💥Mains Ready By December. Smash Mains & Smash PYQ Admissions Open
Talk to Mentor

Civilsdaily

Login

Subject: Governance

Important aspects of Society

  • Citizen-Centric Governance: Important Aspects of Development In Any Democracy

    Central idea

    • Citizen-centric governance is an evolving concept, and to put it into action requires clarity in the actions that civil servants perform and how citizens engage with the state. Citizen engagement is about collaborative partnerships and dialogue and must involve all stakeholders to ensure the overall development of a community or a nation.

    Citizen-Centric Governance

    • Paradigm shift in traditional governance: Citizen-centric governance refers to a paradigm shift in the traditional governance structures where the focus is shifted from the power holders to the citizens.
    • Access to information and services to citizens: Traditionally, governance structures hold the power to make decisions that affect the lives of citizens. But citizen-centric governance focuses on providing citizens with access to information, services, and resources and on engaging them in the policy-making process.
    • Increased citizen participation: The objective of citizen-centric governance is to increase citizen participation in decision-making processes

    Mission Karmayogi

    • Capacity building of civil servants: Mission Karmayogi, the National Programme for Civil Services Capacity Building has been strategically working to build the capacities of civil servants through various innovative interventions to sensitise and reframe the fabric of citizen participation.
    • karmachari to karmayogi: Today, thousands of railway employees, Gramin Dak Sevaks, police personnel in the UTs and employees of BSNL are all going through an outcome-based capacity-building programme that is shifting them from thinking like a karmachari to acting like a karmayogi.

    Citizen Engagement

    • Citizen engagement refers to how citizens participate in the political, social and economic aspects of their community or society.
    • Citizen engagement is highly embedded in the nature of the political and governance context and existing power relations.
    • It needs to be understood as a core component of any governance system, and in democracies, citizen engagement is a basic principle because it is understood that governments derive their authority and power from the people.

    What the multi-stakeholder engagement requires?

    • Constructive dialogue: Development by the people and for the people is indeed possible. Citizen engagement towards democratising the process of development necessarily involves a constructive dialogue between and amongst all stakeholders.
    • Mutual trust and respect: Meaningful dialogue among the stakeholders the state, citizenry, private sector, media, civil society and academia can sustain only when there is mutual trust. The relationship between these multiple stakeholders needs to be driven by mutual respect and an appreciation of interdependence and reciprocity.
    • Redrawing boundaries of engagement: However, this may involve redrawing boundaries of engagement and roles that stakeholders have traditionally assumed for themselves.
    • Partnership approach: The multi-stakeholder engagement would require the adoption of the partnership approach by all parties involved.

    Conclusion

    • Citizen-centric governance and citizen engagement are important aspects of development in any democracy. By adopting a partnership approach and mutual respect for each other’s roles, stakeholders can work together to ensure the overall development of a community and nation at large. The Indian government’s program, Mission Karmayogi, is a right step towards building the capacities of civil servants and sensitizing them to citizen participation.
    Are you an IAS Worthy Aspirant? Get a reality check with the All India Smash UPSC Scholarship Test

    Get upto 100% Scholarship | 900 Registration till now | Only 100 Slots Left

     

  • Autism Spectrum Disorders: Prevalence in India and Way Ahead

    Central Idea

    • In India, the prevalence of autism spectrum disorders (ASD) is a widely debated issue due to a lack of systematic estimates. Most estimates have been derived from studies based on school children, revealing that over one crore Indians may be on the autism spectrum. However, there are notable cultural differences in diagnosing autism between countries, which highlights the need to assess the prevalence of autism spectrum disorders specifically in the Indian context.

    What is Autism?

    • Spectrum disorder: Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects communication, social interaction, and behaviour. It is called a spectrum disorder because the symptoms and severity can vary widely between individuals.
    • Common symptoms: Some common symptoms of autism include difficulty with social interactions, such as maintaining eye contact or understanding nonverbal cues, delayed speech and language development, repetitive behaviors, and sensory sensitivities.
    • Cause: Autism is believed to be caused by a combination of genetic and environmental factors, but the exact cause is not yet fully understood.
    • Cure: There is currently no cure for autism, but early interventions and therapies can help individuals with autism lead fulfilling and independent lives.

    Prevalence of Autism in India

    • Lack of systematic estimates: Autism is a global issue and affects individuals of all cultures, ethnicities, and socioeconomic backgrounds. However, there is a lack of systematic estimates of autism prevalence in India.
    • Methos failed: Researchers have attempted to estimate prevalence through government hospitals, but this method failed due to the absence of central medical registries.
    • Conservative estimates: As a result, prevalence was estimated through school-based assessments. According to conservative estimates, well over one crore Indians are on the autism spectrum. This highlights the need for further research and attention to address the prevalence of ASD in India.
    • Cultural Differences and Diagnosis of Autism:
    • Notable cultural differences exist in the diagnosis of autism spectrum disorder. In the US and UK, the majority of children with autism spectrum diagnosis are verbal, with average or higher IQ, and attending mainstream schools.
    • However, in India, a significant majority of children with a clinical diagnosis of autism also have intellectual disability and limited verbal ability. This difference is driven by sociological factors, such as access to appropriate clinical expertise, provisions for inclusion in mainstream schools, and availability of medical insurance coverage.

    Challenges in Assessing Autism

    • Assessment tools: Assessment of autism spectrum disorder is primarily behavioral, and most widely used autism assessment tools are not available in Indian languages.
    • Indigenous autism assessment tools challenges: There has been a rise in the development of indigenous autism assessment tools. Despite the development of these tools, it can be challenging to compare across different assessment measures.

    Demand and Supply in India

    • Shortage of mental health professionals: Most autism assessment tools need to be administered by specialist mental health professionals. However, there is a significant shortage of mental health professionals in India, with less than 10,000 psychiatrists, a majority of whom are concentrated in big cities.
    • Delay is costly: Delay in interventions can be costly for neurodevelopmental conditions such as autism.
    • Demand and supply gap need to be met: This gap between demand and supply cannot be met directly by specialists alone, and parallel efforts to widen the reach of diagnostic and intervention services through involving non-specialists is required. Emerging evidence suggests the feasibility of involving non-specialists in autism identification and intervention through digital technology and training programs.

    Way ahead: Need for an All-India Program

    • National program on autism: The need of the hour is to develop a national program on autism in India that links researchers, clinicians, service providers to the end-users in the autism community.
    • Essential components: This program needs to have three essential components that are joined up: assessment, intervention, and awareness.
    • Assessment: Research is needed to develop appropriate assessments and design efficient implementation pathways.
    • Intervention: Clinical and support service workforce needs to be expanded by training non-specialists such that a stepped-care model can be rolled out effectively across the nation.
    • Awareness: Large-scale initiatives need to be launched to build public awareness that can reduce the stigma associated with autism and related conditions.

    Conclusion

    • There are challenges in diagnosing and assessing autism in India which highlights the need for a comprehensive and coordinated effort to address them. By expanding the clinical and support service workforce, training non-specialists, and developing appropriate assessments and interventions, India can improve outcomes for those on the autism spectrum and reduce the stigma associated with the condition. This national program needs to be informed by consultation with different stakeholders, with a primary focus on end-users within the Indian autism community.

  • New India Literacy Program (NLIP)

    literacy

    Central idea: 22.7 lakh adults from 10 states and union territories in India became qualified as literate adults in 2022-23 by passing an assessment test conducted under New India Literacy Program (NLIP).

    What is New India Literacy Program (NLIP)?

    • The NLIP/ Nav Bharat Saksharta Abhiyan is aimed at providing literacy to non-literates in the age group of 15 years and above.
    • The scheme is implemented for a period of five years from FYs 2022-23 to 2026-27.
    • The scheme has five main components, which are as follows:
    1. Foundational Literacy and Numeracy,
    2. Critical Life Skills,
    3. Vocational Skills Development,
    4. Basic Education, and
    5. Continuing Education

    Beneficiaries of the scheme

    • The beneficiaries under the scheme are identified through a door-to-door survey on a mobile app by surveyors in the States/UTs.
    • Non-literates can also avail the benefits of the scheme through direct registration from any place through a mobile app.
    • The scheme is mainly based on volunteerism for teaching and learning.
    • Volunteers can also register through a mobile app for this purpose.

    Implementation of the scheme

    • The scheme is based on technology and implemented predominantly through an online mode.
    • The teaching-learning material and resources have been made available on the DIKSHA platform of NCERT and can be accessed through mobile apps.
    • Furthermore, other modes like TV, Radio, Samajik Chetna Kendra, etc. are also to be used for the dissemination of Foundational Literacy and Numeracy.

    Conclusion

    • The New India Literacy Programme (NILP) is a crucial step towards making India a literate country.
    • The scheme’s implementation through technology and the use of volunteers for teaching and learning will make it easier for non-literates to access education.

     

  • Duty exemption for drugs for Rare Diseases

    rare

    Central idea: The Centre has exempted all drugs and food for special medical purposes, imported for personal use, for the treatment of rare diseases listed under the National Policy for Rare Diseases 2021 from basic customs duty.

    What are Rare Diseases?

    • Rare diseases are those medical conditions that affect a small percentage of the population.
    • In India, a disease is considered rare if it affects less than 1 in 2,000 people.
    • These diseases are often genetic and are chronic, degenerative, and life-threatening.
    • There are over 7,000 known rare diseases, and it is estimated that about 70 million people in India are affected by them.
    • Many of these diseases do not have a cure, and the treatment can be expensive and difficult to access.

    Need for duty exemption

    • This decision has been taken to help reduce the burden of the cost of treatment for patients and families.
    • The drugs and food required for the treatment of these rare diseases are often expensive and need to be imported.
    • This exemption will result in substantial cost savings and provide much-needed relief to patients with rare diseases.

    Key medicines under this exemption

    • The central government has fully exempted Pembrolizumab (Keytruda), a drug used in the treatment of various types of cancer, from basic customs duty.
    • Previously, the GST rate for Keytruda was cut to 5 per cent from 12 per cent in a meeting held in September 2021 by the GST Council.
    • Life-saving drugs Zolgensma and Viltepso used in the treatment of spinal muscular atrophy were exempted from GST when imported for personal use.

    How the new duty exemption works?

    • The exemption has been granted by the Central Board of Indirect Taxes and Customs (CBIC) by substituting “Drugs, Medicines or Food for Special Medical Purposes (FSMP)” instead of “drugs or medicines”.
    • To avail of this exemption, the individual importer has to produce a certificate from the central or state director health services or district medical officer/civil surgeon of the district.

    How are life-saving medicines taxed?

    • Drugs/medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs/vaccines attract a concessional rate of 5 per cent or nil.
    • In its meeting in September 2021, the GST Council had reduced tax rates for several life-saving drugs.

     

  • Public Policy Education: Essential For Developing Effective Policies

    Central Idea

    • Government policies play a crucial role in determining the future of a country. They not only impact economic growth and public welfare but also improve the ease of living for citizens. Unfortunately, there is a lack of interest in public policy education in India, with only a small percentage of policymakers having formal education in public policy and administration.

    Public policy education

    • Public policy education refers to the study and teaching of the principles, theories, and methods involved in the development, implementation, and evaluation of policies that address societal issues.
    • This field of education aims to equip students with the knowledge and skills necessary to analyze, create, and manage public policies effectively.

    How the government policies, economic growth, and public welfare are closely interconnected?

    • Government policies: Governments create and implement policies to guide economic activities, maintain social order, and promote the welfare of their citizens. These policies cover a wide range of areas, such as fiscal and monetary policy, trade policy, education, healthcare, social security, and infrastructure development. The effectiveness of these policies can have a direct impact on economic growth and public welfare.
    • Economic growth: Economic growth is the increase in a country’s output of goods and services over time, usually measured by the growth rate of gross domestic product (GDP). A growing economy typically leads to higher employment, increased income, and improved living standards for citizens. Government policies play a crucial role in stimulating or hindering economic growth by influencing factors such as investment, consumption, trade, and innovation.
    • Public welfare: Public welfare refers to the overall well-being of a society, encompassing aspects such as income distribution, access to essential services, health, education, and environmental quality. Government policies can significantly impact public welfare by determining the allocation of resources, setting priorities, and providing social safety nets.

    Paucity of Programs

    • As per the All-India Council for Technical Education, there are 3,182 institutions with an approved intake of 4.22 lakh in business management programs, but only about 130 universities that offer public administration programs and only 29 institutes that offer public policy programs.
    • The batch size of public policy courses is 20-60, and there are few jobs available for people pursuing such courses, which disincentivizes educational institutions and students from choosing public management courses.

    Lack of Exposure to Public Management

    • Most civil servants undergo departmental induction training programs that focus on the role they play in their department and not much on how to make good public policies.
    • Consequently, very few civil servants have exposure to public management before joining service, which is critical for developing effective policies.

    Suggestions to boost public policy education in India

    1. Public Management as a Compulsory Subject in UPSC:
    • Public management should be a compulsory subject for the UPSC civil service examination, either as a substitute for one optional subject or an additional paper. This will incentivize universities and private institutions to offer public policy education, research, and case studies at the graduate or post-graduate level, leading to a major boost in public policy education.
    • Additionally, civil servants who join government would have formal education in public management before they enter service, and even those who do not make it to government jobs would develop better understanding and sensitivity towards complexities involved in public management, making them better citizens and effective private sector managers.
    1. Larger Component of Public Policy in Induction Training: Existing training institutions of the government should have a larger component of public policy as part of their induction training. Moreover, a case study bank for training should also be established.
    2. Specialized Positions of Public Policy Analysts: The government can create certain specialized positions of public policy analysts to be picked up from the market directly, thereby creating new job avenues for the graduates of public policy programs.

    Conclusion

    • The lack of formal education in public management has led to governance lagging behind private sector management in terms of efficiency and effectiveness. Public policy education is essential for developing effective policies that spur economic growth, public welfare, and improve ease of living for citizens.

    Mains Question

    Q. What is public policy education, and why is it important for policymakers in India to have formal education in public policy and administration? Suggest measures to boost public policy education in India.

  • Healthcare: Remarkable Progress But The Gaps Needs to be Addressed

    Central Idea

    • The Indian healthcare system has overcome many challenges and has made significant progress, but there are still many tough health challenges that need to be addressed. There is need to bridge the gap between the services available in metropolitan and Tier-II and Tier-III cities, provide healthcare insurance to the unorganised middle class, and use Artificial Intelligence and digital technology to improve healthcare services.

    Overcoming past challenges

    • The Indian healthcare system has overcome seemingly insurmountable problems, including high maternal and infant mortality rates, and low hospital delivery rates.
    • The National Family Health Survey (NFHS-5) results show that even in the so-called BIMARU states, hospital deliveries have soared to 89 per cent.

    Current Health Challenges

    • Five interrelated challenges: The current macro picture shows at least five interrelated challenges that are pervading the population, including non-communicable diseases (NCDs), obesity, and chronic respiratory diseases.
    • NCDs: The proportion of deaths due to NCDs has increased from around 38 per cent in 1990 to 62 per cent in 2016.
    • Obesity: Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5. Awareness about leading healthy lives will save millions from illness and decelerate premature death.

    Current state of healthcare in India

    1. Infrastructure:
    • The state of infrastructure matters. Since 2018, governments at the Centre as well as the state have been trying to bolster primary healthcare by establishing health and wellness centres.
    • But there are still huge variations between states, and some states have better arrangements than others. States must step up efforts to improve infrastructure in the healthcare sector.
    1. Bridging the gap in hospital services:
    • In urban areas, the challenge is to bridge the gap in hospital services between large urban agglomerations and Tier-II and Tier-III cities.
    • Large hospital chains provide only 4-5 per cent of the beds in the private sector.
    • Standalone hospitals and nursing homes provide 95 per cent of private hospital beds but are unable to provide multi-specialty, leave alone tertiary and quaternary care.
    • The gaps between services available in the metros and big cities and in districts must be bridged.
    1. Health Insurance Coverage:
    • Low health insurance penetration and the very high personal outgo on healthcare remain a challenge.
    • But over the past three years, more than four crore Indians have bought health insurance.
    • From 2018, the Ayushman Bharat insurance scheme for 10 crore poor families has been undertaken to provide insurance against hospitalisation for up to Rs 5 lakh per year per family.
    • Nearly 74 per cent of Indians are either covered or eligible for health insurance coverage.
    1. Use of Artificial Intelligence and digital technology:
    • An emerging concern is the use of Artificial Intelligence (AI) and digital technology to improve healthcare services.
    • Surgery assisted by robots, the use of genetic codes, clinical decision support systems, and telemedicine can help in making healthcare more accessible and efficient.

    Conclusion

    • India has shown how the impossible can be achieved, but the healthcare system needs to overcome various challenges to fully redeem its advantage of having the youngest population. The government needs to step up efforts in improving infrastructure, bridging the gap in hospital services, and providing health insurance coverage for the unorganized middle class. It is also essential to regulate the use of AI and digital technology in the healthcare sector to ensure accountability and prevent malpractice.
    Are you an IAS Worthy Aspirant? Get a reality check with the All India Smash UPSC Scholarship Test

    Get upto 100% Scholarship | 900 Registration till now | Only 100 Slots Left

     

  • DPDP Bill 2022: Need for Sector-Specific Safeguards

    Central Idea

    • India’s digital economy is growing rapidly and generating massive amounts of personal data. As citizens embrace convenience, understanding how this data is handled and protected has become critical. The Digital Personal Data Protection (DPDP) Bill 2022 aims to safeguard citizens’ information from misuse and unauthorised access but lacks specificity in certain clauses such as the interaction with sectoral data protection regulations.

    The Digital Personal Data Protection (DPDP) Bill 2022

    • The Digital Personal Data Protection (DPDP) Bill 2022 is a proposed legislation aimed at safeguarding the personal data of Indian citizens from misuse and unauthorized access.
    • The bill aims to regulate the handling of personal data in the rapidly growing digital economy of India.

    Seven principles of DPDP Bill, 2022

    According to an explanatory note for the bill, it is based on seven principles-

    1. Lawful use: The first is that usage of personal data by organisations must be done in a manner that is lawful, fair to the individuals concerned and transparent to individuals.
    2. Purposeful dissemination: The second principle states that personal data must only be used for the purposes for which it was collected.
    3. Data minimisation: Bare minimum and only necessary data should be collected to fulfill a purpose.
    4. Data accuracy: At the point of collection. There should not be any duplication.
    5. Duration of storage: The fifth principle talks of how personal data that is collected cannot be stored perpetually by default, and storage should be limited to a fixed duration.
    6. Authorized collection and processing: There should be reasonable safeguards to ensure there is no unauthorised collection or processing of personal data.
    7. Accountability of users: The person who decides the purpose and means of the processing of personal data should be accountable for such processing

    Challenges regarding conflicting sectoral regulations in India

    • The DPDP Bill 2022 lacks specificity in certain clauses regarding the interaction with sectoral data protection regulations.
    • While the Bill allows for filling regulatory gaps, conflicting sectoral regulations may create confusion.
    • India already has sectoral regulations regarding data protection, such as the Reserve Bank of India’s directive on storage of payment data and the National Health Authority’s Health Data Management Policy. Any deviation from existing regulations will further require the industry to readjust their operations again at considerable cost.

    Approach to regulate privacy and protect data

    • The two major approaches to regulating privacy and protecting data is comprehensive legislation and sector-specific regulations
    • The European Union’s General Data Protection Regulation (GDPR) as an example of comprehensive legislation with sector-specific provisions
    • The American sectoral approach as a patchwork of regulations tailored to specific industries, with flaws in inconsistent protection, enforcement, and lack of federal regulation

    Way ahead: Finding the right balance for India

    • There is a need for greater clarity and specificity in the interaction between the DPDP Bill and sectoral regulations in India
    • It is important to build on existing sectoral regulations to avoid undermining their efforts and require further costly adjustments
    • The role of sectoral experts in ensuring a safer, more secure, and dynamic digital landscape for Indian citizens in the future is important.

    Conclusion

    • The DPDP Bill must serve as the minimum layer of protection, with sectoral regulators having the ability to build on these protections for a safer and more secure digital landscape.
    Are you an IAS Worthy Aspirant? Get a reality check with the All India Smash UPSC Scholarship Test

    Get upto 100% Scholarship | 900 Registration till now | Only 100 Slots Left

     

  • Type 1 and Type 2 Diabetes among Children

    diabetes

    The National Commission for Protection of Child Rights (NCPCR) has written to Education Boards of all States/UTs, stating schools must ensure proper care/facilities for children with Type 1 diabetes (T1D).

    What is Diabetes?

    • Diabetes is a chronic medical condition that occurs when the body cannot regulate blood sugar levels properly.
    • Blood sugar, also known as blood glucose, is the main source of energy for the body’s cells.
    • Insulin, a hormone produced by the pancreas, helps the body use and store glucose from food.
    • In diabetes, the body either does not produce enough insulin or cannot use the insulin it produces effectively, resulting in high blood sugar levels.
    • Over time, high blood sugar levels can cause serious health problems, such as damage to the heart, blood vessels, eyes, kidneys, and nerves.

    Types of Diabetes

    There are two main types of diabetes: Type 1 and Type 2.

    • Type 1 diabetes: It is an autoimmune disease in which the immune system attacks and destroys insulin-producing cells in the pancreas, resulting in a lack of insulin. This type of diabetes is typically diagnosed in children and young adults, although it can occur at any age. It requires insulin injections or pump therapy for survival.
    • Type 2 diabetes: It is a metabolic disorder in which the body becomes resistant to the effects of insulin or doesn’t produce enough insulin to maintain normal glucose levels. This type of diabetes is often associated with lifestyle factors such as obesity, physical inactivity, and poor diet. It is typically diagnosed in adults, but it is becoming increasingly common in children and adolescents as well. Treatment for Type 2 diabetes may include lifestyle changes, oral medications, or insulin therapy.

    Menace of diabetes in India

    • According to data from the International Diabetes Federation Atlas 2021, India has the world’s highest number of children and adolescents living with Type I Diabetes Mellitus (TIDM).
    • There are over 2.4 lakh TID patients in the Southeast Asia region.

    Measures to mitigate TID impact on students

    • CBSE circular in 2017 allowed students with T1D in Classes X and XII to carry certain eatables to board exam hall to avoid low sugar episodes.
    • They are permitted to carry medicines, snacks, water, a glucometer, and testing strips.
    • NCPCR suggests states allow students to use smartphones to monitor sugar levels.
    • Tamil Nadu has been providing free insulin to children with T1D since 1988.

    Back2Basics: National Commission for Protection of Child Rights (NCPCR)

    • NCPCR is a statutory body established in India under the Commissions for Protection of Child Rights Act, 2005.
    • Its objective is to protect, promote and defend the rights of children in India.
    • It functions as a watchdog to prevent child rights violations, as well as to take action against those responsible for such violations.
    • The NCPCR also advocates for the implementation of laws, policies and programs aimed at promoting child welfare and development.

     

    Are you an IAS Worthy Aspirant? Get a reality check with the All India Smash UPSC Scholarship Test

    Get upto 100% Scholarship | 900 Registration till now | Only 100 Slots Left

  • Healthcare: Public Health and The Insurance Funding

    Central Idea

    • The Tamil Nadu public health model has achieved success in improving healthcare outcomes and maintaining equity in healthcare delivery. However, the shift in healthcare funding to insurance companies has brought both benefits and drawbacks to the public healthcare system.

    The key features of the Tamil Nadu public health model

    • Primary Healthcare: The Tamil Nadu public health model is based on a strong emphasis on primary healthcare, which is the first point of contact for patients seeking medical attention. Primary healthcare centres provide basic healthcare services and preventive care, which are critical to reducing the burden of disease.
    • Public Health Infrastructure: The state has a well-established public health infrastructure, including a network of primary healthcare centres, secondary and tertiary care hospitals, and medical colleges. The state government has also invested in health infrastructure, including sanitation facilities, water supply, and waste management.
    • Health Insurance: The Tamil Nadu government has implemented a comprehensive health insurance scheme, the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which provides free healthcare services to families living below the poverty line and low-income groups.
    • Human Resource Development: The state government has also focused on developing human resources in healthcare. It has set up a large number of nursing and paramedical institutions to train healthcare professionals.
    • Health Awareness: The Tamil Nadu government has launched various health awareness campaigns to educate people about health issues, including communicable and non-communicable diseases. The government has also launched campaigns to promote healthy lifestyle choices, such as a balanced diet and regular exercise.
    • Partnership with NGOs: The government has partnered with non-governmental organizations (NGOs) to implement various health programs. These partnerships have helped in the effective delivery of healthcare services in remote and rural areas of the state.
    • Innovations: Tamil Nadu has implemented several innovative approaches in healthcare, such as telemedicine, which enables patients to receive medical consultation and treatment remotely using technology. The state has also established mobile clinics to provide healthcare services to people living in remote areas.

    Benefits of Decentralization

    • Improved access to healthcare: Decentralization can help to improve access to healthcare services, particularly in rural or remote areas. By empowering local communities and healthcare providers to make decisions about healthcare delivery, services can be tailored to meet the specific needs of the population.
    • Better quality of care: Decentralization can lead to better quality of care by enabling healthcare providers to respond more quickly and effectively to the needs of their patients. It can also promote innovation and experimentation in healthcare delivery, leading to new and improved approaches to patient care.
    • Increased accountability: Decentralization can increase accountability in healthcare delivery by empowering local communities and healthcare providers to monitor and evaluate the quality of care. This can help to identify and address problems in healthcare delivery, leading to improved outcomes for patients.
    • Cost savings: Decentralization can lead to cost savings in healthcare delivery by reducing the administrative costs associated with centralized decision-making and management. It can also promote greater efficiency in healthcare delivery, leading to reduced waste and duplication of services.

    Insurance Funding in healthcare

    • Insurance funding in healthcare refers to the use of insurance mechanisms to finance healthcare services. This involves pooling financial resources from individuals or groups through insurance schemes, which are then used to pay for healthcare services.
    • Insurance funding can help to mitigate the financial risks associated with healthcare, and ensure that individuals have access to the care they need without incurring excessive costs.

    Drawbacks of Insurance Funding

    • Shifted focus: The focus on indemnity and negotiations with insurance companies has shifted the focus of hospitals from patient care to claiming money.
    • Compromised quality of service: The appointment of contractual employees with meager pay has created a divide between permanent high-paid staff and temporary low-salaried staff, leading to a compromise in the quality of service.

    Facts for prelims

    Type of Insurance Funding Description
    Private health insurance Purchased by individuals or employers to cover healthcare costs. Coverage, cost, and benefits vary widely and may be offered by commercial insurers, nonprofit organizations, or government programs
    Public health insurance Provided by government-run programs, typically funded through taxes or other government revenues. Coverage is provided to eligible individuals based on criteria such as age, income, or medical need. Pradhan Mantri Jan Arogya Yojana (PMJAY) is a government-funded health insurance program that provides free health coverage to economically disadvantaged families across India.
    Social health insurance A hybrid model that combines elements of private and public insurance. Individuals and employers contribute to a national insurance fund that is used to pay for healthcare services, typically managed by a government agency but delivered by private providers
    Employer-sponsored insurance Private insurance provided by employers to their employees, often mandatory in many countries. Employers are required to provide a certain level of coverage to their employees.

    Conclusion

    • While insurance funding has brought benefits, it has also created challenges, including the erosion of compassion among health professionals and a diversion of funds from public to private hospitals. It is necessary to strike a balance between decentralization, insurance funding, and preserving the fundamental principles of equity, compassion, and excellence in care to maintain the success of Tamil Nadu’s public healthcare system.

    Mains Question

    Q. Highlight the benefits of decentralization in healthcare delivery. Analyse the benefits and drawbacks of insurance funding in India?

    Are you an IAS Worthy Aspirant? Get a reality check with the All India Smash UPSC Scholarship Test

    Get upto 100% Scholarship | 900 Registration till now | Only 100 Slots Left

     

  • Tuberculosis (TB): India’s Renewed Commitment

    TB

    “The theme of World TB Day 2023 — “Yes, we can end TB!”

    Central Idea

    • India’s National TB Elimination Programme has set a goal to eliminate TB by 2025. However, with India contributing 28% of the global TB burden and spending only 2.1% of its total budget on healthcare, the pace of program implementation has slowed down, especially during COVID-19. Increased investments and multi-sector collaboration are required to meet the target. 24 th March is marked as World TB day.

    Back to basics: TB

    • Tuberculosis is an infectious disease caused by bacteria called Mycobacterium tuberculosis.
    • It mainly affects the lungs, but can also affect other parts of the body such as the kidneys, spine, and brain.
    • TB spreads through the air when a person with active TB disease in the lungs or throat coughs, sneezes, or speaks.
    • Symptoms of TB include coughing that lasts for three or more weeks, chest pain, coughing up blood, fatigue, fever, and weight loss.
    • TB can be treated with antibiotics, but drug-resistant forms of TB are a growing concern.

    India’s Battle Against TB

    • International Union Against TB: India’s fight against TB began in 1929, when it joined the International Union Against Tuberculosis.
    • TB division: After independence, the Union government established a TB division under the Directorate General of Health Services with the Ministry of Health to oversee the plan.
    • National TB Control Programme: The National TB Institute was established in Bengaluru in 1959, and the National Tuberculosis Control Programme (NTP) was formulated in 1962. The Revised National TB Control Programme was developed in 1963.
    • National TB Elimination Programme: India’s National TB Elimination Programme now leads the effort to eliminate TB by 2025, five years ahead of the Sustainable Development Goals.
    • TB Harega Desh Jeetega: TB Harega Desh Jeetega (TB will lose, the nation will win) campaign to raise awareness about the disease and encourage people to get tested and treated.

    Challenges in Implementation

    • Lower budgetary allocation: India contributes 28% of the global TB burden, and as of 2022-23, it spends only 2.1% of its total budget on healthcare, the lowest among BRICS countries, and comparable to Bangladesh (2.5%) and Pakistan (3.4%).
    • Slow release of funds: The Joint Monitoring Mission Report 2019 by the Ministry of Health mentions that the slow release of funds has had a significant impact on the program’s effectiveness.
    • Low fund utilization: The low fund utilization has resulted in a lack of resources for critical TB control interventions such as early detection, diagnosis, and treatment.
    • COVID-19 slowed down implementation: Implementation of the TB program has slowed down with COVID-19 and requires further policy development, planning, and additional financing.

    Way Ahead: Opportunities for Collaboration

    • Different actors need to join hands to support the government’s inter-sectoral, multi-centric program approach for TB elimination and empower community response at the grass roots level.
    • Investing in strategic areas like diagnostics and access that have been barriers in the past is critical for reshaping the national TB strategy.
    • The theme of World TB Day 2023, “Yes, we can end TB!” conveys a message of hope that getting back on track to turn the tide against the TB epidemic is possible.

    Facts for Prelims: CB-NAAT

    • CB-NAAT stands for Cartridge-Based Nucleic Acid Amplification Test, which is a diagnostic test used to detect the presence of genetic material of certain types of bacteria, including Mycobacterium tuberculosis.
    • CB-NAAT is a highly sensitive and specific test that can detect MTB and drug-resistant strains of MTB in a short amount of time.
    • The test uses a small cartridge that contains all the necessary reagents and probes to detect MTB nucleic acid. The sample (usually sputum or other respiratory specimen) is mixed with the reagents and the cartridge is placed into a machine that performs the amplification and detection of the nucleic acid.
    • CB-NAAT has been endorsed by the World Health Organization (WHO) as a preferred test for the diagnosis of TB and drug-resistant TB.
    • The Government of India has launched a national program called Revised National TB Control Programme (RNTCP) to provide free diagnosis and treatment of TB, and CB-NAAT is a key component of this program.
    • However, the cost of the test remains a challenge, and efforts are underway to make the test more affordable and accessible to all.

    TB

    Conclusion

    • To successfully eliminate TB by 2025, India must prioritize sustainability through strategic investments, focusing on areas with the greatest need and adequately resourcing TB initiatives. With collaborative efforts and commitment, India can overcome its TB burden and achieve its ambitious target. Together, we can make it happen.

    Mains Question

    Q. Highlight the major initiatives taken by India to combat Tuberculosis and enumerate the challenges and way ahead towards achieving the goal of TB elimination by 2025.