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

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

India COVID-19 Emergency Response and Health System Preparedness Package

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Coronovirus outbreak and its mitigation

The Centre has approved a centrally funded ‘India COVID-19 Emergency Response and Health System Preparedness Package’ with the objective of strengthening national and state health systems.

About the Package

  • The package is 100 per cent centrally funded project under the National Health Mission.
  • It will be implemented in three phases from January 2020 to March 2024.
  • It aims at strengthening national and state health systems to support prevention and preparedness, procurement of essential medical equipment, consumables and drugs, etc.
  • The three phases of the project are Phase – 1 from January 2020 to June 2020, the second phase is from July 2020 to March 2021 and the third phase from April 2021 to March 2024.

What are the major activities planned under this package?

  • The key activities to be implemented under Phase -1 includes support to states/UTs for the development of dedicated COVID-19 hospitals and other hospitals, isolation blocks, negative pressure isolation rooms, ICUs with ventilators, the oxygen supply in hospitals etc..
  • The central package will also assist the state/ UTs for the Procurement of Personal Protection Equipment (PPE), N95 masks and ventilators, over and above what is being procured and supplied by the govt.
  • The activities under the first phase also include the disinfection of hospitals, government ambulances, etc.

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

[pib] Kendriya Bhandar

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Kendriya Bhandar

Mains level : Not Much

Kendriya Bhandar which functions under the Department of Personnel and Training (DoPT) has taken the unique initiative of providing “Essentials Kits” to needy families during the ongoing lockdown.

About Kendriya Bhandar

  • The Central Govt. Employees Consumer Cooperative Society Ltd. is popularly known as Kendriya Bhandar.
  • It was set up in 1963 as a welfare project for the benefit of Central Govt. employees and public at large.
  • It is functioning under aegis of Ministry of Personnel, Public Grievances & Pensions and was registered with Delhi Registrar of Cooperative Societies.
  • Subsequently, it was registered with Central Registrar of Cooperative Societies, Govt. of India as a Multi-State Consumer Cooperative Society in September 2000.

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

Delhi’s ‘5T’ war against virus

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : COVID-19 and its mitigation

Delhi CM has announced a “5T plan” created by his government to contain COVID-19 spread in Delhi. These five Ts are testing, tracing, treatment, teamwork and tracking-monitoring.

5Ts strategy

1)Testing

  • Testing when done on a mass scale enables the actual data of people affected by novel coronavirus.
  • Like South Korea, Delhi will be testing on a large scale.
  • Through rapid testing, the government will also be able to identify COVID-19 hotspots and take necessary action.

2)Tracing

  • The second T is tracing, which involves identifying and quarantining people who have come in contact with infected persons.
  • Delhi authorities are taking the help of police to trace whether the people who have been advised to self-quarantine are actually doing it or not.

3)Treatment

  • The third component is the treatment.
  • Serious patients who are suffering from heart diseases and patients above 50 years will be isolated in hospitals and the rest with minor symptoms will be kept in isolation in hotels and dharamshalas.

4)Teamwork

  • The fourth element of the five-point plan is teamwork and collective efforts are being made to fight the virus.
  • All State governments must learn from each other and work together.

5)Tracking and monitoring

  • The fifth T is tracking and monitoring.
  • The state should ensure that all these measures are in place and all the systems are functioning smoothly.

 

Also read:

‘Bhilwara Model’ for containment of coronavirus

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

‘Bhilwara Model’ for containment of coronavirus

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Bhilwara Model

Mains level : Agressive strategies to contain covid-19 spread

Bhilwara in Rajasthan was one of the early hotspots of the COVID-19 outbreak. The government responded with extraordinarily aggressive measures — and the ‘Bhilwara model’. The success of the model is attributed to the fact that Bhilwara, which was the first district in Rajasthan to report most number of covid cases has now reported only one positive case since March 30.

What is the Bhilwara Model?

  • The Bhilwara COVID-19 containment “model” refers to the steps taken by the administration in Rajasthan’s Bhilwara district to contain the disease, after it emerged as a hotspot for coronavirus positive cases.
  • Bhilwara district was among the most-affected places in India during the first phase of the COVID-19 outbreak.
  • The measures taken by the state govt. included imposing a curfew in the district which also barred essential services, extensive screening and house-to-house surveys to check for possible cases.
  • It went for detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected.

What did the administration do as part of the containment strategy?

  • The “Bhilwara model” of tackling COVID-19 cases involves, simply, “ruthless containment”.
  • Within three days of the first positive case the district health administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56k houses and of 280k people.
  • Thousands were identified to be suffering from influenza-like illness (ILI) symptoms and were kept in home quarantine.
  • Intense contact tracing was also carried out of those patients who tested positive, with the Health Department preparing detailed charts of all the people whom they had met since being infected.
  • The state also took the help of technology, using an app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through GIS.
  • The administration backed up the surveys by imposing a total lockdown on the district, with the local police ensuring strict implementation of the curfew.
  • The patients were treated with hydroxychloroquine (HCQ), Tamiflu and HIV drugs.

What were the challenges the administration faced in imposing these extraordinary measures?

  • The biggest challenge that the administration faced was containing the rising number of cases after the initial outbreak.
  • The doctors of the private hospital who had tested positive had come into contact with numerous people including the staff and patients who visited the private hospital during the period when the doctors were already infected.
  • Some of these patients had come from other states and after the first case of COVID-19 was detected.
  • The government also had an uphill task ahead of them assembling the teams of doctors, auxiliary nurse and midwives and nursing students who went to conduct the house-to-house surveys.
  • Owing to the fact that Bhilwara, a thriving textile city with an estimated population of 30 lakh, it was also a difficult task for the government to strictly impose the curfew uniformly in all areas.

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

[pib] Centre for Augmenting WAR with COVID-19 Health Crisis (CAWACH)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : CAWACH

Mains level : Not Much

Department of Science & Technology has approved setting up of a Centre for Augmenting WAR with COVID-19 Health Crisis (CAWACH).

What is CAWACH?

  • CAWACH will help to address various challenges faced by country due to severe impact of COVID-19.
  • CAWACH will identify up to 50 innovations and startups that are in the area of novel, low cost, safe and effective ventilators, respiratory aids, protective gears, novel solutions for sanitizers, disinfectants, diagnostics, therapeutics, informatics and any effective interventions to control COVID-19.
  • The CAWACH’s mandate will be to extend timely support to potential startups by way of the requisite financial assistance and fund deployment targeting innovations that are deployable in the market within next 6 months.
  • The Society for Innovation and Entrepreneurship (SINE), a technology business incubator at IIT Bombay supported by DST has been identified as the Implementing Agency of the CAWACH.
  • It will provide access to pan India networks for testing, trial and market deployment of these products and solutions in the identified areas of priority COVID-19 solutions.

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

What is Drive-through Testing?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Drive-through Testing

Mains level : Coronovirus outbreak and its mitigation

To work around the challenges of home-based testing in the country, a New Delhi based firm has offered ‘drive-through test’ for COVID-19.

Drive-through Testing

  • Those who feel sick drive up to a test centre where nurses wearing protective gear collect a nose or throat sample from the car itself.
  • Results are mailed or messaged in a day.
  • This method of mass testing has allowed reduced contact between patients and healthcare workers, thereby lessening the chances of transmission.
  • South Korea has led the world in the number of tests per million to check for coronavirus infection through this method.

Germany: leading through examples

  • Germany is conducting around 3,50,000 coronavirus tests a week, far more than any other country.
  • It means that more people with few or no symptoms are reported thereby increasing the number of known cases and adequate quarantines.

Limitations (for India)

  • We have seen so far is that many are uncomfortable with the home collection process.
  • Some people are worried that lab personnel visiting home in full protective gear would scare the neighbours.
  • There are also instances when spouses of some healthcare personnel have separated for a while.

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

BCG vaccine

Note4Students

From UPSC perspective, the following things are important :

Prelims level : BCG Vaccine

Mains level : Coronovirus and the hunt for its vaccine

According to a  US-based research, a combination of reduced morbidity and mortality could make the Bacillus Calmette-Guerin (BCG) vaccination a “game-changer” in the fight against novel coronavirus.

What is BCG Vaccine?

  • Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).
  • In countries where TB or leprosy is common, one dose is recommended in healthy babies as close to the time of birth as possible.
  • In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.

How can TB vaccine help fight COVID-19?

  • The BCG vaccine contains a live but weakened strain of tuberculosis bacteria that provokes the body to develop antibodies to attack TB bacteria.
  • This is called an adaptive immune response, because the body develops a defense against a specific disease-causing microorganism, or pathogen, after encountering it.
  • Most vaccines create an adaptive immune response to a single pathogen.
  • Unlike other vaccines, the BCG vaccine may also boost the innate immune system, first-line defenses that keep a variety of pathogens from entering the body or from establishing an infection.

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

Telemedicine/Telehealth as a tool to fight COVID-19

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Telemedicine/Telehealth

Mains level : Telemedicine and its effectiveness

 

The Medical Council of India and the NITI Aayog have developed new guidelines released on March 25, 2020 for registered medical practitioners to deliver consultations to patients via telemedicine.

Telemedicine

  • Telemedicine involves the use of telecom and virtual technology to deliver health care outside of traditional health-care facilities.
  • It is the essential delivery of health care services where distance is a critical factor — comes in.
  • At least one doctor is needed for a population of 1,000, according to WHO guidelines.
  • Telemedicine, thus, holds significance for countries like India that have low doctor-to-patient ratios.

About the guidelines

  • The guidelines aim to empower registered doctors to reach out to patients safely using technologies for the exchange of valid information.
  • This information can be used for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for continuing the education of healthcare providers.
  • The guidelines have empowered medical practitioners. They have, however, also imposed many restrictions.
  • Registered medical practitioners, for instance, have to take the patient’s consent.
  • If the patient denies her consent, however, the practitioner cannot insist that the patient to go in for telemedicine.

How telemedicine can help against COVID-19?

  • Telemedicine can help bridging the gap between people, physicians and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels.
  • It thus helps reducing the spread of the virus to mass populations and the medical staff on the frontlines.
  • It can help provide routine care for patients with chronic diseases who are at high risk if exposed to the virus.

Limitations

  • The out-of-hospital management is has not been yet established in India. Perhaps a ‘crisis-based’ evolution of telemedicine can help find local testing centers and also manage the flow of patients seeking a test.
  • However, for a smaller subset of higher risk patients, the clinical course may not be consistent with conventional telemedicine.
  • These patients often present with a more serious condition require rapid hospitalization.
  • Telemedicine hasn’t traditionally been used in response to public health crises. Many health practitioners are not equipped to deliver care in this way.
  • Another issue is access to broadband – some hospitals struggle with running a quality connection within their facilities and now we are faced with taking this to potential new areas of care, such as an outside tent.

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

[pib] ArogyaSetu App

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ArogyaSetu App

Mains level : Coronovirus outbreak and its mitigation

 

The Government of India has launched a mobile app ArogyaSetu developed in a public-private partnership to bring the people of India together in a resolute fight against COVID-19.

AarogyaSetu App

  • The App enables people to assess themselves the risk of their catching the Corona Virus infection.
  • It will calculate this based on their interaction with others, using cutting edge Bluetooth technology, algorithms and artificial intelligence.
  • Once installed in a smartphone through an easy and user-friendly process, the app detects other devices with AarogyaSetu installed that come in the proximity of that phone.
  • The app can then calculate the risk of infection based on sophisticated parameters if any of these contacts has tested positive.
  • The personal data collected by the App is encrypted using state-of-the-art technology and stays secure on the phone till it is needed for facilitating medical intervention.

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

Supreme Court upholds “Right to discuss COVID-19”

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Right to Discuss, Art. 19

Mains level : Coronovirus outbreak and its mitigation

The Supreme Court has upheld the right to free discussion about COVID-19, even as it directed the media to refer to and publish the official version of the developments in order to avoid inaccuracies and large-scale panic.

Right to Discuss

  • The Right to Discuss falls under the purview of the right to freedom of speech and expression.
  • Article 19(1)(a) of the Constitution of India states that all citizens shall have the right to freedom of speech and expression.
  • It ensures all citizens the liberty of thought and expression.
  • The exercise of this right is, however, subject to “reasonable restrictions” for certain purposes being imposed under Article 19(2) of the Constitution of India.
  • These restrictions are imposed in the interests of the sovereignty and integrity of India, the security of the State, friendly relations with foreign States, public order, decency or morality or in relation to contempt of court, defamation or incitement to an offence.

Why such a move?

  • The court was responding to a request from the Central government that media outlets, in the “larger interest of justice”, should only publish or telecast anything on COVID-19 after ascertaining the factual position from the government.
  • Any deliberate or inaccurate reporting by the media, particularly web portals, had the serious and inevitable potential of causing panic in a larger section of the society.
  • Any panic reaction in the midst of an unprecedented situation based on such reporting would harm the entire nation.
  • Creating panic is also a criminal offence under the Disaster Management Act, 2005.

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

PM-CARES Fund

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PM-CARES Fund

Mains level : Not Much

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

PM-CARES Fund

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

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

What is Hantavirus?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Hantavirus

Mains level : Rise in zoonotic diseases and their possible causes

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

What is Hantavirus?

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

Its origin

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

Symptoms

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

Mortality risk

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

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

PCR Test for Diagnosis of the COVID-19

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polymerase Chain Reaction Test

Mains level : Coronovirus outbreak and its mitigation

 

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

The PCR Test

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

Various Stages:

1) Collection and transport

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

2) Extraction of viral RNA

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

3) Putting THE RNA in THE PCR mix

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

4) Amplification of the viral DNA

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

5) Testing against controls

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

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

Smart-locking India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

Nature and characteristics of COVID-19

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

Susceptibility and the measures needed to contain the spread

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

Should India shut down the cities?

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

Conclusion

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

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

Tracking the big three

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

India’s record on extreme poverty, hunger and health

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

What are the various targets set on the nutrition problem?

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

Four areas India needs to focus to achieve the set targets

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

Examples from the world

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

Conclusion

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

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

State lethargy amidst cough syrup poisoning

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

Fourth mass glycol poisoning

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

Measures required and example from the US

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

Need for the recall policy

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

Conclusion

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

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

Spontaneous Regression

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Spontaneous healing/regression

Mains level : Not Much

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

Spontaneous healing/regression

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

How does it occur?

  • The research states that much of our physical reality is created in our minds and perception changes our experiences, sometimes to the point of changing our bodies.
  • Therefore it argues that healing our identities may be a key tool to recovery.

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

Powering the health-care engine with innovation

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

Expanding the supply side

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

Transformative solutions

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

Challenges in mainstreaming healthcare innovations

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

Way forward

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

Conclusion

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

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

A mix Indian health care can do without

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

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

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

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

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

Conclusion

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

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

Why emergency response units are needed to ensure safety of sanitation workers

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Read the attached story

Mains level : Upliftment of the manual scavengers

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

PEMSR ACT, 2013

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

The Supreme Court judgment

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

Directives by National Commission for Scheduled Castes

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

Emergency Response Sanitation Unit (ERSU)

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

Workshop on creating awareness on the issue

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

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

Euthermia: the anomaly of human body temperature

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Euthermia

Mains level : Not Much

 

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

Why we follow 98.6°F?

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

The body is cooler

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

Why there’s decrease in body temperature?

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

So what’s the normal temperature?

  • The strong influences of age, time of day, and genders determine the healthy body temperature.

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

Global Report on Medical Data Leak

Note4Students

From UPSC perspective, the following things are important :

Prelims level :  Global Report on Medical Data Leak

Mains level : Medical administartion in India and its loopholes

 

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

 Global Report on Medical Data Leak

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

Highlights of the report

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

What led to the leaks?

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

Impact of leaks

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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

Context

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

The advent of the private sector

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

The dominance of the private sector and malpractices

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

Failure of the government

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

Conclusion

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

 

 

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

Yada Yada Virus

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Yada Yada

Mains level : NA

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

Yada Yada

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

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

National Policy for the treatment of 450 ‘Rare Diseases’

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Rare Diseases

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

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

About the Policy

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

Why need such a policy?

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

Features of the policy

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

What are rare diseases?

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

Definition

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

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

[op-ed snap] Horror in Kota

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

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

Context

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

Public health as a political agenda

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

Poor infrastructure

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

Conclusion

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

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

2020 as the “Year of the Nurse and Midwife”

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO

Mains level : Role of nurses and midwives , ASHA

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

Year of the Nurse and Midwife

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

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

[op-ed snap] For a personal healing touch

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Personalised Health care - importance of family physician

Context

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

Organised structures

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

Problematic proposition

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

Challenges with the proposition

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

Family physician

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

Commercialization of care 

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

Advantage of small clinics

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

The need for empathy

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

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

Prevalence of Mental disorders in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Mental health and associated issues in India

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

Highlights of the report

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

Statewise data

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

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

National guidelines for clinical trials under Gene Therapy

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Prevention of genetic diseases

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

About the guidelines

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

What are Genetic diseases?

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

Why need such guidelines?

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

Way Forward

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

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

[op-ed snap] Staggering spread: On vaccines

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Vaccine Hesitancy

Context

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

Global Measles cases

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

Vaccine Hesitancy

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

Countering Vaccine Hesitancy

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : UNAIDS

Mains level : AIDS - tackling it

Context

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

HIV/ AIDS

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

Bridging gaps

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

Progress

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

High and low points

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

Concerns remaining

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

Complacency, new factors

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

Necessity

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

Need for a vigil in India

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

Drug treatment

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

Way ahead

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

Back2Basics

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

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

Polydactyly

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Polydactyly

Mains level : Social boycott practices in India


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

Polydactyly/polydactylism/hyperdactyly

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

Causes

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

Prevalence

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

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

India Hypertension Control Initiative (IHCI)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : India Hypertension Control Initiative (IHCI)

Mains level : Read the attached story


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

What is Hypertension?

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

About IHCI

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

Success of the move

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

Marked change

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

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

Lancet report on premature deaths in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : DALY,

Mains level : Major causes of deaths in India


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

About the study

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

Highlights

YLLs (years of life lost)

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

DALYs (disability-adjusted life years)

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

Deaths due to various reasons

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : RAAH app

Mains level : Mental health and associated issues in India


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

RAAH

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

How does it work?

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

Key features

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

About NIMHANS

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

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

[op-ed snap] Chasing the cure

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Alzheimer's

Mains level : New drug and its challenges

Context

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

Alzheimer’s

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

Latest news

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

Challenges remain

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

Back2Basics

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Immunisation and its importance

Context

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

Vaccine Hesitancy

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

Vaccination

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

The Indian perspective

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

Flu vaccine

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

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

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

Note4Students

From UPSC perspective, the following things are important :

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

Mains level : Need for digital health record


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

What is the National Health Stack (NHS)?

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

What is the National Digital Health Blueprint (NDHB)?

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

Features

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

Why is the NHS necessary?

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

Is all the data going to be safe/secure?

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

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

National Health Profile 2019

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Health Profile 2019

Mains level : Highlights of the study


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

What is National Health Profile (NHP)?

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

Utility of NHP

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

Highlights of the 14th edition of the NHP

Per capita health expenditure

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

Disease profile

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

Life expectancy

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

Economically active population

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

Birth/Death rates

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

Sex Ratio

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

Dip in IMR

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

Various causes of death

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

Pollution related illness

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

Medical education infrastructure

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

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

Indian Human Brain Atlas

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IBA100

Mains level : Brain Atlas


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

IBA100

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

Indian brain is smaller

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

Utility of the atlas

  • This study will help in the early diagnosis of brain diseases like Alzheimer’s.

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

[op-ed snap] Pills within reach

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Medicines use in India

Context

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

Other features

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

Benefits

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

Challenges

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

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

IndiGen Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IndiGen Initiative

Mains level : Applications of Genome Sequencing


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

IndiGen initiative

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

Why such move?

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

Benefits

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

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

[op-ed snap] Put away the stick

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Fertility rate

Mains level : Population control - challenges

Context

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

Two child norm for jobs

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

Limitations of the two-child norm

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

Fertility rate

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

Population growth

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

What needs to be done

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

Conclusion

State governments should rethink throttling rights to enforce population control.


Back2Basics

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

 

 

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

Peritoneal dialysis

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Dialysis

Mains level : National Dialysis Programme

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

What is Dialysis?

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

National Dialysis Programme

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

Hemodialysis (HD, commonly known as blood dialysis)

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

Peritoneal dialysis (PD, commonly known as water dialysis)

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

Why such move?

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

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

[pib] WHO India Country Cooperation Strategy 2019–2023

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Country Cooperation Strategy

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

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

Country Cooperation Strategy

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

Why need CCS?

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

Significance

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

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

World Vision Report

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Highlights of the report

Mains level : Economic implications of the Eye impairment

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

Highlights of the report

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

India praised

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

Regional and gender distribution

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

Why vision matters?

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

Prevention is possible

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

Various factors

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

Barriers to eye care

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

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

[pib] e-DantSeva

Note4Students

From UPSC perspective, the following things are important :

Prelims level : e-DantSeva

Mains level : Significance of oral health


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

e-DantSeva

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

Features

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

Why such move?

  • Dental caries/cavities and periodontal disease remain the two most prevalent dental diseases of the Indian population and dental infections have a potential for serious diseases/infections.
  • Oral health is indispensable for the wellbeing and good quality of life.
  • Poor oral health affects growth negatively in all aspects of human development.

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

[pib] UMMID Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : UMMID Initiative

Mains level : Prevention of genetic diseases


UMMID

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

Why such initiative?

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

NIDAN (National Inherited Diseases Administration) Kendras

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

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

[op-ed snap] A lifeline for India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMJAY

Mains level : PMJAY - benefits and the road ahead

CONTEXT

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

PMJAY

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

The journey so far – healthcare

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

Working with States

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

Private sector participation

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

Employment

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

IT infrastructure

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

Way ahead

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

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

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

Controlled Human Infection Model (CHIM)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : CHIM

Mains level : CHIM and ethical issues with it

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

About CHIM

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

Benefit

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

Concerns

  • The risk in such trials is that intentionally infecting healthy people with an active virus and causing them to be sick is against medical ethics.
  • It also involves putting human lives in danger.

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : Need to ban e-cigarettes

Context

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

The Ban

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

E-cigarettes over Cigarettes

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

Ban is justified

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

Numbers were the trigger

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

Conclusion

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

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

Cabinet approves ban on e-cigarettes

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : Hazards of ENDS


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

Prohibition of E-cigarettes Ordinance, 2019

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

What are e-cigarettes?

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

Why does the government want to ban these devices?

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

Does this mean traditional tobacco products are safer?

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

Who gains from the move?

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

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

Paraquat herbicide

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Paraquat

Mains level : Preventing farmers death due to hazardous chemicals

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

Paraquat

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

Why lethal?

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

Need for worldwide ban

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

Back2Basics

Rotterdam Convention

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

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

Bombay blood group

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Blood Groups

Mains level : Not Much

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

Bombay blood group

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

Rare in India, rarer globally

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

Testing for the group

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

Transfusion limitations

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

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

National Genomic Grid

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Genomic Grid

Mains level : Need for such grid

National Genomic Grid

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

About National Cancer Tissue Biobank

  • The NCTB is functioning in close association with the Indian Council for Medical Research (ICMR).
  • NCTB, which has the capacity to stock 50,000 genomic samples from cancer patients, already has samples from 3,000 patients.

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

[op-ed snap] Empowering primary care practitioners

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Strengthening primary health care to improve public health

Context

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

Problems with Indian healthcare

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

Focus on hospitalization

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

NMC – community health care provision

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

Way ahead

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

Best case – Japan

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

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

Biosimilar Medicines

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Biosimilars

Mains level : Not Much

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

What is Biosimilarity?

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

Biosimilars

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

Biosimilars vs generics

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

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

India gets its first national essential diagnostics list

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Medical diagnosis

National Essential Diagnostics List (NEDL)

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

How are diagnostics regulated?

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

Why need NEDL?

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

Benefits

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

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

Notifiable Disease

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Notifiable diseases

Mains level : Need for notifying diseases

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

What is a notifiable disease?

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

Why notify diseases?

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

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

Every child to get Rota virus vaccine by September

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Rotavirus

Mains level : Nothing much

NEWS

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

Background

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

Rotavirus Vaccine

  1. Rotavirus vaccine was introduced in 2016 and is now available in 28 States/Union Territories. It is expected to be available in all 36 States/Union Territories by September 2019.

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

The making of cyborgs and the challenges ahead

Note4Students

From UPSC perspective, the following things are important :

Prelims level : What neuroprosthetics is

Mains level : Neuro modulation and breakthroughs in health sector

Context

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

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

Problems

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

Breakthrough 

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

Future of neuromodulation

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

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

Genome India Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Genome India Initiaitve

Mains level : Benefits of genome mapping


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

What is a Genome?

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

Genome India Initiative

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

Why such move?

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

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

[op-ed snap] Patients and victims

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Regulation of medical devices

CONTEXT

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

Recalling of medical Device

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

The slow reaction by India

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

Defence by corporate

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

Conclusion

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

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

National Data Quality Forum (NDQF)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Data Quality Forum (NDQF)

Mains level : Utilizing meadical health data

National Data Quality Forum

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

Why need NDQF?

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

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

[op-ed snap] A WASH for healthcare

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Wash and Primary health Sector

CONTEXT

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

Background

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

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

Report’s Findings

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

Enhancing primary healthcare

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

WHO’s Initiative 

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

Educating the health workers

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

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

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

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

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

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

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

Generic Drugs

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Generic Drugs

Mains level : Healthcare in India

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

What are generic drugs?

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

Prescribing generic drugs

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

Issues with generic drugs

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

Way forward

  • The government should keep strict price control on medicines and ensure that the highest quality medicines are given to the patients.
  • All laws, checks and balances should be directed at giving the best possible treatment at the best cost.

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

Food and Nutrition Security Analysis, India, 2019

Note4Students

From UPSC perspective, the following things are important :

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

Mains level : Malnutrition in India

State of deficit

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

What is malnutrition?

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

Types of malnutrition

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

Food and malnutrition in the country

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

Double burden of malnutrition

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

States Performance

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

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

[op-ed snap] Healthcare’s primary problem

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Reforms in primary health care sector

CONTEXT

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

Preventable Disease

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

Measures that should have been taken

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

Crumbling healthcare in Bihar

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

Revamp primary health infrastructure

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

Conclusion

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Improvement in self care interventions

CONTEXT

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

The relevance of self-care health interventions

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

Meaning of self help health care

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

The situation of self help health care in India

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

Conclusion

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

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

[op-ed snap] Start with preventive care

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

Mains level : Preventive health care

CONTEXT

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

Challenges in this profession

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

Developments in healthcare

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

The big challenge today

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

Conclusion

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Self Care

Mains level : Importance of Self Care


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

What is Self-Care?

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

About the guidelines

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

Autonomy and engagement

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

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

Pilot Scheme for distribution of Fortified Rice through PDS

Note4Students

From UPSC perspective, the following things are important :

Prelims level : BIofortification

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

About the Scheme

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

How it is finalized?

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

Back2Basics

Fortification

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

How is Rice fortified?

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

Regulating Fortification

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

About Food Fortification Resource Centre (FFRC)

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

 

 

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

[pib] Proton Therapy

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Proton Therapy

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


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

Proton Therapy

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

How it works?

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

Why in news?

  • It is the most technologically advanced method to delivery radiation treatments to cancerous tumors available today.
  • The unique characteristics of how protons interact within the human body in fewer complications and side effects than standard radiation therapy.

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NITI Aayog’s Health Index

Mains level : Read the attached story


Kerala tops yet again

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

NITI Aayog’s Health Index

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

Performance by states:

Image source: Business Standard

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

Explained: Why is the litchi toxin causing deaths?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AES, Litchi toxin

Mains level : Preventing child mortality


Background

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

What is acute encephalitis syndrome (AES)?

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

Is encephalitis different from hypoglycaemic encephalopathy?

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

What happens in hypoglycaemic encephalopathy?

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

What killed so many children in Bihar?

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

Why has it affected only young children in Bihar?

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

Role of Litchi

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

How is MCPG hazardous?

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

What can be done to prevent this?

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

Can hypoglycemic encephalopathy be treated?

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

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

[op-ed snap] AI for public 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.

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

[op-ed snap] A failing state

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

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

CONTEXT

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

Background

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

Reasons

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

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

Study on AES

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

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

Malnutrition –

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

No Action by the state on report

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

Poorly Equipped PHCs

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

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

CONTEXT

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

Background

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

Reasons for violence against doctors

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

Provisions in place

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

Effectiveness of such a law

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

Conclusion

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

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

Acute Encephalitis Syndrome (AES) outbreak in Bihar

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AES

Mains level : Preventing Child Mortality

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

What is AES?

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

Symptoms of AES

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

Who is at risk?

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

Treatment for AES

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

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

[op-ed snap] Welfare policy and Modi 2.0

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

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

CONTEXT

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

Analysis of welfare projects

1.Technology and bureaucracy

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

The flaw in design –

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

Examples from other countries –

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

Way ahead

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

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

2. Analysis of Ayushman Bharat

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

Challenges

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

Strengthening health care infrastructure –

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

3. Balance in Centre-state relations

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

Way Ahead to balance centre state relation

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

4. Education Policy

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

Conclusion

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

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

[op-ed snap] Caught napping

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nipah virus

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

CONTEXT

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

Background

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

Circulation of virus

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

Lack of proactiveness on part of the state

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

Way Forward

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

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

ICMR calls for complete ban on e-cigarettes

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ENDS

Mains level : e-Cigarette ban in India


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

Electronic nicotine delivery systems (ENDS)

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

Why such ban?

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

ENDS cannot help quit smoking

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

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

WHO strategy to tackle global snakebite ’emergency’

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : WHO strategy on snakebites

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

The Strategy

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

Snakebite: An Emergency

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Read the attached story

Mains level : Awareness about antenatal care and breastfeeding

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

Breastfeeding room in Taj

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

Why such move?

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

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

National Institute of Nutrition

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NIN

Mains level : NIN and its mandate


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

Issue over NIN decision

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

About NIN

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

Mandate of NIN

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

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

Global Drug Survey Report 2018

Note4Students

From UPSC perspective, the following things are important :

Prelims level : GDS

Mains level : Read the attached story


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

Global Drug Survey

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

Drugs menace in India

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

Less cannabis

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

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

India facing critical shortage of healthcare providers: WHO

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Healthcare lacunae in India

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

Critical Shortage in India

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

Health workforce in India

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

WHO says

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

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

WHO for eliminating industrially produced trans fats by 2023

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Trans Fats

Mains level : Health issues over consumption of Trans Fats

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

Regulatory action by WHO

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

About Trans Fats

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

Hydrogenation Process

  • Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
  • Hydrogenation increases the shelf life and flavor stability of foods.

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

ICMR launches ‘MERA India’ to eliminate malaria by 2030

Note4Students

From UPSC perspective, the following things are important :

Prelims level : MERA India

Mains level : Menace of Malaria in India

‘Malaria Elimination Research Alliance (MERA) India’

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

Why such move?

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

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

Khasi ‘kingdoms’ to revisit 1947 agreements

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Khasi Kingdom, Himas

Mains level : Reorganisation of States in India

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

Concerns of Khasis

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

History of Khasi Merger in India

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

Back2Basics

Statehood to Meghalaya

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

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

Dentists can practise as General Physicians after bridge course

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Adressing shortage of doctors in India

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

Meeting shortage of doctors

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

About the bridge course

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Details of the Guidelines

Mains level : Global obesity crisis

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

Recommendations at a glance:

Infants (less than 1 year) should:

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

Children 1-2 years of age should:

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

Children 3-4 years of age should:

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

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

Worlds first Malaria Vaccine: RTS,S (Mosquirix)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : About the vaccine

Mains level : Malaria and its incidence in India

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

RTS,S vaccine (Mosquirix)

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

Why fear Malaria?

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

Why trials in Malawi?

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

How badly is India affected by malaria?

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

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

Biomarkers found for lymph node metastasis in oral cancer

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Biomarkers

Mains level : Not Much

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

What are Biomarkers?

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

Biomarkers to check oral cancer

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

Five genomic biomarkers

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

Diagnosing oral cancer metastasis

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

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

[op-ed snap] A manifesto for health

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

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

CONTEXT

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

Current health scenario in the country

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

Proposals to improve Health Sector

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

Way Forward

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

 

 

 

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

CSIR plans genome sequencing to map population diversity

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Genome Sequencing

Mains level : Applications of Genome Sequencing

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

Genome Sequencing

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

About the Project

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

Methodology

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

Utility of the Project

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

Ethical issues involved

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

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Healthcare lacunae in India

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

Out-of-pocket costs of health

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

Mortality burden

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

Issues with India

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

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

‘Display information on 7 common antibiotics’

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PVPI

Mains level : Pharmacovigilance initiatives in India

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

Pharmacovigilance Programme of India (PvPI)

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

CDSCO guidelines to manufacturers

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

Why such move?

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

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

[op-ed snap]US vs Europe in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing Much

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

CONTEXT

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

Divergent Approaches

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

Concerns

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

US model

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

European Model

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

Equality v/s liberty

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

Degrading Health standards In India

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

Challenges in building sustainable healthy blocks

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

Conclusion

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

 

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

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Candida Auris

Mains level : Read the attached story

Candida Auris

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

What makes it so freaky?

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

What made it so strong?

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

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

[pib] Solidarity Human Chain

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Solidarity Human Chain, WHO

Mains level : Not Much

Solidarity Human Chain

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

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

Septic tanks meet norms says 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.

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

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.

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

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.

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

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.

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

[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.

 

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

[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.

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

[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.

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

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.

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

[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.

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

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.

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

[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.

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

[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

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

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.

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

[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.