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

Jul, 16, 2019

[op-ed snap] A WASH for healthcare

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.

Jul, 13, 2019

[pib] LaQshya Initiative

News

  • The Minister of State (Health and Family Welfare) informed about LaQshya Initiative in the Lok Sabha.

LaQshya Initiative

  • Government of India has launched “LaQshya” (Labour room Quality improvement Initiative) to improve quality of care in labour room and maternity operation theatres in public health facilities.
  • Aim: To reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity Operation Theatre and ensure respectful maternity care.

Objectives

  • To reduce maternal and newborn mortality & morbidity due to hemorrhage, retained placenta, preterm, preeclampsia and eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, and newborn sepsis, etc.
  • To improve Quality of care during the delivery and immediate post-partum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.
  • To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facilities.

Following types of healthcare facilities have been identified for implementation of LaQshya program:

  1. Government medical college hospitals.
  2. District Hospitals & equivalent health facilities.
  3. Designated FRUs and high case load CHCs with over 100 deliveries/month ( 60 in hills and desert areas)
Jul, 09, 2019

Generic Drugs

News

  • 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.
Jul, 08, 2019

Food and Nutrition Security Analysis, India, 2019

News

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).
Jul, 03, 2019

[op-ed snap] Healthcare’s primary problem

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.
Jul, 02, 2019

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

Jul, 01, 2019

[op-ed snap] Start with preventive 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.

Jul, 01, 2019

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


News

  • 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.
Jun, 29, 2019

Pilot Scheme for distribution of Fortified Rice through PDS

News

  • 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.

 

 
Jun, 27, 2019

[op-ed snap] India must recognise the right to a minimally decent life

News

  • The thought provoking aftermath of the horrific tragedy in Muzaffarpur, Bihar has led to serious questions on the nature of governance in India.
  1. First, like the constitutional principle of a basic structure, it is time to articulate an equally robust doctrine of basic rights.
  2. Second, these basic rights must be viewed primarily as positive, rights not against interference from the state (negative rights) but to the provision of something by it.
  3. Third, just as individuals are punished for legal violations, the government of the day must also be punished for the violation of these basic rights.

But what are basic rights? How are they different from other fundamental rights?

  • Basic rights flow from basic needs such as physical security or subsistence.
  • Needs are different from wants. Basic needs are different: their non-fulfillment can cause great harm, even kill.
  • Moreover, wants are subjective; one cannot be mistaken We may not be able to tell if we need an antibiotic because mind can’t tell the difference between bacterial and viral infections.
  • This determination is done by a more objective criterion. Needs depend on the way human bodies are constituted.
  • They are a solid necessity; one cannot get on without them. Nor can they be fulfilled by substitutes. For us, nothing can take the place of water, food and air.
  • It is true that though terribly important, basic needs are not what we live for.
  • They don’t make our life worth living. But anything really worth pursuing depends on the satisfaction of basic needs.

Their fulfillment: A necessity

  • When basic needs are not fully met, we feel vulnerable and helpless. We complain and demand elementary justice from our community, especially from the state.
  • Elementary justice requires that before anything else, the state does everything at its disposal to satisfy all basic needs of its citizens, particularly of those who cannot fend for themselves.
  • We feel aggrieved when the state abdicates this responsibility.

What does the language of rights add to the idea of basic needs?

First, a right is something that is owed to us; it is not a favour

  • So, rights help the recognition of anything that satisfies basic needs as an entitlement.
  • Basic rights are claims on the state to provide us with goods and services that satisfy our basic needs.
  • Second, when something is identified as a basic right, it puts the state under a duty to enable its exercise. The state becomes its guarantor.
  • For example, the right to physical security, the first basic right, is socially guaranteed when the state provides its people a well-trained, professional police force.
  • When society and its government render on its commitment to do so, we hold them accountable.
  • It follows that basic rights are a shield for the defenseless against the most damaging threats to their life which include starvation, pestilence and disease.

The second is the right to minimum economic security and subsistence, that includes clean air, uncontaminated water, nutritious food, clothing and shelter

  • By showing the devastation caused by its absence, the Muzaffarpur tragedy amply proves that the right to primary health care is also an integral part of the right to subsistence.
  • A straightforward link exists between malnutrition and disease.
  • AES, the biochemical disease that results from eating litchi fruit pulp, occured only in malnourished children.
  • It is common knowledge that malnourishment lowers resistance to disease. A similar link exists between disease, unemployment and poverty.

What can be done to ensure minimum basic rights?

  • Credible threats to these rights can be reduced by the government by establishing institutions and practices that assist the vulnerable.
  • For example, by setting up hospitals with adequate number of doctors, nurses, beds, medical equipment, intensive care units, essential drugs and emergency treatments.
  • For this, proper budgetary allocation is required that depends in turn on getting one’s political priority and commitment right.
  • When a government fails to provide primary health care to those who can’t afford it, it violates their basic rights.

Need for a Legal Accountability

  • To these two basic rights, the author adds a third — the right to free public expression of helplessness and frustration, if deprived of other basic rights.
  • The scope of freedom of expression is large and all of it can be deemed basic.
  • But the relevant part of it is, the right to make one’s vulnerability public, be informed about the acts of commission and omission of the government regarding anything that adversely affects the satisfaction of basic needs,
  • The right to critically examine them and hold state officials publicly accountable is a basic right on a par with right to physical security and subsistence and inseparably linked to them.

The clear message

  • In short, defaulting governments must be held legally accountable.
  • The systematic violation of basic rights by authorities could be treated on a par with the breakdown of constitutional machinery.

Conclusion

  • These three basic rights can be summed up in a single phrase, the right to a minimally decent life. This is a threshold right.
  • A society may soar, strive for great collective achievement. There are no limits to the longing for a better life.
  • But the point of having a threshold of minimal decency is that our life must not fall below a certain level of existence.
  • Anything short of a minimally decent life is simply not acceptable. It is this precisely that horrifies us about the callousness of the Bihar government in Muzaffarpur and governments in India more generally.
  • They routinely abdicate responsibility for the suffering they directly or indirectly cause.
  • This is why we must ask why governments are not immediately and severely penalized when they undermine the exercise of these basic rights.
Jun, 27, 2019

[pib] Proton Therapy


News

  • 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.
Jun, 26, 2019

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


News

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

Jun, 24, 2019

Explained: Why is the litchi toxin causing deaths?


News

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.
Jun, 22, 2019

[pib] Janani Suraksha Yojana

News

Janani Suraksha Yojana (JSY)

  • Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NHM).
  • It is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women.
  • The scheme is under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States (LPS).
  • It was launched in April 2005 by modifying the National Maternity Benefit Scheme (NMBS).
  • The NMBS came into effect in August 1995 as one of the components of the National Social Assistance Programme (NSAP).
  • The scheme was transferred from the Ministry of Rural Development to the Department of Health & Family Welfare during the year 2001-02.

Various measures under JSY

  • The scheme focuses on the poor pregnant woman with special dispensation for States having low institutional delivery rates namely the States of UP, Uttaranchal, Bihar, Jharkhand, MP, Chhattisgarh, Assam, Rajasthan, Orissa and J&K.
  • While these States have been named as Low Performing States (LPS), the remaining States have been named as High performing States (HPS).
  • Exclusion criteria of age of mother as 19 years or above and up to two children only for home and institutional deliveries under the JSY have been removed.
  • Eligible mothers are entitled to JSY benefit regardless of any age and any number of children.
  • BPL pregnant women, who prefer to deliver at home, are entitled to a cash assistance of Rs 500 per delivery regardless of age of women and the number of children.
  • States are encouraged to accredit private health facilities for increasing the choice of delivery care institutions.
Jun, 21, 2019

[op-ed snap] AI for public health

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.

Jun, 20, 2019

AWaRe: A WHO tool for safer use of antibiotics


News

  • The WHO has launched a global campaign that urges countries to adopt its new online tool aimed at guiding policy-makers and health workers to use antibiotics safely and more effectively.

AWARE Tool

The tool, known as ‘AWaRe’, classifies antibiotics into three groups:

  • Access   — antibiotics used to treat the most common and serious infections
  • Watch    — antibiotics available at all times in the healthcare system
  • Reserve — antibiotics to be used sparingly or preserved and used only as a last resort

Antimicrobial resistance

  • Antimicrobial resistance (AMR or AR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe
  • The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics.
  • Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
  • Bacteria, not humans or animals, become antibiotic-resistant.
  • These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
  • Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
  • A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
  • It leads to higher medical costs, prolonged hospital stays, and increased mortality.
Jun, 19, 2019

[op-ed snap] A failing state

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.
Jun, 19, 2019

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

Jun, 13, 2019

Acute Encephalitis Syndrome (AES) outbreak in Bihar

News

  • 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.
Jun, 08, 2019

[op-ed snap] Welfare policy and Modi 2.0

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.

Jun, 06, 2019

[op-ed snap] Caught napping

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.

Jun, 04, 2019

ICMR calls for complete ban on e-cigarettes


News

  • 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.
May, 25, 2019

WHO strategy to tackle global snakebite 'emergency'

News

  • 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.
May, 24, 2019

Taj Mahal: First Indian Heritage Site to Get a Breastfeeding Room

News

  • 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.
May, 17, 2019

National Institute of Nutrition


News

  • 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
May, 16, 2019

Global Drug Survey Report 2018


News

  • 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.
May, 11, 2019

India facing critical shortage of healthcare providers: WHO

News

  • 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.
May, 10, 2019

WHO for eliminating industrially produced trans fats by 2023

News

  • 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.
Apr, 29, 2019

ICMR launches 'MERA India' to eliminate malaria by 2030

News

‘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.
Apr, 26, 2019

Khasi ‘kingdoms’ to revisit 1947 agreements

News

  • 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.
Apr, 26, 2019

Dentists can practise as General Physicians after bridge course

News

  • 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.
Apr, 26, 2019

WHO guidelines on physical activity for children under 5 years of age

News

  • 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.
Apr, 25, 2019

Worlds first Malaria Vaccine: RTS,S (Mosquirix)

News

  • 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.
Apr, 22, 2019

Biomarkers found for lymph node metastasis in oral cancer

News

  • 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.
Apr, 19, 2019

[op-ed snap] A manifesto for health

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.

 

 

 

Apr, 19, 2019

CSIR plans genome sequencing to map population diversity

News

  • 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.
Apr, 16, 2019

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

News

  • 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.
Apr, 13, 2019

‘Display information on 7 common antibiotics’

News

  • 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.
Apr, 09, 2019

[op-ed snap]US vs Europe in India

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.

 

Apr, 08, 2019

Candida Auris : Fungus immune to drugs is secretly sweeping the globe

News

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.
Apr, 05, 2019

[pib] Solidarity Human Chain

News

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.
Mar, 19, 2019

Septic tanks meet norms says Ministry

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.
Mar, 18, 2019

Topical gel protects farmers from pesticides

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.
Mar, 16, 2019

West Nile Virus

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.
Mar, 14, 2019

WHO strategy to fight flu pandemics

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.
Mar, 09, 2019

[op-ed snap] The Delta 32 effect

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.

 

Mar, 08, 2019

[pib] NABL launches Quality Assurance Scheme for Basic Composite Medical Laboratories

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.
Mar, 04, 2019

[op-ed snap]The basics are vital

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.
Feb, 26, 2019

Ayushman Bharat will not cover cataract ops, dialysis and normal deliveries

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.
Feb, 26, 2019

[pib] 4th Global Digital Health Partnership Summit

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.
Feb, 22, 2019

WHO prescribes ‘aerobics 150’ to stay fit

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.
Feb, 21, 2019

[pib] HOPE Portal

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.
Feb, 20, 2019

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

Note4Students

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

From UPSC perspective, the following things are important:

Prelims level:  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
Feb, 16, 2019

WHO issues new international standard for music devices

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.
Feb, 14, 2019

[op-ed snap] Every drop matters

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.
Feb, 07, 2019

[op-ed snap] We need a leap in healthcare spending

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.
Feb, 05, 2019

[op-ed snap] Missing the healing touch

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.
Jan, 30, 2019

New Delhi superbug gene reaches the Arctic

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.
Jan, 29, 2019

[op-ed snap] Think differently about healthcare

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.

 

Jan, 29, 2019

Explained: Zearalenone in cereals

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.
Jan, 24, 2019

[op-ed snap] Moving away from 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.
Jan, 21, 2019

[pib] World Integrated Medicine Forum 2019

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.
Jan, 18, 2019

Measles Rubella Vaccination: Understanding the question of parental consent

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.
Jan, 17, 2019

CCHS: What makes sleep deadly in this rare disease?

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.
Jan, 16, 2019

National Action Plan for Drug Demand Reduction (2018-2023)

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.
Jan, 16, 2019

Fish from Andhra Pradesh, West Bengal banned in Patna

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.
Jan, 12, 2019

[op-ed snap] Ayushman Bharat’s success will hinge on the private sector taking ownership

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.
Jan, 05, 2019

[pib] Menstrual Hygiene for Adolescent Girls Scheme

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: 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.
Dec, 29, 2018

[pib] Cabinet approves setting up of the National Commission for Indian System of Medicine Bill, 2018

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.
Dec, 11, 2018

[pib] ‘India Day’ inaugurated as Partners ‘Forum 2018 takes Centre stage

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.
Dec, 10, 2018

Report on ‘toxic’ talc worries India

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: 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.
Dec, 10, 2018

Four new devices notified as drugs for regulation

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.
Dec, 04, 2018

[op-ed snap] J&J case is a step in the right direction, finally

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
Nov, 28, 2018

Why gene editing of babies is problematic

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.
Nov, 27, 2018

[pib] Integrated Health Information Platform (IHIP)

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.
Nov, 23, 2018

[pib] Cabinet approves the Allied and Healthcare Professions Bill, 2018

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.
Nov, 13, 2018

National body set up to study rare form of diabetes

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.
Nov, 12, 2018

Defeating pneumonia

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.
Nov, 06, 2018

Global Drug Survey set to cover Indians

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


News

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
Nov, 02, 2018

[pib] 1st Annual Senior Care Conclave

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.
Oct, 18, 2018

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.
Oct, 15, 2018

[pib] Analytical report of the National Health Profile-2018 released

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

Oct, 10, 2018

[pib] ‘MedWatch’ Mobile Health App

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.
Oct, 05, 2018

[pib] Assistive Aids and Appliances distributed to Senior Citizens Under 58th Rashtriya Vayoshri Yojana Camp

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
Oct, 04, 2018

Toilet-for-all: WHO calls for more investment

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.
Oct, 02, 2018

Assam launches wage compensation scheme for pregnant women in tea garden districts

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.
Sep, 25, 2018

Panel approves nutrition norms

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.
Sep, 21, 2018

[op-ed snap] PMJAY: The promises and challenges of a bold experiment

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
Sep, 20, 2018

[op-ed snap] India’s ignored mental health challenge

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
Sep, 20, 2018

[pib] Cabinet approves enhancement of various initiatives under ICDS Scheme

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.
Sep, 17, 2018

NACO releases HIV Estimations 2017 report

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.
Sep, 12, 2018

[pib] Health Ministry issues a notification for bringing the HIV/AIDS Act, 2017 in force

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.

 

Sep, 06, 2018

[pib] Rashtriya Poshan Maah celebrations get under way across India

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.
Sep, 05, 2018

Drug-resistant superbug spreading in hospitals

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.
Sep, 04, 2018

Draft charter of Patients’ Rights released

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.
Aug, 27, 2018

[op-ed snap] A plan for change: on Mental Healthcare Act

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

 

Aug, 27, 2018

Ayushman Bharat and concepts of insurance

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.
Aug, 24, 2018

State can stop voluntary retirement of doctors

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.”
Aug, 21, 2018

WHO highlights ways to reduce cancer risk

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.
Aug, 20, 2018

Rythu Bima providing instant aid to families

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the 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.
Aug, 20, 2018

Cover mental illness, IRDAI tells insurers

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

Aug, 17, 2018

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Medical Termination of Pregnancy (MTP) Act

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


Context

Abortion law in India

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

Objectives of the law

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

What are the barriers in the law?

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

What does this lead to?

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

Amendments returned back

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

Way Forward

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

Odisha launches health scheme for 70 lakh families

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

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


News

Biju Swasthya Kalyan Yojana

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: PEGylated Streptokinase

Mains level: Read the attached story.


News

What is Clot Buster?

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

PEGylated Streptokinase

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

Developed under PPP

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

Brain Stroke- the second biggest killer

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

Back2Basics

Council of Scientific and Industrial Research

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

 

Aug, 08, 2018

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Scheme

Mains level: Prevention of drug abuse


News

Assistance for Prevention of Alcoholism and Substance (Drug) Abuse

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat scheme

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


Context

Lack of transparency in transplants

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

NITI Aayog’s vision document

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

Mismatch between policy and actual programs

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

Organ transplant is a complex process

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

Reverse flow of resources

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

Dependence on private sector

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

Poor effects of medical rationing

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

Way Forward

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

[op-ed snap] Tackling HIV

Note4students

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

From UPSC perspective, the following things are important:

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

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


Context

UNAIDS report: Reduction in HIV incidence

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

Efforts by India

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

Gaps in policy

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

What needs to be done?

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

Way Forward

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

Back2Basics

United Nations Programme on HIV/AIDS (UNAIDS)

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

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


Context

NHPM scheme

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

Issue over Pricing-Model

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

Treatment Rates- NOT the elephant in the room

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

States examples are promising

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

AB-NHPM mandates to timely  refine its approach

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

Hospitals should carefully consider the following issues

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

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

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

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

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

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

Way Forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Read the attached story


News

Solving the Manpower Issue

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

The ECHO Model for Telemedicine

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

Particulars of the training

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

 

Jul, 07, 2018

[pib] Creation of National Health Stack

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: NHS

Mains level: Read the attached story


News

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

Context

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

Proposed National Health Stack (NHS)

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

Making Ayushman Bharat more promising

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

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

Utility of the National Health Stack

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: NIMHANS Digital Academy, Ayushman Bharat, HWCs

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


News

Promoting Mental Healthcare in India

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

NIMHANS Digital Academy

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

Health and Wellness Centres

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

Back2Basics

National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore

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

Govt may scrap trials for some IVD devices

Note4students

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

From UPSC perspective, the following things are important:

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

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


News

Clinical Trials of Medical Devices

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

Proposed Amendment in Medical Devices Rules

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

What are the amendments?

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

What are the benefits of doing so?

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

But it raises few questions as well

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

India launches its first National Healthcare Facility Registry

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Read the attached story


News

National Health Resource Repository (NHRR)

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

What is it going to provide?

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

National Health Profile (NHP)-2018

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

In a first, WHO recommends quadrivalent influenza vaccine

Image result for influenza

Note4students

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

The following things are important from UPSC perspective:

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

Mains level: Read the attached story


News

Quadrivalent vaccine approved

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

Why Quadrivalent vaccine?

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

Benefits of Quadrivalent Vaccine

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

Incidences of different Strains

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

 Indian context

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

Back2Basics

Influenza

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

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

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

Influenza B

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

New health scheme flawed: IMA

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat Scheme

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


News

Limitations of Insurance Driven Healthcare

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

Issues highlighted by IMA

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

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

Key Suggestions

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

Back2Basics

Indian Medical Association

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

[op-ed snap] Holes in the scheme

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme (NHPS)

Mains level: Various issues associated with the implementation of NHPS


Context

Launch of NHPS

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

Why this system of checks?

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

Associated Concerns 

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

Way forward

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

20 States on board to implement Ayushman Bharat

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Universal health coverage and related issues


News

Status of States Joining the ambitious programme

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

Back2Basics

Ayushman BharatNational Health Protection Mission (AB-NHPM)

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Programme

Mains level: Universal health coverage and associated Moral hazard


News

Ayushman Bharat operational details

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

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

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

A penalty for Delay in Premium

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

Administration of the Scheme

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

Admin Cost Sharing

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: The new framework.


News

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

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

Explanation

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

What is the claim ratio?

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

Concern related to reverse bidding

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

Expand national programmes to eliminate malaria by 2030: WHO

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: World Health Organization, World Malaria Day

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


News

Expanding the coverage of National Malaria Programmes

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

Targeting the Vulnerable

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

Back2Basics

National framework for Malaria Elimination (NFME)

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

Health Ministry to roll out prog to combat hepatitis

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particular of the Hepatitis disease

Mains level: Targets set under the initiative.


News

Important decision taken by the Health Ministry

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

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

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

Budgetary provisions

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

Back2basics

Hepatitis

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: ‘Kayakalp’ initiative, Mera Aspataal initiative

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


News

Fixing accountability of medical institutions

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

Mera Aspataal initiative

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

Back2Basics

‘Kayakalp’ initiative

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Scheme

Mains level: The important dimensions discussed in the newscard.


News

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

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

Issues with the older health policies

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

Need of primary health care in India

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

Commitment of the government under the National Health Policy 2017

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

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

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

The scheme will help in Employment generation in the Health Sector

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

Back2basics

Ayushman Bharat-National Health Protection Mission

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

[op-ed snap] Healthy India, happy India

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

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


News

India’s health indicators

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

Current issues in Indian Healthcare System

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

Low doctor-population ratio in India

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

The public expenditure on the health sector

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

Need of providing proper healthcare to the elderly people

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

Ayushman Bharat scheme

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

The way forward

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

'Risk of bone fracture high in urban India’

Note4students

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

From the UPSC perspective the following things are important:

Prelims Level: Osteoporosis and Osteopenia

Mains Level: Findings of the study


News

Indian Journal of Medical Research

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

Particulars of the study

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

Particulars of the Osteoporosis 

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

Particulars of the Osteopenia

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

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

Note4students

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

Prelims Level: Particulars of the NMC bill

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


News

Acceptance of suggestions

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

These changes address some of the loudest criticisms of the Bill

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

Other changes accepted by the cabinet

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

Future challenges

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

Government to tweak Modicare for North-East states

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Ayushman Bharat, Atal Amrit Abhiyan

Mains level: Schemes for Universal health coverage


News

Special plan under Modicare for North-East India

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

Atal Amrit Abhiyan

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

Cabinet nod for changes to NMC Bill

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission (NMC) Bill

Mains level: Issues related to medical education regulation


News

Amendments to the National Medical Commission (NMC) Bill

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

Back2Basics

National Medical Commission (NMC) Bill

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

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

Image source

Note4students

Mains Paper 3: Internal Security | Basics of cyber security

From UPSC perspective, the following things are important:

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

Mains level: Concerns related to data security


News

Draft Digital Information in Healthcare Security Act (DISHA)

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

Provisions of the act

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

Judicial access 

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS Scheme

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


News

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

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

Expectations from the state governments

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

Legal necessities

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

Targeted groups

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

WHO on the NHPS

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

Raising the core budgetary spending every year is not enough 

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

The way forward

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

Union Cabinet approves Ayushman Bharat health scheme

Image source

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Universal health coverage and related issues


News

Scheme for Universal Health Coverage

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

About the scheme

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

Inclusions in the scheme

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

[op-ed snap] Unhealthy Binaries

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme

Mains level: Healthcare infrastructure in India


Context

Misleading beliefs related to the healthcare sector

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

Institutional infrastructure to track health outcomes

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

Status of such infrastructure in India

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

Optimal performance not possible

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

Patient tracking

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

Way forward

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

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

Image Source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS

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


News

Context

  1. National Health Protection Scheme (NHPS)

Same schemes are successfully implemented in many states

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

Maharashtra: Rajiv Gandhi Jeevandayi Aarogya Yojana

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

Selection of insurance provider for the scheme

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

Accreditation of participating hospitals(under the scheme)

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

The NHPS is not enough

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the index

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


News

“Healthy States, Progressive India” report

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

Goal of the Health outcomes index

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

Making of the “Performance On Health Outcomes” index

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

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

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

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

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

The way forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Universal health coverage and constraints in implementing it


News

SECC to be used

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

Criteria for selection

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

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

Aadhar to be used

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

Back2Basics

Socio-Economic and Caste Census (SECC)

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

[op-ed snap] Saving lives

Image Source

Note4students

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

From UPSC perspective, the following things are important:

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

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


News

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

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

Several countries showing a way forward for India

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

How can we solve this problem? 

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

Biggest cause of death

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

The way forward

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

Complaints over medical bills: Centre seeks states’ response

Note4students

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

From UPSC perspective, the following things are important:

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

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


News

Complaints of inflated medical bills rising

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

Ministry’s directive

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

Act not adopted by all states yet

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

Back2Basics

Clinical Establishments (Registration and Regulation) Act, 2010

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

Article 252 Constitution of India

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Status of child care in India


News

Reduction in under-five deaths

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

Meeting MDG target

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

Back2Basics

Neonatal and Infant Mortality Rate

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

National Health Protection Scheme will not help its intended beneficiaries

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the scheme

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


News

Context

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

Medical expenses: Deprived households

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

Hospitalization is not enough

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

What should be done?

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

Will there be any benefit of the scheme?

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

[op-ed snap] Hardly a gamechanger

Image Source

Note4students

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

From UPSC perspective, the following things are important:

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

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


News

National Health Protection Scheme(NHPS)

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

Debate on crucial issues
FIRST: Financial issues

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

SECOND: Low reimbursement in government schemes

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

THIRD: Unwillingness to pay reimbursement

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

Other important issues

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

The way forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: State of health sector in India


Context

NITI Aayog Health Index

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

Responsibilities of different tiers of government

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

Lack of sufficient data

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

Way forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Issues related to health sector


News

Healthy States Progressive Report

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

About the report

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

Common challenges across states

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the scheme

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


News

Health Sector: Challenges infront of India

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

National Health Protection Scheme (NHPS)

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

Financial support

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

Health and Wellness centres

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

The Ayushman Bharat programme: Two main aims

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

How can the programme be a game changer?

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

Not all issues will be solved with this scheme

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

Suggestions for effective implementation

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

Global cancer survival rates improve, but wide gaps remain

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: Findings of the study


News

Findings of the study

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

Particular case of the Breast Cancer

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

Particulars of the research

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

[op-ed snap] Making health insurance work

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS

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


News

 Health programme: Budget 2018

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

The National Health Protection Scheme

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

How will the scheme work?

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

What is the main concern?

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

Financial issues regarding the scheme

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

Responsibility of the State Government

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

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

Note4students

Mains Paper 3: Economy | Government Budgeting

From UPSC perspective, the following things are important:

Prelims level: National Institute of Public Finance and Policy

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


News

Possible cost of implementing healthcare plan of the Budget 2018 

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

Other particulars of the research

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

Back2baiscs

 National Institute of Public Finance and Policy

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

Modicare will find it tough to get out of the blocks

Image source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme, RSBY

Mains level: Lacunae in public health infrastructure in India


Context

World’s largest public healthcare scheme

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

India’s perennial healthcare failure

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

International experiments similar to Modicare

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

Results from these experiments

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

RSBY in India

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

Why this failure?

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

Way forward

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

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

Image Source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Ayushman Bharat Programme

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


News

What is the issue?

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

Fresh hopes: Ayushman Bharat

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

Lessons from other developing countries

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

Need of insurance in health care system

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

Health Centres under the Ayushman Bharat programme

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Clionical trials, bioavailability, bioequivalence

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


News

Draft rules for clinical trials

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

Ease of doing trials

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

Other measures

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

[op-ed snap Capacity building for primary health care

Image Source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the AYUSH.

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


News

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

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

How can AYUSH help?

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

Issue of AYUSH cross-prescription

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

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

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

Is capacity-building of licensed AYUSH practitioner enough?

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

Back2basics

AYUSH

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

Objectives of the AYUSH

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

 

Jan, 18, 2018

[op-ed snap] The price prescription

Image Source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

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


News

Context

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

Health of a citizen has primacy: SC

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

WHO’s survey on tobacco consumption in India

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

Effects of the GST on tobacco consumption

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

What should be done?

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

NPPA fixes retail price of 30 drug formulations

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Regulation governing medical sector in India


News

Fixing retail price of essential drugs

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

Back2Basics

National Pharmaceutical Pricing Authority

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission

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


News

Statement by the President

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

Why is this statement important?

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

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

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

[op-ed snap] Prescription for the future

Image Source

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Attached stories and particulars of the NMC bill

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


News

What is the issue?

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

Reasons behind these protests(against the bill)

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

Issues with the Medical Council of India(MCI)

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

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

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

Flawed electoral process of the MCI: Solution through NMC bill

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

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

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

Solution through non-doctors

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

[op-ed snap] Heed the patient

Image source

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Reforms required in health sector


Context

National Medical Commission Bill 2017

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

Most medical practitioners do not possess educational qualification

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

Role of IMA in quackery

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

National Medical Commission Bill 2017 overlooks this problem

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

What is needed now?

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

Way forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

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


News

Status of Indian Pharmaceutical Sector

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

The Future of India in Pharmaceutical Sector

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

How is India a fertile ground for Medical Innovations?

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

What should be done to capitalize on these opportunities?

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

The way forward

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

[pib] Maternity Benefits Under Pradhan Mantri Matru Vandana Yojana

Note4Students

From UPSC perspective, the following things are important:

Prelims level: Pradhan Mantri Matru Vandana Yojana (PMMVY)

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


News

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

The objectives of the scheme are

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

Also

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the act

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


News

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

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

Provisions for ‘advance directives’ in the act

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

Rights conferred under the act

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

Responsibilities for the government

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

Issues that should be taken care of

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

Govt to assess impact of Hepatitis B immunization drive

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: UIP(Read B2B)

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


News

Assessing the impact

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

Seriousness of the Hepatitis B problem

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

National Action Plan for Viral Hepatitis (NAPVH)

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

Back2basics

Universal Immunization Programme(UIP)

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

[pib] Charges on Health Services

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Regulation of health sector and associated issues


News:

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

Provisions

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

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

Dec, 23, 2017

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: NPCDCS, PMSSY, etc.

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


News

Rising number of cancer cases in India

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

State-wise data

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

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

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

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

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

Other efforts done by the government

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

[op-ed snap] Powering rural healthcare

Image Source

Note4students

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

From UPSC perspective, the following things are important:

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

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


News

What is the issue?

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

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

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

How can renewable power sources help in this situation?

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

Continuous power supply has improved efficiency of PHCs in Chhattisgarh

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

Can solar systems be scaled up in Rural India?

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

The way forward

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

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

Note4students

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

From UPSC perspective, the following things are important:

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

Mains level: Improving healthcare system in India


Context

Recent incidents of conduct of high-profile corporate hospitals

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

Major issues

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

Steps to improving access

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

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

Steps to improving quality of care

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

Managing cost

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

Universal Health Care is solution

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not much

Mains level: Specially mentioned in the syllabus


News

Particulars of the report

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

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

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: India Hypertension Management Initiative

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


News

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

Aim:

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

Essential Components

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

[op-ed snap] The Missing Healing Touch

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

Prelims level: not much

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


News

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

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

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Generic medicines, bioequivalence

Mains level: Issues related to health sector and way forward


Context

Dichotomy in medicine sector

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

Problems

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

Government’s role

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

Generic medicines

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

What can be done?

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

Challenges before generic medicines can become mainstream

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

Back2Basics

Bioequivalence

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

[op-ed snap] States of healthcare

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

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


News

Context

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

How health status changes around the world?

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

Why is it necessary to understand these health transitions?

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

Why was ‘Global Burden of Disease’ initiated?

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

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

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

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

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

Under-five mortality rate

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

Different classes of diseases

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

Five leading individual causes of disease burden in India

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

Causes behind different diseases

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

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

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

The way forward

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

[op-ed snap] Paradise Papers, Gorakhpur

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Not Much

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


News

Two important incidents

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

Relation between the two incidents

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

Need of a Higher Health Budget

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

How can we improve our health budget?

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

‘Revenue loss’ around the world

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

India’s Position on revenue loss

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

The way forward

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

Tuberculosis cases: Govt announces steps to check under reporting

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the TB

Mains level: Government aim of eliminating TB by 20125


News

Directions to Private hospitals

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

Why this direction?

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

Other steps by the government

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

Level of TB in India

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

Fewer TB deaths in India: WHO

Note4students

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

The following things are important from UPSC perspective:

Prelims Level: Particulars of the TB disease, Click here

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


News

Decline in TB deaths

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

Government’s plan against TB

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

India has the second highest unvaccinated children for measles in world

Note4students

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

From UPSC perspective, the following things are important:

Prelims level: Particulars of the Measles

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


News

New report on Measles

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

India’s situation

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

Back2basics

Measles

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

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

Image Source

Note4students

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

From the UPSC perspective following things are important:

Prelims Level: Not much

Mains Level: Specially mentioned in the Mains Syllabus


News

Context

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

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

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

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

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

Public health cadre by Odisha

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

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

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

The Way Forward

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

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