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

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

National Commission for Safai Karamcharis gets 3-year extension

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NCSK

Mains level : Manual scavenging in India

The Union Cabinet has approved a three-year extension of the tenure of the National Commission for Safai Karamcharis (NCSK) that was set to end on March 31.

About National Commission for Safai Karamcharis

  • The commission was set up in 1993 under the NCSK Act 1993 for a period of three years, which has been extended since then.
  • The NCSK Act is however ceased to have effect from February 29, 2004.
  • After that, the tenure of the NCSK has been extended as a non-statutory body from time to time through resolutions.

Why was NCSK set up?

  • The commission helps in coming up with programmes for the welfare of sanitation workers.
  • It also monitors the implementation of the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013.
  • Till December 31, 2021, 58,098 manual scavengers had been identified.

Need for eliminating Manual Scavenging

  • Undignified life (all the 6 Fundamental Rights are compromised, directly or indirectly).
  • It directly perpetuates castism.
  • Modern, Secular India has no place for such “professions”.
  • It no way suits India’s rising global profile – ‘super power’ aspirations.
  • Women are mostly disprivileged since most manual scavengers are dalit women.

What else needs to be done?

  • Though the government has taken many steps for the upliftment of the safai karamcharis, the deprivation suffered by them in socio-economic and educational terms is still far from being eliminated.
  • Although manual scavenging has been almost eradicated, sporadic instances of their deaths do occur.

Way forward

  • There is a continued need to monitor the various interventions and initiatives of the government for welfare of safai Karamcharis.
  • The govt must strive to achieve the goal of complete mechanization of sewer/septic tanks cleaning in the country and rehabilitation of manual scavengers.

Try this question from CSP 2016:

Q.’Rashtriya Garima Abhiyaan’ is a national campaign to:

(a) rehabilitate the homeless and destitute persons and provide them with suitable sources of livelihood

(b) release the sex workers from their practice and provide them with alternative sources of livelihood

(c) eradicate the practice of manual scavenging and rehabilitate the manual scavengers

(d) release the bonded labourers from their bondage and rehabilitate them

 

Post your answers here:
4
Please leave a feedback on thisx

 

Also try this question from our AWE initiative:

Manual scavenging has been called as a worst surviving symbol of untouchability. Critically discuss the measures taken by Government to eradicate this practice? (250 W)

 

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

Extinguishing the tobacco industry’s main narrative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Price and tax measures to reduce demand of tobacco

Context

There is no doubt that tobacco use is highly detrimental to public health. We have to find the ways and the means to reduce the demand for tobacco among existing as well as aspiring users.

Impact of tobacco

  • Tobacco is a product that kills more than 13 lakh Indians every year.
  • Annual burden: The annual economic burden from tobacco use is estimated to be ₹177,340 crore which is more than 1% of India’s GDP.
  • About 27 crore people above the age of 15 years and 8.5% of school-going children in the age group 13-15 years use tobacco in some form in India.

Are price and tax measures effective against tobacco use?

  • When tobacco products become more expensive, people either quit using them or use them less, and it incentivises many to not initiate the habit.
  • Because it hurts both revenue and profits, the tobacco industry, globally, is always devising tactics and narratives that will pre-empt any kind of tax increases on tobacco products.
  • The narrative of “increasing illicit trade” is something the tobacco industry has historically used to pre-empt potential tax increases on tobacco products in most countries around the world.
  • The story is no different in India.
  • In a recent report by the Tobacco Institute of India, it was said that the illicit cigarette volume in India has grown by 44% from 2011 to 2019 while adding that high and increasing tax rates provide a profitable opportunity for tax evasion and encourage growth in illegal trade.
  • A study published in 2018 which used a survey of empty cigarette packs collected from retail outlets across different cities in India estimated that illicit cigarettes constitute 2.7% of the market.
  • The second study published in 2020 used tax-gap analysis to estimate that the percentage of illicit cigarettes was 5.1% in 2009-10 and 6.6% in 2016-17.

Are taxes and prices key determinants of illicit trade?

  • It is to be noted that taxes and prices are not the key determinants of illicit trade.
  • There is sufficient evidence in the literature on illicit trade in cigarettes that shows tax increases only have a minimal impact, if at all, on illicit trade.
  • There are several countries where tobacco taxes are quite high and yet have low levels of illicit trade, while there are also countries with high levels of illicit trade despite having relatively low tax rates.
  • Several factors such as the quality of tax administration, the strength of the regulatory framework, government commitment to control illicit trade, the strength of governance, social acceptance, and the presence of informal distribution networks are known to play a larger role in determining the scale and the extent of an illicit market.

Way forward

  • WHO protocol: Eliminating all forms of illicit trade in tobacco products through a package of measures is one of the major objectives of the Protocol to Eliminate Illicit Trade in Tobacco Products under the World Health Organization’s Framework Convention on Tobacco Control.
  • The Protocol provides the tools and the measures to eliminate or minimise illicit trade which includes strong governance, establishing an international track and trace system, and securing supply chains.
  • India has already ratified the World Health Organization Protocol and it should now show leadership in implementing these measures to effectively address even the relatively lower levels of illicit trade.

Conclusion

There is no scientific or public health rationale not to increase tax on tobacco products for unfounded fear of increasing illicit trade.

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

Worrying trends in nutrition indicators in NFHS-5 data

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Dealing with the nutrition gap

Context

The NFHS-5 factsheets for India and all states and Union territories are now out. At first glance, it appears to be a mixed bag — much to cheer about, but concern areas remain.

Positives from the NFHS-5 survey

  • Change in demographic trends: For the first time since the NFHS 1992-93 survey, the sex ratio is slightly higher among the adult population.
  • Improvement in sex ratio at birth: For the first time in 15 years that the sex ratio at birth has reached 929 (it was 919 for 1,000 males in 2015-16).
  • The total fertility rate has also dropped from 2.2 per cent to a replacement rate of 2 per cent, albeit with not much change in the huge fertility divide between the high and low fertility states.
  • Improvement in literacy level of women: There has been an appreciable improvement in general literacy levels and in the percentage of women and men who have completed 10 years or more of schooling, which has reached 41 per cent and 50.2 per cent respectively.
  • Improvements in health indicators: The health sector deserves credit for achieving a significant improvement in the percentage of institutional births, antenatal care, and children’s immunisation rates.
  • There has also been a consistent drop in neonatal, infant and child mortality rates — a decrease of around 1 per cent per year for neonatal and infant mortality and a 1.6 per cent decrease per year for under five mortality rate.

Nutrition: Area of concern

  • Increase in anaemic people: India has become a country with more anaemic people since NFHS-4 (2015-16), with anaemia rates rising significantly across age groups, ranging from children below six years, adolescent girls and boys, pregnant women, and women between 15 to 49 years.
  • Why anaemia is a concern? Adverse effects of anaemia affect all age groups — lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
  •  Further, anaemia among adolescent girls (59.1 per cent) advances to maternal anaemia and is a major cause of maternal and infant mortality and general morbidity and ill health in a community.
  • The detailed report will explain why a dedicated programme like Anaemia Mukt Bharat which focused on IFA consumption failed to gain impetus.
  • Slow pace of improvement in nutritional indicators: Between NFHS 4 and NFHS 5, the percentage of children below five years who are moderately underweight has reduced from 35.8 per cent to 32.1 per cent.
  • Moderately stunted children have fallen from 38.4 per cent to 35.5 per cent, moderately wasted from 21 per cent to 19.3 per cent and severely wasted have increased slightly from 7.5 per cent to 7.7 per cent.
  • Inadequate diet: The root cause for this is that the percentage of children below two years receiving an adequate diet is a mere 11.3 per cent, increasing marginally from 9.6 per cent in NFHS-4.

Way forward

  • India’s nutrition programmes must undergo a periodic review.
  • The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.

Conclusion

The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.

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

Put out the data, boost the dose of transparency

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Dealing with Covid

Context

The Government must make COVID-19 data including that for vaccine regulatory approvals and policy available.

Kay decisions

  • On December 25, the Prime Minister of India announced two key decisions.
  • Vaccination of children: All children in the 15-17 age bracket will be eligible to receive COVID-19 vaccines from January 3, 2022.
  • Third shot: All health-care workers, frontline workers and the people aged 60 years and above (with co-morbidities and on the advice of a medical doctor) can get a third shot, or ‘precaution dose’.
  •  The eligibility for the precaution dose will be on the completion of nine months or 39 weeks after the second dose.
  • Teenage children whose birth year is 2007 or before will be eligible for COVID-19 vaccines.
  • Children will receive Covaxin, the reason being (according to the note) it is the only emergency use listed (EUL) World Health Organization vaccine available for use in this age group in India.

Issues with the decision

  • Lack of scientific evidence: The decision is said to be based on ‘advice of the scientific community’.
  • A few members of the National Technical Advisory Group on Immunisation (NTAGI) in India,  have written or spoken publicly about not having enough scientific evidence to administer booster doses and vaccinate children in India.
  • Successive national and State-level sero-surveys have reported that a majority of children in India had got natural infection, while staying at home and thus developed antibodies.
  • The studies have shown that children rarely develop moderate to severe COVID-19 disease.
  • Targeted vaccination approach not adopted: Most public health and vaccine experts favour a ‘targeted vaccination approach’ by prioritising high-risk children for COVID-19 vaccination.
  • However, such an approach is likely to face an operational challenge in the identification of the eligible children.
  • Consultation cost:  A majority of the elderly have one or other comorbidities. Of the 14 crore elderly population in India, an estimated 7 to 10 crore people could have co-morbidities.
  •  If they have to seek advice from a physician, in order to get vaccinated, this essentially means that there would be up to 10 crore of medical consultations, which would come at a cost —  all of which is avoidable.

Suggestions

  • Do away with prescription: The conditionality of comorbidities and the need for advice/prescription by a doctor for ‘the precaution shot’ in the elderly should be done away with.
  • Third dose to all immunocompromised adults: There is scientific evidence and consensus on administering the third dose for immunocompromised adults.
  • The Indian government should urgently consider administering a third dose for all immunocompromised adults, irrespective of age.
  • Third dose on a different vaccine platform: Studies have found that a heterologous prime-boost approach — third shot on a different vaccine platform — is a better approach.
  • Identify policy questions: Various pending policy questions on COVID-19 vaccine need to be identified urgently.
  • The technical expert should be given complete access to COVID-19 data for analysis and to find answers to those scientific and policy questions.
  • Vaccine supply and stock management: Vaccination for teenage children, exclusively with Covaxin (which means 15 crore doses for this sub-group) has other implications.
  • Covaxin will also be needed for people coming for their first shot, returning for their second shot, and then for their ‘precaution dose’ if a third shot of the same vaccine is allowed.
  • Focus on primary vaccination: The precaution dose and vaccination for children should not divert attention from the task of primary vaccination, which continues to be an unfinished task in India; 46 crore doses are still needed for the first and second shots.
  • Make data public: It is time the Union and State governments in India make COVID-19 data — this includes clinical outcomes, testing, genomic sequencing as well as vaccination — available in the public domain.
  • This would help in formulating and updating COVID-19 policy and strategies and also assess the impact of ‘precaution dose’ as well as vaccination of children.

Conclusion

The Indian government urgently needs to make COVID-19 data available, including the one used for regulatory approvals of vaccines and for vaccine policy decisions. This will bring transparency in decision making and increase the trust of the citizen in the process.

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

NITI Aayog releases fourth edition of State Health Index

Note4Students

From UPSC perspective, the following things are important :

Prelims level : State Health Index

Mains level : Competitive Federalism

NITI Aayog has released the fourth edition of the State Health Index for 2019–20.

State Health Index

  • The State Health Index is an annual tool to assess the performance of states and UTs. It is being compiled and published since 2017.
  • The index is part of a report commissioned by the NITI Aayog, the World Bank, and the Union Health and Family Welfare Ministry.
  • The reports aim to nudge states/UTs towards building robust health systems and improving service delivery.

Components of the index

  • It is a weighted composite index based on 24 indicators grouped under the domains of ‘Health Outcomes’, ‘Governance and Information’, and ‘Key Inputs/Processes’.
  1. Health outcomes: It includes parameters such as neonatal mortality rate, under-5 mortality rate, and sex ratio at birth.
  2. Governance: This includes institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
  3. Key inputs: It consists of the proportion of shortfall in healthcare providers to what is recommended, functional medical facilities, birth, and death registration, and tuberculosis treatment success rate.

Performance of the states

  • For the fourth year in a row, Kerala has topped a ranking of States on health indicators. Uttar Pradesh has come in at the bottom.
  • Kerala is followed by Tamil Nadu and Telangana, which improved its ranking.

 

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Issues with Health Surveys in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NFHS and other survey mentioned

Mains level : Need for national health data architecture

This article discusses the feasibility of conducting a single comprehensive survey for collecting health-related data in India.

Context

  • In a country perennially thirsty for reliable health data, the National Family Health Survey (NFHS) is like an oasis.
  • It has a large volume of data that is openly accessible.
  • The report of the fifth round of the NFHS was recently released. Since then, we had many articles covering different aspects (malnutrition, fertility, and domestic violence to name a few).

What is NFHS?

  • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • Three rounds of the survey have been conducted since the first survey in 1992-93.
  • Currently, the survey provides district-level information on fertility, child mortality, contraceptive practices, reproductive and child health (RCH), nutrition, and utilization and quality of selected health services.
  • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

Issues with health surveys in India

  • Multiple surveys: The NFHS is not the only survey. In the last five years, there has been the National NCD Monitoring Survey (NNMS), the National Mental Health Survey (NMHS) etc.
  • Huge cost: Each survey funding for different rounds of NFHS costs upto ₹250 crore.
  • Huge chunk of data: The size of the survey has obvious implications for data quality.
  • Different estimates: Multiple surveys also raise the problem of differing estimates, as is likely, due to sampling differences in the surveys.
  • Limited respondents: The respondents are largely women in the reproductive age group (15-49 years) with husbands included.
  • Global obligations: Some of these surveys are done to meet the global commitments on targets (NCDs, tobacco, etc.).
  • Undefined purpose The health surveys have confusing research with programme monitoring and surveillance needs. Ex. Questions on domestic violence in NFHS.

Need of the hour

  • Alignment of purpose: There have been previous attempts to align these surveys but they have failed as different advocates have different “demands” and push for inclusion of their set of questions.
  • Regularity of surveys: NFHS is the only major survey that India has a record of doing regularly. One does not know if and when the other surveys will be repeated.

One-stop solution

  • National health data architecture: With diverse aspects of health, there is a need to plan the public health data infrastructure for the country.
  • Budgetary outlay: We also need to ensure that these data are collected in an orderly and regular manner with appropriate budgetary allocation.
  • Purpose definition: This requires clarity of purpose and a hard-nosed approach to the issue that randomized activities.
  • National-level indicators: We have to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.

How should surveys be done?

  • There should be three national surveys done every three to five years in a staggered manner:
  1. NFHS focuses on Reproductive and Child Health (RCH) issues
  2. Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviors) and
  3. Nutrition-Biological Survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)

We need to look at alternate models and choose what suits us best.

Way forward

  • Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
  • States have to become active partners including providing financial contributions to these surveys.
  • It is also very important to ensure that the data arising from these surveys are in the public domain.

Conclusion

  • We are ready to establish public health data architecture for our complexity of needs.
  • We have the technical capacity to do so.
  • All it requires now is the political will.

 

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

Extending outpatient health care coverage

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Extending coverage to OP care

Context

Over the past two decades, initiatives announced to extend health care coverage to the indigent sections have come under criticism due to their near-exclusive focus on hospitalisation (inpatient, IP) care.

Significance of outpatient health care

  • What is outpatient health care: Outpatient (OP) health care, mainly comprising doctor consultations, drugs, and tests, can be called ‘the elephant in the room’ of Indian public health care policy.
  • OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health.

Why do we need to extend OP care coverage?

  • How IP care differs from OP care? IP care comprises high-impact and unavoidable episodes that are less prone to misuse than OP care, for which demand is considerably more sensitive to price and is thus more prone to overuse under health insurance.
  • IP insurance prioritised: This logic, among other reasons, has led to IP insurance schemes being prioritised.
  • [1] OP care and preventive care is neglected: While a price-sensitive demand for OP care entails that it could be misused under insurance, it also means that OP care is the first to come under the knife when there is no insurance.
  • In India, where there are many public IP insurance schemes but no OP coverage, this incentive is further amplified.
  • The mantra of ‘prevention is better than cure’ thus goes for a toss.
  • [2] Against economic sense: It defies economic sense to prioritise IP care over OP care for public funds.
  • Preventive and primary care services which often come with externalities, elicit little felt need and demand, and must therefore be the primary recipients of public investment.
  • Not conducive to epidemiological profile: Greater investments in IP care today translate to even greater IP care investments in future, further reduction in primary care spending, and ultimately lesser ‘health’ for the money invested.
  • None of these are conducive to the epidemiological profile that characterises this country.

Issues with using private commercial insurance to extend OP care coverage nationwide

  • Some recent policy pronouncements by the Centre have conveyed an inclination to expand healthcare coverage with little fiscal implications for the government.
  • Challenges:
  • [1] The OP practices are under-regulated and there is a lack of standards.
  • [2] The difficulty to monitor OP clinical and prescribing behaviours and the concomitant higher likelihood of malpractices.
  • [3] Low public awareness of insurance products and a low ability to discern entitlements and exclusions.
  • [4] Add to it the inexperience that a still under-developed private OP insurance sector brings.
  • All these entail tremendous and largely wasteful costs and administrative complexity, and it would be of little help even if the government was to step in with considerable subsidies.

Suggestion

  • Need for fiscal and time commitment: Significant improvements in healthcare are implausible without significant fiscal and time commitments.
  • No perfect model: There is no ‘perfect’ model of expanding healthcare — the emphasis must be on finding the best fit.
  • Implementing even such a best fit could involve adopting certain modalities with known drawbacks.
  • Expand public spending: The focus must be on expanding public OP care facilities and services financed mainly by tax revenues.
  • For India, wisdom immediately points to successful countries that are (or were, at one point) much closer to its socioeconomic fabric, such as Thailand, than countries like the U.S. which we currently look to emulate.
  • Now, the sparse number and distribution of public facilities offers various modes of rationing care, and their expansion is likely to result in a considerable spike in demand.
  • Contracting with private players: Contracting with private players based on objective and transparent criteria would also be called for, with just enough centralised supervision to deter corruption while preserving local autonomy.
  • To deter supply-side malpractices, low-powered modes of provider payment, such as capitation, may be considered for private providers wherever possible.

Conclusion

There are several compelling reasons for extending outpatient health care coverage even though there are several challenges to overcome to achieve this.

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How lack of public data on pandemic could harm us

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Omicron variant

Mains level : Paper 2- Importance of data in dealing with pandemic

Context

Questions are being asked about India’s preparedness as the cases with the Omicron variant of the Coronavirus has been on the rise in the country.

Where does India stand?

[1] The Positives

  • Addressing oxygen shortage: The extreme shortages of oxygen that we saw barely six months ago will hopefully not be a feature of a third wave.
  • Vaccinated population: We have now vaccinated more than 50% of the adult population with both doses of vaccine, and approximately 85% have received one or two doses.
  • Ramping up testing to deal with a spike should not require an increase in capacity.
  • More vaccine doses: We have more vaccine doses than in May 2021 and the potential for oral antiviral therapy in the near future.

[2] The negatives

  • Lack of data: An urgent and important one is the lack of publicly available data on the pandemic from Government sources, particularly in regard to testing, but also in terms of being able to correlate disease severity with age, prior medical conditions, locations and other variables.
  • Data from the Indian Council of Medical Research (ICMR), India’s premier medical research agency, remains inaccessible.
  • The National Centre for Disease Control (NCDC) has not responded.
  • The CoWIN data contains valuable information but it is of little value for future planning and prediction unless it can be tied to testing data and clinical information at the level of individuals.
  • ICMR data not correlated to CoWIN platform data: The Indian Council of Medical Research holds data on every COVID-19 test conducted in India.
  • However, these data are not correlated to the vaccine data in the CoWIN platform.
  • Data with States is inaccessible: Data on hospitalisations, etc. are apparently available at the State level, but seem inaccessible.

What we can know from the data about pandemic

  • Infer the probability of reinfection: If we knew that a person had tested positive on successive tests separated by, say four months or more, with a negative test in-between, that would suggest a reinfection.
  • We could then infer the probability of such a reinfection.
  • Probability of vaccine breakthrough infection: With information about testing and vaccination status, we could compute the probability of a vaccine breakthrough event.
  • To know the efficacy of single vaccine dose: By checking to see whether the positive test happened after the first but before the second dose of vaccine, or after the second dose, the relative efficacy of such single vaccine doses at preventing disease could be derived.
  • Effect of the vaccine on disease severity: By examining symptoms reported after a vaccine breakthrough event, we could understand the extent to which vaccines reduce disease severity.
  • Impact of new variant: Add to this a layer of sequence information, and we could study the impact of new variants.

Role of the volunteer organisation

  • The most trustworthy and granular data on cases in India have resulted from the remarkable and public-spirited work of a volunteer organisation, Covid19India.org.
  • Their work has now been taken over by several other voluntary groups, all operating on the same broad principles of data accessibility: covid19bharat.org, incovid19.org and covid19tracker.in.

Way forward

  • Commitment towards data accessibility: We need to stress on data availability because this is the one area where a swift realignment is possible.
  • The more widely data are shared, the greater the likelihood of integration of the rapidly shifting scientific frontier with clinical practice.
  • Learning from the experience of South Africa: With the advantages of a relatively high-quality surveillance system among low- and middle-income countries (LMIC) countries, bolstered by a commitment towards transparency and data accessibility, South Africa’s rapid sharing allowed the world to prepare swiftly for the appearance of the highly mutated Omicron variant.
  • It is clear that pre-emptive decisions on vaccination and other measures could be made faster and better if more integrated data were available.

Consider the question “Why availability and accessibility of data is important in dealing with the Covid-19 pandemic? What are the challenges facing health data accessibility in India?”

Conclusion

Now, more than ever before is the time for us to urgently reassess our attitude towards data for public health purposes and the role of national health agencies in sharing data, generated with public funds, with scientists in India and across the world.

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

Amendment to the NDPS Act

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NDPS Act

Mains level : Narcotics crime in India

The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2021 was passed by Lok Sabha.

Must read:

[Burning Issue] Substance Abuse in India

About NDPS Act

  • The Narcotic Drugs and Psychotropic Substances Act, commonly referred to as the NDPS Act was promulgated in 1985.
  • It prohibits a person from the production/manufacturing/cultivation, possession, sale, purchasing, transport, storage, and/or consumption of any narcotic drug or psychotropic substance

What is the 2021 amendment?

  • The 2021 Bill amends the Narcotic Drugs and Psychotropic Substances Act, 1985 and seeks to rectify a drafting “anomaly” created by a 2014 amendment to the parent legislation.
  • It contains a legislative declaration about what one section refers to.
  • It says Section 2 clause viii(a) corresponds to clause viii(b) in Section 27, since 2014 when the provision was first brought in.
  • Section 27A of the NDPS Act, 1985, prescribes the punishment for financing illicit traffic and harbouring offenders.

Earlier amendment in 2014

  • In 2014, a substantial amendment was made to the NDPS Act to allow for better medical access to narcotic drugs.
  • It defined “essential drugs”; under Section 9 and allowed the manufacture, possession, transport, import inter-State, export inter-State, sale, purchase, consumption and use of essential narcotic drugs.
  • But before the 2014 amendment, a Section 2(viii)a already existed and contained a catalogue of offences for which the punishment is prescribed in Section 27A.

What is Section 21A?

  • Section 27A reads: Whoever indulges in financing, directly or indirectly or harbours any person engaged in any of the aforementioned activities, shall be punishable with rigorous imprisonment.
  • The term shall not be less than ten years and may extend to twenty years.
  • The accused shall also be liable to fine which shall not be less than one lakh rupees but which may extend to two lakh rupees.

What was the drafting “anomaly”?

  • While defining “essential drugs” in 2014, the legislation re-numbered Section 2.
  • The catalogue of offences, originally listed under Section 2(viii)a, was now under Section 2(viii)b.
  • In the amendment, Section 2(viii)a defined essential narcotic drugs.
  • However, the drafters missed amending the enabling provision in Section 27A to change Section 2(viii)a to Section 2(viii)b.

What was the result of the drafting error?

  • Section 27A punished offences mentioned under Section 2(viiia) sub-clauses i-v.
  • However, Section 2 (viiia) sub-clauses i-v, which were supposed to be the catalogue of offences, does not exist after the 2014 amendment. It is now Section 2(viiib).
  • This error in the text meant since 2014, Section 27A was inoperable.

When was the error noticed?

  • In June this year, the Tripura High Court, while hearing a reference made by the district court, flagged the drafting error, urging the Centre to bring in an amendment and rectify it.
  • In 2016, an accused had sought bail before a special judge in West Tripura in Agartala, citing this omission in drafting.

Why can’t it be applied retrospectively?

  • Article 20(1) of the Constitution says that no person shall be convicted of any offence except for violation of the law in force at the time of the commission.
  • The person shall not be subjected to a penalty greater than that which might have been inflicted under the law in force at the time of the commission of the offence.
  • This protection means that a person cannot be prosecuted for an offence that was not a “crime” under the law when it was committed.

Does the latest amendment make it retrospective?

  • In September, the government brought in an ordinance to rectify the drafting error, which Lok Sabha. “It shall be deemed to have come into force on the 1st day of May 2014,” the Bill reads.
  • Retrospective application is permitted in clarificatory amendments.
  • This 2021 amendment is not a substantive one, that is why the retrospective is allowed.

 

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Tobacco Consumption in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Cancer related fatality in India

Tobacco use is known to be a major risk factor for several non-communicable diseases in India.

Tobacco abuse in India

  • In India, 28.6% of adults above 15 years and 8.5% of students aged 13-15 years use tobacco in some form or the other.
  • This makes the country the second-largest consumer of tobacco in the world.

Concern: No action against Tobacco

  • India bears an annual economic burden of over ₹1, 77,340 crores on account of tobacco use.
  • There has been no major increase in taxation of tobacco products to discourage the consumption of tobacco in the past four years since the introduction of GST.
  • Only in 2020-21, the Union Budget had the effect of increasing the average price of cigarettes by about 5%.
  • Yet, the excise duty on tobacco in India continues to remain extremely low.

A worrying trend

  • No increase in tax: The absence of an increase in tax means more profits for the tobacco industry and more tax revenue foregone for the government.
  • Revenue losses: This revenue could have easily been utilized during the COVID-19 pandemic.
  • Losses due to GST: There has been a 3% real decline in GST revenues from tobacco products in each of the past two financial years.

Present governance of Tobacco

  • GST slab: Tobacco at present is a highly taxed commodity. It is kept in the 28% GST slab (other than for tobacco leaves which is taxed at 5%).
  • Heavy cess: Tobacco and its various forms are also subject to a heavy burden of cess, given that the commodity is seen as a sin good.
  • Statutory warning: The government also uses pictures of cancer patients on the packages of cigarettes to discourage its use.

Federal issues

  • Excise taxes on many tobacco products used to be regularly raised in the annual Union Budgets before the GST.
  • Similarly, several State governments used to regularly raise value-added tax (VAT) on tobacco products.
  • During the five years before the introduction of the GST, most State governments had moved from having a low VAT regime on tobacco products to having a high VAT regime.

Implication of such policies

  • Increased consumption: The lack of tax increases in post-GST years might mean that some current smokers smoke more now and some non-smokers have started smoking.
  • Reverse trend in decline: This could potentially lead to a reversal of the declining trend in prevalence.
  • Affordability: Tobacco products are more affordable post-GST as shown in recent literature from India.
  • Missing up national target: This might jeopardise India’s commitment to achieving 30% tobacco use prevalence reduction by 2025 as envisaged in the National Health Policy of 2017.

Way forward

  • Several countries in the world have high excise taxes along with GST or sales tax and they are continuously being revised.
  • We must adhere to the WHO recommendation for a uniform tax burden of at least 75% for each tobacco product.
  • The Union government should take a considerate view of public health and significantly increase excise taxes — either basic excise duty or NCCD — on all tobacco products.
  • Taxation should achieve a significant reduction in the affordability of tobacco products to reduce tobacco use prevalence and facilitate India’s march towards sustainable development goals.

 

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Global Health Security Index, 2021

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Global Health Security Index, 2021

Mains level : Health security

Countries across all income levels remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security (GHS) Index.

About GHS Index

  • The GHS Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations.
  • It is a project of the Johns Hopkins Centre for Health Security, the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU) and was first launched in October 2019.
  • It assesses countries across 6 categories, 37 indicators, and 171 questions using publicly available information.
  • It benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader strength of the health system, and country adherence to global norms.

Parameters assessed

The report is based on a questionnaire of 140 questions, organized across 6 categories, 34 indicators, and 85 sub-indicators. The six categories are:

  1. Prevention: Prevention of the emergence or release of pathogens
  2. Detection and Reporting: Early detection and reporting for epidemics of potential international concern
  3. Rapid Response: Rapid response to and mitigation of the spread of an epidemic
  4. Health System: Sufficient and robust health system to treat the sick and protect health workers
  5. Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
  6. Risk Environment: Overall risk environment and country vulnerability to biological threats

Global performance

  • In 2021, no country scored in the top tier of rankings and no country scored above 75.9, the report showed.
  • The world’s overall performance on the GHS Index score slipped to 38.9 (out of 100) in 2021, from a score of 40.2 in the GHS Index, 2019.
  • This, even as infectious diseases are expected to have the greatest impact on the global economy in the next decade.
  • Some 101 countries high-, middle- and low-income countries, including India, have slipped in performance since 2019.

Indian scenario

  • India, with a score of 42.8 (out of 100) too, has slipped by 0.8 points since 2019.
  • Three neighboring countries — Bangladesh, Sri Lanka and Maldives — have improved their score by 1-1.2 points.

Conclusion

  • Health emergencies demand a robust public health infrastructure with effective governance.
  • The trust in government, which has been a key factor associated with success in countries’ responses to COVID-19, is low and decreasing, the index noted.

 

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Need for closer scrutiny of reduced out-of-pocket expenditure on health

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Scrutinising reduced out-of-pocket expenditure on health

Context

The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.

India’s total public spending on health

  • One of the lowest in the world: India’s total public spending on health as a percentage of GDP or in per capita terms has been one of the lowest in the world.
  • Majority spent by the States: The Union government traditionally spends around a third of the total government spending whereas the majority is borne by the States.
  • There has been a policy consensus for more than a decade now that public spending has to increase to at least 2.5% of GDP.
  • However, there has not been any significant increase so far.
  • Despite several pronouncements, it has continued to hover around 1%-1.2% of GDP.

Why NHA report is being celebrated?

  • The National Health Accounts (NHA) report capture spending on health by various sources, and track the schemes through which these funds are channelised to various providers in a given time period for a given geography.
  • The National Health Accounts (NHA) report for 2017-18 is being celebrated widely as it shows that total public spending on health as a percentage of GDP has increased to a historic high of 1.35% of GDP.
  • The increase shown in NHA 2017-18 is largely due to increase in Union government expenditure.
  • Increase in Centre’s share: For 2017-18, the Centre’s share in total public spending on health has jumped to 40.8%.
  • However, if we study the spending pattern of the Ministry of Health and Family Welfare and the Ministry of AYUSH, we see that expenditure increased to 0.32% of GDP from 0.27% in 2016-17 — insufficient to explain the overall jump.

Issues with NHA report

  • Expenditure of DMS included: Much of this increase has actually happened on account of a tripling of expenditure of the Defence Medical Services (DMS).
  • Compared to an expenditure of ₹10,485 in 2016-17, it increased to ₹32,118 crore.
  • Though the increasing spending for the health of defence personnel is a good thing, such spending does not benefit the general population. 
  •  Within government expenditure, the share of current health expenditure has come down to 71.9% compared to 77.9% a year ago.
  • Capital expenditure included: This essentially means, capital expenditure has increased, and specifically in defence.
  • There is a problem in accounting capital expenditure within the NHA framework.
  • Why capital expenditure needs to be left out: Equipment brought or a hospital that is built serves people for many years, so the expenditure incurred is used for the lifetime of the capital created and use does not get limited to that particular year in which expenditure is incurred.
  • The World Health Organization proposes to leave out capital expenditure from health accounts estimates, instead focus on current health expenditure.
  • Incomparable to other countries: In NHA estimates in India, in order to show higher public investment, capital expenditure is included; thus, Indian estimates become incomparable to other countries.
  • The NHA estimate also shows that out-of-pocket expenditure as a share of GDP has reduced to less than half of the total health expenditure.
  • NSSO 2017-18 data suggest that during this time period, utilisation of hospitalisation care has declined compared to 2014 NSSO estimates for almost all States and for various sections of society.
  • Sign of distress: The decline in out-of-pocket expenditure is essentially due to a decline in utilisation of care rather than greater financial protection.
  • Actually, the NSSO survey happened just after six months of demonetisation and almost at the same time when the Goods and Services Tax was introduced.
  • The disastrous consequences of the dual blow of demonetisation and GST on the purchasing power of people are quite well documented.
  • Another plausible explanation is linked to limitations in NSSO estimates. The NSSO fails to capture the spending pattern of the richest 5% of the population (who incur a large part of the health expenditure).
  • Thus, out-of-pocket expenditure measured from the NSSO could be an under-estimate as it fails to take into account the expenditure of the richest sections.

Conclusion

The reduction of out-of-pocket expenditure is a sign of distress and a result of methodological limitations of the NSSO, rather than a sign of increased financial protection.

 

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What the latest NFHS data says about the New Welfarism

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- What findings of NHFS-5 imply

Context

The second and final phase of NFHS-5 was released which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population.

Major findings

[1] Success of New Welfarism

  • Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women.
  • The improvements are as striking as they were based on the performance of the phase 1 states.
  • In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.

[2] Child-related outcomes

  • India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade.
  • For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021.
  • On diarrhoea too, adding the new data reverses the earlier finding.
  • However, on anaemia and acute respiratory illness, there seems to have been deterioration.
  • The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states.
  •  The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.

[3] Catch up by the laggard states

  • If the new child stunting numbers are right, a different picture of India emerges.
  • Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh!
  • On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.
  • Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021.

Conclusion

When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics.

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National Health Accounts Estimates: 2017-18

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Health Accounts Estimates: 2017-18

Mains level : Health expenditure in India

Out-of-pocket expenditure (OOPE) as a share of total health expenditure and foreign aid for health has both come down as per the findings of the National Health Accounts (NHA) estimates for India for 2017-18.

What is National Health Accounts (NHA)?

  • The NHA estimates are prepared by using an accounting framework based on internationally accepted System of Health Accounts 2011, provided by the World Health Organization (WHO).
  • It is released by Ministry of Health & Family Welfare.
  • It describes health expenditures and flow of funds in the country’s health system over a financial year of India.
  • It answers important policy questions such as what are the sources of healthcare expenditures, who manages these, who provides health care services, and which services are utilized.
  • It is a practice to describe the health expenditure estimates according to a global standard framework, System of Health Accounts 2011 (SHA 2011), to facilitate comparison of estimates across countries.

Objective of the NHA

  • To describe the Current Health Expenditures (CHE).

The details of CHE are presented according to

  • Revenues of healthcare financing schemes: – entities that provide resources to spend for health goods and services in the health system;
  • Healthcare financing schemes: entities receiving and managing funds from financing sources to pay for or to purchase health goods and services;
  • Healthcare providers: entities receiving finances to produce/ provide health goods and services;
  • Healthcare functions: It describes the use of funds across various health care services.

About NHA (2017-2018)

  • The 2017-18 NHA estimates shows government expenditure on health exhibiting an increasing trend and growing trust in public health care system.
  • With the present estimate of NHA 2017-18, India has a continuous Time Series on NHA estimates for both government and private sources for five years since 2013-14.
  • These estimates are not only comparable internationally, but also enable the policy makers to monitor progress towards universal health coverage as envisaged in the National Health Policy, 2017.

Key Highlights

Increase in GDP share: The NHA estimates for 2017-18 clearly show that there has been an increase in the share of government health expenditure in the total GDP from 1.15% in 2013-14 to 1.35% in 2017-18.

Increase in govt share in expenditures: In 2017-18, the share of government expenditure was 40.8%, which is much higher than 28.6% in 2013-14.

Per-Capita increase in expenditure: In per capita terms, the government health expenditure has increased from Rs 1042 to Rs.1753 between 2013-14 to 2017-18.

Focus on total healthcare: The primary and secondary care accounts for more than 80% of the current Government health expenditure.

Social security expenditure: The share of social security expenditure on health, which includes the social health insurance program, Government financed health insurance schemes, and medical reimbursements made to Government employees, has increased.

Decline in foreign aid: The findings also depict that the foreign aid for health has come down to 0.5%, showcasing India’s economic self-reliance.

Decline in OOPE: The government’s efforts to improve public health care are evident with out-of-pocket expenditure (OOPE) as a share of total health expenditure coming down to 48.8% in 2017-18 from 64.2% in 2013-14.

Way forward

  • After 18 months of Covid-19, financial year 2017-18 appears to be from another era.
  • However, learnings from that year’s NHA help us to plan for health system strengthening in the post-Covid years.
  • The special financing packages for Covid emergency response, announced by the central government in 2020 and 2021, represent an extraordinary situation.
  • The resolve to increase public financing for health must remain strong even after Covid.

 

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Key Demographic Transitions captured by 5th round of NFHS

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Family Health Survey

Mains level : Read the attached story

The Union health ministry released the summary findings of the fifth round of the National Family and Health Survey (NFHS-5), conducted in two phases between 2019 and 2021.

About NFHS

  • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • The previous four rounds of the NFHS were conducted in 1992-93, 1998-99, 2005-06 and 2015-16.
  • The survey provides state and national information for India on:

Fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services etc.

Objectives of the survey

Each successive round of the NFHS has had two specific goals:

  • To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes
  • To provide information on important emerging health and family welfare issues.

Key highlights of the NFHS-5

[1] Women outnumbering men

  • NFHS-5 data shows that there were 1,020 women for 1000 men in the country in 2019-2021.
  • This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.
  • To be sure, in the 2005-06 NFHS, the sex ratio was 1,000 or women and men were equal in number.

[2] Fertility has decreased

  • The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to replace itself from one generation to next.
  • TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1. To be sure, in rural areas, the TFR is still 2.1.
  • In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.

[3] Population is ageing

  • A decline in TFR, which implies that lower number of children are being born, also entails that India’s population would become older.
  • Sure enough, the survey shows that the share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.

[4] Children’s nutrition has improved

  • The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.
  • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.
  • The share of overweight children has increased from 2.1% to 3.4%.

[5] Nutrition problem for adults

  • For children and their mothers, there are at least government schemes such as Integrated Child Development Services (ICDS) that seek to address the nutritional needs at the time of childbirth and infancy.
  • However, there is a need to address the nutritional needs of adults too.
  • The survey has shown that though India might have achieved food security, 60% of Indians cannot afford nutritious diets.
  • While the share of women and men with below-normal Body Mass Index (BMI) has decreased, the share of overweight and obese (those with above-normal BMI) and the share of anaemic has increased.

[6] Basic sanitation challenges

  • Availability of basic amenities such as improved sanitation facilities clean fuel for cooking, or menstrual hygiene products can improve health outcomes.
  • There has been an improvement on indicators for all three since the last NFHS. However, the degree of improvement might be less than claimed by the government.
  • For example, only 70% population had access to an improved sanitation facility.
  • While not exactly an indicator of open defecation, it means that the remaining 30% of the population has a flush or pour-flush toilet not connected to a sewer, septic tank or pit latrine.

[7] Use of clean fuel

  • The share of households that use clean cooking fuel is also just 59%.

[8] Financial inclusion

  • The share of women having a bank account that they themselves use has increased from 53% to 79%.
  • Households’ coverage by health insurance or financing scheme also has increased 1.4 times to 41%, a clear indication of the impact of the government’s health insurance scheme.

 

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HomoSEP: Robot for cleaning Septic Tanks

Note4Students

From UPSC perspective, the following things are important :

Prelims level : HomoSEP

Mains level : Manual scavenging in India

IIT Madras has developed a robot that can, if deployed extensively, put an end to this practice of sending people into septic tanks.

HomoSEP

  • HomoSEP stands for “homogenizer of septic tanks”.
  • It has a shaft attached to blades that can open like an inverted umbrella when introduced into a septic tank.
  • This is helpful as the openings of the septic tanks are small and the tank interiors are bigger.
  • The sludge inside a septic tank contains faecal matter that has thickened like hard clay and settled at the bottom.
  • This needs to be shredded and homogenized so that it can be sucked out and the septic tank cleaned. The whirring blades of the robot achieve precisely this.

Manual scavenging deaths in India

  • A statement by the Social Justice and Empowerment Ministry conveyed that in the five years till December 31, 2020, there have been 340 deaths due to manual scavenging.
  • Uttar Pradesh (52), Tamil Nadu (43) and Delhi (36) leads in the list. Maharashtra had 34 and Gujarat and Haryana had 31 each.
  • This is despite bans and prohibitory orders.

Various policy initiatives

  • Prohibition of Employment as Manual Scavengers and their Rehabilitation (Amendment) Bill, 2020: It proposes to completely mechanise sewer cleaning, introduce ways for ‘on-site’ protection and provide compensation to manual scavengers in case of sewer deaths.
  • Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013: Superseding the 1993 Act, the 2013 Act goes beyond prohibitions on dry latrines, and outlaws all manual excrement cleaning of insanitary latrines, open drains, or pits.
  • Rashtriya Garima Abhiyan: It started national wide march “Maila Mukti Yatra” for total eradication of manual scavenging from 30th November 2012 from Bhopal.
  • Prevention of Atrocities Act: In 1989, the Prevention of Atrocities Act became an integrated guard for sanitation workers since majority of the manual scavengers belonged to the Scheduled Caste.
  • Judicial intervention: In 2014, a Supreme Court order made it mandatory for the government to identify all those who died in sewage work since 1993 and provide Rs. 10 lakh each as compensation to their families.

 

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Health Care Equity in Urban India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Healthcare scenario in urban areas

The report on ‘Health Care Equity in Urban India’ exploring health vulnerabilities and inequalities in cities in India was recently released.

About the report

  • The report is released recently by Azim Premji University in collaboration with 17 regional NGOs across India.
  • It notes that a third of India’s people now live in urban areas, with this segment seeing rapid growth from about 18% (1960) to 28.53% (2001) to 34% (in 2019).
  • The study draws insights from data collected through detailed interactions with civil society organizations in major cities and towns.
  • This also included an analysis of the National Family and Health Surveys (NHFS), the Census of India, and inputs from State-level health officials on the provision of health care.
  • It also looks at the availability, accessibility, and cost of healthcare facilities, and possibilities in future-proofing services in the next decade.

Key highlights of the report

  • Urban poverty on rise: Close to 30% of people living in urban areas are poor.
  • Declining life expectancy: Life expectancy among the poorest is lower by 9.1 years and 6.2 years among men and women, respectively, compared to the richest in urban areas.
  • Chaotic health governance: The report, besides finding disproportionate disease burden on the poor, also pointed to a chaotic urban health governance.
  • Multiplicity and non-coordination: The multiplicity of healthcare providers both within and outside the government without coordination challenges to urban health governance.
  • Lack of political attention: Urban healthcare has received relatively less research and policy attention.

Major recommendations

The report calls for:

  • Strengthening community participation and governance
  • Building a comprehensive and dynamic database on the health and nutrition status, including co-morbidities of the diverse, vulnerable populations
  • Strengthening healthcare provisioning through the National Urban Health Mission, especially for primary healthcare services
  • Putting in place policy measures to reduce the financial burden of the poor
  • A better mechanism for coordinated public healthcare services and better governed private healthcare institutions

Conclusion

  • As urbanization is happening rapidly, the number of the urban poor is only expected to increase.
  • A well-functioning, better coordinated, and governed health care system is crucial at this point.
  • The pandemic has brought to attention the need for a robust and resourced healthcare system.
  • Addressing this will benefit the most vulnerable and offer critical services to city dwellers across income groups.

 

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More a private sector primer than health-care pathway

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- UHC and challenges

Context

NITI Aayog recently published a road map document entitled “Health Insurance for India’s Missing Middle”.

About missing middle and provision in the NITI Aayog report

  • The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), aims to extend hospitalisation cover of up to ₹5 lakh per family per annum to a poor and vulnerable population of nearly 50 crore people.
  • Left out segment: Covering the left out segment of the population, commonly termed the ‘missing middle’ sandwiched between the poor and the affluent, has been discussed by the Government recently.
  • Towards this, NITI Aayog recently published a road map document entitled “Health Insurance for India’s Missing Middle”.
  • Primary role for private commercial health insurer: The report proposes voluntary, contributory health insurance dispensed mainly by private commercial health insurers as the prime instrument for extending health insurance to the ‘missing middle’.

Issues with the provision in the NITI Aayog report

  • Narrow coverage: Government subsidies, if any at all, will be reserved for the very poor within the ‘missing middle’ and only at a later stage of development of voluntary contributory insurance.
  • This is a major swerve from the vision espoused by the high-level expert group on UHC a decade ago, which was sceptical about such a health insurance model.
  • No country has ever achieved UHC by relying predominantly on private sources of financing health care.
  • Contributory insurance not best way: Evidence shows that in developing countries such as India, with a gargantuan informal sector, contributory health insurance is not the best way forward and can be replete with problems.
  • Issues with low premium model: For hospitalisation insurance, the report proposes a model similar to the Arogya Sanjeevani scheme, albeit with lower projected premiums of around ₹4,000-₹6,000 per family per annum.
  • This model is a little different from commercial private insurance, except for somewhat lower premiums.
  • Low premiums are achieved by reducing administrative costs of insurers through an array of measures, including private use of government infrastructure.
  • This model is vulnerable to nearly every vice that characterises conventional private insurance.
  • Insufficient measures to deal with adverse selection: The report suggests enrolment in groups as a means to counter adverse selection.
  • The prevailing per capita expenditure on hospital care is used to reflect affordability of hospital insurance, and thereby, a possible willingness to pay for insurance.
  • Both these notions are likely to be far-fetched in practice, and the model is likely to be characterised by widespread adverse selection notwithstanding.
  • OPD insurance on a subscription basis: The report proposes an OPD insurance with an insured sum of ₹5,000 per family per annum, and again uses average per capita OPD spending to justify the ability to pay.
  • However, the OPD insurance is envisaged on a subscription basis, which means that insured families would need to pay nearly the entire insured sum in advance to obtain the benefits.
  • Clearly, this route is unlikely to result in any significant reduction of out-of-pocket expenditure on OPD care.
  • Role of government:The NITI report defies the universally accepted logic that UHC invariably entails a strong and overarching role for the Government in health care, particularly in developing countries.

Consider the question “What are the challenges in achieving universal health coverage? What are the issues with private sources  financing health care to achieve UHC?”

Conclusion

The National Health Policy 2017 envisaged increasing public health spending to 2.5% of GDP by 2025. Let us not contradict ourselves so early and at this crucial juncture of an unprecedented pandemic.

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

Strengthening healthcare through ABHIM

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ABHIM

Mains level : Paper 2- ABHIM

Context

The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM), announced recently, seeks to realise greater investment in the health system as proposed in the Budget, implement the Fifteenth Finance Commission recommendations such as strengthening of urban and rural primary care, stronger surveillance systems and laboratory capacity.

Measures of ABHIM

  • It will support infrastructure development of 17,788 rural health and wellness centres (HWCs) in seven high-focus States and three north-eastern States.
  • In addition, 11,044 urban HWCs will be established in close collaboration with Urban Local Bodies.
  • The various measures of this scheme will extend primary healthcare services across India.
  • Areas like hypertension, diabetes and mental health will be covered, in addition to existing services.
  • Support for 3,382 block public health units (BPHUs) in 11 high-focus States and establishment of integrated district public health laboratories in all 730 districts will strengthen capacity for information technology-enabled disease surveillance.
  • To enhance the capabilities for microbial surveillance, a National Platform for One Health will be established.
  • Four Regional National Institutes of Virology will be established.
  • Laboratory capacity under the National Centre for Disease Control, the Indian Council of Medical Research and national research institutions will be strengthened.
  • Fifteen bio-safety level III labs will augment the capacity for infectious disease control and bio-security.

Way forward

  • There is a need to train and deploy a larger and better skilled health workforce.
  • We must scale up institutional capacity for training public health professionals.
  • Private sector participation in service delivery may be invited by States, as per need and availability.
  • ABHIM, if financed and implemented efficiently, can strengthen India’s health system by augmenting capacity in several areas and creating a framework for coordinated functioning at district, state and national levels.
  • Many independently functioning programmes will have to work with a common purpose by leaping across boundaries of separate budget lines and reporting structures.
  • That calls for a change of bureaucratic mindsets and a cultural shift in Centre-State relations.

Conclusion

The ABHIM can fix the weaknesses in India’s healthcare system.

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Preparing for outbreaks

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ABHIM

Mains level : Paper 2- ABHIM

Context

Prime Minister Narendra Modi launched the Ayushman Bharat Health Infrastructure Mission, one of the largest pan-India schemes for strengthening healthcare infrastructure, in his parliamentary constituency Varanasi in Uttar Pradesh.

Aims of Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) and how it seeks to achieve it

  • This was launched with an outlay of ₹64,180 crore over a period of five years.
  •  In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment, including critical care services.
  • The latter goal would be met with the establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts.
  • Laboratories and their preparedness: The government will be establishing integrated district public health labs in 730 districts to provide comprehensive laboratory services.
  • Research: ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
  • One health approach: The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
  • Surveillance labs: A network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.
  • Local capacities in urban areas: A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
  • The services from the existing urban primary health centres will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres and polyclinics or specialist clinics.

Conclusion

The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) is another addition to the arsenal we have to prepare for such oubreaks in the future.

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Ayushman Bharat Health Infrastructure Mission

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AB- Health Infrastructure Mission

Mains level : Not Much

PM has launched the Ayushman Bharat Health Infrastructure Mission (AB-HIM), one of the largest pan-India schemes for strengthening healthcare infrastructure.

AB- Health Infrastructure Mission

  • AB-HIM is being rolled out as India’s largest scheme to scale up health infrastructure.
  • It is aimed at ensuring a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.

Key features

  • Health and Wellness Centres: In a bid to increase accessibility it will provide support to 17,788 rural HWC in 10 ‘high focus’ states and establish 11,024 urban HWC across the country.
  • Exclusive Critical Care Hospital Blocks: It will ensure access to critical care services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’.
  • Integrated public health labs: will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
  • Disease surveillance system: The mission also aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
  • Integrated Health Information Portal: All the public health labs will be connected through this Portal, which will be expanded to all states and UTs, the PMO said.

Why is the scheme significant?

  • India has long been in need of a ubiquitous healthcare system.
  • A 2019 study has highlighted how access to public health care remained elusive to those living on the margins.
  • The study found that 70 per cent of the locations have public healthcare services.
  • However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
  • In 45 per cent of the surveyed locations, people could access healthcare services by walking, whereas in 43 per cent of the locations they needed to use transport.

 

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On Digital Health ID, proceed with caution

Note4Students

From UPSC perspective, the following things are important :

Prelims level : DHID

Mains level : Issues with ABDM

Much recently, the Prime Minister had launched the Digital Health ID project (DHID), generating debate on issues related to the use of technology in a broken health system.

Explained: Digital Health ID

Good intents of the DHID

  • The key objective of DHID is to improve the quality, access and affordability of health services by making the service delivery “quicker, less expensive and more robust”.
  • The ambition is undoubtedly high. Given that health systems are highly complex, the DHID would hardly be able to address some of the issues plaguing it.

Why need DHID?

(a) Record maintenance

  • The use of technology for record maintenance is not just inevitable but necessary. Its time has certainly come.
  • A decade ago, the process to shift towards electronic medical records was initiated in the private sector.
  • It met with limited success, despite the strong positives.
  • With DHID, the burden of storing and carrying health records for every visit to the doctor is minimised.

(b) Better tracking of medical history

  • The doctor has instant access to the patient’s case history –the treatment undertaken, where and with what outcomes — enabling more accurate diagnosis and treatment.
  • As the DHID enables portability across geography and healthcare providers, it also helps reduce re-testing or repeating problems every time a patient consults a new doctor.
  • That’s a huge gain, impacting the quality of care and enhancing patient satisfaction and confidence.

(c) Better Diagnosis

  • DHID can have a transformative impact in promoting ecosystems that function as paperless facilities.
  • Paperless hospitals can promote early diagnosis before the patient reaches the doctor after spending long hours in queue.
  • The doctor can already go through the patient’s record and the pharmacist can make the drugs available by the time the patient reached its counter.

(d) Promoting medical research

  • Digitisation of medical records is another important positive, given the problems related to space and retrieving huge databases.
  • Well organised repositories that enable easy access to records can stimulate much-needed research on medical devices and drugs.
  • This storehouse of patient data can be valuable for clinical and operational research.

Given our population, would this be an idealistic expectation?

  • We need to conduct pilot studies to assess the use of technology for streamlining patient flows and medical records and thereby increase efficiencies across different typologies of hospitals and facilities.
  • While technology helps smoothen processes and enhance patient experience, there is a cost attached.
  • Investments have to be made upfront and results should not be expected overnight.

Issues with DHID

(a) A costly affair

  • In the immediate short run, DHID will increase administrative costs by about 20 per cent, due to the capital investment in data infrastructure.
  • Over the long run, the additional cost to healthcare is expected to be about 2 per cent.
  • Any scaling up of this reform would require extensive fiscal subsidies and more importantly providing techno-logistical support to both government and private hospitals.

(b) Privacy concerns

  • Most important is the issue of privacy, the high possibility of hacking and breach of confidentiality.
  • The possibility of privacy being violated increases with the centralisation of all information.
  • Though it is said that the patient is the owner of the information, how many of us deny access, as a matter of routine, when we download apps or programmes that seek access to all our records?
  • How far is this “consent” practical for an illiterate, vulnerable patient desperate to get well?
  • So, taking refuge behind a technical statement that access is contingent on patient consent is unconvincing.

Ground situation in India

  • Inherently unaffordable healthcare: The costs in the Indian context can be high and that should lead to a careful assessment of the project.
  • Digital divide: Such a scenario is not inconceivable and in the case of health, may cause immense hardship to the most marginalised sections of our population.
  • Infrastructure gap: A large majority of facilities do not have the required physical infrastructure — electricity, accommodation, trained personnel.
  • Usual nature of technical glitches: Cards getting corrupted, servers being down, computers crashing or hanging, and power outages are common in India.
  • Conformity over data synchronization: The inability to synchronise biometric data with ID cards has resulted in large-scale exclusions of the poor from welfare projects.
  • Accuracy of records: Besides, the efficacy of the DHID hinges on the assumption that every visit and every drug consumed by the patient is faithfully and accurately recorded.
  • Increased workload on Medical Professionals: Moreover, while electronic mapping of providers may enable patients to spot a less busy doctor near their location, it is simplistic to assume that the patient will go there.

Plugging the existing gaps

  • Patient preference for a doctor is dependent upon perception and trust. Likewise, teleconsultations need a huge backend infrastructure and organisation.
  • Teleconsulting has certainly helped patients access medical advice for managing minor ailments, getting prescriptions on the phone and even getting drugs delivered home.
  • But in handling chronic diseases that necessitate continuity of care, teleconsultations have been problematic and cannot be substituted for actual physical examination.
  • Continuity of care is central to good outcomes in inpatient management of chronic diseases.
  • The one serious shortcoming of using teleconsultation for such management is the high attrition rate of doctors within the context of an overall shortage of doctors.
  • Technology can be of little use in the absence of doctors and basic infrastructure.

Way forward

  • What is needed is building very robust firewalls and trust.
  • Seeing the frequency with which Aadhaar cards have been breached, it is not unreasonable to be concerned with this issue and the implications it has at the family and societal levels.
  • For this reason, instead of a big bang approach, it is better to go slow and steady.
  • That’s the only way to ensure that a good policy does not die along the way due to poor implementation.

 

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What are the concerns of digital health mission?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat Digital Mission

Mains level : Ayushman Bharat Digital Mission

The Ayushman Bharat Digital Mission (ABDM), was recently launched by the PM.

About Ayushman Bharat Digital Mission

  • The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
  • The mission will enable access and exchange of longitudinal health records of citizens with their consent.
  • This will ensure ease of doing business for doctors and hospitals and healthcare service providers.

The key components of the project include

  • Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
  • Healthcare Professionals Registry (HPR)
  • Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine

How will it work?

  • In order to be a part of the ABDM, citizens will have to create a unique health ID – a randomly generated 14-digit identification number.
  • The ID will give the user unique identification, authentication and will be a repository of all health records of a person.
  • The ID can also be made by self-registration on the portal, downloading the ABMD Health Records app on one’s mobile or at a participating health facility.
  • The beneficiary will also set up a Personal Health Records (PHR) address for the issue of consent, and for future sharing of health records.

Major privacy issues involved

  • Informed Consent: The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
  • Data leakages issue: Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
  • Digital divide: Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
  • Data Migration: The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.

Other challenges

  • Existing digitalization is yet incomplete: India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
  • Lack of healthcare facilities: The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
  • Lack of finance: With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.

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Antimalarial drug resistance in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Malaria and it vaccines

Mains level : Non-communicable diseases burden on India

In recent years there is increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.

What is Malaria?

  • Malaria is caused by the bite of the female Anopheles mosquito if the mosquito itself is infected with a malarial parasite.
  • There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
  • Therefore, to say that someone has contracted the Plasmodium ovale type of malaria means that the person has been infected by that particular parasite.

Burden of Malaria in India

  • In 2018, the National Vector-borne Disease Control Programme (NVBDCP) estimated that approximately 5 lakh people suffered from malaria.
  • 63% of the cases were of Plasmodium falciparum.
  • The recent World Malaria Report 2020 said cases in India dropped from about 20 million in 2000 to about 5.6 million in 2019.

Treatment of Malaria

  • Malaria is treated with prescription drugs to kill the parasite. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug.
  • In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment.
  • This is especially against Plasmodium falciparum parasite which is responsible for almost all malaria-related deaths in the world.

Why in news now?

  • There are reports of artemisinin resistance in East Africa and is a matter of great concern as this is the only drug that has saved several lives across the globe.
  • In India, after the failure of chloroquine to treat P. falciparum malaria successfully, artemisinin-based combination therapy was initially introduced in 2008.
  • Currently, several combinations of artemisinin derivatives are registered in India.

Artemisinin-based combination therapy failure in India

  • In 2019, a report from Eastern India indicated the presence of two mutations in P. falciparum cases treated with artemisinin that linked to its presence of resistance.
  • Again in 2021, artemisinin-based combination therapy failure was reported from Central India where the partner drug SP showed triple mutations with artemisinin wild type.
  • This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. Here it is needed to change the partner drug as has been done in NE states in 2013.

History of drug resistance

  • In the 1950s chloroquine resistance came to light.
  • Both chloroquine and pyrimethamine resistance originated from Southeast Asia following their migration to India and then on to Africa with disastrous consequences.
  • Similarly, artemisinin resistance developed from the six Southeast Asian countries and migrated to other continents, as is reported in India and Africa.
  • It would not be out of context that artemisinin is following the same path as has been seen with chloroquine.
  • Now, the time has come to carry out Molecular Malaria Surveillance to find out the drug-resistant variants so that corrective measures can be undertaken in time to avert any consequences.
  • Some experts even advocate using triple artemisinin-based combination therapies where the partner drug is less effective.

Try this PYQ:

Widespread resistance of malarial parasite to drugs like chloroquine has prompted attempts to develop a malarial vaccine to combat malaria.

Why is it difficult to develop an effective malaria vaccine?

(a) Malaria is caused by several species of Plasmodium

(b) Man does not develop immunity to malaria during natural infection

(c) Vaccines can be developed only against bacteria

(d) Man is only an intermediate host and not the definitive host

 

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1
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Explained: Digital Health ID

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Various facts related to digital health ID

Mains level : Features of the ABDM

The PM has recently launched the flagship Ayushman Bharat Digital Mission (ABDM) which involves the creation not just a unique digital health ID for every citizen.

Ayushman Bharat Digital Mission

What is the unique health ID?

  • If a person wants to be part of the ABDM, she must create a health ID, which is a randomly generated 14-digit number.
  • The ID will be broadly used for three purposes: unique identification, authentication, and threading of the beneficiary’s health records, only with their informed consent, across multiple systems and stakeholders.

Why is this initiative significant?

  • The initiative has the potential to “increase the ease of living” along with “simplifying the procedures in hospitals”.
  • At present, the use of digital health ID in hospitals is currently limited to only one hospital or to a single group, and mostly concentrated in large private chains.
  • The new initiative will bring the entire ecosystem on a single platform.
  • The system also makes it easier to find doctors and specialists nearest to you.
  • Currently, many patients rely on recommendations from family and friends for medical consultation, but now the new platform will tell the patient who to reach out to, and who is the nearest.
  • Also, labs and drug stores will be easily identified for better tests using the new platform.

How can one get it?

  • One can get a health ID by self-registration on the portal or by downloading the ABMD Health Records app on one’s mobile.
  • Additionally, one can also request the creation of a health ID at a participating health facility.
  • Health facilities may include government or private hospitals, community health centres, and wellness centres of the government across India.
  • The beneficiary will also have to set up a Personal Health Records (PHR) address for consent management, and for future sharing of health records.

What is a PHR address?

  • It is a simple self-declared username, which the beneficiary is required to sign into a Health Information Exchange and Consent Manager (HIE-CM).
  • Each health ID will require linkage to a consent manager to enable sharing of health records data.
  • An HIE-CM is an application that enables sharing and linking of personal health records for a user.
  • At present, one can use the health ID to sign up on the HIE-CM; the National Health Authority (NHA), however, says multiple consent managers are likely to be available for patients to choose from in the near future.

What does one need to register for a health ID?

  • Currently, ABDM supports health ID creation via mobile or Aadhaar.
  • The official website states that ABDM will soon roll out features that will support health ID creation with a PAN card or a driving licence.
  • For health ID creation through mobile or Aadhaar, the beneficiary will be asked to share details on name, year of birth, gender, address, mobile number/Aadhaar.

Is Aadhaar mandatory?

Ans. No, it is voluntary.

  • One can use one’s mobile number for registration, without Aadhaar.
  • If the beneficiary chooses the option of using her Aadhaar number, an OTP will be sent to the mobile number linked to the Aadhaar.
  • However, if she has not linked it to her mobile, the beneficiary has to visit the nearest facility and opt for biometric authentication using Aadhaar number.
  • After successful authentication, she will get her health ID at the participating facility.

Are personal health records secure?

  • The NHA says ABDM does not store any of the beneficiary health records.
  • The records are stored with healthcare information providers as per their “retention policies”.
  • They are “shared” over the ABDM network “with encryption mechanisms” only after the beneficiary express consent.

Can one delete my health ID and exit the platform?

Ans. Yes, the NHA says ABDM, supports such a feature.  Two options are available: a user can permanently delete or temporarily deactivate her health ID.

  • On deletion, the unique health ID will be permanently deleted, along with all demographic details.
  • The beneficiary will not be able to retrieve any information tagged to that health ID in the future, and will never be able to access ABDM applications or any health records over the ABDM network with the deleted ID.
  • On deactivation, the beneficiary will lose access to all ABDM applications only for the period of deactivation.
  • Until she reactivates her health ID, she will not be able to share the ID at any health facility or share health records over the ABDM network.

What facilities are available to beneficiaries?

  • Users can access personal digital health records right from admission through treatment and discharge.
  • One can access and link his/her personal health records with your health ID to create a longitudinal health history.

What other features will be rolled out?

  • Upcoming new features will enable access to verified doctors across the country.
  • The beneficiary can create a health ID for her child, and digital health records right from birth.
  • Third, she can add a nominee to access her health ID and view or help manage the personal health records.
  • Also, there will be much inclusive access, with the health ID available to people who don’t have phones, using assisted methods.

How do private players get associated with a government digital ID?

  • The NHA has launched the NDHM Sandbox: a digital architecture that allows helps private players to be part of the National Digital Health Ecosystem as health information providers or health information users.
  • The private player sends a request to NHA to test its system with the Sandbox environment.
  • The NHA then gives the private player a key to access the Sandbox environment and the health ID application programming interface (API).
  • The private player then has to create a Sandbox health ID, integrate its software with the API; and register the software to test link records and process health data consent requests.
  • Once the system is tested, the system will ask for a demo to the NHA to move forward. After a successful demo, the NHA certifies and empanels the private hospital.

Now try this PYQ:

Consider the following statements:

  1. Aadhaar metadata cannot be stored for more than three months.
  2. State cannot enter into any contract with private corporations for sharing of Aadhaar data.
  3. Aadhaar is mandatory for obtaining insurance products.
  4. Aadhaar is mandatory for getting benefits funded out of the Consolidated Fund of India.

Which of the statements given above is/are correct?

(a) 1 and 4 only

(b) 2 and 4 only

(c) 3 only

(d) 1, 2 and 3 only

 

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What is Meningitis?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Meningitis

Mains level : NA

The World Health Organization (WHO) has launched the first-ever global strategy to defeat meningitis, a debilitating disease that kills hundreds of thousands of people each year.

What is Meningitis?

  • Meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord.
  • People of any age can get meningitis.

What Causes Meningitis?

  • Most cases are caused by bacteria or viruses, but some can be due to certain medicines or illnesses.
  • Meningitis is usually caused by a viral infection but can also be bacterial or fungal.
  • Both kinds of meningitis spread like most other common infections do — someone who’s infected touches, kisses, or coughs or sneezes on someone who isn’t infected.
  • Bacterial meningitis is rare, but is usually serious and can be life-threatening if not treated right away.
  • Viral meningitis (also called aseptic meningitis) is more common than bacterial meningitis and usually less serious.
  • Many of the viruses that cause meningitis are common, such as those that cause colds, diarrhea, cold sores, and the flu.

What Are the Signs & Symptoms of Meningitis?

  • Meningitis symptoms vary, depending on the person’s age and the cause of the infection.
  • The first symptoms can come on quickly or start several days after someone has had a cold, diarrhea, vomiting, or other signs of an infection.

Common symptoms include:

  • fever
  • lack of energy
  • irritability
  • headache
  • sensitivity to light
  • stiff neck
  • skin rash

Treatment

  • Several vaccines protect against meningitis, including meningococcal, Haemophilus influenzae type b and pneumococcal vaccines.
  • If dealt with quickly, meningitis can be treated successfully.

 

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Ayushman Bharat Digital Mission

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat Digital Mission

Mains level : Features of the ABDM

The PM has launched the Ayushman Bharat Digital Mission to provide a digital Health ID to people which will contain their health records.

Ayushman Bharat Digital Mission

  • The pilot project of the National Digital Health Mission was announced by PM Modi during his Independence Day speech from the Red Fort on August 15, 2020.
  • The mission will enable access and exchange of longitudinal health records of citizens with their consent.
  • This will ensure ease of doing business for doctors and hospitals and healthcare service providers.

The key components of the project include

  • Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application,
  • Healthcare Professionals Registry (HPR)
  • Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine

What makes this special?

  • The mission will create integration within the digital health ecosystem, similar to the role played by the Unified Payments Interface (UPI) in revolutionising payments.
  • Citizens will only be a click-away from accessing healthcare facilities.

 

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Disease surveillance system

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Integrated disease surveillance project

Mains level : Paper 2- Disease surveillance

Context

A well-functioning system can reduce the impact of diseases and outbreaks.

Importance of disease surveillance system

  • Successful tackling of cholera in 1854 in London by use of the health statistics and death registration data from the General Registrar Office (GRO) started the beginning of a new era in epidemiology.
  • Importance of data: The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
  • This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
  • Subsequently, the high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
  • Then, in the second half of the Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
  • These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

Surveillance in India

  • The Government of India launched the National Surveillance Programme for Communicable Diseases in 1997.
  • However, this initiative remained rudimentary.
  • In wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
  • The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

Issues with surveillance: Interstate variation

  • Variation among states: The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
  • In the fourth round of serosurvey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected.
  • This points towards a weak disease surveillance system.
  • In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.
  • While Kerala is picking the maximum COVID-19 cases; it could pick the first case of the Nipah virus in early September 2021. 
  • On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.

Way forward

  • A review of the IDSP in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems.
  • These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
  • Increase allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
  • Trained workforce: The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
  • The vacancies of surveillance staff at all levels need to be urgently filled in.
  • Capacity increase: The laboratory capacity for COVID-19 needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
  • The interconnectedness of human and animal health: The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.
  • The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
  • Strengthening registration system: There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of death (MCCD).
  • Coordination: It is also time to ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
  • The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

Consider the question “Examine the measure for disease surveillance in India? How it can help reduce the impact of the diseases?”

Conclusion

We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with the application of principles of epidemiology, we can reduce their impact.

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What is Serotype 2 Dengue?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Dengue

Mains level : NA

The Union Health Ministry has flagged the emerging challenge in 11 States across India of serotype 2 dengue, which it said is associated with “more cases and more complications” than other forms of the disease.

Try this PYQ from CSP 2015:

Q. Consider the following statements:

  1. In tropical regions, Zika virus disease is transmitted by the same mosquito that transmits dengue.
  2. Sexual transmission of Zika virus disease is possible.

Which of the statements given above is/are correct?

(a) 1 only

(b) 2 only

(c) Both 1 and 2

(d) Neither 1 nor 2

 

Post your answers here!
2
Please leave a feedback on thisx

What is Dengue?

  • Dengue is a mosquito-borne viral infection, found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
  • It is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus.
  • These mosquitoes are also vectors of chikungunya, yellow fever and Zika viruses.
  • Dengue is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature, relative humidity and unplanned rapid urbanization.

Its transmission

  • The virus is transmitted to humans through the bites of infected female mosquitoes, primarily the Aedes aegypti
  • Other species within the Aedes genus can also act as vectors, but their contribution is secondary to Aedes aegypti.
  • Mosquitoes can become infected from people who are viremic with dengue.

Various serotypes

  • Dengue is caused by a virus of the Flaviviridae family and there are four distinct, but closely related, serotypes of the virus that cause dengue (DENV-1, DENV-2, DENV-3 and DENV-4).
  • Recovery from infection is believed to provide lifelong immunity against that serotype.
  • However, cross-immunity to the other serotypes after recovery is only partial and temporary.
  • Subsequent infections (secondary infection) by other serotypes increase the risk of developing severe dengue.

UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

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

Outpatient Opioid Assisted Treatment Centres

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Drug rehabiliation

The state government in Punjab is banking on Outpatient Opioid Assisted Treatment Centres (OOAT) to curb the drug menace in the state.

What are the OOAT Centres?

  • The move to set up OOAT centres in Punjab began in October 2017.
  • The centres administer de-addiction medicine, a combination of buprenorphine and naloxone, to the opioid-dependent people registering there.
  • Administered in the form of a pill, the treatment is primarily for addicts of opioid drugs, including heroin, poppy husk and opium.
  • There are such private and state-run centres in Punjab.

Why is the Punjab government planning?

  • Punjab is planning to open OOAT linked extension centres and clinics in rural areas to broaden the outreach of this treatment.
  • The idea is that patients get medicine nearer their place of residence.
  • It will also reduce pressure on existing OOAT centres which cater to patients from far-off places.

Administering medicine at OOAT Centres

The patients are broadly put into three categories or phases.

  • In the induction phase, the newly-registered patients are administered medicine at the OOAT centres for a week or two to manage withdrawal symptoms in the presence of the doctor and counselor.
  • In the second, stabilization, phase, which extends between two to four months.
  • The patient is put on watch for taking any opioid-based “super-imposed” illicit drug and accordingly maximum tolerated dose is administered to nullify the kick of the “super-imposed” drug.
  • In the third, maintenance, phase, the patient is given take-home medicine and it continues for a year and a half before an assessment is done to see whether the medicine can be tapered off.

Why is Punjab banking so much on OOAT therapy?

There are two major approaches to wean away opioid-dependent persons.

  • One is the abstinence approach and another alternate medication approach.
  • There are more chances of relapse in an abstinence-based approach as compared to alternate medication for de-addiction.
  • In the abstinence approach, it would have taken years to rehabilitate patients by admitting them to facilities and there would have been increased chances of relapse.
  • On the other hand, the alternate medication approach has been acknowledged as better in various scientific studies worldwide.

UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

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

Why India needs an NHS-like healthcare model

Note4Students

From UPSC perspective, the following things are important :

Prelims level : India's expenditure on health

Mains level : Paper 2- India needs NHS like healthcare model

Context

Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.

About NHS

  • Every year, Britain’s legendary health network National Health Service (NHS) cures 15 million patients with chronic ailments, at a fraction of the cost spent by the US.
  • The NHS funded by direct taxes is also the fifth largest employer in the world, after McDonalds and Walmart.
  • One of every 20 British workers is employed as a doctor, nurse, catering and technical personnel.

Public healthcare in India

  • Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.
  • In contrast, China invests around 3 per cent, Britain 7 per cent and the United States 17 per cent of GDP.
  • So, 62 per cent of health expenses in India are paid for by patients themselves
  • This is one of the main reasons for families falling into poverty especially during the pandemic.
  • In India, hospitals are beleaguered with absentee staff.
  • As per a Niti Aayog database, in the worst state of Bihar in 2017-18, positions for 60 per cent of midwives, 50 per cent of staff nurses, 34 per cent of medical officers and 60 per cent of specialist doctors were vacant.
  • Those on the job, despite being handsomely paid, are chronically overworked.

Conclusion

In the 21st century, not much has improved in India’s public hospitals. Still, in India doctors are often equated with gods. What India needs in NHS like healthcare model.

UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

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

Issues related to people with disabilities

Note4Students

From UPSC perspective, the following things are important :

Prelims level : CRPD

Mains level : Paper 2- Ensuring the dignity of persons with disability

Context

Twenty years ago on August 6 in Erwadi in Tamil Nadu’s Ramanathapuram, a fire broke out in a thatched shelter, engulfing 43 chained people who had psychosocial disabilities.

Legal provision for the persons with disabilities

  • India ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007.
  • The Rights of Persons with Disabilities Act  was enacted in 2016.
  • The Mental Healthcare Act (MHCA) was enacted in 2017.

Failure of the states

  • Sates have failed to uphold the human rights of people with disabilities in general and those with psychosocial and intellectual disabilities in particular.
  • Only eight states/UTs — Karnataka, Andhra Pradesh, Uttar Pradesh, Jammu & Kashmir, Maharashtra, Odisha, Kerala, and West Bengal — have framed rules for implementation of MHCA.
  • Unless we implement the law in letter and spirit, the Global Mental Health Movement will remain a mere buzzword and the CRPD-reliant MHCA will remain a law only on paper.

Violations of rights in private asylums

  • Private asylums survive because of their close proximity to faith-based healing centres.
  • Because mental health conditions carry a high stigma, caregivers flock to these faith-based facilities in the hopes of finding a cure.
  • Private players take advantage of their vulnerabilities, forcing such persons with psychosocial issues to be grouped together and chained in these shelters.
  • Chaining in any way or form is outlawed under Section 95 of the MHCA.

Way forward

  • Human right approach: We must work to ensure that the human rights approach to disability is integrated into mental health systems, education, law, and bureaucracy.
  • We move away from pathologisation, segregation, and a charity-based approach.

Conclusion

Implementation of rights of the persons with disability needs implementation in letter and spirit and human rights based approach.

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

India’s technical education: Issues and Suggestions

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AICTE

Mains level : Paper 2- Issues of technical education in India

Context

This year, AICTE approved the closure of 63 engineering colleges across the country.

Deterioration of quality

  • Tweaking with curriculum: Private entrepreneurs took the lead to meet the growing demand of the country in technical education in the mid-Eighties, but with little idea of the subject.
  • Subjects like materials, applied physics and thermodynamics which forms the building blocks of engineering became dispensable.
  • Because they were both tough to teach for the teachers and tough to pass for the students.
  • Expansion: This softening of subjects coupled with unfettered expansion in the early and mid-2000s, resulted in real dilution of the overall standards in the country.
  • Lack of adequate number of teachers, lack of quality in those available, inability of the management to make adequate investments in a dynamic environment, lack of employment opportunities, shelf life of skills coming down with every technology-related intervention and a constant experimentation with curriculum have all been the bane of quality in technical education.

Issues

  • Engineering education suffers from regulatory gaps, poor infrastructure, lack of qualified faculty and the non-existent industry linkage that contributed to the abysmal employability of graduates from most of these institutes.
  • No linkage with Industry: Not a single industry body, be it CII, FICCI or ASSOCHAM has managed to effectively inform the education planners on the growth in different employment sectors.
  • No independent body to suggest AICTEC: The government also has not taken any tangible steps to set up an independent body to advise AICTE on this vital aspect.
  • Excessive changes: A constant fiddling with the curriculum, reducing total credits, giving multiple choices in the name of flexibility, dispensing with mathematics and physics at the qualification level, teaching in local languages may all be good arguments, but one must assess their utility and their effect on technical education in the long run.

Way forward

  • Proactive: Rather than being reactive, institutions must proactively define the practicing elements of education.
  • Investment in teaching: The corrective measures for these shortfalls are technology intensive, are experiential, and need investments in teaching.
  • Quality assurance body: The ultimate measure of performance is embedded in quality assurance.
  • The need of the hour is to create a truly autonomous quality assurance body at an arms-length from the government, manned by eminent persons both from the industry as well as academia.

Conclusion

The education paradigm is staring at a large shift and technical education cannot remain immune to that change.

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

Organ Transplantation in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NOTP

Mains level : Organ transplantation in India

The Government of India is implementing National Organ Transplant Programme (NOTP) to promote organ donation and transplantation across all States/Union Territories (UTs).

National Organ Transplant Programme (NOTP)

  • In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
  • Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.

Types of Organ Donations

  • The law allows both deceased and living donors to donate their organs.
  • It also identifies brain death as a form of death.
  • Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.

(1) Deceased donors:

  • They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
  • Uterus transplant is also performed, but it is not regarded as a life-saving organ.
  • Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
  • Brainstem death is also recognized as a form of death in India, as in many other countries.
  • After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs

(2) Living donors:

They are permitted to donate the following:

  • one of their kidneys
  • portion of pancreas
  • part of the liver

Features of the NOTP

  • Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
  • Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio- material centre.
  • As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.

More moves for facilitation:  Green Corridors

  • Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
  • Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
  • A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.

About NOTTO

National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

  1. National Human Organ and Tissue Removal and Storage Network
  2. National Biomaterial Centre (National Tissue Bank)

[I] National Human Organ and Tissue Removal and Storage Network

  • This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
  • The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
  • Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
  • It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.

[II] National Biomaterial Centre (National Tissue Bank)

  • The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
  • It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
  • The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.

The centre will take care of the following Tissue allografts:

  1. Bone and bone products
  2. Skin graft
  3. Cornea
  4. Heart valves and vessels

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

A cardinal omission in the COVID-19 package

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Importance of medical workforce in making the healthcare system robust

Context

On July 8, 2021, the Union government announced the “India COVID-19 Emergency Response and Health Systems Preparedness Package: Phase II”. But it lacks provision for the medical workforce.

Objectives of the package

  • The stated purpose of the package is to boost health infrastructure and prepare for a possible third wave of COVID-19.
  • There is plan to increase COVID-19 beds, improve the oxygen availability and supply, create buffer stocks of essential medicines; purchase equipment and strengthen paediatric beds.

What is lacking in the package?

  • Workforce shortage: The package barely has any attention on improving the availability of health human resources.
  • As reported in rural health statistics and the national health profile there are vacancies for staff in government health facilities, which range from 30% to 80% depending upon the sub-group of medical officers, specialist doctors to nurses, laboratory technicians, pharmacists and radiographers, amongst others.
  • Interstate variation: In addition, there are wide inter-State variations, with States that have poor health indicators with the highest vacancies.

Way forward

  • Package for filling the existing vacancies: The COVID-19 package II needs to be urgently supplemented by another plan and a similar financial package (with shared Union and State government funding) to fill the existing vacancies of health staff at all levels. 
  • An objective approach to assess the mid-term health human resource needs could be the Indian Public Health Standards (IPHS).
  • IPHS prescribes the human resources and infrastructure needed to make various types of government health facilities functional.
  • The pandemic should be used as an opportunity to prepare India’s health system for the future.
  • Scrutiny of the progress on policy decision: The progress on key policy decisions, for the last few years, to strengthen India’s health system, including those in India’s national health policy of 2017, need to be objectively scrutinised.
  • These two sets of policy decisions should be reviewed and progress monitored, through a meeting of the Central Council of Health and Family Welfare, of which the Health Ministers of the States are members.

Conclusion

India’s health system will not benefit from ad hoc and a patchwork of one or other small packages. It essentially needs some transformational changes.

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

Mental health care in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Shift in mental health care system needed

Context

Recently, a High Court suggested that homeless persons with health conditions be branded with a permanent tattoo, when vaccinated against COVID-19.

Issue

  • In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison.
  • On the other hand, many persons with mental health issues live and even die alone on the streets.
  • Three losses dominate the mental health systems narrative: dignity, agency and personhood.
  • Issues with the laws: Far-sighted changes in policy and laws have often not taken root and many laws fail to meet international human rights standards.
  • Many also do not account for cultural, social and political contexts resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
  • There is also the social legacy of the asylum, and of psychiatry and mental illness itself, that guides our imagination in how care is organised.

Way forward: A responsive care system

  • We must understand mental health conditions for what they are and for how they are associated with disadvantage.
  • These situations are linked, but not always so, therefore, not all distress can be medicalised.
  • Adopt WHO guidelines: Follow the Guidance on Community Mental Health Services recently launched by the World Health Organization.
  • The Guidance, which includes three models from India, addresses the issue from ‘the same side’ as the mental health service user and focuses on the co-production of knowledge and on good practices.
  • Drawn from 22 countries, these models balance care and support with rights and participation.
  • Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance.
  • This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
  • Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
  • Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.
  • Small emergency care and recovery centres for those who need crisis support instead of larger hospitals, and long-term inclusive living options in an environment that values diversity and celebrates social mixing, will reframe the archaic narrative of how mental health care is to be provided.

Conclusion

Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.

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

NITI Aayog releases study on ‘Not-for-Profit’ hospital model

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : India's healthcare system and its limitations

NITI Aayog has released a comprehensive study on the not-for-profit hospital model in the country, in a step towards closing the information gap on such institutions and facilitating robust policymaking in this area.

‘Not-for-Profit’ hospitals

  • The “Not-for-Profit” Hospital Sector has the reputation of providing affordable and accessible healthcare for many years.
  • This sector provides not only curative healthcare, but also preventive healthcare, and links healthcare with social reform, community engagement, and education.
  • They utilize the resources and grants provided to them by the Government to provide cost-effective healthcare to the population without being overly concerned about profits.
  • However, this sector remains largely understudied, with a lack of awareness about its services in the public domain.

Significance for India

  • As per the NITI Aayog’s report, the not-for-profit hospitals account for only 1.1% of treated ailments as of June 2018.
  • The report further revealed that for-profit hospitals account for 55.3% of in-patients, while not-for-profit hospitals account for only 2.7% of in-patients in the country.
  • The cumulative cost of care at not-for-profit hospitals is lesser than for-profit hospitals by about one-fourth in the in-patient department.
  • This is reckoned by the package component of cost, which is approximately 20% lower, the doctor’s or surgeon’s charges, which are approximately 36% lower and the major aspect being the bed charges, which are approximately 44% lower than the for-profit hospitals.

NITI Aayog’s approach

  • Categorization of the prominent not-for-profit hospitals based on the premise of services and their ownership
  • Understanding the business model of the hospitals i.e. the financial viability, and their dependence on donations and grants
  • Understanding the challenges faced by these hospitals
  • Formulation of recommendations for policy interventions to promote the sector

Categories of such hospitals

Using the above-mentioned approach and secondary research, the following four categories were defined for the not-for-profit hospitals:

  1. Faith-based Hospitals
  2. Community-based Hospitals
  3. Cooperative Hospitals
  4. Private Trust Hospitals

Why need such hospitals?

  • There has been relatively low investment in the expansion of the health sector in the private domain.
  • The not-for-profit hospital sector provides not only curative but also preventive healthcare.
  • It links healthcare with social reform, community engagement, and education.
  • It uses government resources and grants to provide cost-effective healthcare to people without being concerned about profits.

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

Centre must make way for states in Covid fight

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Role of the States in health crisis

The States are better equipped to deal with the health emergencies and the Centre needs to augment them in their efforts. The article deals with this issue.

Role of the States in health crisis

  • Covid-19 pandemic is a national crisis calling for concerted efforts by both, the Government of India (GoI) and state governments.
  • Health is a state subject, and the states have been pioneering many health programmes on their own, some with support and funding from the GoI, for a very long time.
  • The number of employees in the health wing of the GoI is negligible as compared to that in any state government.
  • The GoI must help them, motivate them to do better and assist them in their task.
  • Also, the GoI must and can play a major role is in vaccination.

Role of the Central government

  • It must try to augment supplies by encouraging companies to produce more and through imports/gifts.
  •  However, whatever it procures must be allotted to states in proportion to their eligible population.
  • State governments must be involved in this policy.
  • The vaccination policy may be left to the state governments based on the allocation. 
  • The GoI must also augment supplies of critical medical goods through imports and donations from friendly nations in view of their acute shortage.
  • It must distribute them to the needy states transparently and equitably.

Steps that need to be taken

  • Lockdowns need to be lifted in a calibrated manner depending on local conditions.
  • Lockdowns are not the solution, they just buy breathing time which can be used by governments to ramp up capacity.
  • State governments must set up efficient and well-functioning control rooms and telemedicine centres to guide people on home treatment and timely admission to hospitals.
  • The private sector can also be fully involved in these efforts.
  • Bed capacity must be increased in both private and public sectors, with all necessary requirements such as oxygen, medicines, and health workers.
  • It is also important to put in place a standard guidance protocol for health workers and control rooms to guide patients through the disease.
  •  Enforcement of masks and distancing in public places must go on till the country is fully vaccinated.
  • The measures suggested above require hard work and efficient management by state governments, by a team of reputed professionals and civil servants.
  • Daily briefing by a professional, not a politician, is the need of the hour at both the Centre and state level, giving some confidence and assurance to the public.

Consider the question “In dealing with the health crisis the Union Government and the State governments are better placed for certain roles.  In light of this, examine the important role of the States in dealing with the Covid pandemic and how the Union government can complement it.”

Conclusion

The central government must realise that states are on the forefront in this war, and therefore, play a supporting and proactive role. It has only a minor, behind-the-scenes role in the health sector.

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

A place for disruptive technology in India’s health sector

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Use of disruptive technologies in medical sector

The adoption of technologies such as AI and blockchain has the potential to transform the medical sector. 

How new technologies can play important role in medical sector

1) Blockchain technology

  • Blockchain technology can help in addressing the interoperability challenges that health information and technology systems face.
  • The health blockchain would contain a complete indexed history of all medical data, including formal medical records and health data from mobile applications and wearable sensors.
  • This can also be stored in a secure network and authenticated, besides helping in seamless medical attention.

2) Big data analytics

  • Big data analytics can help improve patient-based services tremendously such as early disease detection.
  • AI and the Internet of Medical Things, or IoMT are shaping healthcare applications.
  • IoMT is defined as a connected infrastructure of medical devices, software applications, and health systems and services.

3) Medical autonomous system

  • Medical autonomous systems can also improve health delivery to a great extent and their applications are focused on supporting medical care delivery in dispersed and complex environments with the help of futuristic technologies.
  • This system may also include autonomous critical care system, autonomous intubation, autonomous cricothyrotomy and other autonomous interventional procedures.

4) Cloud computing

  • Cloud computing is another application facilitating collaboration and data exchanges between doctors, departments, and even institutions and medical providers to enable best treatment.

Challenges

  • The possible constraints in this effort are standardisation of health data, organisational silos, data security and data privacy, and also high investments.

Using technology for Universal Health Coverage

  • According to the World Health Organization, Universal health coverage (UHC) is a powerful social equalizer and the ultimate expression of fairness.
  • Studies by WHO show that weakly coordinated steps may lead to stand-alone information and communication technology solutions.
  • India needs to own its digital health strategy that works and leads towards universal health coverage and person-centred care.
  • Such a strategy should emphasise the ethical appropriateness of digital technologies, cross the digital divide, and ensure inclusion across the economy.
  • ‘Ayushman Bharat’ and tools such as Information and Communication Technology could be be fine-tuned with this strategy to promote ways to protect populations.
  • Online consultation should be a key part of such a strategy.

Using local knowledge

  • In addition to effective national policies and robust health systems, an effective national response must also draw upon local knowledge.
  • Primary health centres in India could examine local/traditional knowledge and experience and then use it along with modern technology.

Way forward

  • Initial efforts in this direction should involve synchronisation and integration, developing a template for sharing data, and reengineering many of the institutional and structural arrangements in the medical sector.
  • Big data applications in the health sector should help hospitals provide the best facilities and at less cost, provide a level playing field for all sectors, and foster competition.

Consider the question “Examine the role technologies such as AI and data analytics could play in the medical sector. What are the challenges in the adoption of such technologies?”

Conclusion

The above-discussed aspects highlight the potential benefits of the adoption of disruptive technologies in the healthcare system. India should embrace it while addressing the concerns with such technologies.

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

China to allow couples for third child

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : One-Child Policy

China will for the first time allow couples to have a third child in a further relaxation of family planning rules five years after a “two-child policy” largely failed to boost birth rates.

Do you think that the One-Child Policy would be effective for population control in India?

What was the One-Child Policy?

  • China embarked upon its one-child policy in 1980 when the Communist Party was concerned that the country’s growing population, which at the time was approaching one billion, would impede economic progress.
  • The policy was implemented more effectively in urban areas.
  • It was enforced through several means, including incentivizing families financially to have one child, making contraceptives widely available, and imposing sanctions against those who violated the policy.

How well did the policy fare?

  • Chinese authorities have long hailed the policy as a success, claiming that it helped the country avert severe food and water shortages by preventing up to 40 crore people from being born.
  • However, the policy was also a source of discontent, as the state used brutal tactics such as forced abortions and sterilizations.
  • It also met criticism and remained controversial for violating human rights, and for being unfair to poorer Chinese since the richer ones could afford to pay economic sanctions if they violated the policy.
  • Additionally, China’s rulers have been accused of enforcing reproductive limits as a tool for social control.
  • The Uighur Muslim ethnic minority, for example, has been forced to have fewer children to restrict the growth of their population.

Demographic changes due to the policy

  • Due to the policy, while the birth rate fell, the sex ratio became skewed towards males.
  • This happened because of a traditional preference for male children in the country, due to which abortion of female fetuses rose and so did the number of girls who were placed in orphanages or abandoned.
  • Experts have also blamed the policy for making China’s population age faster than other countries, impacting the country’s growth potential.
  • It is also suggested that because of the long-lingering impact of the policy, China would be unable to reap the full benefits of its economic growth and will need other ways to support it.

Skeptics of the new move

  • Experts say relaxing limits on reproductive rights alone cannot go a long way in averting an unwanted demographic shift.
  • The main factors behind fewer children being born, they say, are rising costs of living, education, and supporting aging parents.
  • The problem is made worse by the country’s pervasive culture of long working hours.
  • There has also been a cultural shift during the decades in which the one-child policy remained in force, with many couples believing that one child is enough, and some expressing no interest in having children.

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

What are Neglected Tropical Diseases (NTD)?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Neglected Tropical Diseases

Mains level : Burden of NTD in India

The ongoing World Health Assembly has declared January 30 as ‘World Neglected Tropical Diseases (NTD) Day’.

Neglected Tropical Diseases

  • NTDs are a group of infections that are most common among marginalized communities in the developing regions of Africa, Asia, and the Americas.
  • They are caused by a variety of pathogens such as viruses, bacteria, protozoa, and parasitic worms.
  • These diseases generally receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
  • Some examples of NTDs include snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease.

Significance of global recognition

  • NTDs affect more than a billion people globally, according to the WHO. They are preventable and treatable.
  • However, these diseases and their intricate interrelationships with poverty and ecological systems — continue to cause devastating health, social and economic consequences.
  • A major milestone in the movement to recognize the global burden of these diseases was the London Declaration on NTDs that was adopted January 30, 2012.
  • The first World NTD Day was celebrated informally in 2020. This year, the new NTD road map was launched.

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

WHO BioHub: Global Facility for Pathogen Storage

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO BioHub and its purpose

Mains level : Not Much

The World Health Organization (WHO) and Switzerland have signed an MoU to launch a BioHub facility that will allow rapid sharing of pathogens between laboratories and partners to facilitate better analysis and preparedness against them.

WHO BioHub

  • The BioHub will enable member states to share biological materials with and via the BioHub under pre-agreed conditions, including biosafety, biosecurity, and other applicable regulations.
  • The facility will help in the safe reception, sequencing, storage, and preparation of biological materials for distribution to other laboratories, so as to facilitate global preparedness against these pathogens.
  • It would be based in Spiez, Switzerland.
  • Pathogens are presently shared bilaterally between countries: A process that can be sluggish and deny the benefits to some.

Its significance

  • This will ensure timeliness and predictability in response activities.
  • The move is significant in the view of the novel coronavirus disease (COVID-19) pandemic and the need to underline the importance of sharing pathogen information to assess risks and launch countermeasures.
  • The move will help contribute to the establishment of an international exchange system for novel coronavirus SARS-CoV-2 and other emerging pathogens.

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

The fault line of poor health infrastructure

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Poor public health infrastructure in India and its consequences

The poor public health infrastructure in India hits the poor hard. The article examines the factors responsible for poor public health infrastructure and suggests the measures to deal with it.

Poor state of health infrastructure

  • World Bank data reveal the poor state of India’s health infrastructure.
  • It reveals that India had 85.7 physicians per 1,00,000 people in 2017.
  • In contrast, it is 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan.
  • India had 53 beds per 1,00,000 people.
  • It is 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan.
  • India had172.7 nurses and midwives per 1,00,000 people in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan.

What are the factors responsible for poor health infrastructure?

  • Stagnant expenditure: Analysis by the Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that health expenditure has been stagnant for years.
  • Lack of expertise with states: Despite health being a state subject, the main bodies with technical expertise are under central control.
  • The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
  • Inter-State variation: States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.
  • Kerala and Delhi have been close to top in years from 2011 to 2019-20.
  • Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in the same years.

Out-of-pocket expenditure and its impact on the poor

  • Due to low levels of public health provision, the World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
  • Some of the poorest States, Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha, have a high ratio of OOP expenditures in total health expenditure.
  • Impact on the poor: High ratio of OOP means that the poor in the poorest States, the most vulnerable sections, are the worst victims of a health emergency.

Way forward

1) Coordinated national plan

  • The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
  • The Centre already tightly controls major decisions, including additional resources raised specifically for pandemic relief, e.g. the PM CARES Fund.
  • The need for a coordinated strategy on essential supplies of oxygen and vaccines is acute.
  • The Centre can bargain for a good price from vaccine manufacturers in its capacity as a single large buyer like the European Union did for its member states.
  • Centre will also benefit from the economies of scale in transportation of vaccines into the country.
  • Once the vaccines arrive in India, these could be distributed across States equitably in a needs-based and transparent manner.
  • Another benefit of central coordination is that distribution of constrained resources like medical supplies, financial resources can internalise the existing disparities in health infrastructure across States.

2) Form Pandemic Preparedness Unit

  • There is a need for the creation of a “Pandemic Preparedness Unit” (PPU) by the central government.
  • PPU would streamline disease surveillance and reporting systems; coordinate public health management and policy responses across all levels of government.
  • It will also formulate policies to mitigate economic and social costs, and communicate effectively about the health crisis.

Consider the question “India has among the highest out-of-pocket expenditure in the world, which is the result of poor public health infrastructure. Examine the factors responsible for poor public health infrastructure and suggest the ways to deal with it.”

Conclusion

As and when we emerge on the other side of the pandemic, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States.

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

Medicine from the Sky Project

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Medicine from the Sky Project

Mains level : Innovation in healthcare services

The Telangana government has selected 16 primary healthcare centres (PHCs) spread around Vikarabad area hospital for pilot testing the ambitious ‘Medicine from the sky’, the first-of-its-kind project involving delivery of medicines through multiple drones.

Medicine from the Sky Project

  • A consortium of seven operators headed by Blue Dart Med-Express had been selected for the project to be launched in the VLOS range of 500 metres initially and will be scaled up gradually to a 9 km range.
  • The selected PHCs are both within the Visual Line of Sight (VLOS) and Beyond Visual Line of Sight (BVLOS) range.
  • The project would be launched in three waves starting with a pilot followed by mapping the route network for the operation of drones for delivering vaccine/medicine in the desired community health centres and PHCs.
  • The project is being launched following the approval granted by the Civil Aviation Ministry to the request made by the State to grant conditional exemption from the Unmanned Aircraft System Rules 2021.

Benefits of the project

  • The project is aimed at assessing alternative logistics route in providing safe, accurate and reliable pickup and delivery of health care items like medicines, vaccines, units of blood and other lifesaving equipment from the distribution centre to a specific location and back.
  • The model, once successful, would enable deliveries from district medical stores and blood banks to PHCs, CHCs and further from PHCs/CHCs to central diagnostic laboratories.

Back2Basics: What is VLOS (Visual Line of Sight)?

  • Visual Line of Sight (‘VLOS’) operations are a type of operation in which the remote pilot maintains continuous, unaided visual contact with the unmanned aircraft. In its simplest term, the aircraft must always be visible to the pilot.
  • This allows the remote pilot to control the flight path of the unmanned aircraft in relation to other aircraft, people, and obstacles for the purpose of avoiding collisions.
  • Extended Visual Line of Sight operations (‘EVLOS’) allows flight Beyond Visual Line of Sight of the Remote Pilot by using ‘trained observers’.
  • Trained observers are used to comply with the separation and collision avoidance responsibilities of the operator.
  • ‘Beyond Visual Line of Sight’ operations is where the flying of a drone is without  a pilot maintaining a visual line of sight on the aircraft at all times.
  • Instead, the pilot operates the UAV using Remote Pilot Station (RPS) / Ground Control Station (GCS) instruments.

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

Brain drain of India’s health worker

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- India's health worker brain drain

The article highlights the issue of shortage of healthcare workers in India even as it exports its healthcare workers to other countries.

India as an exporter of healthcare workers

  • For several decades, India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council countries, Europe and other English-speaking countries.
  • As per OECD data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017.
  • In these four countries, 56,000 Indian-trained nurses were working in the same year.
  • There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.
  • There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.

Shortage of nurses and doctors

  • The migration of healthcare workers is part of the reason for the shortage in nurses and doctors.
  • If we look at the figures for countries where we export our healthcare workers, we see just how big the difference is between the sending and the receiving countries.
  • As per government reports, India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1,404.
  • This is well below the WHO norm of 3 nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
  • But, this does not convey the entire problem.
  • The distribution of doctors and nurses is heavily skewed against some regions.
  • Moreover, there is high concentration in some urban pockets.

Factors driving migration

  • There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries.
  • However, there are strong push factors that often drive these workers to migrate abroad.
  • The low wages in private sector outfits along with reduced opportunities in the public sector plays a big role in them seeking employment opportunities outside the country.
  • The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration.

Measures to check brain drain and issues with it

  • Over the years, the government has taken measures to check the brain drain of healthcare workers with little or no success.
  • In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US.
  • The NORI certificate is a US government requirement for doctors who migrate to America on a J1 visa and seek to extend their stay beyond three years.
  • The non-issuance of the NORI would ensure that the doctors will have to return to India at the end of the three-year period.
  • The government has included nurses in the Emigration Check Required (ECR) category.
  • This move was taken to bring about transparency in nursing recruitment and reduce the exploitation of nurses in the destination countries.
  • The government’s policies to check brain drain are restrictive in nature and do not give us a real long-term solution to the problem.

Way forward

  • We require systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to workers and building an overall environment to motivate them to stay in the country.
  • The government should focus on framing policies that promote circular migration and return migration — policies that incentivise healthcare workers to return home after the completion of their training or studies.
  •  It could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.
  • The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world.
  • Increased investment in healthcare, especially in the public sector, is thus the need of the hour.
  • This would, in turn, increase employment opportunities for health workers.

Consider the question “What are the factors driving the migration of healthcare workers from India? Suggest the measure to stem their migration.”

Conclusion

India needs systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to health workers and building an overall environment that could prove to be beneficial for them and motivate them to stay in the country.

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

Risk of mucormycosis in Covid-19 patients

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Mucormycosis

Mains level : Paper 2- Mucormycosis infection risk in Covid-19 patients

About mucormycosis

  • Mucormycosis is a fungal infection that has a high mortality rate of 50 per cent.
  • An increasing number of Covid-19 patients have been developing this infection while still at the hospital or after discharge.
  • The disease often manifests in the skin and also affects the lungs and the brain.
  • Some of the common symptoms include sinusitis, blackish nasal discharge, facial pain, headaches, and pain around the eyes.

Who is at risk

  • Patients who have been hospitalised for Covid-19 and particularly those who require oxygen therapy during Covid-19 illness are at a much higher risk of mucormycosis.
  • However, there are some cases of mucormycosis in patients with asymptomatic Covid-19 infection.
  • Before the pandemic, patients with uncontrolled diabetes were at a higher risk of mucormycosis.
  • The risk of mucormycosis rises for these patients for two reasons.
  • First is that Covid-19 further impairs their immune system.
  • Second, they are given corticosteroids for their treatment it leads to a rise in their blood sugar level thus increasing their risk of mucormycosis.

Treatment

  • Today, we have a number of drugs and anti-fungal medicines that can treat mucormycosis.
  • These are given by IV or taken orally.
  • Surgery is needed to remove the affected dead tissues along with antifungal therapy.

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

Digital Technologies and Inequalities

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Growing inequality in access to health and education

Impact of pandemic

  • The novel coronavirus pandemic has accelerated the use of digital technologies in India, even for essential services such as health and education, where access to them might be poor.
  • Economic inequality has increased: people whose jobs and salaries are protected, face no economic fallout.
  • Well-recognised channels of economic and social mobility — education and health — are getting rejigged in ways that make access more inequitable in an already unequal society.

Growing inequality in access to education

  • According to National Sample Survey data from 2017, only 6% rural households and 25% urban households have a computer.
  • Access to Internet facilities is not universal either: 17% in rural areas and 42% in urban areas.
  • Surveys by the National Council of Educational Research and Training (NCERT), the Azim Premji Foundation, ASER and Oxfam suggest that between 27% and 60% could not access online classes for a range of reasons: lack of devices, shared devices, inability to buy “data packs”, etc.
  • Further, lack of stable connectivity jeopardises their evaluations.
  • Besides this, many lack a learning environment at home.
  • Peer learning has also suffered.

Inequality in access to health care

  •  India’s public spending on health is barely 1% of GDP.
  • Partly as a result, the share of ‘out of pocket’ (OOP) health expenditure (of total health spending) in India was over 60% in 2018.
  • Even in a highly privatised health system such as the United States, OOP was merely 10%.
  • Moreover, the private health sector in India is poorly regulated in practice.
  • Both put the poor at a disadvantage in accessing good health care.
  • Right now, the focus is on the shortage of essentials: drugs, hospital beds, oxygen, vaccines.
  • In several instances, developing an app is being seen as a solution for allocation of various health services. 
  • Digital “solutions” create additional bureaucracy for all sick persons in search of these services without disciplining the culprits.
  • Platform- and app-based solutions can exclude the poor entirely, or squeeze their access to scarce health services further.
  • In other spheres (e.g., vaccination) too, digital technologies are creating extra hurdles.
  • The use of CoWIN to book a slot makes it that much harder for those without phones, computers and the Internet. 

Issues with the creation of centralised database

  • The digital health ID project is being pushed during the pandemic when its merits cannot be adequately debated.
  • Electronic and interoperable health records are the purported benefits.
  • For patients, interoperability i.e., you do not have to lug your x-rays, past medication and investigations can be achieved by decentralising digital storage say, on smart cards as France and Taiwan have done.
  • Given that we lack a data privacy law in India, it is very likely that our health records will end up with private entities without our consent, even weaponised against us.
  • For example, a private insurance companies may use health record to deny poor people an insurance policy or charge a higher premium.
  • There are worries that the government is using the vaccination drive to populate the digital health ID database.

Way forward

  • Unless health expenditure on basic health services (ward staff, nurses, doctors, laboratory technicians, medicines, beds, oxygen, ventilators) is increased, apps such as Aarogya Setu, Aadhaar and digital health IDs can improve little.
  • Unless laws against medical malpractices are enforced strictly, digital solutions will obfuscate and distract us from the real problem.
  • We need political, not technocratic, solutions.

Conclusion

Today, there is greater understanding that the harms from Aadhaar and its cousins fall disproportionately on the vulnerable. Hopefully, the pandemic will teach us to be more discerning about which digital technologies we embrace.

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

A ‘One Health’ approach that targets people, animals

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Zoonotic diseases

Mains level : Paper 2- 'One Health' approach to deal with infections diseases

The article highlights the need for a holistic approach to animal and human health as more than two-thirds of existing and emerging infectious diseases are zoonotic.

Need to document the link between environment animal and human health

  • Studies indicate that more than two-thirds of existing and emerging infectious diseases are zoonotic, or can be transferred between animals and humans, and vice versa.
  • Another category of diseases, anthropozoonotic infections, gets transferred from humans to animals.
  • The transboundary impact of viral outbreaks in recent years such as the Nipah virus, Ebola, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) has reinforced the need for us to consistently document the linkages between the environment, animals, and human health.

India’s ‘One Health’ vision

  • India’s ‘One Health’ vision derives its blueprint from the agreement between the tripartite-plus alliance.
  • The alliance comprises the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), the World Health Organization (WHO) and the United Nations Environment Programme (UNEP) — a global initiative supported by the United Nations Children’s Fund (UNICEF) and the World Bank under the overarching goal of contributing to ‘One World, One Health’.
  • In keeping with the long-term objectives, India established a National Standing Committee on Zoonoses as far back as the 1980s.
  • This year, funds were sanctioned for setting up a ‘Centre for One Health’ at Nagpur.
  • Further, the Department of Animal Husbandry and Dairying (DAHD) has launched several schemes to mitigate the prevalence of animal diseases since 2015.
  • Hence, under the National Animal Disease Control Programme, ₹13,343 crore have been sanctioned for Foot and Mouth disease and Brucellosis control.
  • In addition, DAHD will soon establish a ‘One Health’ unit within the Ministry.
  • Additionally, the government is working to revamp programmes that focus on capacity building for veterinarians such as  Assistance to States for Control of Animal Diseases (ASCAD).
  • There is increased focus on vaccination against livestock diseases and backyard poultry.
  •  DAHD has partnered with the Ministry of Health and Family Welfare in the National Action Plan for Eliminating Dog Mediated Rabies.

Need for coordination

  •  There are more than 1.7 million viruses circulating in wildlife, and many of them are likely to be zoonotic.
  • Therefore, unless there is timely detection, India risks facing many more pandemics in times to come.
  • There is need to address challenges pertaining to veterinary manpower shortages, the lack of information sharing between human and animal health institutions, and inadequate coordination on food safety at slaughter.
  • These issues can be remedied by consolidating existing animal health and disease surveillance systems — e.g., the Information Network for Animal Productivity and Health, and the National Animal Disease Reporting System.

Conclusion

As we battle yet another wave of a deadly zoonotic disease (COVID-19), awareness generation, and increased investments toward meeting ‘One Health’ targets is the need of the hour.

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

[pib] MANAS Platform

Note4Students

From UPSC perspective, the following things are important :

Prelims level : MANAS Platform

Mains level : Not Much

The MANAS App to promote wellbeing across age groups was recently launched.

Name, acronym and the purpose; thats all. The rest of the theory is of less importance.

MANAS Platform

  • MANAS is an acronym for Mental Health and Normalcy Augmentation System.
  • It is a comprehensive, scalable, and national digital wellbeing platform and an app developed to augment the mental well-being of Indian citizens.
  • MANAS was initiated by the Office of the Principal Scientific Adviser to the Government of India and jointly executed by NIMHANS Bengaluru, AFMC Pune and C-DAC Bengaluru.
  • It was endorsed as a national program by the Prime Minister’s Science, Technology, and Innovation Advisory Council (PM-STIAC).
  • It integrates the health and wellness efforts of various government ministries, scientifically validated indigenous tools with gamified interfaces developed/researched by various national bodies and research institutions.

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

NCAHP Bill 2020

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Commission for Allied and Healthcare Professions Bill 2020

Mains level : Paper 2- NCAHP Bill 2020

The article highlights the key aspects of NCAHP Bill 2020 which recognises the allied healthcare professionals and seeks to regulate and set the standards of education.

Regulating allied health professions

  • The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAHP) was passed by Parliament in March.
  • Global evidence demonstrates the vital role of allied professionals in the delivery of healthcare services.
  • They are the first to recognise the problems of the patients and serve as safety nets.
  • Their awareness of patient care accountability adds tremendous value to the healthcare team in both the public and private sectors.
  • The passage of this Bill has the potential to overhaul the entire allied health workforce by establishing institutes of excellence and regulating the scope of practice by focusing on task shifting and task-re distribution.

What the Bill provides for

  • This legislation provides for regulation and maintenance of standards of education and services by allied and healthcare professionals and the maintenance of a central register of such professionals.
  • It recognises over 50 professions such as physiotherapists, optometrists, nutritionists, medical laboratory professionals, radiotherapy technology professionals, which had hitherto lacked a comprehensive regulatory mechanism.
  • This Bill classifies allied professionals using the International System of Classification of Occupations (ISCO code).
  • This facilitates global mobility and enables better opportunities for such professionals.
  • The Act aims to establish a central statutory body as a National Commission for Allied and Healthcare Professions.
  • The Bill has the provision for state councils to execute major functions through autonomous boards.

Shift in perception and policy in healthcare delivery

  • There has been a paradigm shift in perception, policy, and programmatic interventions in healthcare delivery in India since 2017.
  • In the past, curative healthcare received substantially greater attention than preventive and promotive aspects.
  • Ayushman Bharat as a programmatic intervention, with its two pillars of Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY), operationalised certain critical recommendations of the National Health Policy, 2017, emphasising wellness in healthcare.
  • With PMJAY, the neediest are protected from catastrophic expenditure and India took the first step towards delivering comprehensive primary healthcare with HWCs.

Conclusion

Caring for patients with mental conditions, the elderly, those in need of palliative services, and enabling professional services for lifestyle change related to physical activity and diets, all require a trained, allied health workforce. The NCAHP is not only timely but critical to this changing paradigm.

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

[pib]  ‘Anamaya’ Initiative

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ‘Anamaya’ Initiative

Mains level : Not Much

Anamaya, the Tribal Health Collaborative was recently launched.

Simply keep in mind, the name and purpose.

‘Anamaya’ Initiative

  • The Collaborative is a multi-stakeholder initiative of the Tribal Affairs Ministry supported by Piramal Foundation and Bill and Melinda Gates Foundation (BMGF).
  • It aims to build a sustainable, high-performing health eco-system to address the key health challenges faced by the tribal population of India.
  • It will converge efforts of various Government agencies and organisations to enhance the health and nutrition status of the tribal communities of India.
  • This collaborative is a unique initiative bringing together governments, philanthropists, national and international foundations, NGOs/CBOs to end all preventable deaths among the tribal communities of India.

Terms of references

  • It will begin its operations with 50 tribal, Aspirational Districts (with more than 20% ST population) across 6 high tribal population states.
  • Over a 10-year period, the work of the THC will be extended to 177 tribal Districts as recognised by the Ministry of Tribal Affairs.

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

Integrated Health Information Platform (IHIP)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IHIP

Mains level : Digital health mission

The Union Minister of Health & Family Welfare has launched the Integrated Health Information Platform (IHIP).

About IHIP

  • The new version of IHIP will house the data entry and management for India’s disease surveillance program.
  • In addition to tracking 33 diseases now as compared to the earlier 18 diseases, it shall ensure near-real-time data in digital mode, having done away with the paper mode of working.

Various functions

  • IHIP will provide a health information system developed for real-time, case-based information, integrated analytics, advanced visualization capability.
  • It will provide analyzed reports on mobile or other electronic devices. In addition, outbreak investigation activities can be initiated and monitored electronically.
  • It can easily be integrated with another ongoing surveillance program while having the feature of the addition of special surveillance modules.

Unique features

  • This is the world’s biggest online disease surveillance platform.
  • It is in sync with the National Digital Health Mission and fully compatible with the other digital information systems presently being used in India.
  • The refined IHIP with automated -data will help in a big way in real-time data collection, aggregation & further analysis of data that will aid and enable evidence-based policymaking.
  • With IHIP, the collection of authentic data will become easy as it comes directly from the village/block level; the last mile from the country.
  • With its implementation, we are fast marching towards AtmaNirbhar Bharat in healthcare through the use of technology.

Also read:

[Burning Issue] Rolling-out of National Digital Health Mission

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

N K Singh bats for moving Health Sector to Concurrent List

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Concurrent List

Mains level : India's healthcare

Health should be shifted to the Concurrent list under the Constitution, and a developmental finance institution (DFI) dedicated to healthcare investments set up, Fifteenth Finance Commission Chairman N.K. Singh has said.

Other key recommendations

  • Bringing health into the Concurrent list would give the Centre greater flexibility to enact regulatory changes and reinforce the obligation of all stakeholders towards providing better healthcare.
  • He has urged the government spending to enhance expenditure on health to 2.5% of GDP by 2025.
  • He said primary healthcare should be a fundamental commitment of all States in particular and should be allocated at least two-thirds of such spending.

The Concurrent List or List-III (of Seventh Schedule) is a list of 52 items (though the last subjects are numbered 47) given in the Seventh Schedule to the Constitution of India.

What is the Seventh Schedule?

  • This Schedule of the Indian Constitution deals with the division of powers between the Union government and State governments.
  • It defines and specifies the allocation of powers and functions between Union & States. It contains three lists; i.e. 1) Union List, 2) State List and 3) Concurrent List.

The Union List

  • It is a list of 98 (Originally 97) numbered items as provided in the Seventh Schedule.
  • The Union Government or Parliament of India has exclusive power to legislate on matters relating to these items.

The State List

  • It is a list of 59 (Originally 66) items.
  • The respective state governments have exclusive power to legislate on matters relating to these items.

The Concurrent List

  • There are 52 (Originally 47) items currently in the list.
  • This includes items which are under the joint domain of the Union as well as the respective States.

Must read

[Burning Issue] India’s Ailing Health Sector and Coronavirus

Healthcare in India

  • The Indian Constitution has incorporated the responsibility of the state in ensuring basic nutrition, basic standard of living, public health, protection of workers, special provisions for disabled persons, and other health standards, which were described under Articles 39, 41, 42, and 47 in the DPSP.
  • Article 21 of the Constitution of India provides for the right to life and personal liberty and is a fundamental right.
  • Public Health comes under the state list.
  • India’s expenditure on healthcare has shot up substantially in the past few years; it is still very low in comparison to the peer nations (at approx. 1.28% of GDP).

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

ACT-Accelerator Coalition

Note4Students

From UPSC perspective, the following things are important :

Prelims level : ACT-Accelerator

Mains level : Coronovirus outbreak

ACT-Accelerator, a global coalition formed in April 2020 to fight the novel coronavirus disease (COVID-19) is facing a severe fund crunch to meet its goals for 2020-21.

ACT-Accelerator

  • The Access to COVID-19 Tools Accelerator (ACT Accelerator) is a G20 initiative announced on 24 April 2020.
  • A call to action was published simultaneously by the World Health Organization (WHO).
  • The ACT Accelerator is a cross-discipline support structure to enable partners to share resources and knowledge.
  • It comprises four pillars, each managed by two to three collaborating partners:
  1. Vaccines (also called “COVAX”)
  2. Diagnostics
  3. Therapeutics
  4. Health Systems Connector
  • India is an active donor in this alliance.

Try this PYQ based on a global coalition:

Q.Consider the following statements:

  1. Climate and Clean Air Coalition (CCAC) to Reduce Short Lived Climate Pollutants is a unique initiative of G20 group of countries.
  2. The CCAC focuses on methane, black carbon and Hydrofluorocarbons.

Which of the above statements is/are correct?

(a) 1 only

(b) 2 only

(c) Both 1 and 2

(d) Neither 1 nor 2

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

What we must consider before digitising India’s healthcare

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Digital Health Mission

Mains level : Paper 2- Issues to consider in digitising health infrastructure

As India seeks to create digital health infrastructure, it must consider several issues.

Integrated digital health infrastructure

  • The National Digital Health Mission aims to develop the backbone needed for the integrated digital health infrastructure of India.
  • This can help not only with diagnostics and management of health episodes, but also with broader public health monitoring, socio-economic studies, epidemiology, research, prioritising resource allocation and policy interventions. 
  • However, before we start designing databases and APIs and drafting laws, we must be mindful of certain considerations for design choices and policies to achieve the desired social objectives.

Factors to be considered

1) Carefully developing pathway to public good

  • There must be a careful examination of how exactly digitisation may facilitate better diagnosis and management, and an understanding of the data structures required for effective epidemiology.
  • We must articulate how we may use digitisation and data to understand and alleviate health problems such as malnutrition and child stunting.
  • We need the precise data we require to better understand crucial maternal- and childcare-related problems.

2) Balancing between public good and individual rights

  • The potential tensions between public good and individual rights must be examined, as must the suitable ways to navigate them.
  • Moreover, for the balancing to be sound and for determining the level of due diligence required, it is imperative to clearly define the operational standards for privacy management.
  • Conflating privacy with security, as is typical in careless approaches, will invariably lead to problematic solutions.
  • In fact, most attempts at building health data infrastructures worldwide — including in the UK, Sweden, Australia, the US and several other countries — have led to serious privacy-related controversies and have not yet been completely successful.

3) Managing the sector specific identities

  • Even if we define and use a sector-specific identity, the question of when and how to link it with that of other sectors remains.
  • For example, with banking or insurance for financial transactions, or with welfare and education for transactions and analytics.
  • Indiscriminate linking may break silos and create a digital panopticon, whereas not linking at all will result in not realising the full powers of data analytics and inference.

4) Working out the operational requirement of data infrastructure

  • We need to work out the operational requirements of the data infrastructure in ways that are informed by, and consonant with, the previous points.
  • In other words, the design of the operationalisation elements must follow the deliberations on above points, and not run ahead of them.
  • This requires identifying the diverse data sources and their complexity — which may include immunisation records, birth and death records, informal health care workers, dispensaries etc.
  • It also requires an understanding of their frequency of generation, error models, access rights, interoperability, sharing and other operational requirements.
  • There also are the complex issues of research and non-profit uses of data, and of data economics for private sector medical research.

5) Issue of due process

  • Finally, “due process” has always been a weak point in India, particularly for technological interventions.
  • Building an effective system that can engender people’s trust not only requires managing the floor of the Parliament and passing a just and proportional law, but also building a transparent process of design and refinement through openness and public consultations.
  • In particular, technologists and technocrats should take care to not define “public good” as what they can conveniently deliver, and instead understand what is actually required.
  • While we can understand the urge to move forward quickly, given the urgent need to improve health outcomes in the country, deliberate care is needed.

Consider the question “While seeking to develop digital health infrastructure through the National Digital Health Mission, we should be mindful of certain considerations for design choices and policies to achieve the desired social objectives. Comment.”

Conclusion

Developing a comprehensive understanding of the considerations related to health data infrastructure may also inform the general concerns of e-governance and administrative digitisation in India, which have not been all smooth sailing.

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

What are Non-Alcoholic Fatty Liver Diseases (NAFLD)?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NAFLD

Mains level : Health threats posed by Fats

The Union Govt has integrated the Non-alcoholic fatty liver disease (NAFLD) in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.

Try this MCQ:

Q.A Company marketing food products advertises that its items do not contain trans-fats. What does this campaign signify to the customers?

  1. The food products are not made out of hydrogenated oils.
  2. The food products are not made out of animal fats/oils.
  3. The oils used are not likely to damage the cardiovascular health of the consumers.

Which of the statements given above is/are correct?

(a) Only 1

(b) 2 and 3 only

(c) 1 and 3 only

(d) 1, 2 and 3

NAFLD

  • NAFLD is the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver, such as harmful alcohol use, viral hepatitis, or medications.
  • According to doctors, it is a serious health concern as it encompasses a spectrum of liver abnormalities.
  • It can cause non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer.

Why such a move?

  • NAFLD is emerging as an important cause of liver disease in India.
  • Epidemiological studies suggest the prevalence of NAFLD is around 9% to 32% of the general population in India with a higher prevalence in those with overweight or obesity and those with diabetes or prediabetes.
  • Researchers have found NAFLD in 40% to 80 % of people who have type 2 diabetes and in 30% to 90% of people who are obese.
  • Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease.
  • Cardiovascular disease is the most common cause of death in NAFLD.

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

vaccine hesitancy

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Dealing with vaccine hesitancy

Reluctance to take the vaccine has several implications. The misinformation around the vaccines needs to be fought through several measures. 

Understanding vaccine hesitancy

  • According to the World Health Organization, vaccine hesitancy is defined as a reluctance or refusal to vaccinate despite the availability of vaccine services.
  • To date, two vaccines have been approved for inoculation in India: Pune-based Serum Institute’s Covishield and Hyderabad-based Bharat Biotech’s Covaxin.
  • An adequate supply of vaccines is in place at least for the first phase, but the trickier part is to persuade the population for vaccination.
  • Like Western nations, vaccine hesitancy has been a cause of concern in the past in India as well.
  • Social media has seen a rising number of self-proclaimed experts who have been making unsubstantiated claims.
  • The debates around hesitancy for COVID-19 vaccines include concerns over safety, efficacy, and side effects due to the record-breaking timelines of the vaccines, competition among several companies, misinformation, and religious taboos.

Need to adopt libertarian paternalism

  • It is suggested that we adopt the idea of libertarian paternalism, which says it is possible and legitimate to steer people’s behaviour towards vaccination while still respecting their freedom of choice.
  • Vaccine hesitancy has a different manifestation in India, unlike in the West.
  • According to the World Economic Forum/Ipsos global survey, COVID-19 vaccination intent in India, at 87%, exceeds the global 15-country average of 73%.

Way forward

  • Instead of anti-vaxxers, the target audience must be the swing population i.e., people who are sceptical but can be persuaded through scientific facts and proper communication.
  • The second measure is to pause before you share any ‘news’ from social media.
  • It becomes crucial to inculcate the habit of inquisitive temper to fact-check any news related to COVID-19 vaccines.
  • The third measure is to use the celebrity effect — the ability of prominent personalities to influence others to take vaccines.
  • Celebrities can add glamour and an element of credibility to mass vaccinations both on the ground and on social media.

Consider the question “What is vaccine hesitancy? Suggest the measures to deal with it”

Conclusion

The infodemic around vaccines can be tackled only by actively debunking myths, misinformation and fake news on COVID-19 vaccines.

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

First steps in India’s journey to universal health care

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PM-JAY

Mains level : Paper 2- Achieving universal health coverage

The article highlights the issues with India’s approach in achieving universal health care and issues with it.

Learning from the experience of Thailand

  • About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
  • What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
  • This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
  • This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.

Budgetary allocations for health

  • The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
  • Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
  • ₹13,192 crore has been allocated as a Finance Commission grant.
  • These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.

Two important and prominent arms of universal health coverage in India merit discussion here

1) Insurance route for achieving universal health coverage and issues with it

  • The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
  • Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
  • However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
  • Beyond low allocations, poor budget reliability merits attention.
  • Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
  • Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
  • Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
  • Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
  • Finally, even high actual coverage should not be equated with effective financial protection.
  • For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.

2) Comprehensive primary care

  • Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
  • Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
  • Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
  • Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
  • This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
  • This offers huge cost projections.
  • The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
  • Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
  • Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
  • Two untoward implications could result from under-investing and spreading funds too thinly.
  • Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
  • Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.

Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?” 

Conclusion

COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.

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

The unmet health challenge

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PMANSY

Mains level : Paper 2- Allocation in Budget for health

The article analyses the allocation for the health sector in the Budget and highlights the need for more allocations.

Need to increase spending on health

  • The Economic Survey argues for the need to increase public spending on healthcare to 2.5-3 per cent of the GDP — it’s about 1.5 per cent currently.
  • The Survey points out that there is not much difference in terms of outcomes and quality between healthcare services in the private sector and such services in public centres.
  • The Economic Survey, therefore, calls for strengthening the National Health Mission (NHM) along with Ayushman Bharat.
  • NHM was initiated in 2005-06 to strengthen public health services.
  • The Ayushman Bharat provide social insurance, thereby financing private sector services with public funds. 
  • The Economic Survey makes a strong pitch for greater regulation of health services in the private sector.

Break-up of allocation in Budget on health (and well being)

  • The finance minister described “health and well-being” as one of the pillars of the budget in her budget speech and announcing a 137 per cent increase in allocations for it.
  • She placed healthcare, water and sanitation and nutrition as the key components of this pillar.
  • However, the figures in the budget documents reveal a different story.
  • There is an absolute increase of 9.6 per cent in allocations for the Department of Health and Family Welfare that includes NHM and Ayushman Bharat.
  • A 26.8 per cent increase for the Department of Health Research and 40 per cent increase for the AYUSH Ministry do not add up to much since each of them are only 3-4 per cent of the total health budget.
  • A Finance Commission grant of Rs 13,000-crore and Rs 35,000-crore for COVID-19 vaccination are one-time allocations and, therefore, do not strengthen the overall system.
  • The core health service and research ministries (H&FW and AYUSH) have together received only an 11 per cent increase.
  • Even in COVID times, the health services get only 2.21 per cent of the total central budget — down from 2.27 per cent in the 2020-21 budget.
  • Computing for inflation, the increase in allocation for health services alone disappears and actually becomes negative.
  • Water and sanitation received a 179 per cent increase from Rs 21,518 crore to Rs 60,030 crore already earmarked for the flagship schemes, Swachh Bharat and Jal Jeevan Mission.
  • But allocation for nutrition decreased by 27 per cent, with the “new” Poshan 2.0 merely combining the poorly performing Supplementary Nutrition Programme and Poshan project.
  • Added together, health, water and sanitation and nutrition make up the claimed 137 per cent increase in allocation to “health” services — with a real decline in healthcare and nutrition.

Pradhan Mantri Atma Nirbhar Swasthya Yojana (PMANSY)

  • Finance Minister also announced a new scheme, the Pradhan Mantri Atma Nirbhar Swasthya Yojana, to support the almost 29,000 health and wellness centres in the country.
  • The scheme also envisages the creation of public health laboratories and critical care hospital blocks and virology institutes.

Concerns with PMANSY

  • PMANSY has an announced allocation of Rs 64,180 crore over six years, but it does not find a place in the present budget documents.
  • But these additional activities could have been slotted in the NHM.
  • Since 2014, the allocation for NHM has been on the wane.
  • Therefore, even the marginal 1.33 per cent increase (from Rs 27,039 crore to Rs 30,100 crore) is a demonstration of the government’s realisation that public services do matter.
  • The allocations of about Rs 10,000-Rs 11,000 crore each year for the PMANSY is not enough for making the public services capable of “universal health coverage”.
  • The High-Level Expert Group on Universal Health Coverage had estimated that by 2020, we need a 114 per cent increase in sub-centres and primary health centres, 179 per cent increase in community health centres and a 230 per cent increase in sub-district and district hospitals.
  • Getting anywhere close to this requires doubling of real allocations every year over a five-year period to reach something like 10 per cent of the budget.
  • In the present budget, it declines to a mere 2.21 per cent.

Way forward

  • If such public provisioning for universal health coverage can’t be done, then effective low-cost rationalised service system options have to be designed.
  • Insurance schemes only create the mirage of affordability of health services while adding to peoples’ expenses.
  • Community and public services are indisputably the most cost-effective for any society.

Consider the question “Examine the benefits of the idea of health and well being under which health, water and sanitation and nutrition are clubbed together.”

Conclusion

Water and sanitation are meaningful for health, but not if it only inflates the allocation to “Health and Wellbeing”. What we need is the real increase in spending on health.

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

Building a robust healthcare system

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Maternal Mortality Rate, Infant Morality Rate

Mains level : Paper 2- Disparity among states in health parameters

The article focuses on the wide variation across the state in terms of the important health parameters and suggests prioritising health.

Variation across the states

  • The efficacy of the public health system varies widely across the country since it is a State subject.
  • Public health system can be judged just by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate.
  • In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala. In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63.
  • The northern States are performing very poorly in these vital health parameters.
  • The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
  • Since health is a State subject, the primary onus lies with the State governments.
  • Each State government must focus on public health and aim to improve the health indicators mentioned above.
  • Unless all the States perform well, there will be no dramatic improvement in the health system.

Steps needed to be taken

  • The governments — both at the Centre and the Empowered Action Group States — should realise that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.
  • The Government of India has a vital role to play.
  • Public and preventive health should be his focus by holding the Empowered Action Group States accountable to the SDGs.
  • They must be asked to reach the levels of the southern States within three to five years.
  • An important measure that can make a difference is a public health set-up in these States that addresses primary and preventive health.

Conclusion

Unless we invest in human capital, FDI will not help.  Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.

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

Ayushman Bharat for CAPFs

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat

Mains level : Universal health coverage

Union Home Minister has rolled out the ‘Ayushman CAPF’ scheme, extending the benefit of the central health insurance programme to the personnel of all Central Armed Police Forces (CAPFs) in the country.

Who are the CAPFs?

  • The CAPFs refers to uniform nomenclature of five security forces in India under the authority of the Ministry of Home Affairs.
  • Their role is to defend the national interest mainly against the internal threats.
  • They are the Border Security Force (BSF), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), Indo-Tibetan Border Police (ITBP), Sashastra Seema Bal (SSB)

Ayushman CAPF

  • Under this scheme, around 28 lakh personnel of CAPF, Assam Rifles and National Security Guard (NSG) and their families will be covered by ‘Ayushman Bharat: PM Jan Arogya Yojana’ (AB PM-JAY).
  • For the CAPF, the existing health coverage was not comprehensive as compared to other military forces.

Do you know?

The goal of universal health coverage (UHC) as stated in the UN Sustainable Development Goals (SDGs no. 3) is one of the most significant commitments to equitable quality healthcare for all.

About Ayushman Bharat

  • PM-JAY aims to provide free access to healthcare for 40% of people in the country.
  • It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
  • It was launched in September 2018 by the Ministry of Health and Family Welfare.
  • The ministry has later established the National Health Authority as an organization to administer the program.

Key features:

  • Providing health coverage for 10 crores households or 50 crores Indians.
  • It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
  • Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
  • Using criteria from the Socio-Economic and Caste Census 2011 to determine eligibility for benefits.
  • There is no restriction on family size, age or gender.
  • All previous medical conditions are covered under the scheme.
  • It covers 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostic care and expenses on medicines.
  • The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.

Note these features. They cannot be memorized all of sudden but can be recognized if a tricky MCQ comes in the prelims.

Must read:

[Burning Issue] Ayushmaan Bharat

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

India’s burden of heart diseases

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Global Burden of Disease (GBD) Report

Mains level : Not Much

According to the Global Burden of Disease, nearly a quarter (24.8 per cent) of all deaths in India is due to cardiovascular diseases (CVDs).

The fastest-growing economy has some perils. In this newscard, you will get to see how CVDs are a legacy of economic growth.

Global Burden of Disease (GBD) Report

  • The GBD is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors.
  • GBD is a collaboration of over 3600 researchers from 145 countries.
  • It is based out of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and funded by the Bill and Melinda Gates Foundation.

Indian burden of CVDs

  • About a third of the senior citizens have been diagnosed with hypertension, 5.2% with chronic heart disease and 2.7% with stroke
  • Even an analysis of the medical certification of cause of death (MCCD) reports points to an increase in the proportion of deaths due to CVD. It went from 20.4 per cent in 1990 to 27.1 per cent in 2004.
  • According to MCCD report, 2018, CVDs accounted for more than half (57%) of the total deaths in the age group of 25–69 years.
  • Case fatality due to CVD in low-income countries, including India, appears to be much higher than in middle and high-income countries.
  • In India, for example, the mean age at which people get the first myocardial infarction is 53 years, which is about 10 years earlier than their counterparts in developed countries.
  • About a third (32 per cent) of the senior citizens have been diagnosed with hypertension, 5.2 per cent were diagnosed with chronic heart disease and 2.7 per cent with stroke.

Women are more vulnerable

  • Numerous studies have also pointed out that CVD remains the number-one threat to women’s health as more women than men die annually due to these diseases.
  • A Harvard study shows low high-density lipoproteins and high triglycerides appear are the main factors that increase the chances of death from cardiovascular disease in women over age 65.
  • As per the LASI report, gender differences were evident in cross-state variations.
  • CVD among men was higher in Kerala (45 per cent), Goa (44 per cent), Andaman and Nicobar (41 per cent) and lower in Chhattisgarh (15 per cent), Meghalaya (16 per cent), Nagaland (17 per cent).

Why CVDs are prevalent in India?

  • Epidemiological evidence suggests that CVD is associated with behavioural factors such as smoking, alcohol use, low physical activity, and insufficient vegetable and fruit intake.
  • In the Indian context, poverty, maternal malnutrition, and early life changes enhance an individual’s risk of CVDs.
  • Rural to urban migration that happens in distress leads to over-crowded and unclean environments in urban slums.
  • Problems of inadequate housing, indoor pollution, infectious diseases, inappropriate diet, stress and smoking crop up as a result.

Need of the hour

  • CVD-risk prevention is one of the important priorities among India’s sustainable development goals.
  • In an earlier estimate, WHO had said with India’s present CVD burden, the country would lose $237 billion from the loss of productivity and spending on healthcare over 10 years (2005–2015).
  • This is because the diseases affect the country’s working population.

Way ahead

  • The government should devise an approach that can improve the efficiency of care and health system preparedness to curb the CVD epidemic currently sweeping India.
  • Attempts in direction to preserve the traditional lifestyle are also necessary.

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

[pib] Longitudinal Ageing Study of India (LASI)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Longitudinal Ageing Study of India (LASI)

Mains level : India's age-old population

The Union Minister for Health & Family Welfare has released INDIA REPORT on Longitudinal Ageing Study of India (LASI) Wave-1.

Discuss various issues pertaining to old-age care in India.

Longitudinal Ageing Study of India (LASI)

  • LASI is a full–scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India.
  • The LASI, Wave 1 covered a baseline sample of 72,250 individuals aged 45 and above till the oldest-old persons aged 75 and above from all States and UTs of India (excluding Sikkim).
  • It is India’s first and the world’s largest ever survey that provides a longitudinal database for designing policies and programmes for the older population in the broad domains of social, health, and economic well-being.
  • The evidence from LASI will be used to further strengthen and broaden the scope of National Programme for Health Care of the Elderly.
  • It would also help in establishing a range of preventive and health care programmes for older population and most vulnerable among them.

Why need such survey?

  • In 2011 census, the 60+ population accounted for 8.6% of India’s population, accounting for 103 million elderly people.
  • Growing at around 3% annually, the number of elderly age population will rise to 319 million in 2050.
  • 75% of the elderly people suffer from one or the other chronic disease.
  • 40% of the elderly people have one or the other disability and 20% have issues related to mental health.
  • This report will provide base for national and state level programmes and policies for elderly population.

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

Bird Flu Outbreak

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Bird Flu

Mains level : Not Much

An outbreak of bird flu was confirmed in Kerala, Rajasthan and Himachal.

Try this question from our AWE initiative:

There is been an increase in occurance of zoonotic human infectious diseases are zoonotic . Give reasons for this. Also suggest ways to contain and decrease the frequency of such events.(250 Words)

What is Bird Flu?

  • Bird flu is an infection caused by avian influenza viruses, which are of different types A, B and C.
  • Type A avian influenza viruses are the most frequently associated with avian influenza epidemics and pandemics.
  • There are 16 hemagglutinin (H1 to H16) and 9 neuraminidase types (N1 to N9) identified till date.
  • There are various modes of transmission of human influenza including inhalation, direct or indirect contact etc. can have manifestations ranging from mild to severe or fatal disease.
  • Avian influenza A (H5N1) results in a high death rate amongst infants and young children.
  • The first outbreak of human infection by avian influenza viruses (H5N1) was observed in 1997 in Hong Kong. Since then a large number of outbreaks have been reported in different parts of the world.

The H5N8 strain

  • The presence of the H5N8 subtype of the Influenza A virus was reported in ducks in parts of Kerala.
  • While it can prove lethal for birds, the H5N8 strain of avian influenza has a lower likelihood of spreading to humans compared to H5N1.
  • While the source of infection is yet to be pinpointed, the role of migratory birds in passing on the virus is suspected.

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

Global Alliance for Vaccines and Immunization (GAVI)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : GAVI

Mains level : Global collaboration against COVID

Union Health Minister has been nominated by the Global Alliance for Vaccines and Immunisation (GAVI) as a member of the GAVI Board.

Q.The Covid-19 pandemic has exposed the limitations of global cooperation. Critically analyse.

GAVI

  • GAVI is a public-private global health partnership with the goal of increasing access to immunization in poor countries.
  • GAVI has observer status at the World Health Assembly.
  • GAVI has been praised for being innovative, effective, and less bureaucratic than multilateral government institutions like the WHO.
  • Members: the WHO, UNICEF, the World Bank, the vaccine industry in both industrialized and developing countries, and the Bill & Melinda Gates Foundation among others.
  • GAVI programs can often produce quantified, politically appealing, easy-to-explain results within an election cycle, which is appealing to parties locked in an election cycle.

Its function

  • It currently supports the immunization of almost half the world’s children, giving it the power to negotiate better prices for the world’s poorest countries and remove the commercial risks of manufacturers.
  • It also provides funding to strengthen health systems and train health workers across the developing world.

Significance of India’s membership

  • The GAVI Board is responsible for the strategic direction and policymaking oversees the operations of the Vaccine Alliance and monitors program implementation.
  • With membership drawn from a range of partner organizations, as well as experts from the private sector, the Board provides a forum for balanced strategic decision making, innovation, and partner collaboration.

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

[pib] PM-JAY SEHAT

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat, PM-JAY SEHAT

Mains level : Not Much

The Prime Minister has launched Ayushman Bharat PM-JAY SEHAT to extend coverage to all residents of Jammu & Kashmir.

Q.Discuss various challenges in ensuring Universal Healthcare in India. (150W)

PM-JAY SEHAT

  • The full form of SEHAT is social, endeavor for health, and telemedicine. Under this scheme, the SEHAT card will be distributed to all the eligible beneficiaries.
  • All the eligible beneficiaries of Jammu and Kashmir can apply for the Scheme through common service center operators
  • Around 1 crore beneficiaries will cover under this scheme. All the eligible citizens of Jammu and Kashmir will get cashless treatment up to Rs 5 lakh under the Scheme.

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

No need for a Two-Child Policy

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : India's population boom

The latest data from the National Family Health Survey-5 (NFHS-5) proves that the country’s population is stabilizing and fears over a “population explosion” and calls for a “two-child policy” is misguided.

Try this PYQ:

Q.Economic growth in country X will necessarily have to occur if

(a) There is technical progress in the world economy

(b) There is population growth in X

(c) There is capital formation in X

(d) The volume of trade grows in the world economy

Two-Child Policy

  • The two-child policy is a state-imposed limit of two children allowed per family or the payment of government subsidies only to the first two children.
  • A two-child policy has previously been used in several countries including Iran, Singapore, and Vietnam.
  • In British Hong Kong in the 1970s, citizens were also highly encouraged to have two children as a limit (although it was not mandated by law), and it was used as part of the region’s family planning strategies.
  • Since 2016, it has been re-implemented in China replacing the country’s previous one-child policy.

Present status in India

  • There is no national policy mandating two children per family.
  • A parliamentarian had tabled a Bill in the Rajya Sabha in 2019 on the matter, proposing incentives for smaller families.
  • PM in 2019 had appealed to the country that population control was a form of patriotism.
  • Months later, the NITI Aayog called various stakeholders for a national-level consultation on the issue, which was subsequently cancelled following media glare on it.
  • In 2020, the PM spoke about a likely decision on revising the age of marriage for women, which many stakeholders view as an indirect attempt at controlling the population size.

Why doesn’t India need it?

  • The survey provides evidence of uptake in the use of modern contraceptives in rural and urban areas.
  • It gives an improvement in family planning demands being met and a decline in the average number of children borne by a woman.
  • The report stated that most States have attained replacement level fertility, i.e., the average number of children born per woman at whom a population exactly replaces itself from one generation to the next.

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

Dominance of Private healthcare in India & Related issues

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat

Mains level : Paper 2- Importance of public investment in health care

  • Lack of resources such as 1:1,700, doctor: citizen ratio, well below the minimum ratio of 1:1,000 stipulated by WHO.

  • Rural areas and smaller towns of India are the worst sufferers, where even basic health services remain inaccessible, many cases were reported where ward boys and alone found running the primary healthcare center.

  • Inadequate government spending on healthcare and lack of access to health insurance to a large section of society.

  • The quality of public health services in India continues to remain below expectations which hamper the economic growth of the country.

  • Government’s inability to build sufficient capacity and infrastructure, difficulty in reaching out to poor and vulnerable groups.

  • An undersized skilled workforce and the absence of upgraded technology is a major challenge in the health sector.

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

[pib] Vision 2035: Public Health Surveillance in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Ayushman Bharat

Mains level : Importance of Public Health Surveillance

NITI Aayog today released a white paper: Vision 2035: Public Health Surveillance (PHS) in India.

Q.Discuss the role of Public Health Surveillance in the success of Ayushman Bharat Abhiyan.

Vision 2035 for PHS

  • It is a continuation of the work on health systems strengthening.
  • It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.
  • Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. Surveillance is ‘Information for Action’.

Let’s have a look at the executive summary of the vision document:

PHS in India

  • Surveillance is an important Public Health function.
  • It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

Why need PHS?

  • Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance.
  • India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated.
  • India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.
  • These successes are a result of effective community-based, facility-based, and health system-based surveillance.
  • The COVID19 pandemic has further challenged the country. India rapidly ramped up its diagnostic capabilities and aligned its digital technology expertise.
  • This ensured that there was a comprehensive tracking of the pandemic.

Highlights of the vision document

  • It builds on initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program.
  • It aligns with the citizen-centricity highlighted in the National Health Policy 2017 and the National Digital Health Blueprint.
  • It encourages the use of mobile and digital platforms and point of care devices and diagnostics for amalgamation of data capture and analyses.
  • It highlights the importance of capitalizing on initiatives such as the Clinical Establishments Act to enhance private sector involvement in surveillance.
  • It points out the importance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the ICMR, and others.

Gap areas in India’s PHS that could be addressed

  • India can create a skilled and strong health workforce dedicated to surveillance activities.
  • Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
  • Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
  • An amalgamation of plant, animal, and environmental surveillance in a One-Health approach.
  • PHS could be integrated within India’s three-tiered health system.
  • Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
  • To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

Moving ahead

  • Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
  • Identify broad disease categories that will be included under PHS.
  • Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
  • Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
  • Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
  • Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action.
  • Encourage innovations at every step-in surveillance activity.

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

National Family Health Survey- 5 (NFHS-5)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NFHS

Mains level : Data on India's health

  • Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all.
  • The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.

The first phase of the fifth National Family Health Survey (NFHS-5) has been released.

Do you think that India is still the sick man of Asia?

What is the National Family Health Survey?

  • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • Three rounds of the survey have been conducted since the first survey in 1992-93.
  • The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
  • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

Part I of the Survey

  • The latest data pertains to 17 states — including Maharashtra, Bihar, and West Bengal — and five UTs (including J&K) and, crucially, captures the state of health in these states before the Covid pandemic.
  • Phase 2 of the survey, which will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh, was delayed due to the pandemic and its results are expected to be made available in May 2021.

Highlights of the NHFS-5

  • The NFHS-5 contains detailed information on population, health, and nutrition for India and its States and Union Territories.
  • This is a globally important data source as it is comparable to Demographic Health Surveys (DHS) Programme of 90 other countries on several key indicators.
  • It can be used for cross country comparisons and development indices.

Good news

  • Several of the 22 states and UTs, for which findings have been released, showed an increase in childhood immunisation.
  • There has been a drop in neonatal mortality in 15 states, a decline in infant mortality rates in 18 states and an increase in the female population (per 1,000 males) in 17 states.
  • Fertility rate decline and increase in contraceptive use were registered in almost all the states surveyed showing trends of population stabilization.

Some bad news

  • There has been an increase in stunting and wasting among children in several states, a rise in obesity in women and children, and an increase in spousal violence.
  • In several other development indicators, the needle has hardly moved since the last NFHS-4.

(1) Hunger Alarm

  • The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades.
  • Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
  • The share of underweight and wasted children has also gone up in the majority of the states.

(2) Fertility Rate

The total fertility rate (TFR) is defined as the average number of children that would be born to a woman by the time she ends childbearing.

  • The TFR across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest NFHS-5.
  • Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
  • In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.
  • India’s population is stabilizing, as the total fertility rate (TFR) has decreased across majority of the states.

(3) Under-5 and infant mortality rate (IMR)

  • The Under 5 and infant mortality rate (IMR) has come down but in parallel recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed.
  • These states are Goa, Gujarat, Himachal Pradesh, Kerala, Maharashtra, Meghalaya, Mizoram, Nagaland, Telangana, Tripura, West Bengal, Lakshadweep and Dadra & Nagar Haveli and Daman and Diu.

For the first time: Gaps in internet use

  • In 2019, for the first time, the NFHS-5, which collects data on key indicators on population health, family planning and nutrition, sought details on two specific indicators: Percentage of women and men who have ever used the Internet.
  • On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet, according to the survey.
  1. First, only an average of 42.6 per cent of women ever used the Internet as against an average of 62.16 per cent among the men.
  2. Second, in urban India, average 56.81 per cent women ever used the Internet compared to an average of 73.76 per cent among the men.
  3. Third, dismal 33.94 per cent women in rural India ever used the Internet as against 55.6 per cent among men.
  • In urban India, 10 states and three union territories reported more than 50 per cent women who had ever used the Internet: Goa (78.1%), Himachal Pradesh (78.9%), Kerala (64.9%), and Maharashtra (54.3%).
  • The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).

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

Healthcare in India & Pandemic

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Coalition for Epidemic Preparedness Innovations

Mains level : Paper 2- Lessons to improve healthcare system

Pandemic has been ravaging the world in a way few could have imagined. It highlighted the flaws in our healthcare system. However, it also offers several important lessons for tackling future pandemics and healthcare emergencies.

Where we stand after 1 year of pandemic

  • About a year after the first cases were reported, we are in a different position than at the start.
  • Doctors, public health specialists and policymakers have a better sense of the interventions that are required.
  • Many treatments initially proposed, based on expert experience, have been tested and removed from management strategies even as modified protocols have improved survival rates.
  • Vaccines have moved even faster than drugs with  nearly 40 of them undergoing clinical trials, a dozen of which are at the phase three stage, and at least one has been licensed post-phase three trials under conditional emergency use authorisation (EUA).
  • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.
  • This highlights the importance of science, technology, multilateral partnerships such as the Coalition for Epidemic Preparedness Innovations and the WHO.

Takeaways from our response to pandemic

1) Increase investment on health services

  • The countries which handled the pandemic best (Thailand and Vietnam) have well-functioning health systems designed to deliver primary healthcare services.
  • These countries also have strong preventive and promotive health services as well as a dedicated public health workforce.
  • Their governments had made sustained investments in health over decades.
  • In contrast, countries which focused mainly on hospital centric medical systems struggled.

2) Important role played by health workers

  • The role of community health workers in recognising, referring and motivating individuals for therapy was remarkable.
  • Healthcare workers, particularly those at the frontline, such as the accredited social health activists (ASHA) who visited hundreds of households repeatedly during the pandemic.
  •  If we are to build back better, we need to give them better recognition, salaries and career progression.

3) Increase community participation

  • Third, community trust and participation is essential for implementation of non-pharmacological interventions.
  • Dharavi in Mumbai is an example of the difference community participation can make.

4) Importance of data

  • Outside of the immediate response, the need for timely and quality data in a health information system was recognised again during the pandemic.
  • Without real time data on testing, disease surveillance and other outcomes, tailored responses are near impossible.
  • The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments.

Conclusion

Future readiness needs to start now, and we have the resources and knowledge to do this — all we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.

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

UN removes Cannabis from ‘Most Dangerous Drug’ Category

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Cannabis

Mains level : Cannabis and its de-regulation

The United Nations Commission on Narcotic Drugs (CND) voted to remove cannabis and cannabis resin from Schedule IV of the 1961 Single Convention on Narcotic Drugs, decades after they were first placed on the list.

Q. Too much de-regulation of Cannabis could lead to its mass cultivation and a silent economy wreaking havoc through a new culture of substance abuse in India. Critically analyse.

What is Cannabis?

  • Cannabis, also known as marijuana among other names, is a psychoactive drug from the Cannabis plant used primarily for medical or recreational purposes.
  • The main psychoactive component of cannabis is tetrahydrocannabinol (THC), which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, including cannabidiol (CBD).
  • It is used by smoking, vaporizing, within the food, or as an extract.

UN’s decision and India

  • Currently in India, the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985, illegalizes any mixture with or without any neutral material, of any of the two forms of cannabis – charas and ganja — or any drink prepared from it.
  • The WHO says that cannabis is by far the most widely cultivated, trafficked and abused illicit drug in the world. But the UN decision could influence the global use of medicinal marijuana,
  • India was part of the voting majority, along with the US and most European nations.
  • China, Pakistan and Russia were among those who voted against, and Ukraine abstained.

Cannabis in India

In India, cannabis, also known as bhang, ganja, charas or hashish, is typically eaten (bhang golis, thandai, pakoras, lassi, etc.) or smoked (chillum or cigarette).

Under international law

  • The Vienna-based CND, founded in 1946, is the UN agency mandated to decide on the scope of control of substances by placing them in the schedules of global drug control conventions.
  • Cannabis has been on Schedule IV–the most dangerous category– of the 1961 Single Convention on Narcotic Drugs for as long as the international treaty has existed.

Fuss over Cannabis

  • Cannabis has various mental and physical effects, which include euphoria, altered states of mind and sense of time, difficulty concentrating, impaired short-term memory and body movement, relaxation, and an increase in appetite.
  • But global attitudes towards cannabis have changed dramatically, with many jurisdictions permitting cannabis use for recreation, medication or both, despite it remaining on Schedule IV of the UN list.
  • Currently, over 50 countries allow medicinal cannabis programs, and its recreational use has been legalized in Canada, Uruguay and 15 US states.

Impact of the decision

  • The reclassification of cannabis by the UN agency, although significant, would not immediately change its status worldwide as long as individual countries continue with existing regulations.
  • The decision would add momentum to efforts for decriminalizing cannabis in countries where its use is most restricted, while further legalizing the substance in others.
  • Scientific research into marijuana’s medicinal properties is also expected to grow.
  • Legalising and regulating cannabis will “undermine criminal markets” as well as its smuggling and cultivation.

Risks of Legalizing Cannabis

(1) Health risks continue to persist

  • There are many misconceptions about cannabis. First, it is not accurate that cannabis is harmless.
  • Its immediate effects include impairments in memory and in mental processes, including ones that are critical for driving.
  • Long-term use of cannabis may lead to the development of addiction of the substance, persistent cognitive deficits, and of mental health problems like schizophrenia, depression and anxiety.
  • Exposure to cannabis in adolescence can alter brain development.

(2) A new ‘tobacco’ under casualization

  • A second myth is that if cannabis is legalized and regulated, its harms can be minimized.
  • With legalization comes commercialization. Cannabis is often incorrectly advertised as being “natural” and “healthier than alcohol and tobacco”.
  • Tobacco, too, was initially touted as a natural and harmless plant that had been “safely” used in religious ceremonies for centuries.

Way ahead

  • It’s important to make a distinction between legalization, decriminalization and commercialization.
  • While legalization and decriminalization are mostly used in a legal context, commercialization relates to the business side of things.
  • For India to liberalise its policy on cannabis, it should ensure that there are enough protections for children, the young, and those with severe mental illnesses, who are most vulnerable to its effects.

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

[pib] The Cancer Genome Atlas (TCGA)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Indian Cancer Genome Atlas (ICGA)

Mains level : Burden of non-communicable diseases on India

The Ministry of Science & Technology has inaugurated the 2nd Cancer Genome Atlas (TCGA) 2020 Conference.

Do you know?

According to the World Cancer Report by the WHO, one in 10 Indians develops cancer during their lifetime and one in 15 dies of the disease!

The Cancer Genome Atlas

  • The Cancer Genome Atlas (TCGA) is a landmark project started in 2005 by the US-based National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI).
  • The idea was to make a catalogue of the genetic mutations that cause cancer.
  • This meant collecting tumour samples and blood samples (known as the germline) from patients and processing them using gene sequencing and bioinformatics.
  • The TCGA is a continuing effort even after fifteen years and has generated over 2.5 petabytes of data for over 11,000 patients.
  • This data is available to researchers all around the world and has been used to develop new approaches to diagnose, treat and prevent cancer.

Indian Cancer Genome Atlas (ICGA)

  • On similar lines, the establishment of an ICGA has been initiated by a consortium of key stakeholders in India led by CSIR in which several government agencies, cancer hospitals, academic institutions and private sector partners.
  • It is aimed at improving clinical outcomes in cancer and other chronic diseases.

Why need such Atlas?

  • Diverse molecular mechanisms- including genetic and lifestyle factors contribute to cancer, posing significant challenges to treatment.
  • Therefore, it is necessary to better understand the underlying factors- patient by patient.
  • In this context, it is important to create an indigenous, open-source and comprehensive database of molecular profiles of all cancer prevalent in Indian population.

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

Swasthya Sathi Health Insurance Scheme

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Swasthya Sathi

Mains level : Ayushman Bharat

West Bengal CM has recently extended the Swasthya Sathi health insurance scheme to cover the entire population of the state.

Do you know?

Delhi, Telangana, Odisha and West Bengal have not implemented the Ayushman Bharat Scheme.

Swasthya Sathi

  • The scheme was launched in West Bengal in 2016.
  • It is a basic health cover for secondary and tertiary care up to Rs five lakh per annum per family.
  • It is quite popular among rural and economically deprived sections of the state’s population.

Highlights of the expanded scheme

  • Every family, every citizen irrespective of the age group will be included in this scheme
  • This is a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family
  • The scheme is completely funded by the state government
  • To cover the entire population of the state, each and every family will be given one smart card to avail the benefits under this scheme, where they will get cashless treatment
  • All state-run and private hospitals are going to come under the Swasthya Sathi
  • The card will be issued to the female guardians of families

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

Is allowing Ayurvedic doctors to perform surgery legally and medically tenable?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Ways to counter shortage of doctors in India

The Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry has allowed postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.

Debate over Ayurvedic surgeries

  • The Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.
  • The debate revolves Ayurveda doctors allowing  ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.
  • The AYUSH Ministry has clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum.

Broader issue

  • The broader issue is the feasiblity of short-term training equip them to conduct surgeries and if this dilutes the medicine standards in India.
  •  As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.
  • Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.

Why such a move?

  • The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue.
  • The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats.
  • However, it would probably still continue to fall short of enough trained specialists in rural areas.

Are there any restrictions on Ayurveda practitioners?

  •  As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas.
  • They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.

Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?

  • The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine.
  • They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda.
  • There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy.

Various risks associated

  • An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone.
  • It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine.
  • Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.

Can this lead to substandard care?

  • Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving.
  • For invasive procedures, like surgery, the risk element can be high.

A matter of rights

  • Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training.
  • There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.

Way forward

  • We need to explore creative ways of addressing this gap by evidence-based approaches, such as task-sharing, supported by efficient and quality referral mechanisms.
  • The advent of mid-level healthcare providers, such as Community Health Providers in many States, is also an opportunity to shift some elements of healthcare (preventive, promotive, and limited curative) to these providers, while ensuring clarity of role and career progression.

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

National Digital Health Mission

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Digital Health Mission

Mains level : Healthcare in India

The National Digital Health Mission will soon be ready for a nationwide roll-out, confirmed the Chairman of National Health Authority and CEO of Ayushman Bharat.

Must read:

[Burning Issue] Rolling-out of National Digital Health Mission

National Digital Health Mission

  • Our PM has launched the National Digital Health Mission on 15th August 2020.
  • The mission aims to create an integrated healthcare system linking practitioners with the patients digitally by giving them access to real-time health records.
  • It is a complete digital health ecosystem. The digital platform will be launched with four key features — health ID, personal health records, Digi Doctor and health facility registry.
  • At a later stage, it will also include e-pharmacy and telemedicine services, regulatory guidelines for which are being framed.

Its implementation

  • The NDHM is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare.
  • The National Health Authority (NHA), is also the implementing agency for Ayushman Bharat.

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

Sex Ratio in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Sex Ratio

Mains level : Sex ratio in India

A 2018 report on “vital statistics of India based on the Civil Registration System” shows crucial data of sex ratios of major states in India.

Sex Ratio

  • Sex ratio at birth is the number of females born per thousand males.
  • Sex ratios are among the most basic of demographic parameters and provide an indication of both the relative survival of females and males and the future breeding potential of a population.

Try this PYQ

Q.Consider the following specific stages of demographic transition associated with economic development:

  1. Low birth rate with a low death rate
  2. High birth rate with a high death rate
  3. High birth rate with a low death rate

Select the correct answer using the codes given below:

(a) 1, 2 and 3 only

(b) 3, 2 and 1 only

(c) 2, 3 and 1 only

(d) 3, 2 and 1 only

Statewise data

  • Arunachal Pradesh recorded 1,084 females born per thousand males, followed by Nagaland (965) Mizoram (964), Kerala (963) and Karnataka (957).
  • The worst was reported in Manipur (757), Lakshadweep (839) and Daman & Diu (877), Punjab (896) and Gujarat (896).
  • Delhi recorded a sex ratio of 929, Haryana 914 and Jammu and Kashmir 952.
  • The number of registered births increased to 2.33 crore in 2018 from 2.21 crore registered births the previous year.

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

What is the Viability Gap Funding (VGF) Scheme?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Viability Gap Funding

Mains level : Not Much

The government has expanded the provision of financial support by means of viability gap funding for public-private partnerships (PPPs) in infrastructure projects to include critical social sector investments in sectors such as health, education, water and waste treatment.

Note the minutes of VGF, its meaning, funding mechanism, various sectors included and its nodal ministry etc. UPSC can ask static statements based question.

What is the move?

  • Now, under this scheme, private sector projects in areas like wastewater treatment, solid waste management, health, water supply and education, could get 30% of the total project cost from the Centre.
  • Separately, pilot projects in health and education, with at least 50% operational cost recovery, can get as much as 40% of the total project cost from the central government.
  • The Centre and States would together bear 80% of the capital cost of the project and 50% of operation and maintenance costs of such projects for the first five years.

Viability Gap Funding (VGF) Scheme

  • Viability Gap Finance means a grant to support projects that are economically justified but not financially viable.
  • The scheme is designed as a Plan Scheme to be administered by the Ministry of Finance and amount in the budget are made on a year-to-year basis.
  • Such a grant under VGF is provided as a capital subsidy to attract the private sector players to participate in PPP projects that are otherwise financially unviable.
  • Projects may not be commercially viable because of the long gestation period and small revenue flows in future.
  • The VGF scheme was launched in 2004 to support projects that come under Public-Private Partnerships.

Its’ funding

  • Funds for VGF will be provided from the government’s budgetary allocation. Sometimes it is also provided by the statutory authority who owns the project asset.
  • If the sponsoring Ministry/State Government/ statutory entity aims to provide assistance over and above the stipulated amount under VGF, it will be restricted to a further 20% of the total project cost.

VGF grants

  • VGF grants will be available only for infrastructure projects where private sector sponsors are selected through a process of competitive bidding.
  • The VGF grant will be disbursed at the construction stage itself but only after the private sector developer makes the equity contribution required for the project.

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

Strengthening the public health capacities in disasters

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Disaster Management Act 2005

Mains level : Paper 2- Making healthcare disaster prepared

The article highlights the importance of the robust public healthcare system for the disaster preparedness and suggests linking it with the primary healthcare.

Reactive approach to disasters

  • In 2005, India enacted the Disaster Management Act, which laid an institutional framework for managing disasters across the country.
  • Under the Act, reactive, ad hoc measures applied in the event of a disaster, was to be replaced with a systematic scheme for prevention, mitigation, and responding to disasters of all kinds.
  • Disaster management considerations were to be incorporated into every aspect of development and the activities of different sectors, including health.
  • While some headway has indeed been achieved, the approach continues to be largely reactive.
  • Significant gaps remain particularly in terms of medical preparedness for disasters.

Medical preparedness for disasters

  • Two important lessons emerge:-
  • First, health services and their continuing development cannot be oblivious to the possibility of disaster-imposed pressures.
  • Second, the legal framework for disaster management must push a legal mandate for strengthening the public health system.

Role of private health sector during disaster

  • Instances of overcharging during Covid illustrates how requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
  • This is particularly important since the future development of hospital care services is being envisaged chiefly under publicly financed health insurance, which would very likely be private-sector led.
  • The Indian private sector landscape, characterised by weak regulation and poor organisation, is incapable for mounting a strong and coordinated response to disasters.
  • During disasters, the limited regulatory ability could be further compromised.
  • While publicly financed insurance could be a medium to introduce some order into this picture, a large majority of private hospitals in the country are small enterprises which cannot meet the inclusion criteria for insurance.
  • Many of these small hospitals are also unsuitable for meeting disaster-related care needs.
  • Punitive action against non-compliant requisitioned hospitals becomes tricky during disasters since health services are already inadequate.
  • Private hospitals are known to prefer lucrative and high-end ‘cold’ cases, especially under insurance, and are generally averse to infectious diseases and critical cases with unpredictable profiles.

Need for strong public sector capacities

  • Due to the above-cited limitations of the private sector, strong public sector capacities are imperative for dealing with disasters.
  • While the Disaster Management Act does require States and hospitals to have emergency plans, medical preparedness is a matter of policy, and, therefore, gaps are pervasive.
  • There is a strong case for introducing a legal mandate to strengthen public sector capacities via disaster legislation.
  • There is also scope for greater integration of disaster management with primary care.
  • Primary care stands for things such as multisectoral action, community engagement, disease surveillance, and essential health-care provision, all of which are central to disaster management.

Way forward

  •  Evidence supports the significance of robust primary care during disasters, and this is particularly relevant for low-income settings.
  • Synergies with the National Health Mission, concurrently with the Disaster Management Act in 2005, could be worth exploring.
  • Interestingly, the National Health Mission espouses a greater role for the community and local bodies, the lack of which has been a major criticism of the Disaster Management Act.
  • Making primary health care central to disaster management can be a significant step towards building health system and community resilience to disasters.

Consider the question “Robust public healthcare system is indispensable for the disaster preparedness which could be achieved through making the primary healthcare central to the disaster management. Comment.

Conclusion

While the novel coronavirus pandemic has waned both in objective severity and subjective seriousness, valuable messages and lessons lie scattered around. It is for us to not lose sight and pick them up.

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

AIDS & India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Gains against HIV

The article highlights the achievement in the fight against AIDS. Most significant are the achievements in the prevention of transmission from mother-to-child.

Significant gains

  • As per recently released 2019 HIV estimates by the National AIDS Control Organization (NACO)/Ministry of Health and Family Welfare with the technical support of UNAIDS there has been a 66.1% reduction in new HIV infections among children and a 65.3% reduction in AIDS-related deaths in India over a nine-year period.
  • The number of pregnant women living with HIV has reduced from 31,000 in 2010 to 20,000 in 2019.
  • Overall, antenatal coverage has expanded, and HIV testing has increased over time and within target range.
  • Treatment coverage has also expanded.

Progress in preventing mother to child transmission

  • Under the leadership of NACO, a ‘Fast-Tracking of EMTCT (elimination of mother-to-child transmission) strategy-cum-action plan’ was outlined by June 2019.
  • The plan entailed mobilisation and reinforcement of all national, State and partners’ collective efforts to achieve the EMTCT goal.
  • Additionally, in March 2020, we began efforts to minimise challenges posed by the COVID-19 pandemic.
  • From 2010 to 2019, India made important progress in reducing the HIV impact on children through prevention of mother-to-child transmission of HIV.
  • This was done through education and communication programmes; increased access to HIV services with innovative delivery mechanisms for HIV testing; counselling and care; and treatment and follow-ups.
  • India made HIV testing for all pregnant women free and HIV treatment is offered the same way nationwide without cost to pregnant mothers living with HIV through the national ‘treat all’ policy.
  • For two years UNICEF has worked with the World Health Organization and NACO to identify high burden districts (in terms of density of pregnant women living with HIV) as the last mile towards disease elimination.
  • Since 2002, when the EMTCT of HIV programmes were launched in India, a series of policy, programmatic and implementation strategies were rolled out so that all pregnant women can access free HIV testing and free treatment regimens for life to prevent HIV transmission from mothers to babies.
  • This has been made possible in government health centres and grass-root level workers through village health and nutrition days and other grass-roots events under the National Health Mission.
  • Indeed, the approach being promoted by UNICEF in focusing attention and resources in high burden districts is supported by the HIV strategic information division of NACO and UNAIDS to better understand the locations and populations most HIV affected, so that technical support and HIV services can be directed towards these areas.

Conclusion

Using data-driven and decision-making approaches it is certain that AIDS will no longer be a public health threat for children in India by the end of 2030, if not before.

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

Obesity in India

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Obesity

Mains level : Obesity in India

Adults in urban India consume much more fat than those in rural areas, found the latest survey by the Indian Council of Medical Research and National Institute of Nutrition.

Do you know?

Over-nutrition is also a form of malnutrition.

‘What India Eats’ Survey

  • Adults in India’s urban centres consumed 51.6 grammes fat per day per head on an average. The volume was 36 g in rural areas, according to the survey report What India Eats.
  • The report categorised fat into two groups:
  1. Visible or added fat, comprising oils and fat in preparing food, in fried food and those derived from meat and poultry
  2. Invisible fat, including fat/oils from rice, pulses, nuts and oilseeds

Urban-Rural data

  • 84 per cent of the rural population secured their energy (E) per day requirement from total fats/oils, or visible / added fats.
  • On the other hand, less than 20 per cent of the urban population derived their E / day from this category.
  • In urban areas of the country, northern India had the highest intake of added fat with 45.9 g / day.
  • Southern India reported the lowest per capita consumption of added fat/oils with 22.9 g / day in this segment of the population.
  • In the urban region of north India, fat intake (67.3 g) was among the highest; and overweight, obesity and abdominal obesity were highest when compared to other regions.

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

Brucellosis: A bacterial disease

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Brucellosis

Mains level : NA

As the novel coronavirus pandemic continues, the health commission has announced this week that a leak in a biopharmaceutical company last year caused an outbreak of brucellosis disease.

Try this PYQ:

Q.Consider the following kinds of organisms:

  1. Bacteria
  2. Fungi
  3. Flowering plants

Some species of which of the above kinds of organisms are employed as bio-pesticides?

(a) 1 only

(b) 2 and 3 only

(c) 1 and 3 only

(d) 1, 2 and 3

What is Brucellosis?

  • Brucellosis is a bacterial disease that mainly infects cattle, swine, goats, sheep and dogs.
  • Humans can get infected if they come in direct contact with infected animals or by eating or drinking contaminated animal products or by inhaling airborne agents.
  • According to the WHO, most cases of the disease are caused by ingesting unpasteurized milk or cheese from infected goats or sheep.
  • Symptoms of the disease include fever, sweats, malaise, anorexia, and headache and muscle pain.
  • While some signs and symptoms can last for long periods of time, others may never go away. Human to human transmission of the virus is rare.
  • These include recurrent fevers, arthritis, swelling of the testicles and scrotum area, swelling of the heart, neurologic symptoms, chronic fatigue, depression and swelling of the liver or spleen.

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

What counts as ‘Act of God’?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Act of God , Force Majeure clause

Mains level : Not Much

Amid disruptions caused by Covid-19, the Finance Minister has referred to an Act of God while businesses are looking at a legal provision, force majeure, to cut losses.

Note the key differences between the Act of God and Force Majeure.

Evoking “Act of God”

  • The force majeure or “Act of God” clause has its origins in the Napoleonic Code.
  • The finance ministry had issued an office memorandum inviting attention to the force majeure clause (FMC) in the 2017 Manual for Procurement of Goods issued by the Department of Expenditure.
  • It clarified that the pandemic should be considered a case of natural calamity and FMC may be invoked, wherever considered appropriate.

What is a force majeure clause?

  • The law of contracts is built around a fundamental norm that the parties must perform the contract.
  • When a party fails to perform its part of the contract, the loss to the other party is made good.
  • However, the law carves out exceptions when the performance of the contract becomes impossible for the parties.
  • A force majeure clause is one such exception that releases the party of its obligations to an extent when events beyond their control take place and leave them unable to perform their part of the contract.
  • FMC is a clause that is present in most commercial contracts and is a carefully drafted legal arrangement in the event of a crisis.
  • When the clause is triggered, parties can decide to break from their obligations temporarily or permanently without necessarily breaching the contract.
  • Companies in such situations use the clause as a safe exit route, sometimes in opportunistic ways, without having to incur the penalty of breaching the contract.

Difference between the two

  • Both concepts elicit the same consequences in law.
  • Generally, an “Act of God” is understood to include only natural unforeseen circumstances, whereas force majeure is wider in its ambit and includes both naturally occurring events and events that occur due to human intervention.

What situations legally qualify for use of force majeure?

  • While some contracts have clauses with standard circumstances, some contracts would have specific circumstances that are more focused.
  • For example, a shipping contract would have a force majeure clause that could cover a natural disaster like a tsunami.
  • If an event is not described, then it is interpreted in a way that it falls in the same category of events that are described.
  • An FMC is negotiated by parties, and events that could potentially hamper the performance of the contract are catalogued.
  • It is not invoked just by expressing that an unforeseen event has occurred.
  • In case a contract does not have a force majeure clause, there are some protections in common law that can be invoked by parties.
  • For example, the Indian Contract Act, 1872 provides that a contract becomes void if it becomes impossible due to an event after the contract was signed that the party could not prevent.

Global precedents dealing with COVID-19 pandemic

  • In China, where the Covid-19 outbreak originated, the Council for Promotion of International Trade is issuing force majeure certificates to businesses.
  • China’s Supreme People’s Court had recognised the 2002 SARS outbreak as a force majeure event.
  • Singapore enacted the Covid-19 (Temporary Measures) Act in April to provide relief to businesses that could not perform their contractual obligations due to the pandemic.
  • The Paris Commercial Court in July ruled that the pandemic could be equated to a force majeure event.
  • In the UK, the Financial Conduct Authority has brought in a test case before the High Court to look into business insurance contracts and interpret the standard wordings in such contracts.
  • The International Chamber of Commerce has developed a Model Code on the force majeure clause reflecting current international practice.

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

Vitamin-D Deficiency

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Vitamin D

Mains level : Not Much

The pandemic-induced lockdown has confined people to their houses for five months now. The resultant lack of sunlight, followed by rains, has brought down the vitamin D levels to the lowest.

Try this PYQ from CSP 2014:

Q.Consider the following pairs:

Vitamin Deficiency:: Disease

  1. Vitamin C::Scurvy
  2. Vitamin D:: Rickets
  3. Vitamin E:: Night blindness

Which of the pairs given above is/are correctly matched?

(a) 1 and 2 only

(b) 3 only

(c) 1, 2 and 3

(d) None

What is Vitamin-D?

  • Vitamin D is an essential vitamin that has myriad positive effects on several systems in the body.
  • Unlike other vitamins, it functions like a hormone and every cell in your body has a receptor for it.
  • It is sparsely found in certain fatty fish and fortified dairy products, and it is extremely difficult to get the Recommended Daily Intake (RDI) of 600-800 IU from diet alone.

There are two main forms of vitamin D in the diet:

– Vitamin D2 (Ergocalciferol) — found in plant foods like mushrooms.
– Vitamin D3 (Cholecalciferol) — found in animal foods like salmon, cod and egg yolks.

Common signs and symptoms of the deficiency

Vitamin D deficiency is incredibly common and most people are unaware of it, as the symptoms are subtle and nonspecific.

– Getting sick or infected often with common cold and flu, because of a weak immune system.
– Fatigue and tiredness
– Bone and muscle pains
– Depression
– Impaired wound healing
– Bone loss and osteoporosis

Sources of Vit. D

  • Sunlight is the best natural source of vitamin D. Sunlight synthesizes cholesterol into Vitamin D3.
  • Usually, 20 to 30 minutes of sun exposure between 10 am and 3 pm is adequate to meet daily requirements, in places with minimum pollution levels.

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

Changing India’s health delivery landscape through NDHM

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NDHM

Mains level : Paper 2- National Digital Health Mission

The National Digital Health Mission promises to transform the Indian healthcare system with the aid of technology. The article highlights the key aspects of the mission.

Building integrated digital health infrastructure through NDHM

  • NDHM is based on the principles of health for all, inclusivity, accessibility, affordability, education, empowerment, wellness, portability, privacy and security by design.
  • NDHM will build the backbone necessary to create an integrated digital health infrastructure.
  • With its key building blocks HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, Telemedicine, and e-Pharmacy, the mission will bring together disparate stakeholders and radically strengthen and, thus change India’s healthcare delivery landscape.
  • NDHM is also a purposeful step towards the achievement of the United Nations’ Sustainable Development Goal of Universal Health Coverage.

Importance of digital intervention in health service

  • Digital interventions significantly enhance the outcomes of every health service delivery programme.
  • Importance of digital intervention is demonstrated in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana scheme.
  • Under PM-JAY, 1.2 crore cashless secondary and tertiary care treatments have been provided using an indigenously developed state-of-the-art IT platform.
  • The Arogya Setu mobile app deploys ICT innovations for contract tracing.

Principal highlight of NDHM

1) Voluntary in nature

  • HealthID is entirely voluntary for citizens.
  • Its absence will not mean denial of healthcare to a citizen.
  • They can choose to generate their Health Account or ID using their Aadhaar card or digitally authenticable mobile number and by using their basic address-related details and email ID.
  • The use of Aadhaar, therefore, is not mandatory.

2) Data sharing based on consent

  • Providing access to and sharing of personal health records is a prerogative of the HealthID holder.
  • The consent of the health data owner is required to access this information or a part of it.The consent can be withdrawn anytime.
  • The personal health record will enable citizens to store and access their health data, provide them with more comprehensive information and empower them with control over their private health records.

3) Compliance with laws and fundamental rights

  • NDHM has been built within a universe of fundamental rights and legislation such as the Aadhaar Act and the IT Act 2008 as well as the Personal Data Protection Bill 2019.
  • This project is also informed by the entire gamut of Supreme Court judgments and core democratic principles of cooperative federalism.
  • The Mission gets its strategic and technical foundation from the National Digital Health Blueprint, the architectural framework of which keeps the overall vision of NHP 2017 at its core and ensures security and privacy by design.

4) Reaching out to the unconnected population

  •  NHDM is a digital mission led by technology powered by the internet.
  • So, to reach out to and empower the large number of “unconnected” masses specialised systems are being built and off-line modules that will be designed to reach out to the “unconnected”.

5) Partnership with all key stakeholders

  • The design of NDHM has been built on the principle of partnership with all key stakeholders — doctors, health service providers, technology solution providers and above all citizens.
  • Without their belief, trust, adoption, and stewardship, this mission will not achieve its desired result.

Consider the question “Examine the key aspects of the National Digital Heath Mission and how it could help transform the Indian healthcare landscape?”

Conclusion

NDHM is a mission whose time has come because health is the first step towards self-reliance and only a healthy nation can become Atma Nirbhar.

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

Reversing health sector neglect with a reform agenda

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2-Universal health coverage in India

The article analyses the issues India could face in implementing the universal health coverage.

Context

  • Both India and the U.S. leads the Covid cases in the world and also lack effective universal health coverage (UHC).

What explains the lack of UHC in both the countries

  • The lack of UHC is due to multiple long-standing factors and historical reasons that have put a damper on the UHC agenda.
  • This long legacy has two important and inter-related implications when it comes to health-care reform.
  • 1) Certain foundational aspects of these health systems that have been adopted over decades tend to dictate the terms of further evolution and lead to a number of compromises.
  • 2) The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.
  • This applies both to AB-PM-JAY and NDHM.

India’s attempt at UHC: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

  • The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC.
  • Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
  • Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
  • Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
  • Distributing benefits among various beneficiary groups, and a formalisation and consolidation of practices in a likely situation of covering outpatient care, are formidable additional challenges.
  • One possible advantage for India over the U.S. could be a relative ease of integrating fragmented schemes into a unified system. The AB-PM-JAY has this ability.

Issues with AB-PM-JAY

1) Universal insurance will not be universal access

  • In India, almost two-third corporate hospital are located in cities.
  • So, such maldistribution of health-care facilities and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.
  • So far, insurance-based incentives to drive private players into the rural countryside have been largely unsuccessful.

2) Lack of regulatory robustness

  • AB-PM-JAY is without enough regulatory robustness to handle everything from malpractices to monopolistic tendencies.
  • This could have major cost, equity, and quality implications.

National Digital Health Mission (NDHM)

  • Integration and improved management of patient and health facility information are sought through NDHM.
  • But in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs.

Consider the question “What are the challenges India faces in the implementation of universal health coverage? Suggest the measures to achieve it.”

Conclusion

Upheavals offer a window for reforms. We cannot afford to be complacent and think that the pandemic will automatically change the Indian health-care landscape. It will require mobilising concerted action from all quarters.

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

What is the National Health ID System?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Health ID System

Mains level : Developing digital health infrastructure

In his address to the nation on Independence Day, the PM has launched the National Digital Health Mission which rolls out a national health ID for every Indian.

Try this question for mains:

Q.What is the National Health ID System? How will it benefit transforming healthcare facilities in India?

National Health ID System

  • This system finds its roots in a 2018 NITI Aayog proposal to create a centralised mechanism to uniquely identify every participating user in the National Health Stack.
  • It will be a repository of all health-related information of a person.
  • According to the National Health Authority (NHA), every patient who wishes to have their health records available digitally must start by creating a Health ID.
  • Each Health ID will be linked to a health data consent manager — such as National Digital Health Mission (NDHM).
  • The Health ID is created by using a person’s basic details and mobile number or Aadhaar number.
  • This will make it unique to the person, who will have the option to link all of their health records to this ID.

What was the original proposal for the health ID?

  • The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
  • In the context of this, the central government’s think-tank NITI Aayog, in June 2018, floated a consultation of a digital backbone for India’s health system — National Health Stack.
  • As part of its consultation, NITI Aayog proposed a Digital Health ID to greatly reduce the risk of preventable medical errors and significantly increase the quality of care.

Stakeholders in the national health ID

  • As envisaged, various healthcare providers — such as hospitals, laboratories, insurance companies, online pharmacies, telemedicine firms — will be expected to participate in the health ID system.

Back2Basics:

National Digital Health Mission (NDHM)

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

[pib] Electronic Vaccine Intelligence Network (eVIN)

Note4Students

From UPSC perspective, the following things are important :

Prelims level : eVIN

Mains level : Vaccination programme in India

The eVIN has reached 32 States and Union Territories (UTs) and will soon be rolled out in the remaining States and UTs of Andaman & Nicobar Islands, Chandigarh, Ladakh and Sikkim.

Try this question from CSP 2016:

Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

(a) Immunization of children and pregnant women

(b) Construction of smart cities across the country

(c) India’s own search for the Earth-like planets in outer space

(d) New Educational Policy

About eVIN

  • The eVIN is an innovative technological solution aimed at strengthening immunization supply chain systems across the country.
  • This is being implemented under the National Health Mission (NHM) by the Ministry of Health and Family Welfare.
  • It aims to provide real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in the country.
  • This system has been used during the COVID pandemic for ensuring the continuation of the essential immunization services and protecting our children and pregnant mothers against vaccine-preventable diseases.

Components of eVIN

  • eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
  • At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.

Benefits of eVIN

  • It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
  • It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
  • While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
  • This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.

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

Private: India’s Ailing Health Sector and Coronavirus

Healthcare is LITERALLY the talk of the town right now. But for all the wrong reasons. Whether it is the lack of beds/ventilators or high cost of treatment, COVID has amplified our present deficiencies.  Like rest of the world, Indians are for the first time so singularly focused on healthcare and public health amid this pandemic. And everyone suddenly wants to fix healthcare!

Confucius, it is said, once observed, “a seed grows with no sound, but a tree falls with huge noise. Destruction has noise, but creation is quiet”. As we all know, the world is at a crossroads. With COVID-19, many of our beliefs and the systems we follow are bound to change OR even get collapsed!

Healthcare in India: A Background

  • The Indian Constitution has incorporated the responsibility of the state in ensuring basic nutrition, basic standard of living, public health, protection of workers, special provisions for disabled persons, and other health standards, which were described under Articles 39, 41, 42, and 47 in the DPSP.
  • Article 21 of the Constitution of India provides for the right to life and personal liberty and is a fundamental right.
  • Public Health comes under the state list.
  • India’s expenditure on healthcare has shot up substantially in the past few years; it is still very low in comparison to the peer nations (at approx. 1.28% of GDP).

All-time Paradoxes of Indian Healthcare

(1) Healthcare is a fundamental right, but it is not fundamentally right in India:

The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution.

The expenditure on healthcare is one of the lowest in the world, lower than nations with similar economic growth rates. Though our economy has grown robustly post-liberalization, investment in healthcare has consistently hovered around 1% of the GDP. In the 2020-21 Budget, it was 1.02% of overall expenditure.

(2) Sector attracts investments, but delivery remains contentious:

India’s healthcare sector has attracted a steady stream of investments, albeit at the higher end of the value chain — the secondary & tertiary care. Lack of penetration, inflated billing, opaqueness in diagnosis, and poor quality of service has ensured that most Indians get treated below the standards prescribed by the WHO.

(3) Among the cheapest in the world, yet unaffordable for most locally:

Healthcare in India is cheap. For example: Compared to India, the cost of a knee replacement treatment is over twenty times more in the US and double in Malaysia. Yet India has one of the world’s highest rates of out-of-pocket spending in healthcare. There are millions in India who cannot afford these procedures in their own country.

(4) Less than one doctor for 1,000 patients, but medical tourism booms:

  • India treated 3.6 lakh foreign patients in 2016 and the country’s medical tourism market is expected to grow to $7-8 billion by 2020.
  • The doctor-patient ratio in India is less than the WHO-prescribed limit of 1:1000. There is a dearth of medical schools and clinicians.
  • Most hospitals in India are overburdened, understaffed, and ill-equipped. However, all this has not prevented the private healthcare sector to establish sophisticated medical tourism facilities on the plank of ‘world-class service at low cost’.

(5) Stark divergence in healthcare outcomes within the country:

Healthcare being a state subject, the healthcare outcomes have remained divergent based on the quality of the state administration. While North India is the most populated part of India, it has one of the most undeserved healthcare infrastructures in the country.

Is India prepared to face this pandemic?

  • Current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
  • Public health experts believe that India is ill-equipped to handle such emergencies. It is not prepared to tackle health epidemics, particularly given its urban congestion.
  • Post unlock, the spread is at a galloping rate.
  • The slum clusters all around the cities and the unhygienic growth, poor waste disposal system will only aggravate the situation.

History shows us that “blame” has been a standard human response during pandemics.

These are some issues surfaced during this pandemic ………..

(1) Poor Infrastructure

  • In the 2019 Global Health Security Index, which measures pandemic preparedness for countries based on their ability to handle the crisis, India ranked 57, lower than the US at 1, the UK at 2, Brazil at 22, and Italy at 31.
  • This is well revealed through indicators like hospital beds per 1,000 people.
  • As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh, 2.11 in Chile, 1.38 in Mexico, 4.34 in China, and 8.05 in Russia.

(2) Fewer doctors per thousand

  • The WHO mandates that the doctor to population ratio should be 1:1,000, while India had a 1:1,404 ratio as of February 2020.
  • In rural areas, this doctor-patient ratio is as low as 1:10,926 doctors as per National Health Profile 2019.

(3) Denial of healthcare

  • Despite private hospitals accounting for 62 percent of the total hospital beds as well as ICU beds and almost 56 percent of the ventilators, they are handling only around 10 percent of the workload.
  • Private hospitals are reportedly denying treatments to the poor. Cases of overcharging patients are also being reported in private hospitals.
  • This is seen in Bihar, which has witnessed an almost complete withdrawal of the private health sector and has nearly twice the bed capacity of public facilities.

(4) Discrepancy in Testing

  • India continues to test less than it should in a post-lockdown scenario where testing is one of the most obvious ways to flatten the curve.
  • The Supreme Court, after ruling on April 8 that private labs should conduct free testing, modified its decision five days later to fix the rate of one of the most dependable tests at Rs 4,500.

(5) Negligence for mental healthcare

  • The tragic death of an actor and the gloom of the Covid-19 pandemic have led to much-needed conversations on mental health in the country.
  • Mental health problems were already a major contributor to the burden of illness in India which usually gets unnoticed.
  • The widespread anxiety due to lockdown has frustrated the laborers, farmers, and various vulnerable sections to a great extent due to the fear of impoverishment and loss of livelihoods.

Need of the hour: A tectonic overhaul

(1) Universal health coverage

  • Access to healthcare in India is not equitable—the rich and the middle class would survive the COVID-19 or any other crisis but not the poor.
  • As part of the SDGs, all countries have pledged to deliver universal health coverage (UHC) by 2030.
  • This includes India. But, sadly, nearly 50 percent of the world’s population lacks essential health services.
  • If any good comes out of this crisis, then it will be India waking up to the reality that investing in health is not a luxury. It is a basic need.

(2) Increasing healthcare professionals in numbers

  • India has handled the COVID-19 pandemic exceptionally well. However, considering the rise in the number of infections, India is in dire need of more medical staff and amenities.
  • If India wants to achieve a 1:1,000 ratio, it will need an additional 2.07 million doctors by 2030. For this, the government needs to increase its spending on the health sector.
  • It needs to aid attempts at constructing new medical institutes.

(3) Revamping medical education

  • If the government wants to stay successful in fighting the COVID-19 pandemic, it needs to rapidly build medical institutions and increase the number of doctors.
  • Once COVID-19 is under control, we need to consider the psychological and professional impact of the pandemic on medical professionals.

(4) Helping the downtrodden

  • How the poor are going to manage without, or even with, any government insurance scheme is a big question.
  • Rather than dumping them on government hospitals only, the private hospitals should be held accountable to take on their treatment.
  • They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.

(5) Enhancing pandemic preparedness

  • With COVID-19 we risk once again falling into the trap of a narrow vertical disease-specific approach.
  • Decades of global health experience have revealed the limitations of narrow “vertical” disease-based programs.
  • However, there is a need for recognition to combine vertical programs with “horizontal” health system strengthening.

(6) Optimum use of technology

  • The COVID-19 crisis has elevated the importance of digital tools and e-health.
  • There is a growing use of mobile apps, online consultations, e-pharmacies, and other tools.
  • These are all welcome and must be leveraged.

(7) Looping-in private players

  • For too long, India has allowed the private health sector to grow, with little regulation.
  • The lack of alignment between the public and private sectors has been clearly exposed to COVID-19 testing and treatment in India.
  • Time is ripe to loop in private players and promote the industrialization of health-sector.

(8) Learning from the successes

  • With crumbling health infrastructure due to overburden, India’s preparedness for handling this epidemic has become a major challenge.
  • The world along with India being no exception has responded with extraordinarily aggressive measures such as phased lockdowns, Bhilwara Model, Pathanamthitta Model, Taiwan model, etc.
  • The success of these models is attributed to various best practices which are were implemented days before the thought of nationwide lockdown was incepted.

Kindly refer for various success models:

[Burning Issue] Success stories in handling COVID-19 crisis

 

Way Forward

  • The aerial spread of the pandemic post unlock poses a threat of rapid dissemination but it can still be contained with an efficient response that combines effective public health, microbiological, clinical, and communication responses.
  • While our laboratory network has improved somewhat, but much needs to be done to improve the community facing primary health services and risk communication to the public.
  • Kerala’s success in responding swiftly and smartly to the outbreak should be a role model for other states.

Conclusion

India’s healthcare system is too small for such a large population. There seems to be a long battle ahead. The public healthcare system cannot be improved overnight. The country needs all hands on deck during and after this crisis—both public and private sectors must work together and deliver universal health coverage for all citizens.

Ultimately, the onus of governance always rests with the government, which needs to set standards, invest resources, ensure quality, and strategically purchase services from the private sector, as needed.

 

 

 

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.