platform on oral health information and knowledge dissemination.

e-DantSeva

  • e-DantSeva is the first-ever national digital platform that provides oral health information both in the form of a website and mobile application.
  • The website and mobile application provide oral health information gathered from authentic scientific resources and connects the public to timely advice for managing any dental emergency or oral health problem.
  • This initiative of the Ministry with AIIMS and other stakeholders aims to sensitize the public about the significance of maintaining optimum oral health.
  • It equips them with the tools and knowledge to do so, including awareness on the nearest oral health service facility.

Features

  • e-DantSeva contains information about the National Oral Health Program, detailed list of all the dental facility and colleges, Information, Education and Communication (IEC) material.
  • It contains a unique feature called the ‘Symptom Checker’, which provides information on symptoms of dental/oral health problems, ways to prevent these, the treatment modes, and also directs the user to find their nearest available dental facility (public and private sectors both).

Why such move?

  • Dental caries/cavities and periodontal disease remain the two most prevalent dental diseases of the Indian population and dental infections have a potential for serious diseases/infections.
  • Oral health is indispensable for the wellbeing and good quality of life.
  • Poor oral health affects growth negatively in all aspects of human development.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] UMMID InitiativePIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : UMMID Initiative

Mains level : Prevention of genetic diseases



UMMID

  • UMMID stands for Unique Methods of Management and treatment of Inherited Disorders.
  • DBT has started the UMMID Initiative which is designed on the concept of ‘Prevention is better than Cure’.
  • Taking into account the congenital and hereditary genetic diseases are becoming a significant health burden in India, and realizing the need for adequate and effective genetic testing and counselling services.
  • The UMMID initiative aims
  1. to establish NIDAN Kendras to provide counselling, prenatal testing and diagnosis, management, and multidisciplinary care in Government Hospitals wherein the influx of patients is more,
  2. to produce skilled clinicians in Human Genetics, and
  3. to undertake screening of pregnant women and new born babies for inherited genetic diseases in hospitals at aspirational districts.

Why such initiative?

  • In India’s urban areas, congenital malformations and genetic disorders are the third most common cause of mortality in newborns.
  • With a very large population and high birth rate, and consanguineous marriage favored in many communities, prevalence of genetic disorders is high in India.

NIDAN (National Inherited Diseases Administration) Kendras

  • As a part of this initiative, in the first phase, five NIDAN Kendras have been established to provide comprehensive clinical care.
  • Screening of 10,000 pregnant women and 5000 new born babies per year for inherited genetic diseases will be taken up at the following seven aspirational districts.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] A lifeline for Indiaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMJAY

Mains level : PMJAY - benefits and the road ahead


CONTEXT

Ayushman Bharat is a conscious attempt to holistically address health, encompassing prevention, promotion and ambulatory care at the primary, secondary and tertiary levels. 

PMJAY

  • It promises to bring healthcare to the poorest through two components: 
    • Health and Wellness Centres (HWCs) delivering comprehensive primary healthcare through the development of 1.5 lakh HWCs
    • PM-JAY, the health assurance scheme delivering secondary and tertiary care to 55-crore people through a health cover of Rs 5 lakh per family per year. 
  • Ayushman Bharat has been designed based on the idea that prevention is better than cure.
  • No one should fall into poverty because of expenditure on healthcare, or die because they cannot afford treatment.
  • It promises free healthcare to the poorest 55 crore people in the country.
  • It would help them avoid the catastrophic healthcare expenditure that pushes 6 crores below the poverty line each year in India. 

The journey so far – healthcare

  • More than 20,000 HWCs have been made operational. 
  • More than five crore people have been screened for a whole range of common non-communicable diseases. 
  • More than 45 lakh hospital admissions have taken place for cashless treatment in more than 18,000 empaneled hospitals across the country, resulting in savings of more than Rs 13,000 crore for the beneficiary families. 
  • Ayushman Bharat has provided a platform and framework for the country to accelerate its progress towards comprehensive universal healthcare. 

Working with States

  • In several states and union territories, it has an opportunity to extend the benefits to far larger numbers, beyond those covered under the scheme. 
  • 11 states/UTs have expanded the coverage to include almost all families. 23 states/UTs have expanded the beneficiary base with the same benefit coverage as under PMJAY or lower. 
  • Several states have merged their many ongoing schemes with PMJAY to make implementation simpler for both beneficiaries and participating hospitals. 
  • They don’t need to deal with different target groups, rates, and reporting systems. 
  • Karnataka has merged seven different existing schemes into one, while Kerala has merged three different schemes.

Private sector participation

  • More than half of the empaneled hospitals are private. Over 62% of the treatments have been done by private hospitals. 
  • PM-JAY has created a massive demand for private and public sector services by making hospital facilities accessible to 55 crore people. 
  • In tier II and tier III cities, private sector hospitals are witnessing an almost 20% increase in footfall. 
  • Public sector facilities have streamlined their processes so as to improve service quality and amenities with funds from PMJAY.

Employment

  • With the setting up of 1.5 lakh HWCs by 2022, an expected 1.5 lakh jobs will be created for community health officers, including 50,000 multi-purpose health workers. 
  • It has generated approximately 50,000-60,000 jobs in the first year itself and is expected to add over 12.5 lakh jobs in both public and private sectors over the next three to five years.
  • 90% of them are in the healthcare sector and the remaining in allied sectors such as insurance and implementation support. 
  • 1.5 lakh beds will be added to existing and new hospitals. This will lead to the creation of around 7.5 lakh new opportunities for doctors, nurses, technicians, pharmacists and frontline healthcare workers such as Pradhan Mantri Arogya Mitras.

IT infrastructure

  • It is supported by a strong IT backbone that facilitates the identification of beneficiaries, records treatments, processes claims, receives feedback, and addresses grievances. 
  • A live dashboard helps in monitoring and improving performance, based on real-time data and regular analysis. 
  • This platform also helps states to compare their performance. 
  • A strong and sophisticated fraud prevention, detection and control system at the national and state level ensures that frauds are largely prevented. 

Way ahead

  • Tap the potential of collective bargaining and leveraging economies of scale to deliver affordable and quality healthcare through devices, implants, and supplies. 
  • Prescribing and ensuring adherence to standard treatment protocols. 
  • Strengthening the linkage between HWCs and PMJAY to improve the backward and forward referrals and enhance overall healthcare services to the poor. 
  • “Greenfield” states with no past experience of implementing healthcare schemes have to work harder to scale up their progress. 

India will make sure healthcare is no longer a privilege and is available to every Indian.

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

Controlled Human Infection Model (CHIM)Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : CHIM

Mains level : CHIM and ethical issues with it


  • The Department of Biotechnology (DBT) is close to finalising three projects involving Indian and European scientists to develop new influenza vaccines using a Controlled Human Infection Model (CHIM).

About CHIM

  • In a Controlled Human Infection Model (CHIM) study, a well-characterized strain of an infectious agent is given to carefully select adult volunteers.
  • This is done in order to better understand human diseases, how they spread, and find new ways to prevent and treat them.
  • These studies play a vital role in helping to develop vaccines for infectious diseases.
  • Such studies, which are being employed in vaccine development in the US, the UK and Kenya, are being considered in India.

Benefit

  • A CHIM approach will speed up the process whereby scientists can quantify whether potential vaccine candidates can be effective in people and identify the factors that determine why some vaccinated people fall sick and others do not.
  • CHIM models help vaccine-makers decide whether they should go ahead with investing in expensive trials.

Concerns

  • The risk in such trials is that intentionally infecting healthy people with an active virus and causing them to be sick is against medical ethics.
  • It also involves putting human lives in danger.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Smoke of the Vaper: On e-cigarettes banop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : Need to ban e-cigarettes


Context

  • When alternatives are peddled as ‘the lesser evil’, virtue is artificially added as a measure of degrees.
  • The evil is often clear and present, as in the case of electronic cigarettes, in all forms — Electronic Nicotine Delivery System (ENDS), vapes, and e-hookahs.

The Ban

  • The Centre’s move to ban these products shows a welcome intolerance of anything that impacts negatively on the health and wellness of the people of the country.
  • The Cabinet recently cleared the Prohibition of Electronic Cigarettes Ordinance, 2019.
  • Now, any production, import, export, sale (including online), distribution or advertisement, and storage of e-cigarettes is a cognizable offence punishable with imprisonment or fine, or both.

E-cigarettes over Cigarettes

  • E-cigarettes, which were to aid smokers kick their habit, do not burn tobacco leaves.
  • Instead these battery-operated devices produce aerosol by heating a solution containing among other things, nicotine.
  • Nicotine is an addictive substance that may, according to studies, function as a “tumour promoter” and aid neuro-degeneration.
  • Some other compounds in the aerosol are toxic substances that have known deleterious effects, and might just be less harmful than cigarettes, not harmless.
  • Seven deaths have been recorded in the U.S. — the largest consumer of e-cigarettes in the world — where, New York recently banned the sale of flavoured e-cigarettes.

Ban is justified

  • There is ample evidence on the harm of nicotine addiction — the reason that it is only approved under the Drugs and Cosmetics Act for use only in nicotine gums and patches.
  • As the WHO’s Framework Convention on Tobacco Control (FCTC) outlines, these devices can only be believed to succeed if smokers have moved on to an alternative nicotine source.
  • There is evidence now that vaping dangled as a cool, fun, activity, lures youngsters, and ironically, serves to introduce them to smoking.
  • The FCTC also records that e-cigarettes are unlikely to be harmless, and long-term use is expected to increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease and other diseases also associated with smoking.

Numbers were the trigger

  • The urgency to act on this front is also justified by the number of users.
  • As per figures submitted to Parliament earlier this year, e-cigarettes and accessories valued at about $1,91,780 were imported to India between 2016 and 2019.

Conclusion

  • The government, already on the right path, must go all out to ensure that its ban is implemented earnestly in letter and spirit, unlike the patchy execution of the Cigarettes and Other Tobacco Products Act.
  • It is essential to ensure this progressive ordinance does not go up in smoke.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Cabinet approves ban on e-cigarettesPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : Hazards of ENDS



  • The Union Cabinet approved a ban on e-cigarettes, citing the need to take early action to protect public health.

Prohibition of E-cigarettes Ordinance, 2019

  • Upon promulgation of the ordinance, any production, manufacturing, import, export, transport, sale (including online sale), distribution or advertisement (including online advertisement) of e-cigarettes shall be a cognizable offence.
  • It is punishable with imprisonment of up to one year, or fine up to ₹1 lakh, or both for the first offence; and imprisonment of up to three years and fine up to ₹5 lakh for a subsequent offence.
  • Storage of electronic-cigarettes shall also be punishable with imprisonment of up to 6 months or a fine of up to ₹50,000 or both.
  • The sub-inspector has been designated as the authorised officer to take action under the ordinance.
  • The Central or State governments may also designate any other equivalent officer(s) as authorised officer for enforcement of the provisions of the ordinance.

What are e-cigarettes?

  • E-cigarettes are battery-powered devices that heat a solution of nicotine and different flavours to create aerosol, which is then inhaled.
  • These devices belong to a category of vapour-based nicotine products called ENDS.
  • E-cigarettes and other ENDS products may look like their traditional counterparts (regular cigarettes or cigars), but they also come in other shapes and sizes and can resemble daily use products, including pens and USB drives.
  • Several companies selling ENDS in India have positioned these products as a safer, less harmful alternative to traditional cigarettes or as devices that could help users quit smoking.

Why does the government want to ban these devices?

  • The Health Ministry and Central Drugs Standards Control Organisation, India’s drug regulatory authority, had attempted in the past to ban the import and sale of these products citing public health concerns.
  • Before the ordinance was announced, the government had been facing hurdles in the form of court cases against the move, as ENDS were not declared as ‘drugs’ in the country’s drug regulations.
  • These products have neither been assessed for safety in the national population, nor been approved under provisions of the Drugs and Cosmetics Act, 1940.Yet, they have been widely available to consumers.
  • Though some smokers have claimed to have cut down smoking while using ENDS, the total nicotine consumption seemed to remain “unchanged”, according to the government

Does this mean traditional tobacco products are safer?

  • Traditional tobacco products like cigarettes and chewing tobacco are already known to be harmful.
  • According to the CDC in the US, cigarette smoking harms “nearly every organ of the body, causes many diseases, and reduces the health of smokers in general”.
  • A study published in The Lancet found tobacco use was the “leading” risk factor for cancers in India in 2016.
  • ICMR estimates that India is likely to face over 17 lakh new cancer cases and over eight lakh deaths by 2020.
  • In 2018, India had nearly 27 crore tobacco users and a “substantial” number of people exposed to second-hand smoke, putting them at an increased risk for cardiovascular diseases, according to WHO.
  • Tobacco kills over 1 million people each year, contributing to 9.5 per cent of all deaths, it said.

Who gains from the move?

  • The government feels its decision will help “protect the population, especially youth and children, from the risk of addiction through e-cigarettes”.
  • It says enforcement of the ordinance will complement its efforts to reduce tobacco use and, therefore, help in reducing the economic and disease burden associated with it.
  • Apart from this, traditional tobacco firms, too, could potentially gain from the ban.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Paraquat herbicidePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Paraquat

Mains level : Preventing farmers death due to hazardous chemicals


  • The use of herbicide Paraquat killed around 170 people in the last two years in Odisha’s Burla district leading to demands for its ban.

Paraquat

  • Paraquat is a toxic chemical that is widely used as an herbicide (plant killer), primarily for weed and grass control.
  • It has been banned in 32 countries including Switzerland, where herbicide producing company Sygenta is based.
  • Paraquat also figures on the list of 99 pesticides and herbicides the Supreme Court to ban in an ongoing case.
  • Paraquat dichloride is being used for 25 crops in India, whereas it is approved to be used on only nine crops by the Central Insecticide Board and Registration Committee. This is a violation of the Indian Insecticides Act.
  • So far in India, only Kerala has banned the herbicide.
  • Another violation: since farmers can’t and don’t read the label on paraquat containers, retailers sell paraquat in plastic carry bags and refill bottles.

Why lethal?

  • There is no antidote to this herbicide, the consumers of which complain of kidney, liver and lung problems.
  • They may recover from kidney problems, but die of lung- and liver-related ailments. Some also witness kidney failure.

Need for worldwide ban

  • Paraquat is yet to be listed in the prior informed consent (PIC) of Rotterdam Convention, is an international treaty on import/export of hazardous chemicals signed in 1998.
  • If a chemical figures in the PIC, the exporting country has to take the importing nation’s prior consent before exporting it.

Back2Basics

Rotterdam Convention

  • The Rotterdam Convention is formally known as the Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade.
  • It is a multilateral treaty to promote shared responsibilities in relation to importation of hazardous chemicals.
  • The convention promotes open exchange of information and calls on exporters of hazardous chemicals to use proper labeling, include directions on safe handling, and inform purchasers of any known restrictions or bans.
  • Signatory nations can decide whether to allow or ban the importation of chemicals listed in the treaty, and exporting countries are obliged to make sure that producers within their jurisdiction comply.
  • India is a party to the convention, with 161 other parties.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Bombay blood groupPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Blood Groups

Mains level : Not Much


  • Over the last two weeks, the “Bombay blood group”, a rare blood type, has been at the centre of attention in Mumbai’s healthcare scene.
  • Demand for the blood type has coincidentally spiked at hospitals, but supply has been scarce.

Bombay blood group

  • The four most common blood groups are A, B, AB and O.
  • The rare, Bombay blood group was first discovered in Mumbai (then Bombay) in 1952.
  • Each red blood cell has antigen over its surface, which helps determine which group it belongs to.
  • The Bombay blood group, also called hh, is deficient in expressing antigen H, meaning the RBC has no antigen H.
  • For instance, in the AB blood group, both antigens A and B are found. A will have A antigens; B will have B antigens. In hh, there are no A or B antigens.

Rare in India, rarer globally

  • Globally, the hh blood type has an incidence of one in four million.
  • It has a higher incidence in South Asia; in India, one in 7,600 to 10,000 are born with this type.
  • This blood type is more common in South Asia than anywhere else because of inbreeding and close community marriages.
  • It is genetically passed. Shared common ancestry among Indians, Sri Lankans, Pakistanis and Bangladeshis has led to more cases of hh blood phenotype in this region.

Testing for the group

  • To test for hh blood, an Antigen H blood test is required.
  • Often the hh blood group is confused with the O group.
  • The difference is that the O group has Antigen H, while the hh group does not.
  • If anyone lacks Antigen H, it does not mean he or she suffers from poor immunity or may be more prone to diseases.
  • Their counts for haemoglobin, platelets, white blood cells and red blood cells are similar to the count of others based on their health index.
  • Because of rarity, however, they do face problems during blood transfusion.

Transfusion limitations

  • The individuals with Bombay blood group can only be transfused autologous blood or blood from individuals of Bombay hh phenotype only which is very rare.
  • Rejection may occur if they receive blood from A, B, AB or O blood group. In contrast, hh blood group can donate their blood to ABO blood types.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Genomic GridPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Genomic Grid

Mains level : Need for such grid


National Genomic Grid

  • In a move to take cancer research to the next level and make treatment viable for people of different economic classes, the government has plans to set up a National Genomic Grid.
  • It will study genomic data of cancer patients from India.
  • The grid to be formed will be in line with the National Cancer Tissue Biobank (NCTB) set up at the IIT Madras.
  • It will collect samples from cancer patients to study genomic factors influencing cancer and identifying the right treatment modalities for the Indian population.
  • The grid will have four parts, with the country divided into east, west, north and south. The genomic samples will help researches to have India-specific studies on cancers.
  • The government plans to set up the National Genomic Grid in the same style with pan-India collection centres by bringing all cancer treatment institutions on board.

About National Cancer Tissue Biobank

  • The NCTB is functioning in close association with the Indian Council for Medical Research (ICMR).
  • NCTB, which has the capacity to stock 50,000 genomic samples from cancer patients, already has samples from 3,000 patients.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Empowering primary care practitionersop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Strengthening primary health care to improve public health


Context

There is a need to empower primary health care providers to make crucial health decisions in India.

Problems with Indian healthcare

    • In India a hospital-oriented, technocentric model of health care took roots. 
    • Building urban hospitals through public investment enjoyed primacy over strengthening community-based, primary health care. 
    • A private sector with a rampant, unregulated dual-practice system flourished. 
    • This influential doctors’ community saw a lucrative future in super-specialty medicine and buttressed the technocentric approach. 
    • This had an enormous impact on the present-day Indian health care.

Focus on hospitalization

    • Preference for ‘high-tech’ medical care has trickled down to even the poor sections which cannot pay for such interventions. 
    • Health insurance schemes like Ayushman Bharat based on providing insurance to the poor for private hospitalisation are influenced by the popular demand for high-quality medical care.
    • Medical Council of India came to be dominated by specialists with no representation from primary care. 

NMC – community health care provision

    • The current opposition to training mid-level providers under the NMC Act 2019 is an example of how the present power structure is inimical to primary health care. 
    • Evidence proves that practitioners of modern medicine trained through short-term courses of a 2-3 year duration can greatly help in providing primary health care to the rural population. 
    • Such medical assistants and non-allopathic practitioners have been written-off as ‘half-baked quacks’ who would endanger the health of the rural masses. 
    • Nations like the U.K. and the U.S. are consistently training paramedics and nurses to become physician assistants or associates through two-year courses in modern medicine.

Way ahead

    • Countries such as the U.K. and Japan have incentivised general practitioners (GPs) and designed a system that strongly favors primary health care. 
    • It is imperative to reclaim health from the ivory towers called ‘hospitals’. 
    • We need to find a way to adequately empower PCPs and give them a prominent voice in our decision-making processes pertaining to health care.
    • No one should be allowed to bypass the primary doctor to directly reach the specialist unless situations such as emergencies so warrant. It is only because of such a system that general practitioners and primary health care have been thriving in the U.K.’s health system.
    • Bhore Committee report (1946) highlighted the need for a ‘social physician’ as a key player in India’s health system. 37 years after the report, PG in family medicine is a reality.

Best case – Japan

    • For the early part of Japan’s history, hospitals catered only to an affluent few. 
    • The government limited the funding of hospitals, restricted them to functions like training of medical students and isolation of infectious cases.
    • Reciprocal connections between doctors in private clinics and hospitals were forbidden.
    • The Japanese Social Health Insurance was implemented in 1927, and the Japanese Medical Association (JMA) as the main player in negotiating the fee schedule. It was headed by Primary Health Care providers.
    • Japan Managed to contain the clout of specialists in its health-care system and accorded a prominent voice to its primary care practitioners (PCP) in decision-making processes.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Biosimilar MedicinesPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Biosimilars

Mains level : Not Much


  • A renowned pharma company has launched in India Versavo (bevacizumab), a biosimilar of Roche’s Avastin is indicated for the treatment of several types of cancers.

What is Biosimilarity?

  • Biosimilarity means that the biological product is highly similar to the reference product notwithstanding minor differences in clinically-inactive components.
  • There are no clinically meaningful differences between the biological product and the reference product in terms of the safety, purity, and potency of the product.

Biosimilars

  • A biosimilar is a biological medicine highly similar to another already approved biological medicine (the ‘reference medicine’).
  • Biosimilars are approved according to the same standards of pharmaceutical quality, safety and efficacy that apply to all biological medicines.
  • Biological medicines contain active substances from a biological source, such as living cells or organisms (human, animals and microorganisms such as bacteria or yeast) and are often produced by cutting-edge technology.

Biosimilars vs generics

  • Biosimilar drugs are often confused with generic drugs. Both are marketed as cheaper versions of costly name-brand drugs.
  • Both are available when drug companies’ exclusive patents on expensive new drugs expire. And both are designed to have the same clinical effect as their pricier counterparts.
  • But biosimilar drugs and generic drugs are very different, mainly because while generic drugs are identical to the original in chemical composition, biosimilar drugs are “highly similar,” but close enough in duplication to accomplish the same therapeutic and clinical result.
  • Another key difference is that generics are copies of synthetic drugs, while biosimilars are modeled after drugs that use living organisms as important ingredients.
  • But many experts hope the two will share a critical commonality and that, like generics, biosimilars will dramatically lower the cost of biologic drugs.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

India gets its first national essential diagnostics listPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Medical diagnosis


National Essential Diagnostics List (NEDL)

  • India has got its first National Essential Diagnostics List (NEDL) finalised by the Indian Council of Medical Research (ICMR).
  • With this, India has become the first country to compile such a list that would provide guidance to the government for deciding the kind of diagnostic tests that different healthcare facilities in villages and remote areas require.
  • NEDL aims to bridge the current regulatory system’s gap that does not cover all the medical devices and in-vitro diagnostic device (IVD).
  • The list is meant for facilities from village till the district level.

How are diagnostics regulated?

  • In India, diagnostics (medical devices and in vitro diagnostics) follow a regulatory framework based on the drug regulations under the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules 1945.
  • Diagnostics are regulated under the regulatory provisions of the Medical Device Rules, 2017.

Why need NEDL?

  • Diagnostics serve a key role in improving health and quality of life.
  • While affordability of diagnostics is a prime concern in low, middle-income countries like India, low cost, inaccurate diagnostics have made their way into the Indian market which has no place in the quality health care system.
  • NEDL builds upon the Free Diagnostics Service Initiative and other diagnostics initiatives of the Health Ministry to provide an expanded basket of tests at different levels of the public health system.

Benefits

  • The implementation of NEDL would enable improved health care services delivery through evidence-based care, improved patient outcomes and reduction in out-of-pocket expenditure; effective utilisation of public health facilities.
  • It would help in effective assessment of disease burden, disease trends, surveillance, and outbreak identification; and address antimicrobial resistance crisis too.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Notifiable DiseasePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Notifiable diseases

Mains level : Need for notifying diseases


  • A month after Union Health Minister asked the Delhi government to make malaria and dengue notifiable diseases, the local authorities has initiated the work to notify malaria in the capital.

What is a notifiable disease?

  • A notifiable disease is any disease that is required by law to be reported to government authorities.
  • The collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks.
  • The World Health Organization’s International Health Regulations, 1969 require disease reporting to the WHO in order to help with its global surveillance and advisory role.
  • Registered medical practitioners need to notify such diseases in a proper form within three days, or notify verbally via phone within 24 hours depending on the urgency of the situation.
  • This means every government hospital, private hospital, laboratories, and clinics will have to report cases of the disease to the government.
  • The onus of notifying any disease and the implementation lies with the state government.
  • The Centre has notified several diseases such as cholera, diphtheria, encephalitis, leprosy, meningitis, pertussis (whooping cough), plague, tuberculosis, AIDS, hepatitis, measles, yellow fever, malaria dengue, etc.

Why notify diseases?

  • Making a disease legally notifiable by doctors and health professionals allows for intervention to control the spread of highly infectious diseases.
  • The process helps the government keep track and formulate a plan for elimination and control. In less infectious conditions, it improves information about the burden and distribution of disease.
  • Any failure to report a notifiable disease is a criminal offence and the state government can take necessary actions against defaulters.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Every child to get Rota virus vaccine by SeptemberGovt. Schemes

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Rotavirus

Mains level : Nothing much


NEWS

Health Ministry has decided to provide Rotavirus vaccine to every child across all States and Union Territories by September 2019.

Background

  1. Diarrhoea is one of the biggest killers in children and Rotavirus was one of the most common causes of severe diarrhoea in children less than 2 years of age.
  2. Rotavirus vaccine along with proper sanitation, handwashing practices, ORS and zinc supplementation will go a long way in reducing the mortality and morbidity due to diarrhoea in children.
  3. In India, every year, 37 out of every 1,000 children born are unable to celebrate their 5th birthday, and one of the major reasons for this is diarrhoeal deaths. 
  4. Out of all the causes of diarrhoea, Rotavirus is a leading cause of diarrhoea in children less than 5 years of age.
  5. Rotavirus diarrhoea can be prevented through vaccination. Other diarrhoea can be prevented through general measures like good hygiene, frequent hand washing, safe water and safe food consumption, exclusive breastfeeding and vitamin A supplementation.

Rotavirus Vaccine

  1. Rotavirus vaccine was introduced in 2016 and is now available in 28 States/Union Territories. It is expected to be available in all 36 States/Union Territories by September 2019.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

The making of cyborgs and the challenges aheadop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : What neuroprosthetics is

Mains level : Neuro modulation and breakthroughs in health sector


Context

A recent medical trial restored partial sight to six blind people via an implant that transmits video images directly to the brain. The device used was called Orion, which feeds images from a camera directly to the brain.

“Cognitive neuroprosthetics” are devices that directly interface with the brain to improve memory, attention, emotion and much more. 

Problems

  1. Current neuromodulation systems need surgical implantation of bulky components with limited battery life.
  2. Batteries impact an intervention’s cost and lifetime, a device’s size and weight, the need for repeat surgeries and problems of tissue-heating and performance compromises. This is due to the relatively high power consumption of the electronics for a given performance requirement.
  3. The National Institutes of Health in the US opines that pacemaker batteries last between 5-15 years, but their average lifespan is 6-7 years; a doctor has to operate again after about 7 years to replace either the battery or the pacemaker itself.

Breakthrough 

  1. A flexible chip-type implant that harnesses glucose present in the body and converts it into electrical energy that can power a neurological implant.
  2. The problem of battery size can be tackled by reducing the power consumption and operating the electronics near fundamental levels of physics.
  3. Achieving a higher number of channels, better signal-to-noise ratio, and improved flexibility and robustness while working at ultra-low power can significantly lower implant sizes without sacrificing performance.
  4. Ultra-low-power semiconductors to generate chipsets that have been validated in lab and animal trials. 

Future of neuromodulation

  1. Spinal cord stimulation and deep brain stimulation are major target applications.
  2. Neuromodulation is the most lucrative sector in the European neurological device market. In India, it is estimated that about 30 million people suffer from various forms of neurological diseases and the average prevalence rate is as high as 2,394 patients per 100,000 of the population.
  3. Current neuromodulation devices cost between $10,000 and $40,000, putting them out of reach for many Indians.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Genome India InitiativePriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Genome India Initiaitve

Mains level : Benefits of genome mapping



  • The Department of Biotechnology (DBT) plans to scan nearly 20,000 Indian genomes over the next five years, in a two-phase exercise, and develop diagnostic tests that can be used to test for cancer.

What is a Genome?

  • A genome is an organism’s complete set of DNA, including all its genes.
  • It contains all the information needed to build and maintain that organism.
  • By sequencing the genome, researchers can discover the functions of genes and identify which of them are critical for life.

Genome India Initiative

  • The initiative aims to make predictive diagnostic markers available for some priority diseases such as cancer and other rare and genetic disorders
  • The first phase involves sequencing of complete genomes of nearly 10,000 Indians from all corners of the country and captures the biological diversity of India.
  • In the next phase, about 10,000 “diseased individuals” would have their genomes sequenced.
  • These vast troves of data sets would be compared using machine learning techniques to identify genes that can predict cancer risk, as well as other diseases that could be significantly influenced by genetic anomalies.
  • 22 institutions, including those from the Council of Scientific and Industrial Research (CSIR) and the DBT would be involved in the exercise.
  • The data generated would be accessible to researchers anywhere for analysis.
  • This would be through a proposed National Biological Data Centre envisaged in a policy called the ‘Biological Data Storage, Access and Sharing Policy’, which is still in early stages of discussion.

Why such move?

  • There is interest among private and public companies in sequencing genomes thanks to the declining costs for the process.
  • From China to the United Kingdom and Saudi Arabia, several countries have announced plans to sequence their population.
  • Currently, genomic data sets under-represent Asia, particularly India, whose population and diverse ethnicity make it an attractive prospect for genome-mining efforts.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Patients and victimsMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Regulation of medical devices


CONTEXT

  • Last year, a series of reports revealed the traumatic experiences of Indian patients who had received faulty hip implants manufactured by the pharma major, Johnson and Johnson
  • Another investigation has revealed that Johnson and Johnson paid hefty compensations to US patients who had received the defective implants.
  • In India, however, the company has challenged government orders to compensate 4,700 patients who had undergone hip replacement surgeries.
  • The reports also highlight that the story is more than that of corporate negligence.
  • That Johnson and Johnson continue to brazen it out in India has much to do with the regulatory deficit in the country.
  • The investigations pertain to implants manufactured under two brand names, ASR and Pinnacle.
  • Both products are not in the market currently.
  • Johnson and Johnson recalled ASR from the global market in 2010, while Pinnacle was withdrawn in 2013.

Recalling of medical Device

  • But recalling a medical device is not like recalling a consumer product.
  • Defective implants can cause crippling pain — even death.
  • Patients who receive such implants need regular monitoring. In several countries, registries track the health of such patients.
  • In fact, Johnson and Johnson’s recalling of ASR owes to the more than 15 warnings, between 2007 and 2009, issued to it by the Australian Joint Registry (though the company describes its decision as “voluntary”).
  • Pinnacle was pulled out of the market after a flurry of lawsuits in the US alerted the country’s Food and Drug Administration (FDA) about the device’s defects.

The slow reaction by India

  • In India, in contrast, regulators were slow to react.
  •  Maharashtra’s FDA red-flagged ASR a few months after Johnson and Johnson withdrew the product from the global market.
  • But it took another year for the Central Drugs Standard Control Organisation to ban the import of ASR.
  • Another year went by before the drug regulator issued an advisory to orthopaedic surgeons asking them to not implant ASR.

Defence by corporate

  • These delays are significant because last year, Johnson and Johnson told a Union Ministry of Health and Family Welfare (MoHFW) expert committee that it cannot trace as many as 3,600 patients who underwent surgeries involving the faulty implant.
  • That India did not have a joint registry when these surgeries happened has compounded the problem.
  • The want of a registry has also come in the way of ascertaining the damage caused by Pinnacle. Johnson and Johnson claims that it has no adverse reports of the device in the country.
  • However, reports in this paper have highlighted the trauma of at least seven patients with Pinnacle implants.

Conclusion

  • In 2017, the MoHFW issued the Medical Devices Rules. However, the country’s base legislation on implants continues to be the Drugs and Cosmetics Act, 1940, which does not have the scope to cover most modern devices, including hip implants.
  • The Indian orthopaedic device market is valued at over 450 million dollars and is expected to grow by 30 per cent per year till 2025.
  • The investigations into faulty hip implants bring out the urgent need for a law to regulate medical devices.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Data Quality Forum (NDQF)Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Data Quality Forum (NDQF)

Mains level : Utilizing meadical health data


National Data Quality Forum

  • The Indian Council of Medical Research (ICMR)’s National Institute for Medical Statistics (ICMR-NIMS), in partnership with Population Council, launched the NDQF.
  • It will integrate learning from scientific and evidence-based initiatives and guide actions through periodic workshops and conferences.
  • Its activities will help establish protocols and good practices of data collection, storage, use and dissemination that can be applied to health and demographic data, as well as replicated across industries and sectors noted a release issued by ICMR.

Why need NDQF?

  • India has a rich resource of data on its population, its health status and demographic behaviour and economic condition among many other aspects of life and environment.
  • This wealth of data can be translated into insights and, eventually, into policy through a layered process involving human and technological inputs at every stage.
  • However, these data often suffer from some common challenges related to human and technological factors and affect its quality.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] A WASH for healthcareMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Wash and Primary health Sector


CONTEXT

Without adequate water, sanitation and hygiene amenities, infection control is severely compromised.

Background

Healthcare facilities are many and varied. Some are primary, others are tertiary. Many are public, some are private. Some meet specific needs, whether dentistry or occupational therapy, and some are temporary, providing acute care when disaster strikes.

  • Whatever their differences, and wherever they’re located, adequate water, sanitation and hygiene (WASH) amenities, including waste management and environmental cleaning services, are critical to their safe functioning.
  • When a healthcare facility lacks adequate WASH services, infection prevention and control are severely compromised.
  • This has the potential to make patients and health workers sick from avoidable infections.
  • As a result (and in addition), efforts to improve maternal, neonatal and child health are undermined. Lack of WASH facilities also results in unnecessary use of antibiotics, thereby spreading antimicrobial resistance.

Report’s Findings

  • As a joint report published earlier this year by the World Health Organization and the UN Children’s Fund (UNICEF) outlines, WASH services in many facilities across the world are missing or substandard.
  • According to data from 2016, an estimated 896 million people globally had no water service at their healthcare facility.
  • More than 1.5 billion had no sanitation service.
  • One in every six healthcare facilities was estimated to have no hygiene service (meaning it lacked hand hygiene facilities at points of care, as well as soap and water at toilets), while data on waste management and environmental cleaning was inadequate across the board.

Enhancing primary healthcare

  • In WHO’s South-East Asia region, efforts to tackle the problem and achieve related Sustainable Development Goal (SDG) targets are being vigorously pursued.
  • As outlined at a WHO-supported meeting in New Delhi in March, improving WASH services in healthcare facilities is crucial to accelerating progress towards each of the region’s ‘flagship priorities’, especially the achievement of universal health coverage.
  • Notably, improving WASH services was deemed essential to enhancing the quality of primary healthcare services, increasing equity and bridging the rural-urban divide.

WHO’s Initiative 

  • A World Health Assembly Resolution passed in May is hoping to catalyse domestic and external investments to help reach the global targets.
  • These include ensuring at least 60% of all healthcare facilities have basic WASH services by 2022; at least 80% have the same by 2025; and 100% of all facilities provide basic WASH services by 2030.
  • For this, member states should implement each of the WHO- and UNICEF-recommended practical steps.
  • Assessments – First, health authorities should conduct in-depth assessments and establish national standards and accountability mechanisms. Across the region, and the world, a lack of quality baseline data limits authorities’ understanding of the problem.
  • National Road Maps  – As this is done, and national road-maps to improve WASH services are developed, health authorities should create clear and measurable benchmarks that can be used to improve and maintain infrastructure and ensure that facilities are ‘fit to serve’.

Educating the health workers

Cleanliness in centres – Second, health authorities should increase engagement and work to instil a culture of cleanliness and safety in all healthcare facilities.

Information Campaign – Alongside information campaigns that target facility administrators, all workers in the health system — from doctors and nurses to midwives and cleaners — should be made aware of, and made to practise, current WASH and infection prevention and control procedures (IPC).

Pre Service Training – To help do this, modules on WASH services and IPC should be included in pre-service training and as part of ongoing professional development.

Inclusive Approach – In addition, authorities should work more closely with communities, especially in rural areas, to promote demand for WASH services.

And third, authorities should ensure that collection of data on key WASH indicators becomes routine. Doing so will help accelerate progress by promoting continued action and accountability. It will also help spur innovation by documenting the links between policies and outcomes. To make that happen, WHO is working with member states as well as key partners to develop a data dashboard that brings together and tracks indicators on health facilities, including WASH services, with a focus on the primary care level.

As member states strive to achieve the ‘flagship priorities’ and work towards the SDG targets, that outcome is crucial. Indeed, whatever the healthcare facility, whoever the provider, and wherever it is located, securing safe health services is an objective member states must boldly pursue.

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

Generic DrugsPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Generic Drugs

Mains level : Healthcare in India


  • The Central Government is considering amendments to the Drugs and Cosmetic Rules, 1945 to ensure that registered medical practitioners dispense only generic medicines.

What are generic drugs?

  • A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by patents.
  • Generic drugs are allowed for sale after the patents on the original drugs expire.
  • Because the active chemical substance is the same, the medical profile of generics is believed to be equivalent in performance.
  • A generic drug has the same active pharmaceutical ingredient (API) as the original, but it may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging.

Prescribing generic drugs

  • The matter was recently brought before the Drugs Consultative Committee (DCC) of the Central Drugs Standard Control Organisation (CDSCO).
  • A proposal attempts that registered medical practitioners can supply different categories of medicines including vaccines to their patients under the exemption provided, with certain conditions, under Schedule K of the Drugs and Cosmetics Rules, 1945.
  • As of now there are no specified types of medicines which can be supplied by doctors to their patients.
  • It is now proposed that registered medical practitioners shall supply generic medicines only and physicians samples shall be supplied free of cost.

Issues with generic drugs

  • The main concern is to offer the best medicines which are most effective so medical professionals should not be forced to prescribe in a particular manner.
  • The government has to ensure easy availability, unclogged supply chain, and strict quality control of generic medicines.
  • It also has to ensure availability and effectiveness also of generic medicines.

Way forward

  • The government should keep strict price control on medicines and ensure that the highest quality medicines are given to the patients.
  • All laws, checks and balances should be directed at giving the best possible treatment at the best cost.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Food and Nutrition Security Analysis, India, 2019DOMR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the report: Food and Nutrition Security Analysis, India, 2019

Mains level : Malnutrition in India


State of deficit

  • The Food and Nutrition Security Analysis, India, 2019, a report by the MoSPI and The World Food Programme lists Maharashtra as one of the six States with high levels of stunting and underweight.
  • The State also has a prevalence of stunting and wasting.
  • Here’s a look at the highlights of the report and overall malnutrition in Maharashtra.

What is malnutrition?

  • Malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight) inadequate vitamins or minerals, overweight, obesity, and resulting diet-related non-communicable diseases.

Types of malnutrition

  • Moderate Acute malnutrition (MAM): Children aged between six months and 59 months who are between the -2 and -3 standard deviation for weight for height (wasting) score.
  • Severe Acute Malnutrition (SAM): Children aged between six months and 59 months and have a weight for height (wasting) score 3 standard deviations below the median, have a mid-upper-arm circumference less than 115 mm, or the presence of bilateral edema.
  • Severe Chronic Malnutrition (SCM): Calculated with the Z-score defined as a height-for-age index less than –3 standard deviations from the mean weight of a reference population of children of the same height and/or having edema.
  • Stunting: Calculation is based on height-for-age. It is is associated with an underdeveloped brain, poor learning capacity, and increased nutrition-related diseases.
  • Wasting: Calculated by weight-for-height. It is associated with decreased fat mass. Also known as wasting syndrome, it causes muscle and fat tissue to waste away.
  • Underweight: Calculated by the weight-for-age formula. It is a body weight considered to be too low to be healthy. It can reflect both stunting and wasting.

Food and malnutrition in the country

  • Over the last 20 years, total food grain production in India increased from 198 million tonnes to 269 million tonnes.
  • Despite increase in food production, the rate of malnutrition in India remains very high.
  • In the food basket, it turns out that in both urban and rural areas, the share of expenditure on cereal and cereal substitutes has declined between 1972-73 and 2011-12, from 57% to 25% in rural areas and from 36% to 19% in urban areas.
  • The energy and protein intake from cereals has decreased in both rural and urban India, largely because of increased consumption of other food items such as milk and dairy products, oils and fat and relatively unhealthy food such as fast food, processed food, and sugary beverages.
  • The consumption of unhealthy energy and protein sources is much higher in urban areas.

Double burden of malnutrition

  • For several decades India was dealing with only one form of malnutrition– undernutrition.
  • In the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India.
  • From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36% to 23% and from 34% to 20% among Indian men.
  • During the same period, the prevalence of overweight/obesity (BMI > 30 kg/m2) increased from 13% to 21% among women and from 9% to 19% in men.
  • Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI.

States Performance

  • The highest levels of stunting and underweight are found in Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat and
  • At the national level, among social groups, the prevalence of stunting is highest amongst children from the STs (43.6 percent), followed by SCs (42.5 percent) and OBCs (38.6 percent).
  • The prevalence of stunting in children from ST in Rajasthan, Odisha and Meghalaya is high while stunting in children from both ST and SC is high in Maharashtra, Chhattisgarh and Karnataka.
  • Prevalence of wasting is highest in Jharkhand (29.0%) and above the national average in eight more States (Haryana, Goa, Rajasthan, Chhattisgarh, Maharashtra, MP, Karnataka and Gujarat) and three UTs (Puducherry, Daman and Diu and Dadra and Nagar Haveli).
  • Prevalence of underweight is also highest in Jharkhand (47.8%) and is above the National average in seven more States (Maharashtra, Rajasthan, Chhattisgarh, Gujarat, UP, MP and Bihar) and one UT (Dadra and Nagar Haveli).
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Healthcare’s primary problemMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Reforms in primary health care sector


CONTEXT

The deaths of 154 children in Bihar due to acute encephalitis syndrome (AES) has laid bare the precarious capacity of the State’s healthcare apparatus to handle outbreaks. AES has been linked to two factors: litchi consumption by starving children and a long, ongoing heat wave.

Preventable Disease

  • AES is largely preventable both before and just after the onset of the disease, and treatable with high chances of success on availability of medical intervention within 2-4 hours of symptoms.
  • Therefore, the first signs of an outbreak must prompt strong prevention measures.

Measures that should have been taken

  • These include, apart from a robust health education drive and replenishing primary health centres (PHCs) with essential supplies, extensive deployment of peripheral health workers (ASHA workers) and ambulance services to facilitate rapid identification and management of suspected cases.
  • Vacant doctor positions in PHCs must be urgently filled through deputation.
  • Furthermore, short-term scaling-up of the Poshan Abhiyaan and the supplementary nutrition programme — which makes available hot, cooked meals for pre-school children at Anganwadis along with take home ration for mothers and distribution of glucose/ORS packets in risk households — are imperative.
  • Nearly every one of these elements lies undermined in Bihar.

Crumbling healthcare in Bihar

  • In Bihar, one PHC caters to about 1 lakh people rather than the norm of 1 PHC per 30,000 people.
  • Furthermore, it is critical for such a PHC, catering to more than three times the standard population size, to have at least two doctors.
  • However, three-fourths of the nearly 1,900 PHCs in Bihar have just one doctor each.
  • Muzaffarpur has 103 PHCs (about 70 short of the ideal number) with 98 of them falling short of basic requirements outlined by the Health Management Information System
  • . Bihar, one of the most populous States, had a doctor-population ratio of 1:17,685 in 2018, 60% higher than the national average, and with only 2% of the total MBBS seats in the country.
  • There is also a one-fifth shortage of ASHA personnel, and nearly one-third of the sub-health centres have no health workers at all.
  • While the State reels under the highest load of malnutrition in India, a study found that around 71% and 38% of funds meant for hot, cooked meals and take home ration, respectively, under the supplementary nutrition programme, were pilfered.
  • Meals were served for just more than half the number of prescribed days, and only about half the number of beneficiaries on average actually got them.
  • Even those PHCs with adequate supplies remain underutilised.
  • Perennial subscription to selective healthcare services by PHCs, like family planning and immunisation, have cultivated the perception that PHCs are inept as centres of general healthcare.
  • This leads patients either directly to apex government hospitals situated far away or to unqualified private providers.
  • This results in a patient losing precious time in transit and landing up in a hospital in a critical and often irreversible stage of illness.
  • Merely strengthening the tertiary care sector will be inefficient and ineffective.
  •  A narrow focus on the hospital sector will wastefully increase costs, ignore the majority of cases, increase the number of cases that are in advanced stages, while continuing to overstretch public hospitals.

Revamp primary health infrastructure

  • The solution lies in building more functional PHCs and sub-health centers; scaling-up the cadres of ASHA workers; strict monitoring of nutrition programmes; and addressing the maldistribution of doctors and medical colleges.
  • The resultant robust primary care system can then be geared towards being more responsive to future outbreaks.
  • We should also bolster our technical capacity to better investigate the causes of such outbreaks and operationalise a concrete long-term strategy.

Conclusion

  • Policy documents, while emphasising on financial and managerial aspects of public health, fail to address the aberrant developmental paradigm of our health services.
  • Decades of hospital-centric growth of health services have eroded faith in community-based healthcare.
  • In these circumstances, even easily manageable illnesses increase demand for hospital services rather than PHCs. There is need to work on inculcating confidence in community-based care.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Miles to go: self-care medical interventionsMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Improvement in self care interventions


CONTEXT

Self-care, which mostly happens outside the formal health system, is nothing new. What has changed is the deluge of new diagnostics, devices and drugs that are transforming the way common people access care, when and where they need them.

The relevance of self-care health interventions

  • With the ability to prevent disease, maintain health and cope with illness and disability with or without reliance on health-care workers, self-care interventions are gaining more importance.
  • Millions of people, including in India, face the twin problems of acute shortage of healthcare workers and lack of access to essential health services.
  • According to the World Health Organization, which has released self-help guidelines for sexual and reproductive health, over 400 million across the world already lack access to essential health services and there will be a shortage of about 13 million health-care workers by 2035.

Meaning of self help health care

  • Self-help would mean different things for people living in very diverse conditions.
  • While it would mean convenience, privacy and ease for people belonging to the upper strata who have easy access to healthcare facilities anytime, for those living in conditions of vulnerability and lack access to health care, self-help becomes the primary, timely and reliable form of care.
  • Not surprisingly, the WHO recognises self-care interventions as a means to expand access to health services.
  • Soon, the WHO would expand the guidelines to include other self-care interventions, including for prevention and treatment of non-communicable diseases.

The situation of self help health care in India

  • India has some distance to go before making self-care interventions for sexual and reproductive health freely available to women.
  • Home-based pregnancy testing is the most commonly used self-help diagnostics in this area in India.
  • Interventions include self-managed abortions using approved drugs — morning-after pills taken soon after unprotected sex, and mifepristone and misoprostol taken a few weeks into pregnancy — that can be had without the supervision of a healthcare provider. 
  • While the morning-after pills are available over the counter, mifepristone and misoprostol are scheduled drugs and need a prescription from a medical practitioner, thus defeating the very purpose of the drugs.
  • The next commonly consumed drug to prevent illness and disease is the pre-exposure prophylaxis (PrEP) for HIV prevention.
  • India is yet to come up with guidelines for PrEP use and include it in the national HIV prevention programme.
  • Despite the WHO approving the HIV self-test to improve access to HIV diagnosis in 2016, the Pune-based National AIDS Research Institute is still in the process of validating it for HIV screening

Conclusion

One of the reasons why people shy away from getting tested for HIV is stigma and discrimination. The home-based testing provides privacy. India has in principle agreed that rapid HIV testing helps to get more people diagnosed and opt for treatment, reducing transmission rates.

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

[op-ed snap] Start with preventive careMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Preventive health care


CONTEXT

The medical profession is a calling. It requires sacrifice and grit to become a healer, a clinician, and from then on, it is a responsibility and commitment to a lifetime of service and learning. Beyond the initial years of studying medicine, doctors have to work very hard every single day to upgrade their knowledge and skills.

Challenges in this profession

  • What makes the process more challenging is the dynamic nature of the world we live in today.
  • Knowledge and the nature of knowledge are evolving, driven by technological developments.
  • Healthcare challenges have also constantly evolved.
  • Doctors have reduced many feared ailments to stories of the past.
  • But ailments have also remodelled and resurfaced and are posing different tests to doctors today.

Developments in healthcare

  • Health is on the national agenda for the first time after Independence. Ayushman Bharat is a game-changer.
  • It will cover the cost of medical care for almost 40% of India’s population, while the 1,50,000 Health and Wellness Centres being developed will strengthen the national focus on preventive healthcare.
  • There is a willingness amongst our administrators to hear the perspectives of the sector.
  • Innovative plans are on the anvil to boost medical education and hospital infrastructure.
  • Skilling for healthcare is gaining momentum, and will undoubtedly be a key engine for job creation.
  • Millions of medical value travellers from over a hundred countries are choosing India for medical and surgical treatment.
  • Huge investments are being made to build hospitals, contemporary medical centres and remote healthcare models.

The big challenge today

  • The World Health Organization has been ringing the warning bells for the last few years on the challenges that NCDs pose.
  • NCDs have been rapidly growing. Cancer, stroke, obesity and diabetes are some of the ailments growing at an alarming pace.
  • They affect people across ages and threaten the younger population a lot more than the older population.
  • The limited pool of medical professionals, technicians and nurses, equipment and hospital beds will make it very difficult to tackle the onslaught of patients and diseases in the coming decade.
  • The entire medical fraternity must come together to tackle this threat with a disruptive and innovative approach of creating a continuum of care.
  • This will enable healthcare to start from preventive care instead of limiting medical excellence to curative care.

Conclusion

On the occasion of National Doctors Day, doctors need to pledge again the medical oath. They have to be the harbingers of change in the attitudes and approaches towards healthcare. They need to become role models for their patients to lead healthier lives. They must educate patients about NCDs, and promote preventive care.

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

WHO launches its first guidelines on self-care interventions for healthIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Self Care

Mains level : Importance of Self Care



  • The WHO has launched its first guidelines on self-care interventions for health.
  • This is in response to an estimate that by 2035 the world will face a shortage of nearly 13 million healthcare workers.
  • Currently at least 400 million people worldwide lack access to the most essential health services.

What is Self-Care?

  • Explaining what self-care means, the WHO says that it is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider.
  • Self-care interventions represent a significant push towards new and greater self-efficacy, autonomy and engagement in health for self-careers and caregivers.
  • WHO noted that self-care is also a means for people who are negatively affected by gender, political, cultural and power dynamics, including those who are forcibly displaced, to have access to sexual and reproductive health services, as many people are unable to make decisions around sexuality and reproduction.

About the guidelines

  • In its first volume, the guidelines focus on sexual and reproductive health and rights.
  • Some of the interventions include self-sampling for human papillomavirus (HPV) and sexually transmitted infections, self-injectable contraceptives, home-based ovulation predictor kits, human immunodeficiency virus (HIV) self-testing and self-management of medical abortion.
  • These guidelines look at the scientific evidence for health benefits of certain interventions that can be done outside the conventional sector, although sometimes with the support of a health-care provider.
  • They do not replace high-quality health services nor are they a shortcut to achieving universal health coverage.

Autonomy and engagement

  • It adds that self-care interventions represent a significant push towards new and greater self-efficacy, autonomy and engagement in health for self-careers and caregivers.
  • People are increasingly active participants in their own health care and have a right to a greater choice of interventions that meets their needs across their lifetime, but also should be able to access, control, and have affordable options to manage their health and well-being.
  • The guidelines, meanwhile, will be expanded to include other self-care interventions, including for prevention and treatment of non-communicable diseases.
  • WHO is establishing a community of practice for self-care, and will be promoting research and dialogue in this area during the self-care month between June 24 and July 24.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Pilot Scheme for distribution of Fortified Rice through PDSGovt. Schemes

Note4Students

From UPSC perspective, the following things are important :

Prelims level : BIofortification


  • A centrally-sponsored pilot scheme on fortification of rice and its dispersal through PDS has been approved by the government.

About the Scheme

  • The Department of Food and Public Distribution has approved the “Centrally Sponsored Pilot Scheme on fortification of rice and its distribution through Public Distribution System.”
  • Financial assistance of up to 90 per cent in case of North-Eastern, Hilly and Island States and up to 75 per cent in case of rest of the States has been extended.
  • Further, the Govt. has also advised all states and UTs especially those states and UTs that are distributing wheat flour through PDS to distribute fortified wheat flour through PDS.

How it is finalized?

  • The Recommended Dietary Allowance for Indian population is finalized by the National Institute of Nutrition (NIN-ICMR) based on the recommendations of the Expert Group.
  • It is based on individual variability and nutrient bio-availability from the habitual diet.

Back2Basics

Fortification

  • Fortification is a complementary strategy to fight malnutrition.
  • Under this, there is addition of key vitamins and minerals such as iron, iodine, zinc, vitamins A & D to staple foods such as rice, wheat, oil, milk and salt are done to improve their nutritional content.
  • This is done to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health.
  • Biofortification is the process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology.
  • It differs from conventional fortification in that Biofortification aims to increase nutrient levels in crops during plant growth rather than through manual means during processing of the crops.

How is Rice fortified?

  • Rice can be fortified by adding a micronutrient powder to the rice that adheres to the grains or spraying of the surface of ordinary rice grains with a vitamin and mineral mix to form a protective coating.
  • Rice can also be extruded and shaped into partially precooked grain-like structures resembling rice grains, which can then be blended with natural polished rice.
  • Rice kernels can be fortified with several micronutrients, such as iron, folic acid and other B-complex vitamins, vitamin A and zinc.

Regulating Fortification

  • FSSAI has formulated a comprehensive regulation on fortification of foods namely ‘Food Safety and Standards (Fortification of Foods) Regulations, 2016’.
  • These regulations set the standards for food fortification and encourage the production, manufacture, distribution, sale and consumption of fortified foods.
  • The regulations also provide for specific role of FSSAI in promotion for food fortification and to make fortification mandatory.
  • WHO recommends fortification of rice with iron, vitamin A and folic acid as a public health strategy to improve the iron status of population wherever rice is a staple food.

About Food Fortification Resource Centre (FFRC)

  • The FFRC is established under India’s government department that regulates food ie FSSAI in collaboration with TATA Trusts.
  • The FFRC works dedicatedly to provide essential support to stakeholders like relevant government ministries, food businesses, development partners etc., promoting and supporting food fortification efforts across India.

 

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

[pib] Proton TherapyPIBPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Proton Therapy

Mains level : Proton Therapy and its edge over other traditional radiaton therapy



  • As informed by Indian Council of Medical Research (ICMR), it is aware of advances in proton therapy, a new advanced type of Radiation therapy.

Proton Therapy

  • Proton therapy is a type of radiation therapy — a treatment that uses high-energy beams to treat tumors.
  • Radiation therapy using X-rays has long been used to treat cancers and noncancerous (benign) tumors.
  • It uses protons rather than x-rays to treat cancer. At high energy, protons can destroy cancer cells.
  • It can also be combined with x-ray radiation therapy, surgery, chemotherapy, and/or immunotherapy.
  • Like x-ray radiation, proton therapy is a type of external-beam radiation therapy.

How it works?

  • Fundamentally, all tissue cells are made up of molecules with atoms as their building blocks.
  • In the center of every atom is the nucleus. Orbiting the nucleus of the atom are negatively charged electrons.
  • When energized protons pass near orbiting electrons, the positive charge of the protons attracts the negatively charged electrons, pulling them out of their orbits. This is called ionization.
  • It changes the characteristics of the atom and consequentially the character of the molecule within which the atom resides.
  • Because of ionization, the radiation damages molecules within the cells, especially the DNA.
  • Damaging the DNA destroys specific cell functions, particularly the ability to divide or proliferate.
  • While both normal and cancerous cells go through this repair process, a cancer cell’s ability to repair molecular injury is frequently inferior.
  • As a result, cancer cells sustain more permanent damage and subsequent cell death than occurs in the normal cell population.

Why in news?

  • It is the most technologically advanced method to delivery radiation treatments to cancerous tumors available today.
  • The unique characteristics of how protons interact within the human body in fewer complications and side effects than standard radiation therapy.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

NITI Aayog “Healthy States, Progressive India” Report and Health Index 2019DOMRPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NITI Aayog’s Health Index

Mains level : Read the attached story



Kerala tops yet again

  • Kerala was ranked the best in the country in terms of health performance, according to health index scores in a report by NITI Aayog.
  • Kerala had an overall score of 74.01, with Andhra Pradesh coming second at 65.13.

NITI Aayog’s Health Index

  • The report is an annual systematic performance tool to measure the performance of the States and UTs.
  • It ranks states and union territories on their year on year incremental change in health outcomes, as well as, their overall performance with respect to each other.
  • The index analyses overall performance and incremental improvement in the States and the UTs for the period with 2015-16 as the base year and 2017-18 as the reference year.
  • HIV and tuberculosis detection and treatment, institutional deliveries, maternal and neonatal mortality rates, and immunisation coverage are among the indices measured and compared.
  • The states are broadly grouped into three: larger and smaller states and union territories so as to maintain a constant when comparing their health indices.
  • States had to fill in the responses in a specially created dashboard while a number of responses were pre-filled while sourced from National Family Health Survey-4 and Health Management Information System.

Performance by states:

Image source: Business Standard

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

Explained: Why is the litchi toxin causing deaths?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AES, Litchi toxin

Mains level : Preventing child mortality



Background

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

What is acute encephalitis syndrome (AES)?

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

Is encephalitis different from hypoglycaemic encephalopathy?

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

What happens in hypoglycaemic encephalopathy?

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

What killed so many children in Bihar?

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

Why has it affected only young children in Bihar?

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

Role of Litchi

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

How is MCPG hazardous?

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

What can be done to prevent this?

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

Can hypoglycemic encephalopathy be treated?

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

[op-ed snap] AI for public healthMains Onlyop-ed snap


CONTEXT

The term AI was coined way back in 1957. But it’s only in the last decade that we have seen an explosion of data, and data is the key fuel for AI and ML algorithms. As patient data and data collected through research is digitised, these algorithms can use it to detect patterns, and then assist health workers with early detection of warning signs as well as clinical decision-making.

Issues with public health programme

  • Public health programmes are complex and dependent on committed human resources, who are in short supply and fairly difficult to keep motivated.
  • These constraints limit the impact of large-scale health programmes, often leaving out families that need these.
  • The progress made in the field of artificial intelligence (AI) and machine learning (ML) in the last decade can bridge this gap.

Usage of AI

From precision medicine, medical record storage and retrieval, medical report diagnosis, and robotics in clinical settings, to virtual consultations and personal fitness trackers that can be used at home, AI is making its presence felt:

Diagnostics and screening: Identifying or predicting diseases based on symptoms;

Health worker performance: Tracking the data captured by health workers, and using it to direct their efforts where they are most needed;

Improving client adherence: Identifying gaps in people’s health-seeking behaviour and suggesting who might drop out of a health programme or course of treatment.

The Astana Declaration on Primary Health Care identified technology as a key driver to improve accessibility, affordability and transparency towards achieving #HealthForAll.

Benefits of AI

  • With the kinds of applications outlined above, AI and ML can be an excellent tool for the health workforce, making their lives easier and their work effective—when a few conditions are met.
  • It can automate repetitive tasks, figure out patterns in huge datasets, and aid clinical decision-making in specific areas, particularly radiology and pathology. What conditions health professionals using AI/ML should ensure?

1. Get the right data: AI and ML algorithms are smart, but only as smart as the data that feeds them. The principle of GIGO (garbage in, garbage out) is applicable here, too. Any bias in the data—method of collection, populations and contexts covered, human error—will make the algorithm biased.

2. Be ethical:  New developments like the EU’s General Data Protection Regulation are forcing investments in data security and privacy, but as public health professionals it’s important to think about ownership, access and use of people’s health data, before collecting it.

3. Get everyone on board: Getting non-IT people to accept the outputs of AI and ML can be an issue. If algorithms and processes are complicated (they often are), try and demystify AI and ML for teams that work on the ground.

4. Be clear about your objective: It’s important to not fall in the trap of setting huge objectives (like finding cure for cancer), but aim for low-hanging fruits and start with something well-defined and achievable.

Way forward

AI and ML can seem daunting to those who don’t dabble in technology, so organisations should get some tech experts on board. They can help define achievable outcomes, design usable systems, and navigate the complex maze of resources available to turn those ideas into reality. What health professionals bring to the table is their understanding of the needs and context, their on-ground networks that enable co-creation, and their experiential insight into how these technologies will affect the lives of communities and health workers. Through such powerful partnerships, we can harness AI to power the movement towards Health for All.

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

[op-ed snap] A failing stateMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : State's lack of preparedness cost children's lives.


CONTEXT

The death of children in Muzaffarpur due to AES, a preventable disease, shows that malnutrition needs to be addressed urgently.

Background

More than 100 children in Bihar’s Muzaffarpur district have died of acute encephalitis syndrome (AES), with the state’s medical authorities initially blaming the deaths on the heat wave, hypoglycemia (sudden drop in blood sugar levels) and lack of awareness.

Reasons

Now, belatedly, they have acknowledged the two most critical reasons for the deaths — malnutrition and the inadequacy of primary health centres (PHCs).

  • The state government’s lack of preparedness is indefensible.
  • AES has struck Muzaffarpur with regularity in the summers since 1995.
  • The disease claimed nearly 1,000 children between 2010 and 2014. It seemed to have become less virulent after 2014.

Study on AES

For example, a 2014 study by researchers from the Christian Medical College, Vellore, and the Centers for Disease Control and Prevention in Atlanta in the US showed how a combination of factors, unique to Muzaffarpur, sharpened the vulnerability of its children to the disease.

Litchi’s toxins – The district is a major litchi-growing region and the study found that toxins present in the fruit were a source of AES.

Malnutrition –

  • But the fruit was a triggering factor only in the case of children who had not received proper nutrition, the study reported.
  • It said that the toxins in the fruit assume lethal proportions when a poorly-nourished child eats litchis during the day and then goes to sleep without a proper meal.
  • The links between the fruit and AES have been debated but most researchers agree that the disease affects only under-nourished children.

No Action by the state on report

However, the state government has not taken the cue from medical research. It does not have a special nutrition programme for AES-prone areas.

Poorly Equipped PHCs

  • Medical literature has also shown that AES can be contained if the child is administered dextrose within four hours of the onset of symptoms.
  • But every AES outbreak in the past 10 years has shown that Muzaffarpur’s PHCs — the first point of healthcare for most AES patients — are ill-equipped to deal with the disease.
  • Most of them do not have glycometers to monitor blood sugar levels.
  • The Sri Krishna Medical College and Hospital, the designated hospital in Muzaffarpur to deal with the disease, do not have a virology lab or adequate number of paediatric beds.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Preventing violence: on protection to doctorsMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Improved health infrastructure is solution to violence against the doctors.


CONTEXT

A law to protect doctors is good, and a health-care upgrade is essential.

Background

  • The attack on a junior doctor on June 10 over the death of a patient had sparked the agitation, which spread to other parts of the country when it appeared that the State government was reluctant to negotiate with the striking doctors.
  • Now that Ms. Banerjee has reached out to young doctors and conceded that their demands are genuine, the government, in West Bengal and elsewhere, must focus on addressing the deficiencies afflicting the health-care system as a whole.

Reasons for violence against doctors

  • Reprisal attacks on doctors by agitated relatives of patients who die during treatment are known to happen.
  • Such violence is invariably the result of systemic problems that adversely affect optimal attention to patients, such as infrastructural and manpower constraints.
  • It is apparent that doctors work in stressful environments, sometimes under political pressure with regard to admissions.

Provisions in place

  • Several States have enacted laws to protect doctors and other health-care personnel from violence.
  • Last week, Union Health Minister Harsh Vardhan wrote to State governments highlighting the need for stringent action against anyone who assaults doctors.
  • He asked States that do not have a law to protect doctors against violence to enact one, and circulated a 2017 draft of a law that envisaged imprisonment besides recovery of compensation from perpetrators for loss or damage to property.

Effectiveness of such a law

  • Ironically, West Bengal, the epicentre of a strike that involved nearly the entire medical fraternity across the country, has such a law too.
  • Like the law in most other States, the West Bengal Act provides for a three-year prison term and a fine, which could go up to ₹50,000, to anyone indulging in violence against any “medicare service person”, which covers doctors, nurses, medical and nursing students and paramedical staff.
  • The offence is cognisable and non-bailable.
  • It also provides for recovery of compensation for the loss.
  •  It is clear that having this law did not prevent the incident that sparked the latest agitation.
  • There are no figures available on how many times the medical service person protection law has been invoked.

Conclusion

In any case, causing simple or grievous injuries to anyone is a criminal offence under the Indian Penal Code. Treating the issue as a law and order problem is just one way. The real solution may lie in improving health infrastructure, counselling patients about possible adverse treatment outcomes, and providing basic security in medical institutions.

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

Acute Encephalitis Syndrome (AES) outbreak in BiharStates in News

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AES

Mains level : Preventing Child Mortality


  • An epidemic of Acute Encephalitis Syndrome (AES) has broken out in five north Bihar districts, with more than 50 children having died in the last nine days.
  • Locally known as Chamki Bukhar, at least 400 children have died in the last one decade due to AES in these districts.

What is AES?

  • AES is a clinical condition most widely caused by infection with Japanese encephalitis virus (JEV) or other infectious and non-infectious causes.

Symptoms of AES

  • The signs and symptoms of AES include – an acute onset of fever, headache and clinical neurological manifestation that includes mental confusion, disorientation, delirium, or coma.

Who is at risk?

  • People in rural areas where the virus is common are at greater risk.
  • But the incidence was highest among children 0-6 years of age.
  • People with weakened immune system – for instance, who have HIV/AIDS, take immune-suppressing drugs – are at an increased risk of encephalitis.

Treatment for AES

  • People suffering from encephalitis need to be treated urgently.
  • Treatment may include antiviral medication, steroid injections among others to support the body, relieve the symptoms.
  • Other treatment options are – bed rest, plenty of fluids, anti-inflammatory drugs to relieve the symptoms such as fever and headache.
  • There is no cure for the disease. However, safe and effective vaccines are available to prevent encephalitis.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Welfare policy and Modi 2.0Mains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Instead of launching new schems focus should be on strengthening existing infrastructure.


CONTEXT

Housing, sanitation, gas connections (Ujjwala), direct benefit transfers (DBT), income support (PM-Kisan) — contrary to early indications, the Narendra Modi government’s first term proved to be far more welfarist than was expected of a government that campaigned on the slogan of minimum government.

Analysis of welfare projects

1.Technology and bureaucracy

  •  Early in its tenure, the government embraced Aadhaar and DBT with gusto. And in its last few months, it began the transition to basic income support through PM-Kisan.
  • Underlying this approach is the assumption that technology can substitute for an incompetent and corrupt welfare bureaucracy.
  • Moving money directly to beneficiary accounts removes bureaucratic layers and tightens monitoring, thus improving efficiency and curbing corruption.

The flaw in design –

  • But recent studies show that rather than reducing bureaucracy, getting the DBT architecture right requires significant bureaucratic intervention. From opening accounts to promoting financial literacy and facilitating bank transactions, local bureaucrats are critical to DBT.
  • Getting the DBT architecture right requires bureaucrats to engage citizens and coordinate across departments — a skill that Indian bureaucrats simply do not posses.

Examples from other countries –

Countries like Brazil and Mexico have invested in large cadres of social workers at the local government level to do just this.

Way ahead

  • Building a competent welfare bureaucracy,-The success of welfare programmes in Modi 2.0 will depend on willingness to recognise that building a competent welfare bureaucracy, even if its only task is to move money, will require empowering local governments with skills and resources.
  • Challenges with Digitised welfare systems
  • Digitised efficiency risks casting citizens as passive recipients of government largesse rather than active claimants of rights.
  • Digitised welfare systems genuinely risk closing off spaces for citizens to complain, protest and demand accountability when rights are denied.

Case study –  Consider the many documented instances of using coercive threats (cutting ration and electricity) to meet Swachh Bharat goals. This is not to argue against administrative efficiency, rather to highlight risks that need resolution.

2. Analysis of Ayushman Bharat

Second, with Ayushman Bharat, Modi 1.0 took a significant step towards engineering an architectural shift in India’s welfare system, away from direct provisioning (government running hospitals and schools) towards financing citizens (through income support and health insurance) and regulating private providers.

Challenges

  • But can a state that struggles with routine tasks regulate a sector as complex as healthcare?
  • Consider this. In the United States, medicare employs 6,000 staff to cover 44 million beneficiaries who handle insurance audits, pricing, and anti-trust cases.
  • The staffing requirement, at equivalent levels in Uttar Pradesh alone, would amount to 10,000 employees.

Strengthening health care infrastructure –

  • Importantly, in a sector like health where predatory practices are rife, well-functioning government hospitals are a necessary check and balance. Regulation cannot be a substitute for investing in public systems.
  • Ayushman Bharat must be complemented with a concerted focus on strengthening public hospitals.

3. Balance in Centre-state relations

This multiplicity of central schemes has served to entrench a silo-driven, one-size-fits-all approach that is inefficient as it fails to capture state-specific needs.

Way Ahead to balance centre state relation

  • But, sensible rationalisation needs a coherent framework.
  • The World Bank’s social protection analysis calls for developing a national social protection strategy with a core basket of schemes that states can adapt to their needs.
  • Greater flexibility to states was also recommended by the Niti Aayog’s chief ministers sub committee report in 2016.
  • Implementing these recommendations will require a radical shift in the role of the central government away from designing and controlling schemes to strategic thinking and supporting states.
  • There are obvious trade-offs with administrative efficiency from centralised schemes that will need to be negotiated.

4. Education Policy

  • Finally, no government can afford to ignore India’s learning crisis.
  • Yet this was one of the most under-prioritised areas in Modi 1.0’s welfare agenda.
  • The newly-released national education policy emphasises the urgent need to ensure all students achieve foundational literacy and numeracy.
  • This needs to be adopted and implemented in mission mode.

Conclusion

The difficult task of building a high quality, 21stcentury welfare state awaits Modi 2.0. India doesn’t need new schemes, rather it needs consolidation and balancing between competing welfare strategies. Getting this right will require significant investments in state capacity. This is the welfare challenge for Modi 2.0.

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

[op-ed snap] Caught nappingMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nipah virus

Mains level : State should be proactuve to contain spread of nipah virus.


CONTEXT

A year after Kerala’s prompt action quickly brought the deadly Nipah virus infection outbreak under check in two districts (Kozhikode and Malappuram), the State has once again shown alacrity in dealing with a reported case.

Background

  • A 23-year-old student admitted to a private hospital in Ernakulam on May 30 tested positive for the virus on June 4.
  • But even as the government was awaiting confirmation from the National Institute of Virology, Pune, steps had been taken to prevent the spread of the disease by tracing the contacts, setting up isolation wards and public engagement.
  • Containing the spread of the Nipah virus is important as the mortality rate was 89% last year, according to a paper in the journal Emerging Infectious Diseases.
  • The source of infection in the index case (student) remains unknown.

Circulation of virus

  • Due to fruit bats -If Kerala was taken by surprise by the first outbreak last year, its recurrence strongly suggests that the virus is in circulation in fruit bats.
  • After all, the virus isolated from four people and three fruit bats (Pteropus medius) last year from Kerala clearly indicated that the carrier of the Nipah virus which caused the outbreak was the fruit bat, according to the paper in Emerging Infectious Diseases.
  • The similarity between human and bat virus – Analysing the evolutionary relationships, the study found 99.7-100% similarity between the virus in humans and bats.
  • The confirmation of the source and the recurrence mean that Kerala must be alert to the possibility of frequent outbreaks.

Lack of proactiveness on part of the state

  • Even in the absence of hard evidence of the source of the virus till a few days ago, fruit bats were widely believed to be the likely candidates.
  •  No continuous monitoring and surveillance – That being so and considering the very high mortality rate when infected with the virus, it is shocking that Kerala had not undertaken continuous monitoring and surveillance for the virus in fruit bats.
  • Absence of a public health protection agency -One reason for the failure could be the absence of a public health protection agency, which the government has been in the process of formulating for over five years, to track such infective agents before they strike.

Way Forward

Not only should Kerala get this agency up and running soon, it should also equip the Institute of Advanced Virology in Thiruvananthapuram to undertake testing of dangerous pathogens. Known for high health indicators, Kerala cannot lag behind on the infectious diseases front.

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

ICMR calls for complete ban on e-cigarettesPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : e-Cigarette ban in India



  • The Indian Council of Medical Research (ICMR) has recommended a complete ban on e-cigarettes and other electronic nicotine delivery systems (ENDS), based on currently available scientific evidence.
  • Last year, the Centre had issued an advisory recommending a ban on the sale of e-cigarettes in India.

Electronic nicotine delivery systems (ENDS)

  • ENDS of which electronic cigarettes are the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporize a solution the user then inhales.
  • The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavoring agents.
  • ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants.

Why such ban?

  • Use of ENDS or e-cigarettes has documented adverse effects on humans, which include DNA damage; carcinogenic, cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders; and adverse impact on fetal development and pregnancy.
  • ICMR noted that e-cigarettes and other such devices contained not only nicotine solution, which was highly addictive, but also harmful ingredients such as flavoring agents and vaporizers.

ENDS cannot help quit smoking

  • The ICMR paper has rejected the argument that e-cigarettes could help smokers quit tobacco consumption.
  • While such benefits have not been firmly established, there is also evidence that there is risk of people continuing to use both them as well as tobacco products.
  • In addition, these devices could encourage non-smokers to get addicted to tobacco.
  • Various flavors and attractive designs are adding to the allure of the devices, and there was an increasing trend of using e-cigarettes among youth and adolescents in many countries.
  • They increase the likelihood to experiment with regular products and increase the intention to indulge in cigarette smoking.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO strategy to tackle global snakebite ’emergency’IOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : WHO strategy on snakebites


  • The World Health Organisation has unveiled a new strategy to dramatically cut deaths and injuries from snakebites, warning a dearth of antivenoms could soon spark a “public health emergency”.

The Strategy

  • The UN agency called for “the restoration of a sustainable market for snakebite treatment”, insisting on the need for a 25-per cent increase in the number of competent manufacturers by 2030.
  • WHO said it planned a pilot project to create a global antivenom stockpile.
  • The strategy also called for integrating snakebite treatment and response into national health plans in affected countries, including better training of health personnel and educating communities.
  • WHO, which two years ago categorised “snakebite envenoming” as a Neglected Tropical Disease, presented a strategy aimed at cutting snakebite-related deaths and disabilities in half by 2030.
  • An important part of the strategy is to significantly boost production of quality antivenoms.

Snakebite: An Emergency

  • Each year, nearly three million people are bitten by poisonous snakes, with an estimated 81,000-138,000 deaths.
  • Another 400,000 survivors suffer permanent disabilities and other after-effects, according to WHO figures.
  • Snake venom can cause paralysis that stops breathing, bleeding disorders that can lead to fatal haemorrhage, irreversible kidney failure and tissue damage that can cause permanent disability and limb loss.
  • Most snakebite victims live in the world’s tropical and poorest regions, and children are worse affected due to their smaller body size.
  • It causes nearly 50,000 deaths in India every year.
  • Four snake varieties – Indian Cobra, Russel’s viper, saw-scaled viper and Indian common krait are mostly responsible for most snakebite deaths.
  • Production of life-saving antivenoms has been abandoned by a number of companies since the 1980s, and availability of effective and safe products is disastrously low in Africa especially, with a similar crisis also looming in Asia.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Taj Mahal: First Indian Heritage Site to Get a Breastfeeding RoomPrelims OnlyPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Read the attached story

Mains level : Awareness about antenatal care and breastfeeding


  • The Taj Mahal has become one of the only three UNESCO Heritage Sites to have a breastfeeding room for women.

Breastfeeding room in Taj

  • In a country like India, breastfeeding has a lot of social stigma attached to it.
  • It is often seen as disgusting or even embarrassing.
  • This initiative aims at removing the social stigma regarding breastfeeding and helping new mothers to get the freedom to breastfeed in public without being forced to cover-up.
  • The main objective continues to be normalizing public breastfeeding.
  • The breastfeeding room will also be introduced in other monuments including the Agra Fort and Fatehpur Sikri.

Why such move?

  • India accounts for one-fifth of neonatal deaths.
  • Over 20 percent neonatal deaths can be prevented if the child is breastfed.
  • Various factors come into play when the question comes to why less than 55 percent babies are breastfed in the country.
  • Aside from poor health of the mother, lack of time and the convenience of formula milk, one of the biggest hindrances when it comes to breastfeeding is the taboo attached to it.
  • There have been various instances internationally where women have been asked to exit the premises or even “take their business in the washroom” for breastfeeding in public.
  • However, initiatives like the one taken in the Taj Mahal, are actively working towards removing the taboo and stigma related to breastfeeding and to normalize something as simple as a mother feeding her child.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Institute of NutritionDOMRStates in News

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NIN

Mains level : NIN and its mandate



  • The National Institute of Nutrition (NIN) has said that it stands by its findings certifying mid-day meals without onion and garlic provided by the Akshaya Patra Foundation (APF) in Karnataka schools as compliant with nutritional norms laid down by the State government.

Issue over NIN decision

  • APF provides food under the government’s mid-day meals programme at 2,814 schools in the State.
  • Absence of onion and garlic from meals made the food unpalatable and resulted in children consuming less quantity of food.
  • The issue is not just about absorption of nutrients, but is also about the food not being as per local tastes.
  • The most important question that authorities are glossing over is why not provide onion and garlic, which are available all round the year and are cheaper than other ingredients.

About NIN

  • The National Institute of Nutrition (NIN) is an Indian Public health, Nutrition and Translational research center located in Hyderabad.
  • The institute is one of the oldest research centers in India, and the largest center, under the Indian Council of Medical Research, located in the vicinity of Osmania University.
  • It was founded by Sir Robert McCarrison in the year 1918 as ‘Beri-Beri’ Enquiry Unit in a single room laboratory at the Pasteur Institute, Coonoor, Tamil Nadu.
  • Within a short span of seven years, this unit blossomed into a “Deficiency Disease Enquiry” and later in 1928, emerged as full-fledged “Nutrition Research Laboratories” (NRL) with Dr. McCarrison as its first Director.
  • It was later shifted to Hyderabad in 1958.
  • At the time of its golden jubilee in 1969, it was renamed as National Institute of Nutrition (NIN).

Mandate of NIN

  • Periodic Assessment of Nutrient intakes, Health and Nutrition status of the population for optimal health, and assist the Government and regulatory bodies in policy making
  • Establishment of Dietary Reference Intake values, Recommended Dietary allowances, Dietary guidelines for Indian population; and assessment of Nutrient Composition of Foods
  • Identify various nutrition deficiency disorders prevalent among different segments of the population
  • Conduct operational research for planning and implementation of National Nutrition Programmes in the country
  • Conduct surveys and study the risk factors of NCDs through multidisciplinary research
  • Conduct innovative basic science Research on nutrient interactions, requirements, responses etc
  • Identify and study food and environmental safety challenges for providing scientific input for policy and regulation
  • Development of human resource in nutrition and also provide evidence-based nutrition knowledge to the community
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Global Drug Survey Report 2018IOCRPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : GDS

Mains level : Read the attached story



  • A global survey of recreational drug-use, which for the first time polled respondents from India, has found that Indians — more than from other nationalities — are seeking help to reduce their alcohol intake.

Global Drug Survey

  • The Global Drug Survey (GDS) is an anonymised online survey that uses a detailed questionnaire to assess trends in drug use and self-reported harms among regular drug users and early adopters of new trends.
  • The survey is not designed to determine the prevalence of drug behaviour in a population.
  • It throws light on stigmatized behaviours and health outcomes of a hidden population that is otherwise difficult to reach.
  • GDS use its data and expertise to create digital health applications delivering screening and brief interventions for drugs and alcohol.
  • GDS also produces a range of drug education materials for health and legal professionals, the entertainment industry and the general public.

Drugs menace in India

  • Alcohol, tobacco and cannabis were the most common stimulants used by Indians.
  • Of the nearly 1,00,000 respondents from 30 countries, Indians reported ‘being drunk’ on an average of 41 times in the last 12 months — behind the U.K., the U.S., Canada, Australia and Denmark in that order but well above the global average of 33 times.
  • Indian respondents to the survey, conducted online October-December 2018, appeared more than other nationalities eager for help with reducing their alcohol intake.
  • According to the 2019 GDS, 51% of the respondents wanted to ‘drink less’ in the following year and 41% ‘wanted help to do so’ — again the highest percentage among other countries.
  • About 6% of the female Indians surveyed reported seeking ‘emergency medical treatment’ in the last 12 months. The global female average was about 13%.
  • None of the males in India reported seeking medical treatment, compared to the global average of 12%.

Less cannabis

  • Only 2% sought emergency medical treatment after using cannabis.
  • Similar to alcohol use, 51% said they wanted to use ‘less cannabis’ in the following year; more than any other nationality and well above the global average of 31%.
  • Alcohol and tobacco apart, the most used drugs globally were cannabis, MDMA (or Ecstacy), cocaine, amphetamines, LSD (or ‘acid’), magic mushrooms, benzodiazepines, prescription opioids, ketamine, nitrous oxide.
  • The survey also found that globally approximately 14% (11,000) reported being taken advantage of sexually while intoxicated in their lifetime and 4% in the last 12 months.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

India facing critical shortage of healthcare providers: WHOIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Healthcare lacunae in India


  • Despite the health sector employing five million workers, India continues to have low density of health professionals.

Critical Shortage in India

  • India faces the problem of acute shortages and inequitable distributions of skilled health workers as have many other low- and middle-income countries.
  • The figures for India are lower than those of Sri Lanka, China, Thailand, United Kingdom and Brazil, according to a WHO database.
  • This workforce statistic has put the country into the “critical shortage of healthcare providers” category.
  • Bihar, Jharkhand, Uttar Pradesh and Rajasthan are the worst hit while Delhi, Kerala, Punjab and Gujarat compare favorably.

Health workforce in India

  • The health workforce in India comprises broadly eight categories, namely: doctors (allopathic, alternative medicine); nursing and midwifery professionals; public health professionals (medical, non-medical); pharmacists; dentists; paramedical workers (allied health professionals); grass-root workers (frontline workers); and support staff.

WHO says

  • Data on the prevalence of occupational vacancies in the health care system in India overall is scarce.
  • Government statistics for 2008, based on vacancies in sanctioned posts showed 18% of primary health centres were without a doctor, about 38% were without a laboratory technician and 16% were without a pharmacist.
  • The need of the hour is to design courses for different categories of non-physician care providers.
  • Competencies (and not qualification alone) should be valued and reform must be brought in regulatory structures to provide flexibility for innovations.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO for eliminating industrially produced trans fats by 2023IOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Trans Fats

Mains level : Health issues over consumption of Trans Fats


  • Trans fat also called the worst form of fat in food, responsible for over 5,00,000 deaths globally from coronary heart disease each year.
  • It could be eliminated from the industrially produced global food supply by 2023 if the World Health Organization (WHO) has its way.
  • The WHO has partnered with the International Food and Beverage Alliance (IFBA) to achieve this target.

Regulatory action by WHO

  • The commitment made by the IFBA is in line with the WHO’s target to eliminate industrial trans fat from the global food supply by 2023.
  • Of particular note was the decision by IFBA members to ensure that the amount of industrial trans fat in their products does not exceed two grams per 100 grams fat/oil globally by 2023.

About Trans Fats

  • Trans fat, also called trans-unsaturated fatty acids or trans fatty acids, is a type of unsaturated fat that occurs in small amounts in nature, but became widely produced industrially from vegetable fats starting in the 1950s.
  • It is used in margarine, snack food, packaged baked goods, and for frying fast food.
  • Since they are easy to use, inexpensive to produce and last a long time, and give foods a desirable taste and texture, they are still widely used despite their harmful effects being well-known.

Hydrogenation Process

  • Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
  • Hydrogenation increases the shelf life and flavor stability of foods.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

ICMR launches ‘MERA India’ to eliminate malaria by 2030Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : MERA India

Mains level : Menace of Malaria in India


‘Malaria Elimination Research Alliance (MERA) India’

  • The Indian Council of Medical Research has launched the MERA India – a conglomeration of partners working on malaria control – in order to prioritise, plan and scale up research to eliminate the disease from India by 2030.
  • The MERA India does not intend to duplicate international efforts rather complement this on a national scale while contributing to the broader global agenda.
  • The alliance will facilitate trans-institutional coordination and collaboration around a shared research agenda which responds not only to programmatic challenges and addresses gaps in available tools, but also proactively contributes to targeted research.
  • It aims to harness and reinforce research in coordinated and combinatorial ways in order to achieve a tangible impact on malaria elimination.
  • The National Vector Borne Diseases Control Program (NVBDCP) of India has developed a comprehensive framework to achieve the overarching vision of “Malaria free India by 2030”.

Why such move?

  • Over the past two decades, India has made impressive progress in malaria control.
  • The malaria burden has declined by over 80 per cent, 2.03 million cases in 2000 to 0.39 million in 2018, and malaria deaths by over 90 per cent, 932 deaths in 2000 to 85 in 2018.
  • This success has provided a strong foundation for the commitment from the leadership of the government of India to eliminate malaria from India by 2030.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Khasi ‘kingdoms’ to revisit 1947 agreementsMains OnlyStates in News

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Khasi Kingdom, Himas

Mains level : Reorganisation of States in India


  • A federation of 25 Himas or Khasi kingdoms that have a cosmetic existence today has planned to revisit the 1948 agreements that made present-day Meghalaya a part of India.

Concerns of Khasis

  • The revisiting is aimed at safeguarding tribal customs and traditions from Central laws in force or could be enacted, such as the Citizenship (Amendment) Bill.
  • The bill is one of the factors in move to strengthen the Federation of Khasi States that were ruled by a Syiem (king-like head of a Hima).
  • Himas are expecting to come to a conclusion on how best it can insulate their customs and traditions from overriding central rules and policies.
  • The Constitution has provided self-rule to a considerable extent through tribal councils, there has been an increasing demand for giving more teeth to the Khasi states.

History of Khasi Merger in India

  • During the British rule, the Khasi domain was divided into the Khasi states and British territories.
  • At that time, the British government had no territorial right on the Khasi states and they had to approach the chiefs of these states if they needed land for any purpose.
  • After independence, the British territories became part of the Indian dominion but the Khasi states had to sign documents beginning with the Standstill Agreement that provided a few rights to the states.
  • The 25 Khasi states had signed the Instrument of Accession and Annexed Agreement with the Dominion of India between December 15, 1947, and March 19, 1948.
  • The conditional treaty with these states was signed by Governor General C. Rajagopalachari on August 17, 1948.

Back2Basics

Statehood to Meghalaya

  • Meghalaya was formed by carving out two districts from the state of Assam: the United Khasi Hills and Jaintia Hills, and the Garo Hills on 21 January 1972.
  • Before attaining full statehood, Meghalaya was given semi-autonomous status in 1970.
  • The Khasi, Garo, and Jaintia tribes had their own kingdoms until they came under British administration in the 19th century.
  • Later, the British incorporated Meghalaya into Assam in 1835.
  • The region enjoyed semi-independent status by virtue of a treaty relationship with the British Crown.
  • At the time of Indian independence in 1947, present-day Meghalaya constituted two districts of Assam and enjoyed limited autonomy within the state of Assam.
  • A movement for a separate Hill State began in 1960.
  • The Assam Reorganisation (Meghalaya) Act of 1969 accorded an autonomous status to the state of Meghalaya.
  • The Act came into effect on 2 April 1970, and an autonomous state of Meghalaya was born out of Assam.
  • In 1971, the Parliament passed the North-Eastern Areas (Reorganization) Act, 1971, which conferred full statehood on the autonomous state of Meghalaya.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Dentists can practise as General Physicians after bridge courseMains Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Adressing shortage of doctors in India


  • The Niti Aayog has agreed to a Dental Council of India proposal to allow dentists to practice as general physicians after a bridge course.

Meeting shortage of doctors

  • The DCI had last year also sent a proposal to the medical education regulator—Medical Council of India — but the previous council did not take it forward.
  • It was urged that unconventional methods be adopted to address the shortage of doctors in the country, particularly in rural areas.
  • Country’s largest body of private doctors—Indian Medical Association—which had earlier opposed a similar course for AYUSH practitioners has vehemently protested the proposed move too.

About the bridge course

  • The DCI has proposed a post Bachelor of Dental Science (BDS) bridge course running for 3 years.
  • The admissions would be either through a common entrance exam or through cumulative marks secured in the BDS course, or even a combination.
  • As per the DCI, the syllabus curriculum, scheme of examination, method of evaluation, degrees and registration all these criteria will be the same as recommended for MBBS.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO guidelines on physical activity for children under 5 years of agePrelims OnlyPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Details of the Guidelines

Mains level : Global obesity crisis


  • The WHO issued guidelines as part of a campaign to tackle the global obesity crisis and ensure that young children grow up fit and well, particularly since development in the first five years of life contributes to children’s motor and cognitive development and lifelong health.

Recommendations at a glance:

Infants (less than 1 year) should:

  • Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake.
  • Not be restrained for more than 1 hour at a time (e.g. prams/strollers, high chairs, or strapped on a caregiver’s back). Screen time is not recommended. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 14–17h (0–3 months of age) or 12–16h (4–11 months of age) of good quality sleep, including naps.

Children 1-2 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, including moderate-to-vigorous-intensity physical activity, spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers, high chairs, or strapped on a caregiver’s back) or sit for extended periods of time. For 1-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 11-14 hours of good quality sleep, including naps, with regular sleep and wake-up times.

Children 3-4 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous intensity physical activity, spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers) or sit for extended periods of time. Sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 10–13h of good quality sleep, which may include a nap, with regular sleep and wake-up times.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Worlds first Malaria Vaccine: RTS,S (Mosquirix)Mains Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : About the vaccine

Mains level : Malaria and its incidence in India


  • The WHO welcomed a pilot project in Malawi of administering a malaria vaccine to children below the age of 2 years.

RTS,S vaccine (Mosquirix)

  • The vaccine has been developed by GSK — the company is donating about 10 million doses of the product for the pilot.
  • It was created in 1987 by GSK, and was subsequently developed with support from the Bill and Melinda Gates Foundation.
  • RTS,S aims to trigger the immune system to defend against the first stages of malaria when the Plasmodium falciparum parasite enters the human host’s bloodstream through a mosquito bite and infects liver cells.
  • The vaccine is designed to prevent the parasite from infecting the liver, where it can mature, multiply, re-enter the bloodstream, and infect red blood cells, which can lead to disease symptoms.
  • In 2014, the vaccine cleared phase III clinical trials which certified that it was both effective and safe for use in humans.

Why fear Malaria?

  • Malaria is a potentially life-threatening parasitic disease caused by the parasites Plasmodium viviax (P.vivax), P.falciparum, P.malariae, and P.ovale transmitted by the female Anopheles mosquito.
  • Malaria, according to the WHO, remains one of the world’s leading killers, claiming the life of one child every two minutes.
  • Children under the age of 5 are at greatest risk from its life-threatening complications.

Why trials in Malawi?

  • A total 3, 60,000 children across three African countries — Malawi, Ghana and Kenya — will be covered every year with the vaccine.
  • Most of these deaths are in Africa, where more than 2,50,000 children die from the disease every year.
  • Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death.

How badly is India affected by malaria?

  • India ranks very high in the list of countries with a serious malaria burden.
  • In 2018, 3,99,134 cases of malaria and 85 deaths due to the disease were reported in the country, according to data from the National Vector Borne Disease Control Programme.
  • Six states — Odisha (40%), Chhattisgarh (20%), Jharkhand (20%), Meghalaya, Arunachal Pradesh, and Mizoram (5-7%) — bear the brunt of malaria in India.
  • These states, along with the tribal areas of Maharashtra and Madhya Pradesh, account for 90% of India’s malaria burden.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Biomarkers found for lymph node metastasis in oral cancerPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Biomarkers

Mains level : Not Much


  • By looking out for five biomarkers, it is now possible to tell in advance if a person with oral cancer of the gum and cheek has lymph node metastasis even before surgery is undertaken.

What are Biomarkers?

  • In medicine, a biomarker is a measurable indicator of the severity or presence of some disease state.
  • More generally a biomarker is anything that can be used as an indicator of a particular disease state or some other physiological state of an organism.

Biomarkers to check oral cancer

  • The ability to correctly predict absence/presence of lymph node metastasis in oral cancer patients is 80-90% based on the five biomarkers.
  • As a result, an oral cancer patient can be spared of a neck dissection to investigate if the cancer has spread to the lymph nodes in case the five biomarkers are absent.
  • Lymph node dissection increases morbidity. However, if the patient tests positive for even one biomarker then an aggressive treatment would be required.
  • An oral cancer patient with cancer spread to the lymph node has a 50% lower chance of survival for five years or more compared with patients in whom it has not spread to the lymph node.

Five genomic biomarkers

  • The team found that lymph node metastasis was associated with five genomic biomarkers.
  • There are five genomic features or biomarkers of lymph node metastasis in oral cancer patients.
  • Two of these are rare, heritable DNA changes in BRCA2 and FAT1 genes.
  • The remaining three are non-heritable (somatic) DNA alterations.

Diagnosing oral cancer metastasis

  • In oral cancer patients, the cancer cells tend to commonly spread to the lymph node in the neck.
  • But not all oral cancer patients have the tendency for the cancer to spread to other organs (metastasis).
  • Oral cancer patients who have lymph node metastasis possess DNA alterations in specific genes that provide cancer cells the ability to spread.
  • These DNA alterations are different from those that cause the primary cancer, and these alterations arise independent of the stage of cancer.
  • So in some patients, the cancer would have spread to the lymph node even at an early stage of oral cancer, while in some patients with advanced (T4 stage) oral cancer, the cancer would not have spread.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] A manifesto for healthMains Onlyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Steps to be taken to improve health care in India.


CONTEXT

Health is making an impact on the political scene, when on the one hand, Prime Minister launches the Ayushman Bharat scheme a year before the elections and on the other hand, the Congress’s manifesto carries the party’s pledge to enact a Right to Healthcare Act.

Current health scenario in the country

  • Stagnated spending – In the past five years, the Union health budget has stagnated in real terms, allocations to the National Health Mission do not cover inflation and there have been avoidable deaths of scores of children in public hospitals in Gorakhpur and other places that can be ascribed to the lack of material and human resources.
  • Failure in regulation – Governments have failed to regulate private hospitals effectively, leading to numerous instances of mismanagement and massive over-charging of patients, such as the tragic case of Adya Singh in Fortis hospital, Gurgaon.
  • Underfunding of the schemes – There are convincing facts which show that the “solution” being offered in the form of the Pradhan Mantri Jan Aarogya Yojna is not only seriously underfunded (current funds being less than one-fourth of required) but it will only scratch the tip of the iceberg of healthcare requirements in India.

Proposals to improve Health Sector

  • Right to Healthcare  – Adopting a Right to Healthcare legislation at the Centre and state levels. This would ensure that all residents of the country are entitled to healthcare facilities. Development of asystem for Universal Healthcare (UHC) would be a key constituent of this initiative, which would require expansion and strengthening of public health services at all levels. Private providers would also be involved, as per need, to supplement the public health system.
  •  Increasing the public health expenditure -Increasing the public health expenditure exponentially through taxation. This expenditure should be increased from the current grossly inadequate 1.2 per cent of the GDP to reach 3.5 per cent of the GDP in the next five years, and eventually touch 5 per cent of the GDP in the medium term.
  • Strengthening of public health services – Three, ensuring major reform and strengthening of public health services with increased staff and infrastructure. A key component of this reform would be guaranteed provision of free essential medicines and diagnostics to all patients in public health facilities, by adopting systems for procurement and distribution which are similar to the current models in Tamil Nadu, Kerala and Rajasthan.
  •  Health sector human resource policy – there should be a comprehensive health sector human resource policy, which provides upgraded skill training, fair wages, social security and decent working conditions for all public health services staff. The services of all contractual health workers, including ASHAs and anganwadi workers, should be regularised.
  • Community-based monitoring and planning – Community-based monitoring and planning of health services that are being practised in a few states should be upscaled and user-friendly grievance redressal systems put in place to ensure social accountability and participation.
  • Replacing Schemes – the PMJAY component of Ayushman Bharat, which is based on a discredited insurance model, should be jettisoned. Such schemes need to be replaced by the universal healthcare system.
  • Regulations – Private hospitals must be brought under the ambit of regulations by modifying and adopting the Clinical Establishments Act in all states. This legislation must ensure that the Charter of Patient’s Rights is observed, it must provide a grievance redressal mechanism to patients, the rates for services must be regulated and standard treatment guidelines should be adopted in healthcare institutions.
  • Price Regulations – essential medicines and medical devices must be subject to price regulation, based on their manufacturing cost. A Uniform Code for Pharmaceutical Marketing Practices should be put in place to curb unethical marketing practices. Manufacturers should be asked, in a stepwise manner, to sell medicines only under their generic name, and doctors should be directed to write generic names of medicines in prescriptions.
  • Focus on vulnerable Sections – These initiatives must be accompanied by measures to ensure that people with special needs — women, children, differently-abled persons, people living with HIV — enjoy appropriate health services.
  • Environment – Traditional social determinants of health such as nutrition, water supply, sanitation and healthy environment must be ensured. There should be plans in place to tackle new determinants like air and water pollution and addictions.

Way Forward

  • Such a paradigm shift towards a rights-based system for universal healthcare, based on massive increase in health budgets and strengthened health systems, is not an unrealistic dream
  • EXAMPLES  -. Several low- and middle-income countries such as Thailand, Brazil and Sri Lanka have such systems in place. 
  • The core ingredient required for UHC is political will. As we prepare to exercise our choice in the elections, we need to boost such political will by supporting parties which have pledged the right to health care to all.

 

 

 

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

CSIR plans genome sequencing to map population diversityMains Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Genome Sequencing

Mains level : Applications of Genome Sequencing


  • In an indigenous genetic mapping effort, nearly 1,000 rural youth from the length and breadth of India will have their genomes sequenced by the Council of Scientific and Industrial Research (CSIR).

Genome Sequencing

  • A genome is all of a living thing’s genetic material. It is the entire set of hereditary instructions for building, running, and maintaining an organism, and passing life on to the next generation.
  • Genome sequencing is figuring out the order of DNA nucleotides, or bases, in a genome—the order of As, Cs, Gs, and Ts that make up an organism’s DNA.
  • The human genome is made up of over 3 billion of these genetic letters.
  • Ever since the human genome was first sequenced in 2003, it opened a fresh perspective on the link between disease and the unique genetic make-up of each individual.
  • Nearly 10,000 diseases — including cystic fibrosis, thalassemia — are known to be the result of a single gene malfunctioning.
  • While genes may render some insensitive to certain drugs, genome sequencing has shown that cancer too can be understood from the viewpoint of genetics, rather than being seen as a disease of certain organs.

About the Project

  • The CSIR project aims at educating a generation of students on the “usefulness” of genomics.
  • It would involve the Hyderabad-based Centre for Cellular and Molecular Biology (CCMB).
  • This is the first time that such a large sample of at least 10,000 Indian genomes will be recruited for a detailed study.
  • The project is an adjunct to a much larger government-led programme, still in the works, to sequence at least 10,000 Indian genomes.
  • Typically, those recruited as part of genome-sample collections are representative of the country’s population diversity.
  • The bulk of them will be college students, both men and women, and pursuing degrees in the life sciences or biology.

Methodology

  • Genomes will be sequenced based on a blood sample and the scientists plan to hold at least 30 camps covering most States.
  • Every person whose genomes are sequenced will be given a report.
  • The participants would be told if they carry gene variants that make them less responsive to certain classes of medicines.

Utility of the Project

  • Globally, many countries have undertaken genome sequencing of a sample of their citizens to determine unique genetic traits, susceptibility (and resilience) to disease.
  • The project would prove India’s capabilities at executing whole-genome sequencing.
  • The human genome has about 3.2 billion base pairs and just 10 years ago cost about 10,000 dollars. Now prices have fallen to a tenth.

Ethical issues involved

  • For instance, having a certain gene makes some people less responsive to clopidogrel, a key drug that prevents strokes and heart attack.
  • CSIR won’t share such information in the report. A person can request such information through their clinician because many disorders have single-gene causes but no cure or even a line of treatment.
  • Ethics require such information to be shared only after appropriate counselling.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

India short of 6 lakh doctors, 2 million nurses: U.S. studyPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Healthcare lacunae in India


  • India has a shortage of an estimated 600,000 doctors and 2 million nurses, say a US study.

Out-of-pocket costs of health

  • In India, 65% of health expenditure is out-of-pocket, and such expenditures push some 57 million people into poverty each year.
  • Even when antibiotics are available, patients are often unable to afford them.
  • High out-of-pocket medical costs to the patient are compounded by limited government spending for health services.
  • The study found that lack of staff that are properly trained in administering antibiotics is preventing patients from accessing live-saving drugs.

Mortality burden

  • Researchers at CDDEP in the U.S. conducted stakeholder interviews in Uganda, India, and Germany, and literature reviews to identify key access barriers to antibiotics in low-, middle-, and high-income countries.
  • The majority of the world’s annual 5.7 million antibiotic-treatable deaths occur in low- and middle-income countries.
  • Here, the mortality burden from treatable bacterial infections far exceeds the estimated annual 700,000 deaths from antibiotic-resistant infections.
  • Health facilities in many of these countries are substandard.

Issues with India

  • In India, there is one government doctor for every 10,189 people (the WHO recommends a ratio of 1:1,000), or there is a deficit of 600,000 doctors.
  • The nurse: patient ratio is 1:483, implying a shortage of two million nurses.
  • Lack of access to antibiotics kills more people currently than does antibiotic resistance, but we have not had a good handle on why these barriers are created.
  • The findings of the report show that even after the discovery of new antibiotic, regulatory hurdles and substandard health facilities delay or altogether prevent widespread market entry and drug availability.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

‘Display information on 7 common antibiotics’Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PVPI

Mains level : Pharmacovigilance initiatives in India


  • The Central Drugs Standard Control Organisation (CDSCO) has now asked  commonly-used antibiotics manufacturers to ensure its details be made available to the general public.
  • This decision was taken considering directives from the National Co-ordination Centre of the Pharmacovigilance Programme of India (PvPI).

Pharmacovigilance Programme of India (PvPI)

  • Pharmacovigilance is defined as the science relating to the detection, assessment, understanding and prevention of adverse effects, principally long term and short term adverse effects of medicines.
  • The  CDSCO has a nation-wide Pharmacovigilance Programme for protecting the health of the patients by promising drug safety.
  • The Programme shall be coordinated by the Indian Pharmacopeia commission, Ghaziabad as a National Coordinating Centre (NCC).
  • The  PvPI was started by the Government of India on 14th July 2010 with the  AIIMS New Delhi as the National Coordination Centre for monitoring Adverse Drug Reactions (ADRs) in the country for safe-guarding Public Health.

CDSCO guidelines to manufacturers

  • CDSCO has written to drug manufacturers, to mention in leaflets inserted into drug packets or on promotional literature, information about the adverse reactions of these medicines.
  • All of the seven formulations  have been instructed to warn patients of the “new” side effects.

Why such move?

  • The Union Health Ministry was alerted about the adverse reactions of Antibiotic Cefixime last year in August.
  • Antibiotic Cefixime is used to treat a wide variety of bacterial infections and is known to have adverse reactions, including pain, diarrhoea, nausea and headaches.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap]US vs Europe in Indiaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : A robust and sustainable health policy is the need of hour.


CONTEXT

The forthcoming election is going to be an inflexion point for India’s health system story — how affordable, how accessible, how equal?

Divergent Approaches

  • Though health is not a political priority as yet, two visions of the future health policy seem to be clearly emerging.
  • One, espoused by the BJP — a centralised hospital insurance-driven health system designed on the Medicare model of the US.
  • The other, of the Congress, calling for guaranteeing every citizen with access to essential health services, resembling the UK and the European model.
  • Both these approaches are widely divergent and will profoundly impact the three pillars of the health system — access, quality and affordability.

Concerns

  • Given India’s fragile economic system and multiple demands on it, notwithstanding India being the second-fastest growing economy, sustainability will be a major concern.
  • The two thought streams, propounded by the BJP and the Congress, are embedded in and reflect two social value systems:
    • In the US, it is individual liberty and personal responsibility.
    • While Europe and countries like Japan are driven by ideas of social responsibility and state accountability.

US model

  • The US confines itself to subsidised care for the poor and elderly, regulates stringently for quality and allows financial incentives like profits to encourage technological innovation.
  • As a consequence, it has over 20 million of its population without access, despite spending 18 per cent of its GDP on health.

European Model

  • The UK and Europe, on the other hand, believe in the principle of collective responsibility ensuring every individual’s inherent right to health and wellbeing, thereby making the state develop financial and regulatory systems that guarantee all individuals equal access to healthcare services and products.
  • These countries spend an average of 10 per cent of the GDP on health with far better outcomes than the US.

Equality v/s liberty

  • When India won independence from the British, we were driven by the European values of equality that got imposed onto a highly stratified social system.
  • Some successes have been achieved in implementing affirmative action.
  • Over the years, however, the economic and social models trended more along the values of individual liberty rather than social equality.

Degrading Health standards In India

  • Disparities have widened to such an extent that latest data seems to suggest that 1 per cent of India’s population enjoys 70 per cent of its wealth.
  • While an Indian is among the 10 richest of the world, we also account for the world’s poorest, over 36 per cent of children stunted due to chronic malnutrition, half of the population defecating in the open and nearly three-quarters without access to tap water.
  • The rising burden of disease in India is but a reflection of such deprivation of essential and basic social goods and the wide inequalities cutting across regions, castes, gender and age.

Challenges in building sustainable healthy blocks

  • Stacked against an incremental and systematic building of the health system blocks, in the manner that Thailand or Turkey did, are powerful lobbies of the health industry that support the narrow agenda of the hospital insurance programme.
  • These lobbies have the support of US-based foundations and donors, World Bank, CII, FICCI, the medical associations and companies related to health insurance, data aggregating IT, medical devices etc.
  • The public health approach that seeks to prioritise comprehensive primary care as an entitlement of every citizen is clearly numbed out and would require peoples’ movements and participation.
  • This is critical as with the meagre resources of 1.1 per cent of GDP, choices are being made.

Conclusion

  • No one would argue that hospital insurance is a wrong policy and that only primary care should be the focus.
  • But a system hanging on hospitals without the foundation of primary care is a sure recipe for disaster as it is clearly unaffordable and unsustainable.
  • Effective primary care not only reduces one-third of hospitalisation but by prioritising well being over sickness, it removes the causal factors to disease and illness.
  • It is important to reiterate the importance of these issues as the last budget showed a 300 per cent increase for health insurance.
  • With the revision of hospital rates, the cost of the health insurance programme will also double and continue to rise.
  • In the absence of a commensurate increase in health budgets, the price will be paid by the large swathes of the poor and middle classes who desperately need good quality primary healthcare.
  • Its absence is responsible for the proportionately higher number of premature deaths, one quarter of the global TB burden and a million dying just for want of clean air.

 

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

Candida Auris : Fungus immune to drugs is secretly sweeping the globePrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Candida Auris

Mains level : Read the attached story


Candida Auris

  • auris is a mysterious and dangerous fungal infection that is among a growing number of germs that have evolved defenses against common medicines.
  • It is a fungus that, when it gets into the bloodstream, can cause dangerous infections that can be life-threatening.
  • It preys on people with weakened immune systems, and it is quietly spreading across the globe.
  • Scientists first identified it in 2009 in a patient in Japan.

What makes it so freaky?

  • It causes serious infections: It can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems.
  • It’s often resistant to medicines: Its infections have been resistant to all types of antifungal medicines.
  • It’s becoming more common: Although auris was just discovered in 2009, it has spread quickly and caused infections in more than a dozen countries.
  • It’s difficult to identify: It can be misidentified as other types of fungi unless specialized laboratory technology is used. This misidentification might lead to a patient getting the wrong treatment.
  • It can spread in hospitals and nursing homes: It has caused outbreaks in healthcare facilities and can spread through contact with affected patients and contaminated surfaces or equipment.

What made it so strong?

  • For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal.
  • But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine.
  • Simply put, fungi, just like bacteria, are evolving defences to survive medicines.
  • Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting.
  • Scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Solidarity Human ChainIOCRPIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Solidarity Human Chain, WHO

Mains level : Not Much


Solidarity Human Chain

  • Ministry of Health and Family Welfare along with World Health Organization (WHO) formed a Solidarity Human Chain as part of the World Health Day celebrations.
  • It aims to reaffirm their commitment to bridging gaps and working collaboratively towards Universal Health Coverage (UHC).
  • April 7 of each year marks the celebration of World Health Day.
  • This year’s World Health Day will focus on equity and solidarity.
  • From its inception at the First Health Assembly in 1948 and since taking effect in 1950, the celebration has aimed to create awareness of a specific health theme to highlight a priority area of concern for the WHO.
  • Over the past 50 years this has brought to light important health issues such as mental health, maternal and child care, and climate change.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Septic tanks meet norms says MinistryPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: SBM Rural

Mains level: Government measures to end Manual Scavenging activities


News

  • Septic tanks and single pits are safe sanitation technologies that meet the standards prescribed by the Sustainable Development Goals, according to the Union Ministry of Drinking Water and Sanitation.

Twin-Leach pit Toilets

  • A large proportion of the remaining toilets have single-leach pits which, like the twin-leach pits, are also safe.
  • The twin-leach pit toilet is among the most economical and safe sanitation technologies, and has been promoted and extensively adopted.
  • However, there are other safe technologies like septic tanks or single pits.

Hazards of twin-leach pits

  • A/c to a report only 26% of rural toilets uses twin-leach pits.
  • The data from the National Annual Rural Sanitation Survey (NARSS) 2018-19, concluded that the remainder of rural toilets [that do not use twin-leach pits] could create a new sanitation nightmare.
  • 34% of rural toilets are connected to septic tanks but failed to clarify that this was a perfectly safe sanitation solution.
  • The waste from the remainder of rural toilets could create a new sanitation nightmare — like groundwater contamination and pushing a new generation into manual scavenging.

What concerns the most?

  • The problem of sludge management along with lack of manpower to empty and clean such tanks is at the core.
  • There is a manpower challenge, given the social context of the country and caste prejudices against such cleaning work, even while acknowledging that the government was preparing technological and entrepreneurial solutions to the problem.
  • The transportation and treatment of faecal waste – including waste emptied from septic tanks – is a problem, and that surveys have shown such waste is often dumped into local ponds and farmlands.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Topical gel protects farmers from pesticidesPrelims Only


Note4students

Mains Paper 3: Science and Technology | Achievement of Indians in science & technology

From UPSC perspective, the following things are important:

Prelims level: About the gel

Mains level: Preventing fatalities due to harmful pesticides


News

  • Using easily available, inexpensive natural polymers, researchers in Bengaluru have developed a gel for the skin to protect agricultural workers from harmful pesticide sprays.

Protective Gel for Farmers

  • The base of the gel is chitosan, a natural substance extracted from the waste shells of crabs and shrimps, to which a nucleophile and few aqua reagents are added to get the consistency and desired pH.
  • Organophosphate pesticides bring about the inhibition of important enzymes (AChE) of the body, which can, in turn, affect the functioning of nervous system, heart, immunity, and even the reproductive system.
  • The gel looks and feels like a cold cream and we can add suitable fragrance too.
  • Since pesticides can inhibit enzymes in blood, different experiments were carried out using rat blood to see if the gel could prevent this.
  • The gel does not just act as a simple physical barrier; it chemically deactivates pesticides.
  • The gel was found to cleave a wide range of commercially available pesticides before they enter the bloodstream, thus reducing the pesticide-induced enzyme inhibition.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

West Nile VirusStates in News


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: WNV & associated facts

Mains level: Preventing WNV spread in India


News

  • Centre has sent a special medical team to Malappuram district of Kerala from where a confirmed case of West Nile Virus (WNV) fever, a mosquito-borne disease was reported.

West Nile Virus

  • As per the World Health Organisation (WHO), the West Nile Virus (WNV) is a member of the flavivirus genus and belongs to the family Flaviviridae.
  • Birds are the natural hosts of this virus.
  • But it spreads to human by Culex mosquitoes.
  • Mosquitoes become infected when they feed on infected birds.
  • Once a person gets infected, the virus multiplies thereby causing illness.

Symptoms

  • Infection usually presents as a mild, non-fatal dengue like illness in humans.
  • The symptoms include fever, headache, tiredness, body aches, nausea, vomiting, occasionally with skin rash and swollen lymph glands.
  • A blood test report can only confirm if a person has been infected with it or not.
  • A very small proportion of infection transmission occurred through organ transplant, blood transfusions and breast milk.
  • Fortunately, there has been no human-to-human transmission of WNV through casual contact so far.

Treatment

  • There is no definite treatment of the disease.
  • Prevention by the disease can be done by preventing mosquito bite, using repellents and wearing full sleeves.
  • It is diagnosed with the blood igm levels and Polymerase Chain Reaction (PCR).
  • There is no vaccination or specific treatment available for the virus but medical practitioners advice that it is important to recognize the disease and manage the symptoms.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO strategy to fight flu pandemicsIOCR


Note4students

Mains Paper 2: Governance | Important International institutions

The following things are important from UPSC perspective:

Prelims Level: Highlights of the Strategy

Mains level: Enhancing preparedness against influenza


News

  • The World Health Organization has launched a strategy to protect people worldwide over the next decade against the threat of influenza, warning that new pandemics are “inevitable”.

Global Influenza Strategy for 2019-2030

It aims to:

  • Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness.
  • To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security.
  • Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals, and treatments, with the goal of making these accessible for all countries.

Influenza epidemics

  • WHO’s new strategy, for 2019 through 2030, aims to prevent seasonal influenza, control the virus’s spread from animals to humans and prepare for the next pandemic.
  • The new strategy called for every country to strengthen routine health programmes and to develop tailor-made influenza programmes that strengthen disease surveillance, response, prevention, control, and preparedness.
  • Influenza epidemics, largely seasonal, affect around one billion people and kill hundreds of thousands annually.

Who recommends

  • WHO recommends annual flu vaccines as the most effective way to prevent the spread of the disease, especially for healthcare workers and people at higher risk of influenza complications.
  • It also called for the development of more effective and more accessible vaccines and antiviral treatments.
  • Due to its mutating strains, vaccine formulas must be regularly updated and only offer limited protection currently.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] The Delta 32 effectop-ed snap


Note4students

Mains Paper 2: Governance | mechanisms, laws, institutions & Bodies constituted for the protection & betterment of these vulnerable sections

From UPSC perspective, the following things are important:

Prelims level: Delta 32

Mains level:  There is possibility of curing HIV and how it can be achieved.


NEWS

CONTEXT

A study published this week in Nature points out that one London HIV Patient received the bone marrow donation from a person who was born with a rare mutation, Delta 32. The transplant wiped out the immune cells vulnerable to HIV and replaced them with cells that are resistant to the virus.

History of HIV remission

  • The London Patient is the second HIV-infected to experience a long-term remission from the virus.
  • About 12 years ago, an American living in Germany — the Berlin Patient — also received a Delta 32 transplant and has remained free of the virus, ever since.
  • However, attempts to replicate the procedures undergone by the Berlin Patient in other HIV-infected people proved unsuccessful.
  • The virus returned as soon as they stopped the standard medications.

Doubts Regarding Total cure of HIV

  • There are reasons that the hopes of a total victory against HIV that have arisen after this week’s Nature study be tempered with realism.
  • Bone-marrow stem transplants are risky — they make a patient vulnerable to life-threatening diseases like acute anaemia — and are expensive procedures.
  • They are not likely to be the treatment option for a vast majority of the 37 million HIV-infected; it’s hard enough to find tissue-matched donors for so many people, let alone locate one that also has the Delta 32 mutation.

New ways to fight HIV

  • The London Patient’s recovery offers a viable pathway to combat HIV.
  • The Nature study demonstrates the potency of gene-editing as therapy for those infected with the virus, similar to the treatment for sickle-cell disease, haemophilia and certain types of cancer.
  • Researchers in different parts of the world are working on procedures to edit people’s immune cells to make them HIV resistant — they would mimic Delta 32.
  • They are also trying to develop reverse vaccination — much like for small pox — where an immune response is engineered to target the virus.
  • Currently, those affected by HIV can have near normal lifespans.
  • However, the cocktail of drugs needed to keep the virus at bay are expensive, and have serious side effects. The London Patient’s recovery portends that cure from HIV is not far away.

 

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

[pib] NABL launches Quality Assurance Scheme for Basic Composite Medical LaboratoriesGovt. SchemesPIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: QAS, NABL

Mains level: Promoting quality healthcare services


News

Quality Assurance Scheme

  • NABL has launched a voluntary scheme called Quality Assurance Scheme (QAS) for Basic Composite (BC) Medical Laboratories.
  • The laboratories performing only basic routine tests like blood glucose, blood counts, and rapid tests for common infections, liver & kidney function tests and routine tests of urine will be eligible to apply under this scheme.
  • These changes have been made in the Clinical Establishments (Central Government) Rules, 2012.
  • The scheme requires minimal documentation and a nominal fee has been prescribed for availing the scheme.

Aim and Objectives

  • The scheme will help to bring quality at the grass root level of India’s health system where laboratories follow the imperatives of quality in all their processes.
  • Through this scheme, patients availing services of small labs in primary health centers, community health centers, doctor’s clinic etc. will also have access to quality lab results.
  • This scheme will enhance the intent of AB-NHPM of universal access to quality healthcare for majority of citizens especially those residing in villages and small towns by providing them access to quality diagnostics.
  • This will ensure end-to-end sample integrity leading to reliable test results and help laboratories to gain patient’s trust and satisfaction.

About NABL

  • National Accreditation Board for Testing and Calibration Laboratories (NABL) is a constituent board of Quality Council of India (QCI) under the Ministry of Commerce and Industry.
  • NABL is Mutual Recognition Arrangement (MRA) signatory to International bodies like International Laboratory Accreditation Co-operation (ILAC) and Asia Pacific Accreditation Co-operation (APAC) for accreditation of Testing including Medical and Calibration laboratories.
  • MRA are based on evaluation by peer Accreditation Bodies and facilitates acceptance of test/ calibration results between countries which MRA partners represent.
  • Thus NABL accredited laboratory results are accepted across more than 80 economies around the world.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap]The basics are vitalop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PMJAY), National Health Mission

Mains level: Need to increase expenditure on Primary health care to build a robust health infrastructure


NEWS

CONTEXT

The overall situation with the NHM, India’s flagship programme in primary health care, continues to be dismal.

Expected expenditure on primary health care services

  • In 2011, a high-level expert group on universal health coverage reckoned that nearly 70% of government health spending should go to primary health care.
  • The National Health Policy (NHP) 2017 also advocated allocating resources of up to two-thirds or more to primary care as it enunciated the goal of achieving “the highest possible level of good health and well-being, through a preventive and promotive healthcare orientation”.

Current spending on primary health care

  • Last year, an outlay of ₹1,200 crore was proposed to transform 1.5 lakh sub-health centres into health and wellness centres by 2022, which would provide a wider range of primary care services than existing sub- and primary health centres (PHC).
  • Going by the government’s own estimate, in 2017, it would cost ₹16 lakh to convert a sub-health centre into a health and wellness centre.
  • This year, the outlay is ₹1,600 crore (a 33% increase) clubbed under the National Health Mission (NHM) budget.
  • The current outlay is less than half the conservative estimate — not to mention that building health and wellness centres at the given rate (15,000 per year) can fulfil not even half the proposed target of 1.5 lakh health and wellness centres till 2022.

Allocation to National Health Mission

  • The overall situation with the NHM, India’s flagship programme in primary health care, continues to be dismal.
  • The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.
  • The NHM budget for this year (₹31,745 crore) barely crosses the actual spending on the programme in 2017-18 (₹ 31,510 crore).

Allocation to Pradhan Mantri Jan Arogya Yojana (PMJAY)

  • The Centre looks fairly committed to increasing access to hospitalisation care, predominantly through private players.
  • This reflects in the 167% increase in allocation this year for the Pradhan Mantri Jan Arogya Yojana (PMJAY) — the insurance programme which aims to cover 10 crore poor families for hospitalisation expenses of up to ₹5 lakh per family per annum — and the government’s recent steps to incentivise the private sector to open hospitals in Tier II and Tier III cities.
  • The increase in the PMJAY budget is a welcome step — spending on this colossal insurance programme will need to rise considerably with every passing year so that its commitments can be met.
  • However, the same coming at the expense of other critical areas is ill-advised.

Staff shortage

  • There is a shortage of PHCs (22%) and sub-health centres (20%), while only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
  • There is a shortage of PHCs (22%) and sub-health centres (20%), while only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
  • Data by IndiaSpend show that there is a staggering shortage of medical and paramedical staff at all levels of care: 10,907 auxiliary nurse midwives and 3,673 doctors are needed at sub-health and primary health centres, while for community health centres the figure is 18,422 specialists.

Way forward

  • While making hospitalisation affordable brings readily noticeable relief, there is no alternative to strengthening primary health care in the pursuit of an effective and efficient health system.
  • The achievement of a “distress-free and comprehensive wellness system for all”, , hinges on the performance of health and wellness centres as they will be instrumental in reducing the greater burden of out-of-pocket expenditure on health.
  • Their role shall also be critical in the medium and long terms to ensure the success and sustainability of the PMJAY insurance scheme, as a weak primary health-care system will only increase the burden of hospitalisation.
  • Apart from an adequate emphasis on primary health care, there is a need to depart from the current trend of erratic and insufficient increases in health spending and make substantial and sustained investments in public health over the next decade. Without this, the ninth dimension (‘Healthy India’) of “Vision 2030” will remain unfulfilled.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Ayushman Bharat will not cover cataract ops, dialysis and normal deliveriesGovt. Schemes


Note4students

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

From UPSC perspective, the following things are important:

Prelims level:  Ayushman Bharat Programme

Mains level: Everything about Ayushman Bharat Programme


News

  • The National Health Authority (NHA) is planning to remove procedures covered under existing national programmes from the list of packages approved for reimbursement under PMJAY (Ayushman Bharat).
  • Certain procedures like cataract surgeries, dialysis and normal deliveries will not be covered by the flagship health scheme.

Avoiding Duplication

  • Procedures or diseases for which there is already an existing national programme, do not need to be covered under AB packages.
  • Diseases for which there are existing national programmes and for which treatment is reimbursed under PMJAY for specified rates include tuberculosis, chronic kidney disease (dialysis), leprosy, malaria, HIV-AIDS and mental health disorders.
  • For many diseases like malaria, where surgeries are not established protocol for treatment, PMJAY approves a daily hospitalization cost of Rs 2,000.

I. Cataract

  • Cataract surgeries have topped the list of claims submitted under PMJAY.
  • In the first three months of PMJAY until Nov 2018 — 6,900 claims had been submitted for cataract surgeries.
  • However they are done for free under the National Blindness Control Programme (NBCP).

II. Normal Delivery

  • The NHA is planning to leave out normal deliveries from the ambit of PMJAY.
  • There are a host of national programmes for mother and child health, high-risk deliveries will continue to be covered.

III. Dialysis

  • The Pradhan Mantri National Dialysis Programme was rolled out in 2016 under which dialysis is already provided free of cost.

Bringing Implants under AB-NHPM

  • The NHA is also in talks with the National Pharmaceutical Pricing Authority (NPPA) to negotiate special rates for implants or other devices that are used under PMJAY to further bring down costs.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] 4th Global Digital Health Partnership SummitIOCRPIB


Note4students

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

From UPSC perspective, the followaing things are important:

Prelims level: About the summit

Mains level: Need of HER in India


News

  • Union Health Ministry has inaugurated the ‘4th Global Digital Health Partnership Summit’ in New Delhi.

4th Global Digital Health Partnership Summit

  • The global intergovernmental meeting on digital health is hosted by the Ministry of Health and Family Welfare in collaboration with WHO and the Global Digital Health Partnership (GDHP).
  • The Conclave discussed the implication of digital health interventions to health services accessibility, quality and affordability and explores ways of leveraging digital health technologies to strengthen the healthcare delivery systems globally.

Electronic Health Record (EHR) in India

  • India has embraced digital health to achieve the targets of UHC.
  • A “National Resource Centre for EHR Standards” has also been set up in order to augment facilitation for adoption of the notified EHR Standards.
  • Indian government has notified health informatics standards and approved Metadata & Data Standards for enabling seamless exchange of information across care providers.
  • It aims to make these systems interoperable and to build electronic health records of citizens.
  • India took the world stage at the 71st World Health Assembly in Geneva, Switzerland by successfully introducing and unanimous adoption of Resolution on Digital Health.

About GDHP

  • The Global Digital Health Partnership (GDHP) is an international collaboration of governments, government agencies and multinational organisations.
  • It is dedicated to improving the health and well-being of their citizens through the best use of evidence-based digital technologies.
  • Governments are making significant investments to harness the power of technology and foster innovation and public-private partnerships that support high quality, sustainable health and care for all.
  • The GDHP facilitates global collaboration and co-operation in the implementation of digital health services.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO prescribes ‘aerobics 150’ to stay fitIOCR


Note4students

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

The following things are important from UPSC perspective:

Prelims Level: Aerobics 150

Mains level:  WHO Guidelines for Physical Activity


News

Aerobics 150

  1. Reiterating the need for physical activity to reduce the incidence of non-communicable diseases (NCD), the WHO has prescribed 150 minutes of weekly physical activity.
  2. It emphasized that physical inactivity is now identified as the fourth leading risk factor for global mortality.

Hazards of physical inactivity

  1. The WHO warned that physical inactivity levels are rising in many countries with major implications for the prevalence of NCDs and the general health of the population worldwide.
  2. Physical inactivity is estimated to be the main cause for approximately 21%-25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischemic heart disease burden.
  3. Regular and adequate levels of physical activity in adults reduces the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls.

WHO Guidelines on Aerobics

  1. There is strong evidence to demonstrate that adults between the ages of 18 to 64 should do:
  • at least 150 minutes of moderate-intensity aerobic physical activity throughout the week
  • at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or
  • an equivalent combination of moderate- and vigorous-intensity activity
  1. Aerobic activity should be performed in bouts of at least 10 minutes duration.
  2. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week.
  3. Muscle-strengthening activities should be done involving major muscle groups on two or more days a week.
  4. Children and youth aged 5-17 years should accumulate at least 60 minutes of moderate-to vigorous-intensity physical activity daily.
  5. Amounts of physical activity greater than 60 minutes provide additional health benefits.

Psychological benefits

  1. Physical activity has also been associated with psychological benefits in young people by improving their control over symptoms of anxiety and depression.
  2. The WHO noted that physical activity provides young people opportunities for self-expression, building self-confidence, social interaction and integration.
  3. It has also been suggested that physically active young people more readily adopt healthy behaviors (For example, avoidance of tobacco, alcohol and drug use) and demonstrate higher academic performance.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] HOPE PortalPIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme, NABH, HOPE Portal

Mains level: Standardization of Healthcare facilities in India


News

  • National Accreditation Board for Hospitals and Healthcare Organizations (NABH) has revamped Entry-Level Certification Process of hospitals to make it simpler, digital, faster and user-friendly.

Why NABH Certification?

  1. HCOs and small HCOs that want to avail benefits associated with IRDAI and Ayushman Bharat.
  2. NABH accreditation provides assurance of quality and care in hospitals at par with international benchmarks.
  3. NABH has designed an exhaustive healthcare standard for hospitals and healthcare providers that have been accredited as per global standards.

HOPE Portal

  1. The revamped certification process is driven through a new portal called HOPE – Healthcare Organizations’ Platform for Entry-Level-Certification.
  2. It is an online platform for smooth and secure registration which provides a self-explanatory questionnaire to be filled by the HCO/SHCOs.
  3. It ensures quality at nascent stages by enrolling a wide range of hospitals across the country including Healthcare Organizations (HCOs).
  4. HOPE also enables them to comply with quality protocols, improve patient safety and the overall healthcare facility of the organization.

Back2Basics

NABH

  1. NABH, a constituent body of QCI, has been working to ensure reliability, efficiency and global accreditation in Indian healthcare sector.
  2. It uses contemporary methodologies and tools, standards of patient safety and infection control.

About QCI

  1. Established in 1997 Quality Council of India (QCI) is an autonomous organization under the DPIIT, Ministry of Commerce and Industry.
  2. It is the Quality Apex and National Accreditation Body for accreditation and quality promotion in the country.
  3. The Council was established to provide a credible, reliable mechanism for third party assessment of products, services and processes which is accepted and recognized globally.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] National Survey on Extent and Pattern of Substance Use in IndiaDOMRPIB


Note4Students

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

From UPSC perspective, the following things are important:

Prelims level:  National Survey on Extent and Pattern of Substance Use in India

Mains level:  Menace of narcotic drugs in India


News

  • An addiction plague has steadily swallowed India a/c to a study conducted by the National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Sciences (AIIMS).
  • The study, named “National Survey on Extent and Pattern of Substance Use in India” is a first of its kind as it gives pan-India and state-level data.

National Survey on Extent and Pattern of Substance Use in India

  1. The survey report, which was submitted to the Union Ministry of Social Justice and Empowerment on noted that 5.7 crore people in the country suffered from alcohol related problems.
  2. The survey spanned all the 36 states and UTs of India and citizens between the ages of 10 to 75 responded to the questions set in the study regarding substance abuse.
  3. The intoxicant categories that were studied are as follows: alcohol, cannabis (bhang and ganja/charas), opioids (opium, heroin and pharmaceutical opioids), cocaine, amphetamine type stimulants (ATS), sedatives, inhalants and hallucinogens.

Magnitude of Substance use in India

I. Alcohol

  1. Of the 16 crore people who consumed alcohol across the country, prevalence of alcohol consumption was 17 times higher among men than among women.
  2. More than four lakh children and 1.8 million adults needed help for inhalant abuse and dependence.
  3. The male to female ratio of alcohol users in India is 17:1 and most men consume either ‘desi’ liquor (30 per cent) or Indian Made Foreign Liquor (30 per cent).
  4. A total of 5.2 per cent of the population indulge in harmful alcohol use, means that every third drinker in the country is in dire need of medical help in curing his/her addiction.

II. Cannabis (Bhang, Ganja & Charas)

  1. According to the survey, over 3.1 crore Indians (2.8%) reported to have used any cannabis product in last one year.
  2. Although, the usage of Bhang use is more common than Ganja or Charas but in case of addiction, the number of dependent users is higher for addicts of Ganja and Charas.
  3. Cannabis consumption is higher than the national average in Uttar Pradesh, Punjab, Sikkim, Chhattisgarh and Delhi.
  4. In Punjab and Sikkim, the prevalence of cannabis use disorders is considerably higher (more than thrice) than the national average.

III. Heroin, Opium & others

  1. At the national level, Heroin is most commonly used substance followed by pharmaceutical opioids, followed by opium (Afeem).
  2. However, in case of harmful dependence, more people are dependent on Heroin than other similar drugs like Afeem.
  3. Of the total 60 lakh users of Heroin and Afeem, majority of them are from Uttar Pradesh, Punjab, Haryana, Delhi, Maharashtra, Rajasthan, Andhra Pradesh and Gujarat.

IV. Sedatives and inhalants

  1. Less than 1% or nearly 1.18 crore people use sedatives, non medical or non prescription use. However, what is more worrying that its prevalence is high among children and adolescents.
  2. At national level, there are 4.6 lakh children that need help against the harmful or dependence over inhalants.
  3. This problem of addiction of children is more prevalent in Uttar Pradesh, Madhya Pradesh, Maharashtra, Delhi and Haryana.
  4. Cocaine (0.10%) Amphetamine Type Stimulants (0.18%) and Hallucinogens (0.12%) are the categories with lowest prevalence of current use in the country.

V. Addicts who inject drugs

  1. According to the survey, there are 8.5 lakh people in the country who inject drugs (PWID).
  2. Users of opium based drugs report high incidence of injecting drugs (heroin 46% and pharmaceutical opioids 46%), a large number of these drug users report risky injecting practices.
  3. This risky practice more prevalent in Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana, Haryana, Karnataka, Maharashtra, Manipur and Nagaland
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO issues new international standard for music devicesPriority 1


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: “Make Listening Safe” Initiative

Mains level: Read the attached story


News

  • The World Health Organization (WHO) and the International Telecommunication Union (ITU) has issued a new international standard for the manufacture and use of musical devices.

 “Make Listening Safe” Initiative

  1. The standard for safe listening devices was developed under WHO’s “Make Listening Safe” initiative by experts from WHO and ITU.
  2. It suggested that half of all cases of hearing loss can be prevented through the following public health measures:
  • Sound allowance function: software that tracks the level and duration of the user’s exposure to sound as a percentage used of a reference exposure
  • Personalized profile: an individualized listening profile, based on the user’s listening practices, which informs the user of how safely (or not) he or she has been listening and gives cues for action based on this information
  • Volume limiting options: options to limit the volume, including automatic volume reduction and parental volume control
  • General information: information and guidance to users on safe listening practices, both through personal audio devices and for other leisure activities

Why such move?

  1. The aim behind the move is to prevent young people from going deaf.
  2. Nearly 50 per cent of people aged 12-35 years are at risk of hearing loss due to prolonged and excessive exposure to loud sounds, including music they listen to through personal audio devices.
  3. Over five per cent of the world’s population has disabling hearing loss (432 million adults and 34 million children); impacting on their quality of life.
  4. The majority live in low- and middle-income countries.
  5. It is estimated that by 2050, over 900 million people or 1 in every 10 people will have disabling hearing loss.
  6. Hearing loss which is not addressed poses an annual global cost of $750 billion.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Every drop mattersop-ed snapPriority 1


Note4Students

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

From UPSC perspective, the following things are important:

Prelims level: Basic knowledge of regulatory framework related to blood in India.

Mains level: The news-card analyses the issues in the regulatory framework of blood donation in India and why it must be reformed to ensure access to safe and sufficient blood, in a brief manner.


Context

  • The regulatory framework in India must be reformed to ensure access to safe and sufficient blood

Background

  • A ready supply of safe blood in sufficient quantities is a vital component of modern health care.
  • In 2015-16, India was 1.1 million units short of its blood requirements.
  • Here too, there were considerable regional disparities, with 81 districts in the country not having a blood bank at all.
  • In 2016, a hospital in Chhattisgarh turned away a woman in dire need of blood as it was unavailable.
  • She died on the way to the nearest blood bank which was several hours away.
  • Yet, in April 2017, it was reported that blood banks in India had in the last five years discarded a total of 2.8 million units of expired, unused blood (more than 6 lakh litres).

Issue

Vigil after collection

  • To prevent transfusion-transmitted infections (TTIs), collected blood needs to be safe as well.
  • Due to practical constraints, tests are only conducted post-collection.
  • Thus blood donor selection relies on donors filling in health questionnaires truthfully.
  • The collected blood is tested for certain TTIs such as HIV and if the blood tests positive, it has to be discarded.
  • However, these tests are not fool-proof as there is a window period after a person first becomes infected with a virus during which the infection may not be detectable.
  • This makes it crucial to minimise the risk in the first instance of collection.

Professional donors

  • Collecting healthy blood will also result in less blood being discarded later.
  • Blood that is donated voluntarily and without remuneration is considered to be the safest.
  • Unfortunately, professional donors (who accept remuneration) and replacement donation (which is not voluntary) are both common in India.
  • In the case of professional donors there is a higher chance of there being TTIs in their blood, as these donors may not provide full disclosure.

Replacement donation

  • In the case of replacement donation, relatives of patients in need of blood are asked by hospitals to arrange for the same expeditiously.
  • This blood is not used for the patient herself, but is intended as a replacement for the blood that is actually used.
  • In this way, hospitals shift the burden of maintaining their blood bank stock to the patient and her family.
  • Here again, there could be a higher chance of TTI’s because replacement donors, being under pressure, may be less truthful about diseases.

Scattered laws, policies and guidelines

  • The regulatory framework which governs the blood transfusion infrastructure in India is scattered across different laws, policies, guidelines and authorities.
  • Blood is considered to be a ‘drug’ under the Drugs & Cosmetics Act, 1940.
  • Therefore, just like any other manufacturer or storer of drugs, blood banks need to be licensed by the Drug Controller-General of India (DCGI).
  • For this, they need to meet a series of requirements with respect to the collection, storage, processing and distribution of blood, as specified under the Drugs & Cosmetics Rules, 1945.
  • Blood banks are inspected by drug inspectors who are expected to check not only the premises and equipment but also various quality and medical aspects such as processing and testing facilities.
  • Their findings lead to the issuance, suspension or cancellation of a licence.

Blood Transfusion Councils

  • In 1996, the Supreme Court directed the government to establish the National Blood Transfusion Council (NBTC) and State Blood Transfusion Councils (SBTCs).
  • The NBTC functions as the apex policy-formulating and expert body for blood transfusion services and includes representation from blood banks.
  • However, it lacks statutory backing (unlike the DCGI), and as such, the standards and requirements recommended by it are only in the form of guidelines.
  • This gives rise to a peculiar situation — the expert blood transfusion body can only issue non-binding guidelines, whereas the general pharmaceutical regulator has the power to license blood banks.
  • This regulatory dissonance exacerbates the serious issues on the ground and results in poor coordination and monitoring.

Poor policies and regulations of Drug Controller-General of India

  • The present scenario under the DCGI is far from desirable, especially given how regulating blood involves distinct considerations when compared to most commercial drugs.
  • It is especially incongruous given the existence of expert bodies such as the NBTC and National AIDS Control Organisation (NACO), which are more naturally suited for this role.
  • The DCGI does not include any experts in the field of blood transfusion, and drug inspectors do not undergo any special training for inspecting blood banks.

Towards a solution

  • In order to ensure the involvement of technical experts who can complement the DCGI, the rules should be amended to involve the NBTC and SBTCs in the licensing process.
  • Given the wide range of responsibilities the DCGI has to handle, its licensing role with respect to blood banks can even be delegated to the NBTC under the rules.
  • This would go a long way towards ensuring that the regulatory scheme is up to date and accommodates medical and technological advances.

Way Forward

  • Despite a 2017 amendment to the rules which enabled transfer of blood between blood banks, the overall system is still not sufficiently integrated.
  • A collaborative regulator can take the lead more effectively in facilitating coordination, planning and management.
  • This may reduce the regional disparities in blood supply as well as ensure that the quality of blood does not vary between private, corporate, international, hospital-based, non-governmental organisations and government blood banks.
  • The aim of the National Blood Policy formulated by the government back in 2002 was to “ensure easily accessible and adequate supply of safe and quality blood”.
  • To achieve this goal, India should look to reforming its regulatory approach at the earliest.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] We need a leap in healthcare spendingop-ed snapPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Basic knowledge of India’s per capita expenditure on health.

Mains level: The news-card analyses India’s per capita expenditure on health which remains among the lowest in the world, in a brief manner.


Context

  • India’s per capita expenditure on health remains among the lowest in the world
  • In the Interim Budget 2019, 10.6% of the total amount in the Interim Budget is allocated to defence, while only 2.2.% is allocated to healthcare.

Background

  • Despite several innovations in the healthcare sector in recent times, in line with India’s relentless pursuit of reforms, the government remains woefully short of its ambition to increase public health spending to 2.5% of GDP.
  • At present, health spending is only 1.15-1.5% of GDP.
  • Funding need not be redirected from current allocations to preventive care, but surely India can make health spending a priority, much like defence.

Meagre allocation to health sector

  • While the Interim Budget is responsive to the needs of farmers and the middle class, it does not adequately respond to the needs of the health sector.
  • The total allocation to healthcare is ₹61,398 crore.
  • While this is an increase of ₹7,000 crore from the previous Budget, there is no net increase since the total amount is 2.2% of the Budget, the same as the previous Budget.
  • The increase roughly equates the ₹6,400 crore allocated for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY).

Per capita spending on health

  • According to the National Health Profile of 2018, public per capita expenditure on health increased from ₹621 in 2009-10 to ₹1,112 in 2015-16.
  • These are the latest official numbers available, although in 2018 the amount may have risen to about ₹1,500.
  • This amounts to about $20, or about $100 when adjusted for purchasing power parity.
  • Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal.

Comparison with other countries (US example)

  • The U.S. spends $10,224 per capita on healthcare per year (2017 data).
  • A comparison between two large democracies is telling: the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.5%.
  • In Budget terms, of the U.S. Federal Budget of $4.4 trillion, spending on Medicare and Medicaid amount to $1.04 trillion, which is 23.5% of the Budget.
  • Federal Budget spending per capita on health in the U.S. is therefore $3,150 ($1.04 trillion/ 330 million, the population).

Per capita Budget expenditure on health in India is among the lowest in the world

  • In India, allocation for healthcare is merely 2.2% of the Budget.
  • Per capita spending on health in the Budget in India is ₹458 (₹61,398 crore/ 134 crore, which is the population). (Medicare and Medicaid come under ‘mandatory spending’ along with social security.)
  • Adjusting for purchasing power parity, this is about $30 — one-hundredth of the U.S.
  • Admittedly, this runaway healthcare cost in the U.S. is not to be emulated, since comparable developed countries spend half as much per capita as the U.S.
  • Yet, the $4,000-$5,000 per capita spending in other OECD countries is not comparable with India’s dismal per capita health expenditure.
  • The rate of growth in U.S. expenditure has slowed in the last decade, in line with other comparable nations.
  • The ₹6,400 crore allocation to Ayushman Bharat-PMJAY in the Interim Budget will help reduce out-of-pocket expenditure on health, which is at a massive 67%.
  • This notwithstanding, per capita Budget expenditure on health in India is among the lowest in the world which requires immediate attention.

Health and wellness centres

  • Last year, it was announced that nearly 1.5 lakh health and wellness centres would be set up under Ayushman Bharat.
  • The mandate of these centres is preventive health, screening, and community-based management of basic health problems.
  • The mandate should include health education and holistic wellness integrating modern medicine with traditional Indian medicine.
  • Both communicable disease containment as well as non-communicable disease programmes should be included.

Budget allocation to various health programmes

  • An estimated ₹250 crore has been allocated for setting up health and wellness centres under the National Urban Health Mission.
  • Under the National Rural Health Mission, ₹1,350 crore has been allocated for the same.
  • The non-communicable diseases programme of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke has been allocated ₹175 crore, from ₹275 crore.
  • Allocation to the National Tobacco Control Programme and Drug De-addiction Programme is only ₹65 crore, a decrease of ₹2 crore.
  • The allocation for each of the wellness centres is less than ₹1 lakh per year which is a meagre amount.

Concerns

  1. Higher taxes on tobacco, alcohol and unhealthy food has not found its way into the Interim Budget
  • NITI Aayog has proposed higher taxes on tobacco, alcohol and unhealthy food in order to revamp the public and preventive health system.
  • This has not found its way into the Interim Budget.
  • A focused approach in adding tax on tobacco and alcohol, to fund non-communicable disease prevention strategies at health and wellness centres, should be considered.

2. Cancer screening and prevention are not covered

  • There is no resource allocation for preventive oncology, diabetes and hypertension.
  • Prevention of chronic kidney disease, which affects 15-17% of the population, is not appropriately addressed.
  • The progressive nature of asymptomatic chronic kidney disease leads to enormous social and economic burden for the community at large.
  • This is in terms of burgeoning dialysis and transplant costs which will only see an exponential rise in the next decade and will not be sustainable unless we reduce chronic kidney disease incidence and prevalence through screening and prevention.
  • Due to lack of focus in preventive oncology in India, over 70% of cancers are diagnosed in stages III or IV.
  • Consequently, the cure rate is low, the death rate is high, and treatment of advanced cancer costs three-four times more than treatment of early cancer.
  • The standard health insurance policies cover cancer but only part of the treatment cost.
  • As a consequence, either out-of-pocket expenditure goes up or patients drop out of treatment.

Way Forward

  • Increase of GDP alone does not guarantee health, since there is no direct correlation between GDP and health outcomes.
  • However, improvement in health does relate positively to GDP, since a healthy workforce contributes to productivity.
  • The 1,354 packages for various procedures in PMJAY must be linked to quality.
  • For various diseases, allocation should be realigned for disease management over a defined time period, not merely for episodes of care.
  • Since a major innovation in universal healthcare, Ayushman Bharat, is being rolled out, it must be matched with a quantum leap in funding.
  • History shows that where there is long-term commitment and resource allocation, rich return on investment is possible.
  • For instance, AIIMS, New Delhi is the premier health institute in India with a brand value because of resource allocation over decades.
  • AIIMS Delhi alone has been allocated nearly ₹3,600 crore in the Interim Budget, which is a 20% increase from last year.
  • Similar allocation over the long term is needed in priority areas.
  • Only if we invest more for the long-term health of the nation will there be a similar rise in GDP.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Missing the healing touchop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Basic knowledge of the health sector allocation in Budget 2019.

Mains level: The news-card analyses this year’s budgetary allocation in the primary health care system in India, in a brief manner.


Context

  • People expected some measures to strengthen the country’s ailing public healthcare system from this year’s Union budget.
  • However, the much-needed strengthening of the country’s primary healthcare system has once again taken a backseat indicating the government’s misplaced priorities.

Outlay on health has increased

  • There is, indeed, an increase of more than Rs 7,000 crore in nominal terms from last year’s expenditure on health in this year’s budget — the outlay has increased from Rs 56,045 crore to Rs 63,298 crore.
  • Accounting for inflation, this amounts to a 9.2 per cent increase in real terms.

Issue

  • However, allocation under the National Rural Health Mission (NRHM) — which provides funds for rural primary healthcare — has been reduced in real terms (accounting for inflation).
  • Its share in the health component of the budget has declined steeply over the past four years — from 52 per cent in 2015-16 to 41 per cent this year.

Neglecting the major components of primary care

  • Within the NRHM, there have been budget cuts for reproductive and child healthcare projects and maintenance of rural healthcare infrastructure.
  • The allocation for controlling communicable diseases under the NRHM has been reduced in real terms.
  • Communicable diseases like TB, diarrhoea, pneumonia, hepatitis and other infections are still a major problem for India.
  • Conversion of health sub-centres to health and wellness centres that put more emphasis on non-communicable diseases does not augur well for primary care in the country.
  • Neglecting these major components of primary care seems to be a continuation of the policies that have led to the virtual dismantling of the rural public health infrastructure.

Allocation for Urban and tertiary care reduced too

  • The National Urban Health Mission has been allocated only Rs 950 crore — this, when the estimated average yearly budgetary requirement for the mission is Rs 3,391 crore from Central funds.
  • Allocation for tertiary care components — the Pradhan Mantri Swasthya Suraksha Yojana (a programme for building-AIIMS like institutes), for example — has also remained stagnant in real terms.
  • Funds for upgrading district hospitals have been reduced by 39 per cent in real terms.

Pradhan Mantri Jan Arogya Yojana

  • Majority of the increase in the budget’s health component has gone to fund the Rs 6,556-crore Pradhan Mantri Jan Arogya Yojana (PMJAY).
  •  The scheme is supposed to give a Rs 5-lakh annual coverage for in-patient care to 10-crore poor families. However, the budgetary allocations do not match up to that promise.

Concerns

  • The National Sample Survey’s (NSS) health data of 2014 shows that out of an estimated total 24.85 crore families in India, 5.72 crore hospitalisations had to be made.
  • By that calculation, out of the 10-crore families, there would be roughly 2.3 crore hospitalisations in a year.
  • This means that from the Rs 6,556 crore government funds, health insurance agencies on average have only Rs 2,850 to pay per hospitalisation (assuming there are no administrative costs or insurance overheads).
  • The average out-of-pocket expenditure (OOPE) per hospitalisation is much higher — around Rs 15,244 as per NSS 2014 data, which amounts to Rs 19,500 in 2019-20 assuming a 5 per cent annual inflation.
  • The PMJAY’s budgetary provisions for insurance agencies will barely cover 15 per cent of this expenditure.

Under-utilisation of funds in the allied sectors

  • In the allied sectors, there was an alarming under-utilisation of funds in the 2018-19 fiscal.
  • The revised estimates for the year show that the National Rural Drinking Water Mission and the Pradhan Mantri Matru Vandana Yojana have utilised only 78 per cent and 50 per cent of the budgeted funds, respectively.
  • The government’s flagship programme, Swachh Bharat Mission (rural), also did not fully utilise the Rs 15,343 crore allocated in 2018-19.
  • Its allocation has been further reduced to Rs 10,000 crore for 2019-20.
  • The neglect of the ICDS under the UPA government has accelerated since 2014.
  • This year’s budgetary allocation for the scheme, in real terms, is still a touch below the expenditure of 2013-14.

Increasing out-of-pocket expenditure: majority of the treatment not covered by the insurance schemes

  • The modest increase in budgetary allocations in health should have been prioritised towards improving the worn-out public sector district hospitals, community health centres, primary health centres and sub-centres in under-served areas.
  • Instead, public money has been inefficiently used for the more expensive intervention of insurance, which can cover just 15 per cent of only in-patient OOPE.
  • NSS 2014 data shows that 97 per cent episodes of illnesses in India are treated in out-patient care centres and this accounts for 63 per cent of the overall medical expenditures.
  • So, a majority of the treatment and expenditures are not even covered by the insurance scheme for in-patient treatment.

Conclusion

  • Neglecting public health infrastructure and public provisioning to make way for monetary support in the form of insurance for buying healthcare services from the private sector is not pro-poor policy.
  • It is transfer of public funds to the corporate sector in the name of pumping technological interventions.
  • There is no surprise that the private sector has welcomed the government’s insurance initiative.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

New Delhi superbug gene reaches the ArcticPrelims OnlyPriority 1


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: blaNDM-1

Mains level:  Tackling the outbreak of such deadly superbugs


News

  • In a significant find in the global spread of multi-drug resistant (MDR) bacteria, scientists have found a “superbug” gene — first detected in New Delhi over a decade back — in one of the last “pristine” places on Earth that is some 12,870 km away.
  • A 70-year-old US woman has died in 2016 because of the superbug NDM-1.

Superbug blaNDM-1

  1. Soil samples taken in Svalbard — a Norwegian archipelago between mainland Norway and the North Pole — have now confirmed the spread of blaNDM-1 (called New Delhi Metallo-beta-lactamase-1) into the High Arctic.
  2. The blaNDM-1 and other ARGs were found in Arctic soils that were likely spread through the faecal matter of birds, other wildlife and human visitors to the area.
  3. This Antibiotic-Resistant Gene (ARG), originally found in Indian clinical settings, conditionally provides multi-drug resistance (MDR) in microorganisms, a/c to the research.
  4. British scientists later found the “superbug” in New Delhi’s public water supply.
  5. Since then, the resistant gene has been found in over 100 countries, including new variants.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Think differently about healthcareop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Basic knowledge of public health and health services in India.

Mains level: The news-card analyses the challenges of India’s public health system vis-à-vis its health services system, in a brief manner.


Context

  • In India, public health and health services have been synonymous.
  • This integration has dwarfed the growth of a comprehensive public health system, which is critical to overcome some of the systemic challenges in healthcare.

Issues and Probable Solutions

Need an interdisciplinary approach

  • A stark increase in population growth, along with rising life expectancy, provides the burden of chronic diseases.
  • Tackling this requires an interdisciplinary approach.
  • An individual-centric approach within healthcare centres does little to promote well-being in the community.
  • Tight laws, regulations around food and drug safety, and policies for tobacco and substance use as well as climate change and clean energy are all intrinsic to health.
  • But they are not necessarily the responsibilities of healthcare services.
  • As most nations realise the vitality of a robust public health system, India lacks a comprehensive model that isn’t subservient to healthcare services.

A different curriculum

  • India’s public health workforce come from an estimated 51 colleges that offer a graduate programme in public health.
  • This number is lower at the undergraduate level.
  • In stark contrast, 238 universities offer a Master of Public Health (MPH) degree in the U.S.

India’s diversity problem

  • In addition to the quantitative problem, India also has a diversity problem.
  • A diverse student population is necessary to create an interdisciplinary workforce.
  • The 2017 Gorakhpur tragedy in Uttar Pradesh, the 2018 Majerhat bridge collapse in Kolkata, air pollution in Delhi and the Punjab narcotics crisis are all public health tragedies.
  • In all these cases, the quality of healthcare services is critical to prevent morbidity and mortality.
  • However, a well organised public health system with supporting infrastructure strives to prevent catastrophic events like this.

Strong academic programmes are critical for interdisciplinary approach

  • Public health tracks range from research, global health, health communication, urban planning, health policy, environmental science, behavioural sciences, healthcare management, financing, and behavioural economics.
  • In the U.S., it is routine for public health graduates to come from engineering, social work, medicine, finance, law, architecture, and anthropology.
  • This diversity is further enhanced by a curriculum that enables graduates to become key stakeholders in the health system.
  • Hence, strong academic programmes are critical to harness the potential that students from various disciplines will prospectively bring to MPH training.

Investments in health/social services take precedence over public health expenditure

  • While benefits from population-level investments are usually long term but sustained, they tend to accrue much later than the tenure of most politicians.
  • This is often cited to be a reason for reluctance in investing in public health as opposed to other health and social services.
  • This is not only specific to India; most national health systems struggle with this conundrum.
  • A recent systematic review on Return on Investment (ROI) in public health looked at health promotion, legislation, social determinants, and health protection.
  • They opine that a $1 investment in the taxation of sugary beverages can yield returns of $55 in the long term.
  • Another study showed a $9 ROI for every dollar spent on early childhood health, while tobacco prevention programmes yield a 1,900% ROI for every dollar spent.
  • The impact of saving valuable revenue through prevention is indispensable for growing economies like India.

Problem of Health Literacy

  • Legislation is often shaped by public perception.
  • While it is ideal for legislation to be informed by research, it is rarely the case.
  • It is health literacy through health communication that shapes this perception.
  • Health communication, an integral arm of public health, aims to disseminate critical information to improve the health literacy of the population.
  • The World Health Organisation calls for efforts to improve health literacy, which is an independent determinant of better health outcome.
  • India certainly has a serious problem with health literacy and it is the responsibility of public health professionals to close this gap.

System of evaluating National programmes

  • Equally important is a system of evaluating national programmes.
  • While some fail due to the internal validity of the intervention itself, many fail from improper implementation.
  • Programme planning, implementation and evaluation matrices will distinguish formative and outcome evaluation, so valuable time and money can be saved.

Public health system and Healthcare services

  • The public health system looks at the social ecology and determinants focusing on optimising wellness.
  • Healthcare services, on the other hand, primarily focus on preventing morbidity and mortality.
  • A comprehensive healthcare system will seamlessly bridge the two.

Way Forward

A council for Public health

  • A central body along the lines of a council for public health may be envisaged to synergistically work with agencies such as the public works department, the narcotics bureau, water management, food safety, sanitation, urban and rural planning, housing and infrastructure to promote population-level health.
  • The proposed council for public health should also work closely with academic institutions to develop curriculum and provide license and accreditation to schools to promote interdisciplinary curriculum in public health.
  • As international health systems are combating rising healthcare costs, there is an impending need to systematically make healthcare inclusive to all.
  • While the proposed, comprehensive insurance programme Ayushman Bharat caters to a subset of the population, systemic reforms in public health will shift the entire population to better health.
  • Regulatory challenges force governments to deploy cost-effective solutions while ethical challenges to create equitable services concerns all of India.

Conclusion

  • With the infusion of technology driving costs on the secondary and tertiary end, it is going to be paramount for India to reinvigorate its public health system to maximise prevention.
  • India’s public health system can no longer function within the shadow of its health services.

 

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

Explained: Zearalenone in cerealsPrelims Only


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: Zearalenone (can be pronounced as Zee-ralley-none)

Mains level: Zearalenone and health issues associated with its consumption


News

  • This month, a Journal of Food Science study detected zearalenone in wheat, rice, corn and oats from markets in Uttar Pradesh.
  • The study, by researchers from Lucknow’s Indian Institute of Toxicology Research (IITR), found the substance in 70 of the 117 samples tested.

What is Zearalenone?

  1. Zearalenone is a fungal toxin infesting cereals such as wheat, maize and barley.
  2. It attacks crops while they are growing, but can also develop when cereals are stored without being dried fully.
  3. While numerous studies document this toxin in cereals across the world, no data existed for India until now.

Zearalenone’s hazard

  1. There is no strong evidence of toxicity in humans so far, though several research groups are investigating.
  2. As a result, the IARC classifies it as a Group 3 carcinogen, which means evidence is not sufficient for an evaluation yet.
  3. Zearalenone behaves like oestrogen, the female sex hormone, and could cause endocrine disturbances in humans. Its nasty effects in animals, such as pigs, are documented.
  4. When fed with mouldy corn, pigs develop inflamed vaginas, infertility and other symptoms.
  5. This is why countries like Brazil regulate zearalenone levels in animal feed.

Yet no cap of Regulation

  1. The FSSAI does not impose maximum limits for zearalenone, though the European Union (EU) does.
  2. Twenty-four of the U.P. samples exceeded the EU regulatory limits of 100-200 mcg/kg of cereals.
  3. Based on this, the authors say India should set limits on zearalenone in cereals.

Other Fungal toxins in Food

  1. Fungal toxins are commonly found in food, and can be a public health concern.
  2. India regulates the levels of some of these, including aflatoxin, deoxynivalenol, ergot and patulin.
  3. The first three infest cereals, while patulin is found in apples.
  4. Each of these toxins has been associated with disease outbreaks.

Impact of Fungal Toxins

  1. For example, in 1974, a hepatitis outbreak in Rajasthan and Gujarat, which made 398 people sick and killed 106, was linked to aflatoxin in maize.
  2. Meanwhile, chronic aflatoxin consumption has been shown to cause liver cancer.
  3. Given this, the International Agency for Research on Cancer (IARC) classifies aflatoxin as a Group 1 carcinogen, meaning there is enough evidence for its carcinogenicity.

Way Forward

  1. More data are needed from cereals in other States, and from other storage conditions, before India decides to set limits.
  2. Since zearalenone favours cool climates, such contamination could be limited to a few States.
  3. Regulations cannot be awaited till outbreak.
  4. The research is an excellent starting point, since nothing was known about the chemical in India so far.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Moving away from 1%op-ed snapPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Basic knowledge of India’s Health sector spending.

Mains level: The news-card analyses why there is a need for substantial increase in the allocation for health in the Union Budget, in a brief manner.


Context

  • India’s health achievements are very modest when compared to its neighbours or even in comparison to large and populous countries such as China, Indonesia or Brazil.

Background

  • India’s neighbours, in the past two decades, have made great strides on the development front.
  • Sri Lanka, Bangladesh and Bhutan now have better health indicators than India, which has puzzled many.
  • Therefore, it is imperative to understand why India is not doing as well as these countries on the health front.

Two important trends

Looking at other developed and transitional economies over many years, two important trends can be discerned:

  1. As countries become richer, they tend to invest more on health, and the share of health spending that is paid out of the pocket declines.
  • Economists have sought to explain this phenomena as “health financing transition”, akin to demographic and epidemiologic transitions.
  • Similar to these transitions, the health financing transition is not bound to happen, though it is widespread.
  • As with the other two transitions, countries differ in terms of timing to start the transition, vary in speed with which they transition through it, and, sometimes, may even experience reversals.
  • Economic, political and technological factors move countries through this health financing transition.

2. Social solidarity for redistribution of resources to the less advantaged is the key element in pushing for public policies that expand pooled funding to provide health care.

  • Out-of-pocket payments push millions of people into poverty and deter the poor from using health services.
  • Pre-paid financing mechanisms, such as general tax revenue or social health insurance (not for profit), collect taxes or premium contributions from people based on their income.
  • But it allow them to use health care based on their need and not on the basis of how much they would be expected to pay in to the pooled fund.

Hence, most countries, which includes the developing ones, have adopted either of the above two financing arrangements or a hybrid model to achieve Universal Health Care (UHC) for their respective populations.

India’s Health sector scenario: Low spending, interventions

  • Unlike these countries, India has not invested in health sufficiently, though its fiscal capacity to raise general revenues increased substantially from 5% of GDP in 1950-51 to 17% in 2016-17.
  • India’s public spending on health continues to hover around 1% of GDP for many decades, accounting for less than 30% of total health expenditure.
  • Besides low public spending, neither the Central nor the State governments have undertaken any significant policy intervention, except the National Health Mission, to redress the issue of widening socio-economic inequalities in health.
  • But the NHM, with a budget of less than 0.2% of GDP, is far too less to make a major impact.
  • Worryingly, the budgetary provision for the NHM has decreased by 2% in 2018-19 from the previous year.
  • Last year, the Union government launched the Pradhan Mantri Jan Arogya Yojana but only ₹2,000 crore was allocated to this ‘game-changer’ initiative.
  • This assumes importance as the National Health Policy 2017 envisaged raising public spending on health to 2.5% of GDP by 2025.

Concerns: Public health expenditure has stagnated since 2014

  • As a percentage of GDP, total government spending (Centre and State) was a mere 0.98% in 2014-15 and 1.02% in 2015-16.
  • Although the revised estimate of government expenditure for 2016-17 and budget estimate for 2017-18 show an apparent increase in allocation (1.17 and 1.28%, respectively), actual expenditure might turn out to be quite less.
  • This could be explained by looking at the difference between the revised allocation and actual expenditure for the years 2014-15 and 2015-16.
  • Actual expenditure dropped by 0.14 and 0.13 percentage points, respectively.
  • Assuming that the trend did not change in the last couple of years, India’s public expenditure on health would be around 1.1% even in 2017-18.
  • This ‘sticky public health spending rate’ of 1%, which does not increase despite robust economic growth for years.
  • It is partly due to a decline in the Centre’s expenditure, which fell from 0.40% of GDP in 2013-14 to 0.30% of GDP in 2016-17 and as per 2018-19 budget allocation, 0.33% of GDP).

Way Forward

Need for a substantial increase in the allocation for health

  • If this sluggish public health spending has to be reversed, there is a need for a substantial increase in the allocation for health in the forthcoming Union Budget.
  • However, the rise in government health spending also depends on health spending by States as they account for more than two-thirds of total spending.
  • Hence, both the Centre and States must increase their health spending efforts, which would reduce the burden of out of pocket expenditure and improve the health status of the population.
  • Otherwise, India would miss the 2025 target and thereby fail to achieve UHC in a foreseeable future.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] World Integrated Medicine Forum 2019PIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: World Integrated Medicine Forum

Mains level: Functions of the forum


News

World Integrated Medicine Forum 2019

  1. Union Ministry for AYUSH will inaugurate the 2nd World Integrated Medicine Forum 2019 on the ‘Regulation of Homeopathic Medical Products; Advancing global collaboration’.
  2. The organizers of the forum are the Central Council for Research in Homeopathy, under the Ministry of AYUSH.
  3. International drug regulators dealing with homeopathic/traditional medicines from various countries are expected to participate.

Aims and Objectives

  1. The regulation of homeopathic medicinal products is highly variable worldwide, ranging at a national level from highly advanced to none whatsoever.
  2. There is a tension between different regulatory needs: on the one hand there is a need for standardization, harmonization and reducing complexity;
  3. On the other hand there is need for a pluralistic regulatory system, which respects the specific characteristics of homeopathy as a holistic, patient-centred medical system.
  4. The forum will explore and illustrate the potential benefits and pitfalls of bi-lateral/multilateral collaboration and advance global cooperation on a synergistic basis.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Measles Rubella Vaccination: Understanding the question of parental consentPriority 1


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: MR and its vaccines

Mains level: Hurdles in immunization programme


News

  • Delhi High Court put on hold the govt plan for a measles rubella vaccination campaign in schools across the capital, saying the decision did not have the consent of parents.
  • The court’s order introduced a dimension to vaccination — the question of consent — that had not been adequately dealt with earlier.

The MR vaccine

  1. The latest Global Measles and Rubella Update say India had 56,399 confirmed measles cases and 1,066 confirmed rubella cases in 2018.
  2. Measles is a serious and highly contagious disease that can cause debilitating or fatal complications, including encephalitis, severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.
  3. The disease is preventable through two doses of vaccine.
  4. Congenital Rubella Syndrome, or CRS, is an important cause of severe birth defects.
  5. A woman infected with the rubella virus early in pregnancy has a 90% chance of passing the virus to her foetus.
  6. This can cause the death of the foetus, or CRS.

Matter of Dignity

  • The petitioners settled principle that choice of an individual, even in cases of life-saving medical treatment, is an inextricable part of dignity which is ought to be protected.

Consent not essential

  1. The consent of parents is not sought during routine immunization programmes.
  2. Consent in routine immunization is implied because it is the parents or members of the family who bring the child to the hospital or healthcare centre.
  3. For such a public good and for a vaccine that is tried and tested, there is ample evidence on safety and efficacy and something which is already a part of the universal immunization programme.

Vaccination

  1. The MR vaccine was recently introduced in the universal immunization programme. It has to be administered to all children between ages 9 months and 15 years.
  2. It is also needed to vaccinate those who did not get it earlier, and before they reach the reproductive age group.
  3. For vaccinations and such public health programmes govt. have never taken consent.

Why in schools

  • Schools, rather than health centres or hospitals, were consciously chosen because nowhere else can such large numbers of children in the relevant age group be targeted.

Global best practice

  1. Parental consent should be obtained prior to vaccination.
  2. This is the standard practice around the world.
  3. The WHO recognizes oral, written, and implied consent for vaccination.
  4. Countries are encouraged to adopt procedures that ensure that parents have been informed and agreed to the vaccination.
  5. In several US states, it is compulsory to provide vaccination records before seeking admission into school, so that the child is not a danger to others.

Way Forward

  1. MR vaccine is safe and effective, in use for over 40 years across 150 countries.
  2. The vaccine being given in the MR campaign is produced in India and is WHO prequalified.
  3. The same vaccine is being given in the routine immunization programme of India and in neighbouring countries.
  4. Vaccination is always a voluntary process, and there should not involve compulsion.
  5. Vaccines should be administered after people are sensitized about the disease and vaccine.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

CCHS: What makes sleep deadly in this rare disease?Prelims Only


Note4students

From the UPSC perspective, the following things are important:

Prelims level: CCHS & associated facts

Mains level: Not Much


News

  • An infant under treatment in Delhi’s is suffering from a rare disease with less than 1,000 known cases all over the world.
  • Those suffering from the disease, called Congenital Central Hypoventilation Syndrome (CCHS), can lose their life if they fall into deep sleep.

A look at how it affects the body:

The disease

  1. CCHS is a disorder of the nervous system in which the cue to breathe is lost when the patient goes to sleep.
  2. This results in a lack of oxygen and a build-up of carbon dioxide in the body, which can sometimes turn fatal.
  3. A typical presentation of the lack of breathing is when the lips start turning blue.
  4. This, in turn, is a typical feature of a carbon dioxide build-up, and is also seen in babies with congenital heart problems when the extremities of the body are deprived of oxygen.
  5. Though the name describes the disorder as congenital, some forms of the disease may also be present in adults.
  6. The disease is also known as Ondine’s Curse.
  7. Ondine, a nymph in French mythology, had cursed her unfaithful husband that he would forget to breathe the moment he fell asleep.

Causes

  1. The mutation of a gene called PHOX2B, which is crucial for the maturation of nerve cells in the body, can cause CCHS.
  2. The mutation is of a dominant trait — if just one of the gene pair changes, the effects would show. It can also be genetically acquired, which is when it is congenital.
  3. However, sudden mutation is more common than a transmission of the mutated gene from parent to child.
  4. The US National Institutes of Health (NIH) estimates that 90% of all known cases of CCHS are actually not inherited from a parent.

Symptoms

  1. Apart from the apparent signs of oxygen deficiency, CCHS patients also have problems in regulation of heart rate and blood pressure, sweat profusely, often have constipation and cannot always feel pain.
  2. Many of them suffer from neural tumours.
  3. In some patients, there is a deficiency of the growth hormone and a propensity of the body to produce much more insulin than is normal.

Treatment

  1. Treatment typically includes mechanical ventilation or use of a diaphragm pacemaker.
  2. People who have been diagnosed as newborns and adequately ventilated throughout childhood may reach the age of 20 to 30 years, and can live independently.
  3. In the later-onset form, people who were diagnosed when they were 20 years or older have now reached the age of 30 to 55 years.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National Action Plan for Drug Demand Reduction (2018-2023)Priority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: NAPDDR

Mains level: Preventing Drug abuse in India


News

  • The Ministry of Social Justice and Empowerment has drafted a five-year action plan for addressing the problem of drug and substance abuse in the country, dumping a long-pending draft policy on the matter.

National Action Plan for Drug Demand Reduction (2018-2023)

  1. It aims to employ a multi-pronged strategy — involving education, de-addiction and rehabilitation of affected individuals and their families — to address the issue.
  2. The objective is to create awareness and educate people about the ill-effects of drugs abuse on the individual, family, workplace and the society at large in order to integrate them back into the society.
  3. The ministry has planned several measures for controlling sale of sedatives, painkillers and muscle relaxant drugs, and checking online sale of drugs by stringent monitoring by cyber cell, under the national action plan.

Various measures in the Plan

  1. It includes holding awareness generation programmes at schools, colleges, universities, workplaces and for police functionaries, paramilitary forces, law enforcement agencies, judicial officers and Bar council, among others.
  2. Plans are also afoot for awareness generation through social, print, digital and online media, and engagement of celebrities, besides strengthening the national toll-free helpline for drug prevention.
  3. It also calls for persuading principals, directors, vice chancellors of educational institutions to ensure that no drugs are sold within/nearby the campus.
  4. It also includes identification of vulnerable areas based on survey, skill development, vocational training and livelihood support of ex-drug addicts through National Backward Classes Finance and other Development Corporations and continuous research on drug use pattern.

Other Initiatives

  1. The ministry, in collaboration with the National Drug Dependence Treatment Centre (NDDTC) under the AIIMS, is also conducting a national survey on the extent and pattern of substance abuse.
  2. A steering committee would be constituted under the chairmanship of the secretary, Social Justice Ministry, and with representatives from the Ministries of Health, HRD, WCD, MHA, Skill development and Entrepreneurship, among others.
  3. The committee will hold quarterly meetings to monitor effective implementation of the NAPDDR.
  4. As a part of the plan, module for re-treatment, ongoing treatment and post-treatment of addicts of different categories and age groups will be developed and database on substance use will be maintained.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Fish from Andhra Pradesh, West Bengal banned in PatnaStates in News


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Formalin

Mains level: Food Safety


News

  • Bihar has imposed a blanket ban for 15 days on sale of fish from Andhra Pradesh and West Bengal in capital Patna after samples were found to be contaminated with formalin.

Formalin traces found

  1. Fishes from these states were contaminated with formalin—a cancer causing chemical, used to preserve the fish.
  2. Apart from formalin, traces of other heavy metals like lead, chrorium and mercury was also found to be more than normal levels in the samples.

What is formalin?

  1. Formalin is derived from formaldehyde which is a known cancer-causing agent. It is used to preserve bodies in mortuaries.
  2. It can also increase shelf life of fresh food.
  3. While fromalin can cause nausea, coughing and burning sensation in eyes, nose and throat in the short term, it can cause cancer if consumed over a long period of time.

Why is fish laced with formalin?

  1. Fish is a highly perishable commodity.
  2. If it isn’t maintained at the proper temperature of 5 degree Celsius, it gets spoilt.
  3. To avoid that and increase its shelf life, the sellers use chemicals such as formalin and ammonia.
  4. If the point of sale is far from the place of catch, formalin is used as a preservative.
  5. Meanwhile, ammonia is mixed with the water that is frozen to keep fish fresh.

About the ban

  1. The ban includes storage and transportation of fish from Andhra Pradesh and West Bengal.
  2. Anybody found violating the ban would face a prison term up to seven years and a fine of Rs 10 lakh.
  3. With samples collected from Patna testing positive, the government has now decided to collect fish samples from different districts and test them for the same.
  4. If found positive, the ban would be extended over the entire state.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Ayushman Bharat’s success will hinge on the private sector taking ownershipop-ed snap


Note4students

Mains Paper 2: Governance| Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

From UPSC perspective, the following things are important:

Prelims level: Basics aspects of Pradhan Mantri Jan Aarogya Yojana.

Mains level: The newscard analyses the issues wrt Pradhan Mantri Jan Aarogya Yojana and can private sector can be roped in, in a brief manner.


Context

  • The Pradhan Mantri Jan Aarogya Yojana (PMJAY) completed 100 days last week. The project is billed as the world’s largest state-funded health scheme.
  • The medical journal, Lancet, has praised the prime minister for prioritising universal healthcare through the PMJAY, which aims to provide cashless treatment to beneficiaries identified through the Central Socio-Economic Caste Census.

Background

Ayushman Bharat

  • Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – RashtriyaSwasthyaBima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). It is an important reform and progressive step in healthcare sector.
  • Ayushman Bharat is an initiative to Address Health Holistically inPrimary, secondary and Tertiary care Systems covering both Prevention and Health Promotion. The Scheme aims to provide cashless benefits of 5 lakhs to 10 Crore Poor Families in the Country.
  • Ayushman bharat is the flagship public healthcare initiative of central government. It includes all the levels of healthcare delivery from primary to tertiary.

It has two components namely-

HEALTH AND WELLNESS CENTRE [HWC]

HWC’S will be upgraded form of primary health centres[PHC].the focus area includes non communicable diseases and infectious diseases along with neonatal and maternal care.HWC are primarily meant for early detection and prevention. This is significant in sense as burden on secondary and tertiary health system will reduce if early detection takes place, moreover rural areas will benefit as HWC will spread across India.

NATIONAL HEALTH PROTECTION SCHEME [NHPS]

NHPS is an insurance scheme which covers costing up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. It will cover 10 crores poor and vulnerable families. The scheme will reduce out of pocket expenditure and offers a choice for treatment at private hospitals.

Strategy of Scheme

  • Establishment of Ayushman Bharat National Health Protection Mission Agency at National Level and State Health Agency to ensure proper implementation of Scheme at National,State and UT levels.
  • The States and UTs can implement scheme through an insurance company or Directly through Trust/Society. This would increase Ambit of the Scheme at Ground levels.

Merits of Scheme

  • A Strong Network of 1.5 Lakhs Health and Wellness Centers across the Country would constitute Foundation of India’s new Healthcare Systems.
  • It will cover more than 10 Crore Poor and Vulnerable Families of the Society.
  • The Support from Trained Nurses and Health Workers increase the Availability near Home in Rural Areas.
  • Vulnerable Sections of the Society would have access to Healthcare to almost all medical and Surgical Conditions that can occur in Lifetime.
  • Package Rates decided by Government for Private Hospitals would help in keeping the cost low.
  • It will generate Employment Especially for Women would help in Economic Empowerment of Women.

Ground reality

  • India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.
  • The country spends an abysmal 1.3 per cent of its GDP on health, way less than the global average of 6 per cent.
  • Over 70 per cent of the total healthcare expenditure is accounted for by the private sector. Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals.
  • Health care bills are the single biggest cause of debt in India, with 39 million people being forced into poverty every year.

Can the PMJAY change that?

  1. Shortage of Doctors and other infrastructures
  • India falls woefully short of number of hospital beds compared to WHO standards. With over three-fourths of hospital beds being in the government sector, the private sector caters to a small segment of well-off population. So, from where will the beds for treatment under the scheme come?
  • Currently, according to a government report, one allopathic government doctor attends to a population of 11,000 — the WHO recommends one doctor for a population of 1,000.
  1. Budgetary allocations

The government has kept aside only Rs 3,000 crore for the PMJAY this year against the expected outflow of Rs 11,000 crore. How can then one expect adequate delivery of healthcare under PMJAY?

  1. The intended beneficiaries of PMJAY are masons, contract workers and farm workers who cannot afford to take off much time for treatment at government or private PMJAY-recognised hospitals. OPD treatment is not covered under the scheme. Another issue, quite unforeseen, is difficulty in locating beneficiaries.

Additional problems with healthcare delivery

  • Secondary-level hospitals like district hospitals and medical colleges have poor infrastructure, especially the former.
  • The tehsil and district hospitals have inadequate equipment and lack specialist manpower.
  • Not even one of the 20 medical colleges in India offers cardiac bypass surgery. There is also a gross shortage of tertiary care hospitals in the public sector with PGI, AIIMS, SGPGI and NIMHANS being among the few that can be relied upon.
  • However, these public hospitals are functioning beyond their capacity with waiting lists of one or two years for elective surgeries.

Can the private sector be depended upon? 

  1. Most consumers complain of rising costs, lack of transparency and unethical practices in the private sector. Moreover, these hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialisation in Tier-1 cities.
  2. Under the PMJAY, the private hospitals have to get registered and fulfill the minimum requirements. They are also expected to expand their facilities and add hospital beds.
  3. Hundred days into the PMJAY, it remains to be seen if private hospitals provide knee replacement at Rs 80,000 (current charges Rs 3.5 lakh) bypass surgery at Rs 1.7 lakh (against Rs 4 lakh).

Way Forward

  1. The PMJAY has created an excellent opportunity for the country to improve its health care.
  2. While the contribution of the private sector will be the key to its success, it’s the will and zeal of the government to implement it that will make or break the scheme.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Menstrual Hygiene for Adolescent Girls SchemeGovt. SchemesPIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Menstrual Hygiene Scheme

Mains level: Read the attached story


News

Menstrual Hygiene Scheme

  1. To address the need of menstrual hygiene among adolescent girls residing primarily in rural areas, Government of India is supporting the Menstrual Hygiene Scheme.
  2. Under the scheme, funds are provided to States/UTs through National Health Mission for decentralized procurement of sanitary napkins packs.
  3. It would thus make its provision to rural adolescent girls at subsidized rates as per proposals received from the States and UTs in their Programme Implementation Plans.

Components of the Scheme

  1. Increasing awareness among adolescent girls on Menstrual Hygiene
  2. Improving access to and use of high quality sanitary napkins by adolescent girls in rural areas.
  3. Ensuring safe disposal of Sanitary Napkins in an environmentally friendly manner.
  4. Provision of funds to ASHAs to hold monthly meeting with adolescents to discuss issues related to menstrual hygiene.

Other inititatives for menstrual health

  1. A range of IEC material has been developed around Menstrual hygiene Scheme, using a 360 degree approach to create awareness among adolescent girls about safe & hygienic menstrual health practices.
  2. It includes audio, video and reading materials for adolescent girls and job-aids for ASHAs and other field level functionaries for communicating with adolescent girls.
  3. ASHAs across the country are trained and play a significant role in promotion of use and distribution of the sanitary napkins.
  4. Department of Health Research, under the Ministry of Health, is involved in assessment of all newer, alternative, environment friendly menstrual hygiene products to look into their safety and acceptability features.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Cabinet approves setting up of the National Commission for Indian System of Medicine Bill, 2018PIB


Note4students

Mains Paper 2: Governance | Statutory, regulatory and various quasi-judicial bodies

From UPSC perspective, the following things are important:

Prelims level: Particulars of the draft bill

Mains level: Features of the proposed Commission


News

  • The Cabinet has approved the draft National Commission for Indian Systems of Medicine (NCIM) Bill, 2018, which seeks to replace the existing regulator Central Council for Indian Medicine (CCIM) with a new body to ensure transparency.

Salient features of the Bill

  1. The draft bill is aimed at bringing reforms in the medical education of Indian medicine sector in lines with the National Medical Commission proposed for setting up for Allopathy system of medicine.
  2. The draft bill provides for the constitution of a National Commission with four autonomous boards entrusted with conducting overall education of Ayurveda, under Board of Ayurveda and Unani, Siddha & Sowarigpa under Board of Unaini, Siddha and Sowarigpa.
  3. There are two common Boards namely, Board of assessment and rating to assess and grant permission to educational institutions of Indian systems of Medicine and Board of ethics and registration of practitioners of Indian systems of medicine to maintain National Register and ethical issues relating to practice under the proposed Commission.
  4. It also proposes a common entrance exam and an exit exam, which all graduates will have to clear to get practicing licenses.
  5. Further, a teacher’s eligibility test has been proposed in the Bill to assess the standard of teachers before appointment and promotions.
  6. The proposed regulatory structure will enable transparency and accountability for protecting the interest of the general public.
  7. The NCIM will promote availability of affordable healthcare services in all parts of the country.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] ‘India Day’ inaugurated as Partners ‘Forum 2018 takes Centre stagePIB


Note4students

Mains Paper 2: IR | Important International institutions

The following things are important from UPSC perspective:

Prelims Level: India Day, RMNCHA+A

Mains level: Addressing Maternal and Child health issues


News

  • The ‘India Day’, an official side event was organized jointly by the Ministry of Health and Family Welfare, and the development partners in the run up to the Partners’ Forum 2018.

India Day 2018

  1. India Day event is aimed to reflect on the journey of the RMNCH+A programme.
  2. RMNCHA+A stands for reproductive, maternal, newborn, child and adolescent.
  3. It aims to share and learn from the good practices and innovations implemented by different States/UTs and organisations to address various health challenges around maternal and child health.
  4. The RMNCH+A strategy is centred on the continuum of care approach, catering to health needs at every stage of the lifecycle.

RMNCH+A strategy in India

  1. RMNCH+A is aligned with the Global Strategy for Women’s, Children’s and Adolescents’ Health.
  2. Its key programming tenets include well-defined targets to end preventable deaths, ensure health and well-being and expand enabling environments, popularly known as the Survive, Thrive and Transform approach.
  3. In India, maternal, child, neonatal and adolescent health gained tremendous momentum since RMNCH+A was rolled out.
  4. India’s maternal mortality rate (MMR) has fallen from 556 in the year 1990 to 130 in 2014–16 (SRS data).
  5. The country’s progress can be gauged from the 77% decline in MMR that it achieved during 1990­–2015, compared to global decline of 44% during this period.
  6. Under-five mortality rate (U5MR) in India has fallen significantly, from 126 per 1,000 live births in 1990 to 39 per 1,000 live births in 2016.

About Partners Forum 2018

  1. The Partnership for Maternal, Newborn and Child Health (PMNCH) has organised 2018 Partners’ Forum in New Delhi.
  2. The 2018 Forum, hosted by the Government of India will centre on improving multisectoral action for results, sharing country solutions and capturing the best practices and knowledge within and among the health sector and related sectors.
  3. It will also emphasize the importance of people- centred accountability bringing forward the voices and lived realities of women, children and adolescents through innovative programming and creative projects.
  4. Specific goals of the Partners’ Forum include:
  • Greater political momentum, sustaining attention to the “Survive-Thrive-Transform” agenda of the Global Strategy, and its contribution to driving the Universal Health Coverage (UHC) and the 2030 SDG.
  • Knowledge exchange, through sharing of lessons learned and best practices to innovate and improve implementation strategies for results.
  • Improved cross-sectoral collaboration through knowledge exchange and joint advocacy strategies.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Report on ‘toxic’ talc worries IndiaIOCR


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Talc

Mains level:  Cancer and its preventive measures


News

  • The debate over whether talcum powder poses serious health risks is in the spotlight again as its perineal use is possibly carcinogenic to humans.

Risks posed by Talcum Powder

  1. A risk assessment on talc published by Health Canada, states that talcum powder is harmful to the lungs when inhaled during breathing and could possibly cause ovarian cancer when used by women in the genital area.
  2. Breathing in products containing talc can lead to coughing, difficulty in breathing, decreased lung function, scarring of the lung tissue.
  3. Its contact with the skin (excluding the female genital area) and mouth is, however, not a health concern.
  4. The draft assessment would be confirmed in a final assessment that would entail Canada adding talc to a list of toxic substances if the proposed conclusions are confirmed.
  5. At that point in time it would also decide on the measures it would take to prohibit or restrict the use of the clay mineral, which finds wide use including in cosmetics, paints, ceramics.

Talcum powder in India

  1. In India, talcum powder is among the most widely known talc-based self-care products.
  2. Most Indians use talcum powder to get rid of sweat and the odour that it generates.
  3. But talcum powder clogs the pores, which are supposed to remain open. This is the main cause of local infections like folliculitis, boils, skin eruptions.
  4. From fighting perspiration and odour, to helping lend the user a ‘fairer’ skin tone, a large number of Indian consumers rely on talcum powder and the market is estimated to be worth about ₹700 crore.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Four new devices notified as drugs for regulationPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level:  Not much

Mains level: Issues related to medical devices, implants etc.


News

  • The Drug Technical Advisory Body (DTAB), the country’s highest drug advisory body, had approved the proposal to include nebulizers, blood pressure monitoring devices, digital thermometers and glucometers under the purview of the Drugs and Cosmetics Act, 1940.

Why such move?

  1. The Drug Controller General of India (DCGI) would regulate the import, manufacture and sale of these devices from January 1, 2020.
  2. All these devices will have to be registered under the quality parameters prescribed under Medical Devices Rules 2017 and other standards set by the Bureau of Indian Standard (BIS) certification.
  3. This is a step which will enable the government to ensure their quality and performance.
  4. Once the proposal gets approved, it would mean companies which are engaged in manufacture and import of this equipment will have to seek necessary permission or license from the Drug Controller General of India.
  5. With this there are only 27 medical devices monitored for quality by the country’s drug regulator.

Expanding list of devices

  1. The health ministry has proposed expanding the list of devices in eight new categories, under the definition of ‘drugs’ to bring them under the purview of the Drugs and Cosmetics Act, 1940.
  2. The eight categories include implantable medical devices, MRI equipment, CT scan equipment, defibrillators, dialysis machines, PET equipment, X-ray machines and bone marrow cell separator.
  3. The proposal to bring high-end medical devices like implants, X-ray machines, MRI and CT scan equipment, dialysis machines under the purview of the drug law is under consideration.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] J&J case is a step in the right direction, finallyop-ed snap


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: Central Drugs Standard Control Organization

Mains level: The long road of justice for people seeking compensation and changes required in the system


Context

Compensation to victims of faulty implants

  1. India made a big stride in compensation, a critical appraisal in terms of various aspects of human life
  2. The government announced that the patients fitted with faulty hip implants supplied by pharmaceutical giant Johnson & Johnson Pvt. Ltd (J&J) be compensated between ₹30 lakh and ₹1.23 crore, along with an additional ₹10 lakh paid towards non-pecuniary damages
  3. This is by far the highest ever compensation announced for a living human being in India
  4. The compensation amount would set a precedent for future cases of medical negligence to be paid to patients in case of injury caused by “faulty” medical devices

Previous cases of neglect

  1. Decades ago, on the intervening night of 2-3 December 1984, a highly toxic chemical made its way into and around the small towns located near the Union Carbide India Ltd (UCIL) pesticide plant in Bhopal exposing more than 500,000 people to the deadly methyl isocyanate (MIC)
  2. In 1989, the Supreme Court ordered UCIL to cough up ₹750 crore for the tragedy touted as the “world’s worst industrial disaster”
  3. That sum was to be distributed among the 105,000 people affected by the leakage of MIC gas, including 3,000 dead and 102,000 injured
  4. There is no disputing that in India, compensation for death or disability arising from the fault of others is paltry
  5. Life in India is obviously much cheaper than in developed nations

More changes coming up

  1. The government is now contemplating changes in the Drugs and Cosmetics Act, 1940, to make pharmaceutical companies liable to pay compensation for injuries and damage caused to consumers by their products, including drugs and medical devices
  2. The Central Drugs Standard Control Organization, the national regulatory body for Indian pharmaceutical and medical device makers, has proposed changes in the existing law to introduce a compensation provision for approved drugs and medical devices that have an adverse impact on a patient
  3. Once this becomes law, it would have large implications, not the least of which is that affected parties will not be given the runaround for the compensation as it would become mandatory for the company or entity concerned to make the payment

Way forward

  1. Indians have always felt powerless, doubting if progress will ever be made in getting a fair compensation in such cases
  2. The right of the victim for compensation has suffered in India but with the J&J case, India has definitely set a new precedent
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Why gene editing of babies is problematicPriority 1


Note4students

Mains Paper 3: Science & Technology | Science and Technology- developments and their applications and effects in everyday life

From UPSC perspective, the following things are important:

Prelims level: CRISPR-Cas9, Gene editing

Mains level: Gene editing, its advantages and issues involved.


News

Context

  • Recently a Chinese researcher created an international sensation with his claim that he had altered the genes of a human embryo that eventually resulted in the birth of twin girls.
  • If proven, it would be the first instance of human offspring having been produced with specific desired attributes, using newly-developed tools of gene “editing”.
  • In the case of the new-born Chinese babies, the genes were claimed to be “edited” to ensure that they do not get infected with HIV, the virus that causes AIDS.

Gene editing

  1. Genes contain the bio-information that defines any individual.
  2. Physical attributes like height, skin or hair colour, more subtle features and even behavioral traits can be attributed to information encoded in the genetic material.
  3. An ability to alter this information gives scientists the power to control some of these features.
  4. Gene “editing” — sometimes expressed in related, but not always equivalent, terms like genetic modification, genetic manipulation or genetic engineering — is not new.
  5. It is widely practised in agriculture, to increase productivity or resistance to diseases, etc.
  6. But even in agriculture, genetic modification is a subject of major debate, especially in developing countries, including India.

CRISPR Technology

  1. CRISPR (short for Clustered Regularly Interspaced Short Palindromic Repeats) technology is a new and the most efficient, tool for gene “editing” developed in the last one decade.
  2. The technology replicates a natural defence mechanism in bacteria to fight virus attacks, using a special protein called Cas9.
  3. CRISPR-Cas9 is a simple, effective, and incredibly precise technology.

How it works?

  1. CRISPR-Cas9 technology behaves like a cut-and-paste mechanism on DNA strands that contain genetic information.
  2. The specific location of the genetic codes that need to be changed, or “edited”, is identified on the DNA strand, and then, using the Cas9 protein, which acts like a pair of scissors, that location is cut off from the strand.
  3. A DNA strand, when broken, has a natural tendency to repair itself.
  4. Scientists intervene during this auto-repair process, supplying the desired sequence of genetic codes that binds itself with the broken DNA strand.

Loopholes in Gene Editing

  1. The technology was used to solve a problem potential infection to HIV that already has alternative solutions and treatments.
  2. It was not necessary to tamper with the genetic material, which can have unintended, and as yet unknown, consequences.
  3. There is no way to verify the claims or whether the “editing” was carried out in the proper manner.
  4. The technology is extremely precise, but not 100% precise every time.
  5. There is a possibility that some other genes also get targeted. In such scenarios, unintended impacts cannot be ruled out.
  6. If regulatory approvals were obtained, then there will be data and information gaps about the experiment.

Ethical uses

  1. The most promising use of the CRISPR technology is in treatment of diseases.
  2. For example, in sickle cell anaemia, a single gene mutation makes the blood sickle-shaped.
  3. This mutation can be reversed using gene editing technology.
  4. In such cases, the genetic codes of just one individual are being changed to cure a disease.

Ethics at Stake

  1. Gene “editing” capabilities now exist with hundreds of researchers and laboratories across the world.
  2. Tampering with the genetic code in human beings is more contentious.
  3. Leading scientists in the field have for long been calling for a “global pause” on clinical applications of the technology in human beings, until internationally accepted protocols are developed.

Core of the Issue

  1. The Chinese researcher has done is to edit the genes of an embryo. Such a change would be passed on to the offspring.
  2. The aforesaid experiment has been basically making changes in the genome of the next generation.
  3. If we allow this, nothing stops people with access to CRISPR technology to produce babies with very specific traits.
  4. There is this highly problematic issue of trying to produce “designer” babies or human beings.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Integrated Health Information Platform (IHIP)PIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: IHIP

Mains level: Need for electronic health information system.


News

  • The Union Health Ministry did soft-launch of the Integrated Disease Surveillance Programme (IDSP) segment of Integrated Health Information Platform (IHIP) in seven states today.

Integrated Health Information Platform (IHIP)

  1. IHIP is real time, village-wise, case based electronic health information system with GIS tagging which will help in prompt prevention and control of epidemic prone diseases.
  2. The initiative will provide near-real-time data to policy makers for detecting outbreaks, reducing the morbidity and mortality and lessening disease burden in the populations and better health systems.
  3. The primary objective of IHIP is to enable the creation of standards compliant Electronic Health Records (EHRs) of the citizens on a pan-India basis.
  4. The EHRs aims to build a comprehensive Health Information Exchange (HIE) as part of this centralized accessible platform.
  5. The success of this platform will depend primarily on the quality of data shared by the states.
  6. For effective implementation of the platform, 32,000 people at the block level, 13,000 at the district level and 900 at the state level have been trained.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Cabinet approves the Allied and Healthcare Professions Bill, 2018PIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Allied and Healthcare Professions Bill, 2018

Mains level: Importance of Healthcare Professionals in India


News

  • The Union Cabinet has approved the Allied and Healthcare Professions Bill, 2018 for regulation and standardization of education and services by allied and healthcare professionals.

Background

  1. Our health system is highly focused on efforts towards strengthening limited categories of professionals such as doctors, nurses and frontline workers (like ASHAs, Auxiliary Nurse Midwife or ANMs).
  2. In the current state of healthcare system, there exist many allied and healthcare professionals, who remain unidentified, unregulated and underutilized.
  3. However, numerous others have been identified over the years, whose potential can be utilised to improve and increase the access to quality driven services in the rural and hard to reach areas.
  4. Allied and Healthcare Professionals (A&HPs) can reduce the cost of care and dramatically improve the accessibility to quality driven healthcare services.

Why such a Bill?

  1. Most of Indian institutions offering AHPs courses lack standardization compared to global standards.
  2. Majority of the countries worldwide, have a statutory licensing or regulatory body that is authorised to license and certify the qualifications and competence of such professionals.
  3. Though such professionals have existed in India healthcare system for many decades there is a lack of acomprehensive regulatory framework and absence of standards for education and training of AHPs.
  4. The Bill thus seeks to establish a robust regulatory framework which will play the role of a standard-setter and regulator for Allied and Healthcare professions.

Allied and Healthcare Professions Bill, 2018

  1. The Bill provides for setting up of an Allied and Healthcare Council of India and corresponding State Allied and Healthcare Councils.
  2. These councils will play the role of a standard-setter and facilitator for professions of Allied and Healthcare.

Provisions of the Bill

  1. The Bill provides for Structure, Constitution, Composition and Functions of the Central Council and State Councils,   e.g.   Framing  policies  and standards, Regulation of professional conduct, Creation and maintenance of live Registers etc.
  2. The Bill will also have an overriding effect on any other existing law for any of the covered professions.
  3. The State Council will undertake recognition of allied and healthcare institutions.
  4. Offences and Penalties clause have been included in the Bill to check mal­practices.
  5. The Bill also empowers the Central and State Governments to make rules.
  6. Central Govt. also has the power to issue directions to the Council, tomake regulations and to add or amend the schedule.

 Composition of the Councils

  1. The Central Council will comprise 47 members, of which 14 members shall be ex-officio representing diverse and related roles and functions and remaining 33 shall be non-ex-officio members who mainly represent the 15 professional categories.
  2. The State Councils are also envisioned to mirror the Central Council, comprising 7 ex-officio and 21 non-ex officio members and Chairperson to be elected from amongst the non-ex officio members.
  3. Professional Advisory Bodies under Central and State Councils will examine issues independently and provide recommendations relating to specific recognised categories.

Major Impact

The Bill aims:

  1. To bring all existing allied and healthcare professionals on board during the first few of years from the date of establishment of the Council.
  2. To provide opportunity to create qualified, highly skilled and competent jobs in healthcare by enabling professionalism of the allied and healthcare workforce.
  3. To bring in high quality, multi-disciplinary care in line with the vision of Ayushman Bharat, moving away from a ‘doctor led’ model to a ‘care accessible and team based’ model.
  4. Opportunity to cater to the global demand (shortage) of healthcare workforce which is projected to be about 15 million by the year 2030, asper the WHO Global Workforce, 2030 report.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

National body set up to study rare form of diabetesDOMR


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Monogenic Diabetes

Mains level:  Efforts for preventing diabetes in India


News

What is monogenic diabetes?

  1. Monogenic diabetes is a rare condition resulting from mutations (changes) in a single gene.
  2. In contrast, the most common types of diabetes—type 1 and type 2—are caused by multiple genes (and in type 2 diabetes, lifestyle factors such as obesity).
  3. Most cases of monogenic diabetes are inherited.
  4. Monogenic diabetes appears in several forms and most often affects young people.
  5. In most forms of the disease, the body is less able to make insulin, a hormone that helps the body use glucose (sugar) for energy.
  6. Rarely, the problem is severe insulin resistance, a condition in which the body cannot use insulin properly.

National Monogenic Diabetes Study Group

  1. A National Monogenic Diabetes Study Group has been formed to identify cases of monogenic diabetes across the country.
  2. At national level it is coordinated by the Indian Council of Medical Research (ICMR), the Madras Diabetes Research Foundation (MDRF) and Dr. Mohan’s Diabetes Specialities Centre (DMDSC).
  3. ICMR already has a young diabetic’s registry. As an off-shoot, a National Monogenic Diabetes Study Group has been formed with MDRF as the nodal centre.
  4. As of now, 33 doctors from across the country are ready to collaborate for this initiative.

Activities under the Group

  1. MDRF would provide guidelines to the collaborators for identifying monogenic diabetes.
  2. They need to look out for certain parameters such as children below six months of age.
  3. They will also look for those diagnosed as Type 1 diabetes but have atypical features such as milder forms of diabetes, and strong family history of diabetes going through several generations.
  4. The collaborators will identify cases of monogenic diabetes and send their details.
  5. They will collect blood samples and following the test results they will be given the treatment.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Defeating pneumoniaPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: U5 mortality in India and measures to prevent them


News

Context

  1. The Partnership for Maternal, Newborn and Child Health summit is to be hosted by India in December.
  2. In 2016, pneumonia was the leading cause for under-five deaths in India, and more than 25 million children under the age of two were found not immunized

Menace of Pneumonia

  1. A report by Save the Children (“Fighting for Breath”) showed that pneumonia kills two children in this age group every minute — more than malaria, diarrhoea and measles combined.
  2. More than 80% of victims have weakened immune systems caused by malnutrition or insufficient breastfeeding and unable to fight the infection.

Indian Case

  1. The “Fighting for Breath” report says that globally, a million children are dying from pneumonia annually, even though it can be treated with antibiotics costing as little as ₹26.
  2. In 2016, pneumonia was the leading cause for under-five deaths in India, and more than 25 million children under the age of two were found not immunized with pneumococcal conjugate vaccine.
  3. While the Indian government has taken several steps to improve the health of children, India continues to top the world ranking in the number of deaths due to the disease
  4. The number of unvaccinated children in the 0-2 age range in developing countries is estimated to be at around 170 million, with India dominating.

Caused by air pollution

  1. Air pollution is a major risk factor for pneumonia.
  2. The sources of pollution vary across and within countries.
  3. Outdoor air pollution, which is associated with emissions from factories, the burning of rubbish and coal, and traffic, is a growing concern.
  4. Children living in urban slum environments often face high levels of exposure to these sources of pollution.

Indoor Pollution is worsening the Situation

  1. Indoor air pollution is a major contributor of respiratory infection in many high-burden pneumonia countries, where the burning of biomass for cooking, heating and lighting are the common sources of pollution.
  2. According to the International Energy Agency’s Energy Access Outlook 2017 report, over 63% of households in India use biomass energy sources.
  3. Research shows that that the association between pneumonia and air pollutant exposure is particularly strong during the first year of life.

Way Forward

  1. It is a well known that exclusive breastfeeding in the first six months acts as an effective vaccine and continued breastfeeding with the gradual introduction of complementary food is another risk-reducer.
  2. Defeating pneumonia necessitates multi-sectoral action plans.
  3. Concerted action by the government, backed by civil society, corporates and communities can help save children’s lives, but we need to move fast.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Global Drug Survey set to cover IndiansPriority 1


Note4students

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

From the UPSC perspective, the following things are important:

Prelims level: Global Drug Survey

Mains level: Lack of awareness related to drugs in India and interventions required to reduce drug abuse


Understanding India’s health issues

  1. The 2018 edition of the Global Drug Survey, the largest poll of its kind in the world surveyed recreational drug use among 1,30,000 people spanning 44 countries
  2. The GDS for 2019 will survey, for the first time, consumption trends in alcohol, cannabis and opiates in India

About GDS

  1. The GDS uses an encrypted, online platform to conduct annual anonymous surveys
  2. No IP addresses are collected and the survey is independent of governments
  3. A key objective of the survey is to understand how advances in technology are influencing drug use and the complexities this pose in determining the levels of harmful dosage and how those who sought to reduce drug-related harm responded
  4. The GDS 2019 will probe social issues, including how the police treat people who use drugs, and the complex problem of sexual assault, consent and drug use

Lack of research in India

  1. Few studies have looked at the use of alcohol and illicit drugs and consequences faced by drug users in India
  2. A 2004 survey by the Union Ministry of Social Justice on the extent and pattern and trends of drug abuse left out women
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] 1st Annual Senior Care ConclavePIB


Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes

From UPSC perspective, the following things are important:

Prelims level: Senior Care Conclave   

Mains level: Various inititatives for elderly population


News

Senior Care Conclave 

  1. The ‘1st Annual Senior Care Conclave’ was recently organised by Confederation of Indian Industry (CII).
  2. The event marked release of a CII Report “Igniting Potential in Senior Care Services”.
  3. It urged corporates to explore opportunities of investment in the emerging field of Senior Care.

Healthcare inititatives for Ageing Population

  1. The National Programme for the Health Care of Elderly (NPHCE) addresses various health related issues of the elderly.
  2. The programme is State oriented and basic thrust of the programme is to provide dedicated health care facilities to the senior citizens (>60 year of age) at various levels.
  3. The basic aim of the NPHCE Programme is to provide dedicated, specialized and comprehensive health care to the senior citizens at various levels of state health care delivery system including outreach services.
  4. Preventive and promotive care, management of illness, health manpower development for geriatric services, medical rehabilitation & therapeutic intervention and IEC are some of the strategies envisaged in the NPHCE.
  5. The NPHCE was launched in 100 identified districts of 21 States and Eight Regional Geriatrics Centres in selected medical colleges as referral units during the 11th Plan period.
  6. Two National Centres for Ageing (NCA) in AIIMS Delhi and Madras Medical College, Chennai have been sanctioned to be developed as centres of excellence for geriatrics.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Explained: How Zika spreads, and harms


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Everything about Zika Virus

Mains level: Tackling Zika Virus menace in India


News

Context

  • In what is India’s first large outbreak of the Zika virus, afresh 100 cases have been detected so far Jaipur itself.
  • A look at how the virus spreads and the big risk it involves — the possibility of babies being born with a defect:

Zika

  1. Zika is a viral infection, spread by mosquitoes.
  2. The vector is the Aedes aegypti mosquito, which also spreads dengue and Chikungunya.
  3. First identified in Uganda in 1947 in monkeys, Zika was detected in humans five years later.
  4. Sporadic cases have been reported throughout the world since the 1960s, but the first outbreak happened only in 2007 in the Island of Yap in the Pacific.
  5. In 2015, a major outbreak in Brazil led to the revelation that Zika can be associated with microcephaly, a condition in which babies are born with small and underdeveloped brains.

Transmission of Zika Virus

  1. Infected people can transmit Zika sexually.
  2. Fears around Zika primarily involve microcephaly, especially when pregnant women are infected.
  3. Generally, the virus is not considered dangerous to anyone other than pregnant women.
  4. Some countries that have had a Zika outbreak, including Brazil, reported a steep increase in Guillain-Barré syndrome — a neurological disorder that could lead to paralysis and death, according to WHO.
  5. In 2017, following a study on Brazil’s confirmed cases, the US National Institutes of Health study estimated the fatality rate at 8.3%.

Symptoms

  1. Most people infected with the virus do not develop symptoms.
  2. When they are manifested, the symptoms are similar to those of flu, including fever bodyache, headache etc.
  3. WHO says these symptoms can be treated with common pain and fever medicines, rest and plenty of water.
  4. If the symptoms worsen, people should seek medical advice.
  5. Additional symptoms can include the occasional rash like in dengue, while some patients also have conjunctivitis.
  6. The incubation period (the time from exposure to symptoms) of Zika virus disease is estimated to be 3-14 days.

Preventive Measures against Zika

  1. Mosquito control measures such as spraying of pesticides, use of repellents etc. are widely suggested.
  2. Because of the possibility of congenital abnormalities and sexual transmission, there is also focus on contraceptives.
  3. WHO requires countries to counsel sexually active men and women on the matter to minimize chances of conception at the time of an outbreak.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Analytical report of the National Health Profile-2018 releasedDOMRPIB


Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Importance of geo-spatial study of health profile of the country


News

Context

  • The Minister of State for Health and Family Welfare has released an Analytical Report of the National Health Profile-2018 prepared by the Central Bureau of Health Intelligence (CBHI).

Analytical Report of National Health Profile – 2018

  1. The report indicates that significant progress has been made in the country for various health outcomes, which is an encouraging sign.
  2. The Profile covers demographic, socio-economic, health status and health finance indicators, along with comprehensive information on health infrastructure and human resources in health.
  3. CBHI has been publishing National Health Profile every year since 2005 and this is the 12th

About National Health Resource Repository (NHRR)

  1. The Union Health Ministry June 2018,  has launched the first ever registry in the country registry of authentic, standardised and updated geo-spatial data of all public and private healthcare.
  2. Aim: To create a reliable, unified registry of country’s healthcare resources showing the distribution pattern of health facilities and services between cities and rural areas.
  3. The ISRO is the project technology partner for providing data security.
  4. Under the Collection of Statistics Act 2008, more than 20 lakh healthcare establishments such as hospitals, doctors, clinics, diagnostic labs, pharmacies and nursing homes would be enumerated under this census, which will capture data on more than 1,400 variables.
  5. The Central Bureau of Health Intelligence (CBHI) has looped in key stakeholders, including leading associations, allied ministries, and several private healthcare service providers.
  6. NHRR will be the ultimate platform for comprehensive information of both, Private and Public healthcare establishments including Railways, ESIC, Defense and Petroleum healthcare establishments.

For further readings, supplement this article with:

India launches its first National Healthcare Facility Registry

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

[pib] ‘MedWatch’ Mobile Health AppPIBPrelims Only


Note4students

From UPSC perspective, the following things are important:

Prelims level: Particulars of the MedWatch Mobile App

Mains level: Not Much


News

Context

  • On the occasion of 86th anniversary, the Indian Air Force has launched an innovative mobile health App named MedWatch in keeping with the PM’s vision of Digital India, Ayushman Bharat and Mission Indradhanush.

MedWatch

  1. The app is conceived by the doctors of IAF and developed in house by Directorate of Information Technology (DIT) with zero financial outlay.
  2. It will provide correct, Scientific and authentic health information to air warriors and all citizens of India.
  3. The app is available on www.apps.mgov.gov.in and comprises of host of features like information on basic First Aid, Health topics and Nutritional Facts.
  4. It includes reminders for timely Medical Review, Vaccination and utility tools like Health Record Card, BMI calculator, helpline numbers and web links.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Assistive Aids and Appliances distributed to Senior Citizens Under 58th Rashtriya Vayoshri Yojana CampPIBPrelims Only


Note4students

Mains Paper 2: Governance | Welfare schemes for vulnerable sections of the population

From UPSC perspective, the following things are important:

Prelims level: RVY, Devices distributed under RVY

Mains level: Incentives for Senior Citizens


News

Rashtriya Vayoshri Yojana (RVY)

  1. A Distribution camp for free of cost distribution of Aids and Assistive Living devises under Rashtriya Vayoshri Yojana (RVY).
  2. It is a scheme of Ministry of Social Justice & Empowerment, Department for Senior Citizen under BPL category.
  3. The event was organized by Artificial Limbs Manufacturing Corporation of India (ALIMCO), a PSU working under the aegis of Ministry of Social Justice and Empowerment.

Assistive Living Devices distributed to Sr. Citizens under RVY

  • Wheelchairs
  • Tetra/Tripod
  • BTE Hearing Aids
  • Crutches
  • Walking Sticks
  • Dentures
  • Spectacles
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Toilet-for-all: WHO calls for more investmentIOCR


Note4students

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

The following things are important from UPSC perspective:

Prelims Level: Particulars of the guidelines

Mains level: Need for investments on Sanitation


News

First Global Guidelines on Sanitation and Health

  1. In its first such guidelines, the WHO warned that world will not reach the goal of universal sanitation coverage by 2030 unless countries make comprehensive policy shifts and invest more funds.
  2. By adopting these new guidelines, countries can significantly reduce the diarrheal deaths due to unsafe water, sanitation and hygiene.
  3. WHO developed the new guidelines because current sanitation programmes are not achieving anticipated health gains.
  4. There is a lack of authoritative health-based guidance on sanitation.

Four Principal Recommendations

  1. Sanitation interventions should ensure entire communities have access to toilets that safely contain excreta.
  2. The full sanitation system should be undergo local health risk assessments to protect individuals and communities from exposure to excreta – whether this be from unsafe toilets, leaking storage or inadequate treatment.
  3. Sanitation should be integrated into regular local government-led planning and service provision to avert the higher costs associated with retrofitting sanitation and to ensure sustainability.
  4. The health sector should invest more and play a coordinating role in sanitation planning to protect public health.

Why invest more on Sanitation?

  1. Poor sanitation is a major factor in transmission of neglected tropical diseases.
  2. For every US $1 invested in sanitation, WHO estimates a nearly six-fold return as measured by lower health costs, increased productivity and fewer premature deaths.
  3. Worldwide, 2.3 billion people lack basic sanitation with almost half forced to defecate in the open.
  4. They are among the 4.5 billion without access to safely managed sanitation services.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Assam launches wage compensation scheme for pregnant women in tea garden districtsStates in News


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Wage Compensation Scheme

Mains level: The initiative seeks to address high MMR among plantation labourers of Assam.


News

Wage Compensation Scheme for Pregnant Women

  1. Assam govt. has launched the Wage Compensation Scheme for Pregnant Women in tea gardens of the state.
  2. Under the scheme, each pregnant woman in tea gardens will get a sum of Rs 12,000 so that she can take better care of herself and her unborn baby without compromising the livelihood of her family.
  3. This initiative will be able to considerably bring down the mortality rate among the pregnant women of the tea community of the state.
  4. The high Maternal Mortality Ratio (MMR) among pregnant women in the tea garden areas due to anaemia and other diseases has been a major cause of concern.
  5. The pregnant women labourers in the tea gardens have to work through their pregnancy till the time of delivery due to crop cycle.
  6. All temporary, permanent or non-workers living within the tea garden areas will be eligible for the scheme.

Compensation Plans under the scheme

  1. As per the scheme, the first installment of Rs 2,000 will be provided during the Ante-Natal Check-up (ANC) registration within the first trimester.
  2. Second installment of Rs 4000 will be credited during the sixth month of the pregnancy and the third installment of Rs 3000 during delivery at a government-approved health institution.
  3. The fourth installment of Rs 3,000 will be credited during the sixth week post-delivery.
  4. Those who did not get Rs 2,500 which was deposited to eight lakh newly opened bank accounts in the tea garden areas will receive Rs 5,000 in December.
  5. Another Rs 2,500 will also be given to those who received a similar amount earlier.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Panel approves nutrition normsGovt. SchemesPrelims Only


Note4students

Mains Paper 1: Social issues | Poverty & development issues

From UPSC perspective, the following things are important:

Prelims level: Nutrition norms mentioned in the newscard

Mains level: Measures to eradicate severe acute malnutrition.


News

Fresh food must for SAM

  1. The National Technical Board on Nutrition (NTBN) has approved guidelines proposed by WCD Ministry for severe acute malnutrition.
  2. India’s top nutrition panel has recommended that severely malnourished children must be fed freshly cooked food prepared from locally available cereals, pulses and vegetables.
  3. This is to be distributed by anganwadi centres, as part of the country’s first-ever guidelines for nutritional management of children suffering from severe acute malnutrition (SAM).
  4. The measures are part of the community-based health management of children suffering from SAM.
  5. The government had, till now, only put in place guidelines for the hospitalization of severely wasted children who develop medical complications.

Greater role for Anganwadi workers

  1. The guidelines outline the role of anganwadi workers and auxillary nurse midwives (ANMs) in identifying severely wasted children.
  2. They have to segregate those with oedema or medical complications and sending them to the nearest health facility or nutrition rehabilitation centres.
  3. The remaining children are enrolled into “community based management”.
  4. This includes provision of nutrition, continuous monitoring of growth, administration of antibiotics and micro-nutrients as well as counselling sessions and imparting of nutrition and health education.

New practices for Meals

  1. According to the recommendations, anganwadi workers have to provide modified morning snacks, hot cooked meals and take home ration for SAM children.
  2. The morning snacks and hot-cooked meals, which are served at anganwadis to children between the age of three to six years, should be “prepared freshly and served at the centralised kitchen/ anganwadi centres.
  3. Locally available cereals, pulses, green leafy vegetables and tubers, vitamin C rich fruits, as well as fresh milk and 3-4 eggs every week” have also been prescribed.
  4. Importantly, the government has also revised the method to be used to measure wasting and advised calculating weight based on the height of children instead of the mid-upper arm circumference.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] PMJAY: The promises and challenges of a bold experimentop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PMJAY)

Mains level: Universal health care in India and challenges thereof


Context

Launch of PMJAY

  1. The Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PMJAY), a health insurance scheme announced in the last budget, will be launched on 23 September
  2. It is arguably the most ambitious social health insurance (SHI) programme ever launched anywhere in the world
  3. PMJAY will provide insurance up to ₹500,000 per family per year for in-patient secondary and tertiary treatment
  4. It will cover over 100 million vulnerable families, which is about 500 million people, the poorest 40% of India’s population
  5. Treatment would be provided by empanelled public and private hospitals

About PMJAY

  1. PMJAY is actually the second tier of Ayushman Bharat, a two-tier scheme. It will ride on the first tier, a network of 150,000 health and wellness centres (HWCs) that will provide free universal and comprehensive primary health care
  2. The HWCs will serve as the awareness, screening and referral link between patients and PMJAY
  3. A cadre of frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) are being trained to facilitate the provision of treatment to beneficiaries at hospitals

Relevance of PMJAY

  1. The significance of PMJAY has to be seen in the context of existing health conditions and health service delivery systems in India
  2. With an average life expectancy of 68.3 years, India trails all its Asian neighbours barring Afghanistan, Pakistan, Myanmar and Laos

Healthcare expenditure not satisfactory

  1. Healthcare is one important factor among several that determine health outcomes along with income, nutrition, and hygiene
  2. The World Health Organization recommends that a country should spend at least 4% of its gross domestic product (GDP) on health
  3. India’s health expenditure at 3.9% of GDP is comparable to this norm
  4. However, the health ministry’s National Health Accounts show that total government health expenditure is only an appalling 1.1% of GDP
  5. Well over 70% of health expenditure is privately financed
  6. More than 62% is direct out of pocket (OOP) spending by patients as against the WHO-recommended OOP ceiling of 40%

Less focus on preventive care

  1. Preventive health spending is more equitable and much more cost effective in improving health standards
  2.  But less than a quarter of India’s meagre public health expenditure is allocated to preventive care
  3. There is thus the continuing high incidence of communicable diseases
  4. There is a rising incidence of non-communicable diseases with income growth, lifestyle changes and environmental degradation, resulting in a rising total burden of disease

Challenges to PMJAY

  • Unknown financial cost of the programme
  1. No actuarial database is available to yield a probability distribution of the expected number of different health episodes requiring different treatments at varying costs
  2. Without such a database, insurance agencies cannot estimate the required premium to adequately cover the pooled risk —the ultimate cost of the programme
  • Coverage erosion
  1. A pattern observed in several countries is that when costs escalate, the package covered by SHI is shrunk and co-payments and coverage caps are introduced, thereby raising the burden of OOP spending
  2. Some private providers might be pushing high-cost treatments not covered by SHI to enhance their profit margins, thereby further raising the OOP burden on patients
  • Implementation failure
  1. PMJAY will ride on the first tier of Ayushman Bharat, a network of 150,000 HWCs spread throughout the country
  2. Fixing this weak primary care foundation of India’s public healthcare system is more urgently needed than providing insurance for secondary and tertiary care

Way forward

  1. These challenges do not imply that PMJAY will fail but that it is only a first step on the road to universal SHI
  2. As a follower country, India can learn from the experiences of others
  3. The Thai model with excellent SHI coverage and OOP spending down to 18% is increasingly seen as the global best practice
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] India’s ignored mental health challengeop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: National Mental Health Policy 2014 and how it has proved ineffective in containing mental health issues in India


Context

Mental health situation in India

  1. India is facing a possible “mental health epidemic”
  2. India’s contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men
  3. The jump far outstrips the approximately 1.4 percentage point increase in India’s share of global population in that period
  4. Suicide is the largest killer of India’s 15-29 and 15-39 age cohorts

Demography of suicides

  1. Suicide makes up a higher percentage of deaths in the more developed states of the south and western and central states have mid-level SDRs
  2. The northwest and less developed north have low SDRs, while the east and northeast have mixed rates
  3. The variations across states are due to the different levels of urbanization, the proportion of the literate population, and the difference in literacy attainment

The gender gap in suicides

  1. Indian women’s SDRs are almost three times higher than the rates expected globally for countries at similar levels of sociodemographic development
  2. This is because women are struggling with disproportionate socio-economic burdens
  3. Their high SDRs relative to men are rooted in factors as varied as the difference in socially acceptable methods of dealing with stress and conflict for women and men, domestic violence and the different ways in which poverty affects the genders
  4. A particularly important detail is that married women form the biggest victim group of suicide deaths among women in general
  5. This group becomes more vulnerable due to arranged and early marriage, young motherhood and economic dependence

Migration also a factor

  1. The past few decades have witnessed economic, labour and social changes on a scale rarely seen before
  2. Such rapid change with the economic dislocation and change in social and community links it brings can be destabilizing
  3. There is a cost to the loss of social links for the men who migrate, as well as for their families that stay behind
  4. The parlous state of agriculture doesn’t help

The social stigma 

  1. The social stigma attached to mental health disorders in India is a major hurdle in addressing them
  2. Until last year, suicide was a criminal offence in India, which was a major cause of under-reporting of suicide deaths in the National Crime Records Bureau of India
  3. Suicide is often preceded by a history of depression, stress, or anxiety
  4. The stigma and general lack of knowledge and understanding when it comes to mental health disorders prevent timely intervention

Fewer facilities and doctors

  1. The state capabilities for addressing mental health issues are close to non-existent
  2. The expenditure on mental health accounts for a tiny fraction of total public health spending
  3. The country has about 5,000 psychiatrists and less than 2,000 clinical psychologists
  4. This is minuscule, given population size

Way Forward

  1. The National Mental Health Policy 2014 shows how wide the gap between good intentions and effectiveness can be
  2. The decriminalization of suicide last year was long overdue and welcome
  3. The Insurance Regulatory and Development Authority of India has mandated that insurance companies are to make provisions to cover mental illnesses in their policies along with physical illnesses
  4. India’s mental health landscape should be improved in order to bring down suicide rates
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Cabinet approves enhancement of various initiatives under ICDS SchemePIBPrelims Only


Note4Students

Mains Paper3: Governance | Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes

The following things are important from UPSC perspective:

Prelims: AWHs and ICDS

Mains level: Not Much


News

Context

  • The CCEA has approved enhancement of honorarium to Anganwadi Workers/Anganwadi Helpers (AWWs/AWHs)and performance linked incentive to AWHs [Umbrella Integrated Child Development Services (ICDS) Scheme].
  • Nearly 27 lakh AWWs/AWHs will be benefitted by the approval.

Details of the approval

  1. The proposals approved consist of the following:
Name of Functionary Old Rates p.m. Revised Rates p.m.
Anganwadi Worker Rs.3,000/- Rs.4,500/-
Anganwadi Worker at Mini-AWC Rs.2,250/- Rs.3,500/-
Anganwadi Helper Rs.1,500/-  

Rs.2,250/-

  1. In addition, monthly performance linked incentive of Rs.250/- has also been approved for Anganwadi Helpers for facilitating proper functioning of Anganwadi Centres (AWCs).

Impact

  1. The programme through targeted interventions will strive to reduce the level of malnutrition, anemia and low birth weight babies.
  2. It will ensure empowerment of adolescent girls, provide protection to the children who are in conflict with law, provide safe place for day-care to children of working mothers, create synergy.
  3. It will further ensure better monitoring, encourage States/UTs to perform, guide and supervise line Ministries and States/UTs to achieve the targeted goals and bring more transparency.

Back2Basics

Integrated Child Development Services (ICDS)

  1. Launched in 1975, ICDS is an programme which provides food, preschool education, and primary healthcare to children under 6 years of age and their mothers.
  2. These services are provided from Anganwadi centres established mainly in rural areas and staffed with frontline workers.
  3. In addition to fighting malnutrition and ill health, the programme is also intended to combat gender inequality by providing girls the same resources as boys.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

NACO releases HIV Estimations 2017 reportDOMRPrelims OnlyPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the report.

Mains level: Preventing discrimination against HIV/AIDS positive persons.


News

Missing the Target

  1. India’s long battle against AIDS is not likely to end any time soon, if the latest figure released by the National AIDS Control Organisation (NACO) is any indication.
  2. The data revealed that, as of 2017, there were still around 21.40 lakh people living with HIV in India, with the prevalence among adults stood at 0.22 per cent.

Particulars of the Report

  1. There were around 87,000 new HIV infections and over 69,000 AIDS-related deaths (ARDs) in 2017.
  2. Around 22,675 mothers needed Antiretroviral Therapy (ART) for prevention of mother-to-child transmission of HIV.
  3. The report has noted that the rate of decline in annual new HIV infections has been relatively slower in recent years.
  4. In 2015, India had reported 86,000 new HIV infections.
  5. Of these, children (<15 years) accounted for 12 per cent (10,400) while the remaining (75,000) were adults (15+ years).

Importance of the Report

  1. The impact of the National AIDS Control Programme (NACP) has been significant, with more than an 80 per cent decline in estimated new infections from the epidemic’s peak in 1995.
  2. The objective of HIV estimations is to provide updated information on the status of the HIV epidemic in India at the national and State/Union Territory level.
  3. Estimations of adult HIV prevalence, annual new infections (HIV incidence), AIDS-related mortality, and prevention of mother-to-child transmission (PMTCT) needs are produced as outcomes of HIV estimations.
  4. The modeled estimates are needed because there is no direct reliable way of measuring these core indicators, which are used to track the epidemic and monitor and evaluate the response in countries around the world.

Back2Basics

HIV estimation in India

  1. The HIV Estimations 2017 is the 14th round in the series of HIV-estimations under the National AIDS Control Programme (NACP).
  2. NACO undertakes HIV estimations biennially in collaboration with the Indian Council of Medical Research (ICMR) – National Institute of Medical Statistics (NIMS).
  3. The first round of HIV estimation in India was done in 1998.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[pib] Health Ministry issues a notification for bringing the HIV/AIDS Act, 2017 in forcePIBPrelims OnlyPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Act

Mains level: Preventing discrimination against HIV/AIDS positive persons.


News

Context

  1. The Ministry of Health and Family Welfare has issued a notification for bringing the HIV AIDS (Prevention and Control) Act, 2017 in force from 10th September, 2018.
  2. The Act safeguards the rights of people living with HIV and affected by HIV.

Provisions of the Act

  1. The provisions of the Act address HIV-related discrimination, strengthen the existing programme by bringing in legal accountability, and establish formal mechanisms for inquiring into complaints and redressing grievances.
  2. The Act lists various grounds on which discrimination against HIV positive persons and those living with them is prohibited.
  3. These include the denial, termination, discontinuation or unfair treatment with regard to:
  • employment
  • educational establishments
  • health care services
  • residing or renting property
  • standing for public or private office
  • provision of insurance
  1. The requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is also prohibited.

Other Provisions

  1. Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household.
  2. The Act also prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.
  3. A person between the age of 12 to 18 years who has sufficient maturity in understanding and managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age.
  4. Every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counseling services.

 

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

[pib] Rashtriya Poshan Maah celebrations get under way across IndiaPIBPrelims Only


Note4Students

Mains Paper 2: Indian Society| Issues relating to poverty and hunger.

The following things are important from UPSC perspective:

Prelims: Poshan Maah

Mains level: Mission Mode implementation of Poshan Abhiyaan.


News

Poshan Maah

  1. The Government is celebrating the month of September, 2018 as the National Nutrition Month under the Poshan Abhiyan.
  2. The key feature of this programme is mobilization of communities across the country and gets their participation in addressing various aspects of the nutritional challenges.
  3. The primary aim is to enable awareness on the importance of nutrition and how individual families can easily access government services to supplement nutrition for their children and pregnant/lactating mothers.
  4. National Nutrition Month has eight key themes-
  • Antenatal Care,
  • Optimal Breastfeeding,
  • Complementary Feeding,
  • Anemia,
  • Growth Monitoring,
  • Education;
  • Diet and right age of marriage for girls,
  • Hygiene and Sanitation and Food fortification.

Jan Andolan under the Project

  1. POSHAN Abhiyaan seeks to synergise efforts of key stakeholders by leveraging technology and intends to take Nutrition Awareness to the level of Jan Andolan or People’s Movement.
  2. This People’s Movement intends to reach 11 crore beneficiaries during the Rashtriya Poshan Maah itself.
  3. Since the launch, Government has organised many Awareness Workshops with an aim to reduce stunting, under-nutrition, anemia and low birth weight.
  4. Stakeholders across India will be encouraged to undertake activities ranging from State Level Workshops to Nomination of Brand Ambassadors to Multi-Media Campaigns.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Drug-resistant superbug spreading in hospitalsPrelims Only


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Staphylococcus Epidermidis, MRSA

Mains level: Growing incidences of HIV in country and measures to prevent it


News

Three variants found in 10 countries

  1. A superbug resistant to all known antibiotics that can cause “severe” infections or even death is spreading undetected through hospital wards across the world.
  2. Researchers from Australia discovered three variants of the multidrug-resistant bug in samples from 10 countries.

Staphylococcus Epidermidis

  1. The bacteria known as Staphylococcus Epidermidis (Gram-positive) are related to the better-known and more deadly MRSA (Methicillin-resistant Staphylococcus Aureus) superbug.
  2. It’s found naturally on human skin and most commonly infects the elderly or patients who have had prosthetic materials implanted, such as catheters and joint replacements.
  3. It can be deadly for the patients who already are very sick in the hospital and it is difficult to cure.
  4. The researchers found that some strains of the bug made a small change in its DNA that led to resistance to two of the most common antibiotics.
  5. Another Australian study suggested some hospital superbugs are growing increasingly tolerant to alcohol-based disinfectants found in handwashes and sanitisers used on hospital wards.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Draft charter of Patients’ Rights releasedGovt. SchemesPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Importance of recognizing Patients Rights


News

NHRC’s draft on Patient Rights

  1. The Health Ministry plans to implement the Charter of Patients’ Rights through State governments for provision of proper health care by clinical establishments.
  2. There was a need for a consolidated comprehensive document on patient’s rights in India.
  3. Some States have adopted the national Clinical Establishments Act 2010 and certain others have enacted their own State-level legislations to regulate hospitals.
  4. However there was no consolidated document on patients’ rights that can be followed by all States uniformly.

Particulars of the Draft

  1. The draft charter includes 17 rights with description which includes all relevant provisions and is inspired by international charters.
  2. This charter expects that Patients’ Rights are given adequate protection and operational mechanisms are set up to make these rights functional and enforceable by law.

Need for Right to Non-Discrimination

  1. Every patient has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health condition, religion, caste, ethnicity or sexual orientation.
  2. The hospital management has a duty to ensure that no form of discriminatory behaviour or treatment takes place with any person under the hospital’s care.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] A plan for change: on Mental Healthcare Actop-ed snap


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Mental Healthcare Act (MHCA), 2017

Mains level: Ignorance and stigma related to mental health care in India & its impacts on patients


Context

MHCA comes into force

  1. For the first time in India, universal mental health care is now a justiciable right following the enforcement of the Mental Healthcare Act (MHCA), 2017
  2. It is for the first time that the law has recognised the right to access health care for citizens — and specifically for mental health

Status of mental health care in India

  1. In India, an estimated 150 million people need mental health care and treatment
  2. Up to 92% of them (no less than 105 million persons) do not have access to any form of mental health care
  3. According to the National Mental Health Survey (NHMS) of India, 2016, India spends less than 1% of its entire health budget on mental health
  4. Stigmatisation and discrimination are serious causes of concern
  5. There are numerous documented cases of human rights violations as a result of poor quality of mental health care, forced admissions in mental health hospitals, and a denial of socio-economic rights

How MHCA aims to curb the malfunctioning of the system?

  1. It mandates the government to provide accessible, affordable, acceptable and high-quality mental health care by
  • integrating mental health-care services at each level of the public health system
  • establishing mental health facilities in proportion to the population in each State
  • providing free mental health-care to socio-economically deprived sections of the population

The government is duty-bound to design and implement mental health promotion and preventive programmes to create awareness about the MHCA using public media

Steps that can be taken for implementation

  • The government will have to make appropriate budgetary provisions to plug existing infrastructure gaps
  1. This will require mapping existing mental health systems in the States for prevailing demand-supply factors for services, identifying shortages in mental health professionals and operational barriers to effective implementation
  2. At the same time, promoting innovative models of community mental health care can support the MHCA using existing community resources
  3. For example, the Atmiyata project (being implemented by the Centre for Mental Health Law & Policy) in Mehsana district, Gujarat, trains community volunteers to provide psychological counselling, social care and referral services to those with mental health problems while reaching out to a population of more than one million
  • State governments will have to immediately set up and ensure the functioning of State mental health authorities and mental health review boards
  1. The State authorities are legally mandated to establish regulations for registering mental health establishments and professionals, conducting social audits and defining quality standards for mental health services and facilities
  2. The mental health review boards, as quasi-judicial bodies, will play a crucial role in ensuring the day-to-day implementation of the MHCA such as monitoring long-stay admissions, registering advance directives, appointing nominated representatives and adjudicating complaints about human rights violations and deficiencies in care/services
  • Implementation of the MHCA will be impossible without coordinated efforts on the part of all stakeholders with an interest in mental health care
  1. Law enforcement officials, judges, mental health professionals and government officials need to be trained as a matter of priority to develop the necessary attitudes and skills for implementing the MHCA
  2. Most importantly, civil society will have to pursue coordinated advocacy efforts with the government in setting up of the necessary infrastructure

Way Forward

  1. At a time when the global health discourse has been advocating universal health coverage and the right to health, India has already made this a reality for mental health care
  2. If well implemented, it will be a pioneering model for universal mental health care across the world and will go a long way to in addressing the mental health concerns of 150 million people

 

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

Ayushman Bharat and concepts of insuranceGovt. SchemesPrelims Only


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Trust Model, Insurance Mode, Law of Large Numbers, Pooling of Risk in economics

Mains level: Read the attached story.


News

Context

  1. Nearly 500 million people or 40% of India’s population will have health insurance as the government gears up to launch Ayushman Bharat, a health policy for the under-privileged.
  2. Modalities with respect to its pricing are still being worked out, but the scheme will be financed by the centre and the state governments.

Trust Model for Premium Payment

  1. Many states have agreed to launch Ayushman Bharat through a trust model and not the insurance model.
  2. Under the trust model, the premium will not be paid to an insurance company, but will be pooled into a trust.
  3. It is this trust that will manage and administer the health scheme and also pay the claims.
  4. Under the insurance model, the state will pay premiums to an insurance company just like you do to your health insurer.
  5. The onus will be on the insurer to administer and pay the claims.
  6. Both insurance and trust models depend on two basic principles: pooling of risk and law of large number.

Pooling of risk

  1. What are the chances of a theft occurring in the entire neighborhoods at once?
  2. Close to zero, but chances that one house gets robbed are much higher.
  3. Now imagine the entire neighbourhood gets together and pools money to insure them against the common threat of theft. So if one house gets burgled, the pool can compensate for that burglary.
  4. This is called pooling of risk. Here, the risk of an event is spread out among all the people facing the risk who are prepared to pay a small sum or premium to get protection from that risk.

Law of large numbers

  1. But pooling of risk is just one part, it’s important for this pool to be large to avoid adverse selection and improve the predictability of a risky event actually taking place to be able to price the product right.
  2. This predictability increases as more people join the pool. This is called the law of large numbers.
  3. According to this law, the average of the results obtained from a large number of trials will be closer to the expected result. Insurers can predict risk more accurately through this law.
  4. So the larger the sample size, the greater is the predictability for insurance—this also leads to pricing the risk right.
  5. This is what Ayushman Bharat model depends on given that it’s meant for 500 million people.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

State can stop voluntary retirement of doctorsPriority 1SC Judgements


Note4students

Mains Paper 2: Polity | Structure, organization & functioning of the Executive & the Judiciary

From UPSC perspective, the following things are important:

Prelims level: Provisions related to freedom of profession

Mains level: Issue of voluntary retirement of doctors leads to decrease in proficiency of Healthcare facilities.


News

Public Interest over & above Right to Retire

  1. The State can stop government doctors from taking voluntary retirement in public interest, the Supreme Court has ruled.
  2. The fundamental right to retire is not above the right to save lives in a country where government hospitals cater to the poorest.
  3. The concept of public interest can also be invoked by the government when voluntary retirement sought by an employee will be against public interest.
  4. The court said public health was suffering from a scarcity of doctors. Qualified doctors did not join the public service.
  5. Even if they did so, they chose voluntary retirement and went into lucrative private practice.

Public Interest has greater say

  1. The Court said that poor could not be put in peril by a paucity of specialists in government hospitals.
  2. The State governments had an obligation “to make an endeavour under Article 47 to look after the provisions for health and nutrition.”
  3. The doctors, as citizens, had certain fundamental duties under Article 51(A) towards their fellow citizens.
  4. The right to practice a profession under Article 19(1) (g) was subject to the interest of the general public, the court said.

Earlier HC  Judgment overruled

  1. The ruling is based on an appeal by the Uttar Pradesh government against the Allahabad High Court’s decision.
  2. The HC allowed Dr. Achal Singh, who was working as Joint Director, Medical, Health and Family Welfare, in Lucknow, to voluntarily retire.
  3. Though the HC allowed Ms. Singh to retire, it rued the way government doctors were seeking voluntary retirement almost every day in the State.
  4. The HC said the government healthcare sector needed senior doctors as they were “absolutely necessary to run the medical services which are part and parcel of the right to life itself.”
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

WHO highlights ways to reduce cancer riskIOCRPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Stats related to incidence of cancer in India and the World


News

Menace of Cancer

  1. With cancer emerging as the second leading cause of death globally, the World Health Organisation (WHO) has listed ways to reduce cancer risk.
  2. The WHO said consumption of tobacco and alcohol, unhealthy diet, and physical inactivity are major factors that increases cancer risk worldwide and are also the four shared risk factors for other non-communicable diseases.

What is Cancer?

  1. Cancer is the uncontrolled multiplication of cells. Cancer can spread from where it started to another part of the body.
  2. The original cancer is called the primary tumor. The cancer in another part of the body is called metastatic or secondary cancer.
  3. Metastatic cancer has the same type of cancer cells as the primary cancer.
  4. The term metastatic cancer is usually used to describe solid tumors that have spread to another part of the body.

What Causes Cancer?

  1. Some chronic infections are risk factors for cancer and have major relevance in low and middle-income countries.
  2. Approximately 15% of cancers diagnosed in 2012 were attributed to carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus.
  3. Hepatitis B and C viruses and some types of HPV increase the risk for liver and cervical cancer, respectively.
  4. Infection with HIV substantially increases the risk of cancers such as cervical cancer.

WHO advisory

  • not to consume any form of tobacco,
  • to make one’s home smoke-free,
  • to enjoy a healthy diet,
  • to vaccinate children against Hepatitis B and HPV,
  • to use sun protections,
  • to take part in organised screening programmes,
  • Breastfeeding reduces a mother’s cancer risk.

Incidence of Cancer in India

  1. Doctors have warned that prevalence of cancer cases are on the rise in India.
  2. The Indian Council of Medical Research stated that approximately 12 to 13 lakh new cases of cancer are being diagnosed every year along with an existing 25 to 30 lakh cancer cases at any given time in India.
  3. The saddest part is that a vast majority of them are being diagnosed in advanced stages.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Rythu Bima providing instant aid to familiesGovt. SchemesPrelims OnlyStates in News


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Rythu Bima scheme

Mains level: The newscard discusses the Rythu Bima scheme which is gaining wide acknowledgement and puts Centre to think over such framework at pan India level.


News

Rythu Bima Scheme

  1. Rythu Bima group life insurance scheme is introduced by the Telangana government for all the landholding (pattadar) farmers in the age group of 18-59 years from August 14.
  2. It is proving to be an instant aid to their families in case of death of the enrolled farmer, irrespective of the cause either natural or otherwise.
  3. The death of farmers with any reason is compensated within a maximum time of seven days by NEFT transaction by crediting the amount of ₹5 lakh each to the nominees.
  4. The settlement of claims has proved to be the fastest under any life insurance schemes available in the country.
  5. Settlement of 52 claims out of deaths of 78 beneficiary farmers in the first five days of implementation of the scheme is an ample proof of fastest life insurance claims settlement in the country.

Seamless Operational Framework

  1. State government departments have been provided with tablet PCs for this.
  2. Agriculture Department officials have been putting the devices to optimal use beginning with collection of details of lands under cultivation by Agriculture Extension Officers early in 2017.
  3. Later, the devices were used during purification of land records and now for Rythu Bima.
  4. Manual work in the settlement of Rythu Bima claims is limited only at village and mandal-level.
  5. The AEO concerned collects the copies of Aadhaar of deceased farmer and the nominee, bank account passbook copy of the nominee, filled-in claim form and death certificate.
  6. These documents are attested by Mandal Agriculture Officer (MAO) at mandal-level.
  7. It’s everything online from the next step onwards — till crediting of claim amount to the nominee account.

Uses NIC developed software

  1. The NIC has developed special software for the purpose of forwarding the claims received from District Agriculture Offices (DAOs) to the LIC without human intervention every day at 5 p.m.
  2. The software creates a text file of all claims received till 4 p.m. every day and forwards them to LIC’s E-Sat office in Hyderabad along with scanned documents in PDF format for further processing.

Way Forward

  1. Rythu Bandhu and Rythu Bima have improved the image of Agriculture Department and its officials in villages enormously and the recognition would help in maintaining good liaison with farmers.
  2. Besides, the act of helping somebody get instant help gives immense satisfaction to the field-level work by the officials.
  3. A scheme with such an operational framework can be a remedy to the distressed farmers at pan-India level.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Cover mental illness, IRDAI tells insurersDOMR


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the act and its provisions

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


News

Provisioned under Mental Healthcare Act

  1. The Insurance Regulatory and Development Authority of India (IRDAI) have directed all insurance companies to make provision to cover mental illness in policies.
  2. Reference is drawn to the Mental Healthcare Act, 2017, which has come into force w.e.f 29.5.2018.
  3. As per Sec 21(4) of the said Act, every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.

Mental Healthcare Act, 2017

Compliment the news with the op-ed snap-

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

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

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


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Medical Termination of Pregnancy (MTP) Act

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


Context

Abortion law in India

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

Objectives of the law

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

What are the barriers in the law?

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

What does this lead to?

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

Amendments returned back

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

Way Forward

  1. We are living in times when abortion is at the centre of global conversations on reproductive health and rights
  2. Adopting and implementing the amendments will take us a few steps closer towards ensuring that all girls and women have access to safe abortion services
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Odisha launches health scheme for 70 lakh familiesPrelims OnlyStates in News


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

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


News

Biju Swasthya Kalyan Yojana

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

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


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: PEGylated Streptokinase

Mains level: Read the attached story.


News

What is Clot Buster?

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

PEGylated Streptokinase

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

Developed under PPP

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

Brain Stroke- the second biggest killer

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

Back2Basics

Council of Scientific and Industrial Research

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

 

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

[pib] Scheme of Assistance for Prevention of Alcoholism and Substance (Drug) AbuseGovt. SchemesPIBPrelims Only


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

Mains level: Prevention of drug abuse


News

Assistance for Prevention of Alcoholism and Substance (Drug) Abuse

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

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


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme

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


Context

Lack of transparency in transplants

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

NITI Aayog’s vision document

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

Mismatch between policy and actual programs

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

Organ transplant is a complex process

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

Reverse flow of resources

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

Dependence on private sector

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

Poor effects of medical rationing

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

Way Forward

  1. Every possible medical intervention should be available to every citizen
  2. The only pressure group which can ensure at least equitable medical care is the electorate
  3. Until such time as it demands this from governments, we will continue to witness the tragic drama of two levels of medical care in India
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Tackling HIVIOCRop-ed snapPriority 1


Note4students

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

From UPSC perspective, the following things are important:

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

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


Context

UNAIDS report: Reduction in HIV incidence

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

Efforts by India

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

Gaps in policy

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

What needs to be done?

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

Way Forward

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

Back2Basics

United Nations Programme on HIV/AIDS (UNAIDS)

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

[op-ed snap] Why private hospitals should join AB-NHPMop-ed snapPriority 1


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

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


Context

NHPM scheme

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

Issue over Pricing-Model

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

Treatment Rates- NOT the elephant in the room

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

States examples are promising

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

AB-NHPM mandates to timely  refine its approach

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

Hospitals should carefully consider the following issues

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

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

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

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

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

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

Way Forward

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

Ayushman Bharat: Hub-and-spoke model to help train health workersGovt. SchemesPriority 1


Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Read the attached story


News

Solving the Manpower Issue

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

The ECHO Model for Telemedicine

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

Particulars of the training

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

 

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

[pib] Creation of National Health StackPIB


Note4students

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

From UPSC perspective, the following things are important:

Prelims level: NHS

Mains level: Read the attached story


News

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

Context

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

Proposed National Health Stack (NHS)

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

Making Ayushman Bharat more promising

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

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

Utility of the National Health Stack

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