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Subject: Governance

Important aspects of Society

  • ICMR releases Ethical Guidelines for AI usage in Healthcare

    health

    The Indian Council of Medical Research (ICMR) has recently released the first-ever set of ethical guidelines for the application of artificial intelligence (AI) in biomedical research and healthcare.

    Ethical Guidelines for AI usage in Healthcare

    • The guidelines aim to create “an ethics framework which can assist in the development, deployment, and adoption of AI-based solutions” in specific fields.
    • Through this initiative, the ICMR aims to make “AI-assisted platforms available for the benefit of the largest section of common people with safety and highest precision possible”.
    • It seeks to address emerging ethical challenges when it comes to AI in biomedical research and healthcare delivery.

    Key features

    • Effective and safe development, deployment, and adoption of AI-based technologies: The guidelines provide an ethical framework that can assist in the development, deployment, and adoption of AI-based solutions in healthcare and biomedical research.
    • Accountability in case of errors: As AI technologies are further developed and applied in clinical decision making, the guidelines call for processes that discuss accountability in case of errors for safeguarding and protection.
    • Patient-centric ethical principles: The guidelines outline 10 key patient-centric ethical principles for AI application in the health sector, including accountability and liability, autonomy, data privacy, collaboration, risk minimisation and safety, accessibility and equity, optimisation of data quality, non-discrimination and fairness, validity and trustworthiness.
    • Human oversight: The autonomy principle ensures human oversight of the functioning and performance of the AI system.
    • Consent and informed decision making: The guidelines call for the attainment of consent of the patient who must also be informed of the physical, psychological and social risks involved before initiating any process.
    • Safety and risk minimisation: The safety and risk minimisation principle is aimed at preventing “unintended or deliberate misuse”, anonymised data delinked from global technology to avoid cyber attacks, and a favourable benefit-risk assessment by an ethical committee among a host of other areas.
    • Accessibility, equity and inclusiveness: The guidelines acknowledge that the deployment of AI technology assumes widespread availability of appropriate infrastructure and thus aims to bridge the digital divide.
    • Relevant stakeholder involvement: The guidelines outline a brief for relevant stakeholders including researchers, clinicians/hospitals/public health system, patients, ethics committee, government regulators, and the industry.
    • Standard practices: The guidelines call for each step of the development process to follow standard practices to make the AI-based solutions technically sound, ethically justified, and applicable to a large number of individuals with equity and fairness.
    • Ethical review process: The ethical review process for AI in health comes under the domain of the ethics committee which assesses several factors including data source, quality, safety, anonymization, and/or data piracy, data selection biases, participant protection, payment of compensation, possibility of stigmatisation among others.

    Policy moves for streamlining AI in Healthcare

    • India already offers streamlining of AI technologies in various sectors, including healthcare, through the National Health Policy (2017), National Digital Health Blueprint (NDHB 2019), and Digital Information Security in Healthcare Act (2018) proposed by the Health Ministry.
    • These initiatives pave the way for the establishment of the National Data Health Authority and other health information exchanges.

    Potential applications of AI in healthcare

    Artificial Intelligence (AI) has revolutionized the healthcare industry by enabling various applications. These applications include:

    • Diagnosis and screening: AI can be used to identify diseases from medical images like X-rays, CT scans, and MRIs.
    • Therapeutics: AI can assist in the development of personalised medicines by analyzing a patient’s genetic makeup.
    • Preventive treatments: AI can predict the risk of developing a disease, helping healthcare professionals to take preventive measures.
    • Clinical decision-making: AI can analyze large amounts of data to assist healthcare professionals in making treatment decisions.
    • Public health surveillance: AI can be used to monitor disease outbreaks and inform public health policies.
    • Complex data analysis: AI can analyze large amounts of data from multiple sources to identify patterns and inform healthcare decision-making.
    • Predicting disease outcomes: AI can predict disease outcomes based on patient data, enabling early
    • Behavioural and mental healthcare: AI can help diagnose and treat mental health conditions.
    • Health management systems: AI can assist in managing patient records, appointment scheduling and reminders, and medication management.

    Various challenges for imbibing

    • Data privacy and security: With the use of AI in healthcare, there is a significant amount of personal and sensitive data is collected. This data needs to be kept secure and protected from potential cyber-attacks.
    • Regulatory and ethical issues: AI technology is still in its early stages of development and there are no clear guidelines or regulations in place for its use in healthcare. There are also ethical considerations, such as accountability, transparency, and bias that need to be addressed.
    • High cost involved: The implementation of AI in healthcare requires significant investment in terms of infrastructure, software, and training. This cost can be a major challenge for healthcare organizations, especially in developing countries.
    • Integration with existing systems: AI systems need to be integrated with existing healthcare systems and processes. This can be challenging, especially in cases where the existing systems are outdated or incompatible with AI technology.
    • Lack of trust and acceptance: AI technology is still relatively new in healthcare and there is a lack of trust and acceptance among healthcare professionals and patients. This can be a major hurdle in the widespread adoption of AI in healthcare.

    Threats posed by AI to healthcare

    • Data privacy and security: The use of AI in healthcare requires the collection and analysis of vast amounts of personal health data, which could be at risk of being stolen or misused.
    • Bias and discrimination: There is a risk that AI algorithms could perpetuate existing biases and inequalities in healthcare, such as racial or gender bias.
    • Lack of transparency: Some AI models are complex and difficult to understand, which can make it difficult to explain the reasoning behind a particular decision.
    • Medical errors: AI systems can make errors if they are trained on biased or incomplete data, or if they are used inappropriately.
    • Ethical concerns: There are several ethical concerns associated with the use of AI in healthcare, including the potential for AI to replace human doctors, the impact on patient autonomy, and the implications for informed consent.

    Way forward

    • Develop a national AI strategy for healthcare: This strategy should include policies for data sharing, privacy, and security, as well as guidelines for the ethical and responsible use of AI.
    • Invest in AI research and development: The government should invest in research and development of AI technologies that can help address the challenges in healthcare.
    • Promote collaboration between stakeholders: Collaboration between stakeholders such as healthcare providers, researchers, government agencies, and industry can help accelerate the development and adoption of AI technologies in healthcare.
    • Train healthcare professionals in AI: The government can work with academic institutions and the industry to create training programs and certifications for healthcare professionals.
    • Address regulatory challenges: The government should work to address regulatory challenges related to the use of AI in healthcare.
    • Focus on affordability and accessibility: This can be achieved by promoting innovation, encouraging competition, and ensuring that AI technologies are integrated into existing healthcare infrastructure.

     

  • Family Courts: Need for Expansion and Reforms

    Central Idea

    • Mumbai’s only family court, inundated with divorce applications and family disputes, showcases a range of emotions and highlights the need for additional family courts to better address these complex and sensitive issues.

    The Nature of Family Court Cases

    • Mostly divorce cases: Common grounds for divorce include domestic violence, adultery, and dowry, but absurd reasons can also be found among the cases.
    • Other issues and counselling: Family courts handle not only divorce cases but also maintenance, child custody, and alimony cases, with judges first suggesting counseling for couples seeking to end their marriages.
    • Emotional scenes: Family courts witness heightened emotions, such as anger, blame, heartbreak, relief, and joy, as people struggle with the consequences of broken relationships.
    • Inequal treatment: Instances of inequality in the judicial system are evident, with influential individuals sometimes receiving preferential treatment.
    • Role of technology and empathy: During the COVID-19 pandemic, non-custodial parents sought to maintain contact with their children through video calls.
    • For instance: A lactation room was recently inaugurated at the Bandra family court to provide a refuge for women with infants amidst child custody and divorce proceedings.

    Why Family courts were established?

    • Family courts were established to provide a forum for speedy settlement of family-related disputes, emphasizing non-adversarial conflict resolution and promoting conciliation.

    What are the challenges faced by Family courts in India?

    • Backlog of cases: One of the most significant challenges faced by family courts in India is the backlog of cases. Family disputes are often complex and require a significant amount of time to resolve, which results in long waiting periods for litigants.
    • Lack of infrastructure: Many family courts in India lack adequate infrastructure, such as courtrooms, staff, and equipment, which makes it difficult to manage cases efficiently.
    • Shortage of judges: There is a shortage of judges in family courts, leading to delays in the disposal of cases.
    • Low awareness: Many people in India are not aware of the role and functions of family courts, which often leads to confusion and delays in the resolution of disputes.
    • Socio-cultural factors: In many cases, socio-cultural factors such as patriarchy, gender discrimination, and dowry-related issues pose significant challenges to family courts in India.
    • Limited jurisdiction: Family courts in India have limited jurisdiction and can only hear certain types of cases related to family disputes. This can result in some cases being heard by multiple courts, leading to delays and confusion.

    The Need for Expansion and Reform in Family Courts: A Case of Mumbai’s family court

    • With over 5,000 divorce cases pending in Mumbai’s family court, frivolous applications and counter-applications add to the pendency of cases and negatively impact children.
    • The current seven judges at Mumbai’s family court are insufficient to handle the caseload, and the promise of 14 additional family courts in Mumbai, along with one each in Thane and Navi Mumbai, is a much-needed and welcome move.

    Conclusion

    • Mumbai’s family court reveals the complexity and emotional intensity of family disputes, and the urgent need for additional family courts to better address these sensitive issues. Expanding the number of family courts will help ensure that more families receive the support and resolution they need during these challenging times.

    Mains Question

    Q. Establish the purpose of Family courts. Discuss the challenges faced by family court in India.

     

     

  • Strengthening the Fight Against Tuberculosis (TB)

    Tuberculosis

    Central Idea

    • The fight against tuberculosis (TB) has been going on for over 30 years since it was declared a global health emergency, yet the goal of ending TB by 2030 is still uncertain. The fight against TB needs a renewed focus on three key areas i.e., vaccine development, newer therapeutic agents, and improved diagnostics to meet the goal of ending TB by 2030.

    Background

    • In 1993, the World Health Organization declared TB a global health emergency and the 1993 World Development Report stated that TB treatment for adults was the best buy among all developmental interventions.
    • Since then, the global response to TB has been slow and lacks urgency.

    Global Fund

    • The Global Fund to Fight AIDS, TB, and Malaria was created in response to the call for action against TB at the G7 summit in Okinawa, Japan, in 2001.
    • The Global Fund has become the single largest channel of additional funding for global TB control.
    • However, it faces constraints due to zero-sum games from donor constituents and competition between the three diseases it finances.

    Tuberculosis

    StopTB Partnership

    • The StopTB Partnership was constituted to mobilize and marshal a disparate set of actors towards the goal of ending TB.
    • It has been adapting to changes, such as using molecular diagnostic tools developed to respond to bioterrorism to diagnose TB and using social safety programs to address the poverty drivers of the TB epidemic.

    Facts for prelims: Basics of 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.

    Tuberculosis

    Three key areas that need attention

    1. Vaccine development:
    • The development of an adult TB vaccine is the first area that needs urgent attention.
    • The current vaccine is 100 years old, and the development and wide use of an adult TB vaccine are essential to ending TB.
    • COVID-19 vaccine development process provides insights into accelerating the process.
    • India’s capabilities can play a significant role in vaccine development and equitable distribution.
    1. Newer therapeutic agents for TB:
    • A few new anti-TB drugs are available but face cost and production constraints.
    • Shorter, injection-free regimens are needed to improve compliance and reduce patient fatigue.
    • A continuous pipeline of new drugs is essential to combat drug resistance.
    1. Improved diagnostics:
    • AI-assisted handheld radiology and passive surveillance of cough sounds can revolutionize TB diagnostics.
    • Incentivize biotech startups to disrupt the complexity and price barriers of molecular testing.

    Tuberculosis

    Conclusion

    • India’s leadership role in the G20 and the upcoming StopTB Partnership board meeting in Varanasi provide the perfect opportunity for India to lead the way in ending TB. With the collective will and action of leaders, it is possible to end TB sooner rather than later.
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  • Old Pension Scheme (OPS): A Call for Equitable Distribution of Resources

    Pension

    Central Idea

    • The demand for the old pension scheme (OPS) is growing in India, particularly after some states announced plans to revert to it. The mainstream critique of OPS is centered around inefficiency and fiscal deficit concerns. However, it is crucial to examine the policy from the class and welfare perspectives.

    What is pension?

    • A pension is a retirement plan that provides a stream of income to individuals after they retire from their job or profession. It can be funded by employers, government agencies, or unions and is designed to ensure a steady income during retirement.

    What is Old Pension Scheme (OPS)?

    • The OPS, also known as the Defined Benefit Pension System, is a pension plan provided by the government for its employees in India.
    • Under the OPS, retired government employees receive a fixed monthly pension based on their last drawn salary and years of service.
    • This pension is funded by the government and paid out of its current revenues, leading to increased pension liabilities.

    Pension

    Did you know: The National Pension System (NPS)?

    • NPS is a market-linked, defined contribution pension system introduced in India in 2004 as a replacement for the Old Pension Scheme (OPS).
    • NPS is designed to provide retirement income to all Indian citizens, including government employees, private sector workers, and self-employed individuals.

    Analyzing the Impact of OPS on India’s Socio-Economic Landscape

    1. Inequality and Regressive Redistribution: Under the National Pension System (NPS), the Sixth Pay Commission increased the basic salary of government employees to cover pension contributions and promote post-retirement savings. As a result, the salary of a government employee is higher than the income of more than 90% of the population. The OPS thus acts as a regressive redistribution mechanism favoring a better-off class.
    2. Rising Pension Liabilities: Pension liabilities of the government increased substantially due to the Sixth pay matrix, reaching 9% of total state expenditure. By 2050, pension expenditure will account for 19.4% of total state expenditures, assuming the current growth rate remains constant.
    3. Disproportionate Burden on the Lower Class: The bottom 50% of the population faces the inequitable burden of indirect taxation, six times more than their income. Due to OPS, they must bear the burden of supporting government employees’ pensions, which could push them further into poverty.
    4. Expenditure Challenges and Public Goods: As India’s population ages and public provision of education and healthcare becomes more critical, OPS poses expenditure challenges for providing public goods. This situation compels governments to compress already low social sector expenditures, pushing marginalized groups into further destitution.
    5. Monopolization of Future Labor Markets: The OPS facilitates the monopolization of future labor markets in the private sector by a proprietary class, allowing supervisory bureaucracy to consolidate its position and emerge as a dominant group.

    Pension

    Recommendations for Equitable Resource Distribution

    • Opposition to the OPS should focus on equitable distribution of resources and expansion of universal provisions of public goods.
    • Implement a participatory pension system for government employees to provide more egalitarian outcomes.
    • Tweak the NPS to provide a guaranteed monthly return for lower-rung employees.
    • Address unequal pay among various ranks of employees through administrative reforms.
    • Advocate for progressive taxation of the top 10% and a rationalization of political executives’ pensions and profligacy.

    Facts for prelims: NPS vs OPS

    Parameter National Pension System (NPS) Old Pension Scheme (OPS)
    Type of System Defined Contribution System Defined Benefit System
    Funding Contributions from employee and employer Government-funded
    Investment Market-linked investments in various asset classes No direct investment involved
    Returns Subject to market risks Predetermined and not market-linked
    Pension Amount Depends on accumulated corpus and investment returns Based on last drawn salary and years of service
    Annuity & Lump-sum Withdrawal Minimum 40% corpus used to purchase annuity, remaining can be withdrawn as lump-sum Fixed monthly pension, no annuity or lump-sum withdrawal
    Portability Portable across jobs and sectors Limited to government employees
    Flexibility Choice of investment options, fund managers, and asset allocation No flexibility, pension determined by predefined formula

    Conclusion

    • It is essential to recognize the disenchantment with neoliberalism driving the demand for the OPS. Government employees and policymakers must work together to address the challenges posed by OPS and implement pension reforms that prioritize equitable resource distribution, efficient allocation, and social welfare.

    Mains Question

    Q. Compare and contrast OPS with the National Pension System (NPS) and discuss the impact of Old Pension Scheme (OPS) on India’s socio-economic landscape.

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  • Rajasthan becomes first state to guarantee Right to Health

    health

    The Rajasthan Assembly passed the Right to Health (RTH), even as doctors continued their protest against the Bill, demanding its complete withdrawal.

    Right to Health (RTH): A conceptual insight

    • RTH is a fundamental human right that guarantees everyone the right to enjoy the highest attainable standard of physical and mental health.
    • It is recognized as a crucial element of the right to an adequate standard of living and is enshrined in international human rights law.

    Scope of RTH

    • RTH covers various health-related issues, including-
    1. Access to healthcare services, clean water and sanitation, adequate nutrition, healthy living and working conditions, health education, and disease prevention.
    2. Accessible, affordable, and quality healthcare services,
    3. Eliminating barriers to healthcare access
    4. Informed consent to medical treatment and accessing information about their health.

    What is the Rajasthan Right to Health Bill?

    • Free treatment: RTH gives every resident of the state the right to avail free Out Patient Department (OPD) services and In Patient Department (IPD) services at all public health facilities and select private facilities.
    • Wider scope of healthcare: Free healthcare services will include consultation, drugs, diagnostics, emergency transport, procedures, and emergency care. However, there are conditions specified in the rules that will be formulated.
    • Free emergency treatment: Residents are entitled to emergency treatment and care without prepayment of fees or charges.
    • No delay in treatment: Hospitals cannot delay treatment on grounds of police clearance in medico-legal cases.
    • State reimbursement of charges: After emergency care and stabilisation, if patients do not pay requisite charges, healthcare providers can receive proper reimbursement from the state government.

    Existing schemes in Rajasthan

    • The flagship Chiranjeevi Health Insurance Scheme provides free treatment up to Rs 10 lakh, which has been increased to Rs 25 lakh in the latest budget.
    • The Rajasthan Government Health Scheme covers government employees, ministers, current and former MLAs, etc.
    • The Nishulk Nirogi Rajasthan scheme provides free OPD and IPD services in government hospitals and covers about 1,600 medicines, 928 surgicals, and 185 sutures.
    • The Free Test scheme provides up to 90 free tests in government hospitals and has benefited 2.93 crore persons between March-December 2022.

    Need for the RTH Scheme

    • The state prioritizes healthcare and wants Rajasthan to be a great example of good health.
    • The Health Minister has received many complaints about private hospitals asking for money from patients who have the Chiranjeevi card.
    • So, they are bringing in a new law to stop this.
    • The new law will make sure that future governments follow it and provide free healthcare to everyone.

    Controversy with the RTH Law: Emergency Care Provisions

    • Emergency care was a contentious issue in the RTH.
    • The clause states that people have the right to emergency treatment and care for accidental emergency, emergency due to snake bite/animal bite and any other emergency decided by the State Health Authority under prescribed emergency circumstances.
    • Emergency treatment and care can be availed without prepayment of requisite fee or charges.
    • Public or private health institutions qualified to provide such care or treatment according to their level of health care can offer emergency care.

    Issues raised by healthcare professionals

    • Existing burden of schemes: Doctors are protesting against the RTH because they question the need for it when there are already schemes like Chiranjeevi that cover most of the population.
    • Specialization concerns: They are also objecting to certain clauses, such as defining “emergency” and being compelled to treat patients outside their specialty as part of an emergency.
    • Unnecessary obligations: The Bill empowers patients to choose the source of obtaining medicines or tests at all healthcare establishments, which means that hospitals cannot insist on in-house medicines or tests.

    Way forward

    • Given the contentious nature of the Bill, it is important for all stakeholders to come to the table and engage in constructive dialogue to resolve the issues at hand.
    • It should involve liaison between government, doctors, patient advocacy groups, and other relevant stakeholders to discuss the concerns raised by all parties and identify potential solutions.
    • This could be followed by a revision of the Bill, incorporating feedback and suggestions from all stakeholders, and a renewed effort to build consensus and support for the legislation.
    • Additionally, greater efforts could be made to improve transparency and accountability in the healthcare system, with a focus on educating patients about their rights.

     

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  • Home Ministry begins process to sell Enemy Properties

    enemy
    MA Jinnah’s house in Mumbai

    The home ministry has begun the process to sell enemy properties, immovable assets left behind by people who have taken citizenship in Pakistan and China after wars with these countries.

    What one means by Enemy Property?

    • Enemy property refers to the assets and properties of individuals or entities that have been declared as “enemies” by the Indian government.
    • This can include individuals or entities who are citizens of a country that is at war with India, or who have engaged in hostilities or acted against the interests of India.

    Why was such a concept initiated?

    • In the wake of the India-Pakistan wars of 1965 and 1971, there was the migration of people from India to Pakistan.
    • Under the Defence of India Rules framed under The Defence of India Act, 1962, the Government of India took over the properties and companies of those who took Pakistani nationality.
    • These “enemy properties” were vested by the central government in the Custodian of Enemy Property for India.
    • The same was done for property left behind by those who went to China after the 1962 Sino-Indian war.
    • The Tashkent Declaration of January 10, 1966 included a clause that said India and Pakistan would discuss the return of the property and assets taken over by either side in connection with the conflict.
    • However, the Government of Pakistan disposed of all such properties in their country in the year 1971 itself.

    Dealing with enemy property

    • The Enemy Property Act, enacted in 1968, provided for the continuous vesting of enemy property in the Custodian of Enemy Property for India (CEPI) under the Home Ministry.
    • The central government, through the Custodian, is in possession of enemy properties spread across many states in the country.
    • Some movable properties too, are categorised as enemy properties.
    • In 2017, Parliament passed The Enemy Property (Amendment and Validation) Bill, 2016, which amended The Enemy Property Act, 1968, and The Public Premises (Eviction of Unauthorised Occupants) Act, 1971.

    Total such properties in India

    enemy

    • There are 12,611 enemy properties in India estimated to be worth over ₹1 lakh crore.
    • The government has earned over ₹3,400 crore from disposal of enemy properties, mostly movable assets like shares and gold.
    • None of the immovable enemy properties has been sold so far.
    • Out of the 12,611 properties vested with the CEPI, 12,485 were related to Pakistani nationals and 126 to Chinese citizens.
    • Uttar Pradesh has the highest number of enemy properties (6,255), followed by West Bengal, Delhi, Goa, Maharashtra, Telangana, Gujarat, Tripura, Bihar, Madhya Pradesh, Chhattisgarh, and Haryana.
    • Kerala, Uttarakhand, Tamil Nadu, Meghalaya, Assam, Karnataka, Rajasthan, Jharkhand, Daman and Diu, and Andhra Pradesh have enemy properties as well.

     

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  • Universal Health Coverage (UHC) Must be Affordable to All

    Central Idea

    • The Universal Health Coverage (UHC) and its implementation in India raises the question of whether we believe in health as a basic human right, which India’s Constitution guarantees under the right to life. The UHC should encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.

    The Definition of Health

    • The definition of health according to the World Health Organization (WHO), which includes mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
    • We cannot achieve health in its wider definition without addressing health determinants, which necessitates an intersectoral convergence beyond medical and health departments.

    Difference between Primary health care (PHC) and Universal health care (UHC)

    • The main difference between PHC and UHC is that PHC is a level of care within the health care system, while UHC is a broader goal of ensuring access to health care for all individuals.
    • PHC is typically provided at the primary care level, while UHC includes all levels of care, from primary to secondary and tertiary care.
    • PHC is focused on basic health care services and health promotion, while UHC aims to provide comprehensive health care services to all individuals.

    Health for All by 2000

    • The slogan Health for All by 2000 proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977. It argues that universal health care/coverage (UHC) was implied as early as 1977.
    • India committed itself to the ‘Health for All’ goal by 2000 through its National Health Policy 1983.

    International Conference on PHC

    • The International Conference on Primary Health Care, at Alma Ata, 1978, which listed eight components of minimum care for all citizens.
    • Components included: It mandated all health promotion activities and the prevention of diseases, including vaccinations and treatment of minor illnesses and accidents, to be free for all using government resources, especially for the poor.
    • Components excluded: Chronic diseases, including mental illnesses, and their investigations and treatment were almost excluded from primary health care. When it came to secondary and tertiary care, it was left to the individual to seek it from a limited number of public hospitals or from the private sector by paying from their own pockets.

    Concerns around The Astana Declaration

    • The Astana declaration of 2018, which calls for partnership with the private sector. However the commercial private sector, which contributes to alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution, is well established.
    • The Astana declaration never addressed poverty, unemployment, and poor livelihood, but eulogizes quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.

    Conclusion

    • Every individual has a right to be healed and not have complications, disability, and death. That right is guaranteed only by individualism in public health, the new global approach to UHC, where nobody is left uncounted and uncared for. The Alma Ata declaration of primary health care can be left behind as a beautiful edifice of past concepts, and we should move forward with a newer concept of UHC.
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  • Data Sharing Governance And India’s Opportunity

    Governance

    Central Idea

    • India’s digital strategies and data governance have advanced in recent years, but there are concerns regarding inclusivity, transparency, security, and sustainability. India’s G-20 presidency presents an opportunity to showcase advancements in data infrastructures and governance, while balancing the interests of stakeholders, promoting ethical and responsible practices, and navigating the complex issues of data sovereignty.

    Governance

    What is Data Governance?

    • Data governance refers to the overall management of the availability, usability, integrity, and security of data used in an organization.
    • Data governance of a country is the policies, procedures, and practices established by the government to ensure that data is effectively managed and protected throughout its lifecycle.
    • This includes defining standards for data collection, storage, usage, and sharing to ensure the accuracy, consistency, and reliability of data.

    DEPA and Related Concerns

    The launch of India’s Data Empowerment and Protection Architecture (DEPA), a consent management tool, has generated both excitement and concern among stakeholders.

    1. Potential: DEPA has the potential to improve data protection and privacy for citizens by giving them greater control over the use and sharing of their personal information. By allowing individuals to easily manage and control their data consents, DEPA could help to build trust in digital technologies and data governance.
    2. Concerns:
    • There are risks associated with DEPA, particularly in terms of security and privacy. If the consent management tool is not properly implemented or managed, there is a risk that personal information could be misused or misappropriated.
    • The implementation of DEPA may be inconsistent across different sectors and jurisdictions, which could undermine its effectiveness and create confusion among citizens.
    1. What needs to be done?
    • In order to realise the potential benefits of DEPA and minimise the risks, it is important that the tool is implemented in a transparent, consistent, and secure manner.
    • This will require close collaboration between the government, the private sector, civil society, and other stakeholders and the development of clear and effective regulations and standards.

    Advancements in Other Sectors and related concerns

    • Digital Payments: Significant progress in financial inclusion and promotion of digital transactions through Unified Payments Interface (UPI) and other options.
    • Digital tech in Healthcare: Use of digital technologies can enhance access to health-care services and empower farmers
    • Security and privacy: There are concerns that relate to security and privacy on the one hand and on infrastructure, connectivity and the availability of a skilled human workforce on the other hand.
    • Data Misuse: There are also concerns around the potential misuse of data and information in these sectors. For example, in the health sector, there is a risk that sensitive medical information could be misused or exploited for commercial purposes, while in agriculture, there is a risk that market information could be manipulated for the benefit of certain actors.
    • Ownership and governance of data: Another issue is that of ownership and governance of data generated and collected in health and agriculture. What are the rights of data providers? And what are the responsibilities towards them? The state has to play a key role in addressing and resolving such issues.

    What is Data sovereignty?

    • It is a principle that a country has the right to control the collection, storage, and use of data within its borders and citizens’ rights to informational self-determination over their data
    • It is closely related to issues of privacy, security, and national sovereignty, and is increasingly important in the age of digital globalization and the proliferation of cloud computing services.

    Data sharing governance and India’s opportunity

    India Data Management Office (IDMO):

    • India’s establishment of an IDMO is a step forward in the country’s journey towards data sharing and data governance.
    • The IDMO is expected to oversee and coordinate the implementation of India’s digital strategies and data governance framework, and to ensure that these efforts are aligned with the country’s values and priorities.
    • It will also work to promote the development and implementation of open-source solutions, which will help to ensure that underlying data architectures are a social public good, and to promote digital technologies to become accessible and affordable for all.
    • Again, this is a great opportunity for India to develop solutions that can be adopted and adapted in other countries. Open source and open innovation models can be important alternatives to proprietary solutions that are governed by big tech companies.

    Conclusion

    • India’s digital strategies and data governance have made significant progress in recent years, but there are important concerns and issues to address. It is crucial to find a middle way between restrictive data sovereignty and limitless data flow, navigate complex issues of privacy, and invest in necessary infrastructure and skills to ensure responsible and accountable data governance.
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  • Tamil Nadu’s TN-KET initiative results in reduced TB deaths

    tb

    Tamil Nadu has pioneered an initiative across the State to reduce the mortality rate among people with tuberculosis named: TN-KET (Tamil Nadu Kasanoi Erappila Thittam) meaning TB death-free project.

    What is TN-KET?

    • TN-KET aims to reduce the mortality rate among people with tuberculosis.
    • This initiative, which began in April 2022, has already achieved significant reduction in the number of early TB deaths.

    Unique features

    • Differentiated TB Care: This is at the heart of the initiative, which aims at assessing whether people with TB need ambulatory care or admission in a health facility to manage severe illness at the time of diagnosis.
    • Radiological assessment: The guidelines require comprehensive assessment of 16 clinical, laboratory and radiological parameters.
    • Triage of assessment: The preliminary assessment of patients based on just three conditions — very severe undernutrition, respiratory insufficiency, and inability to stand without support — was found to be feasible for quick identification at diagnosis.

    Outcome: Significant reduction in early TB deaths

    • Above features vastly cut down the delay and increasing the chances of saving lives.
    • The initiative has achieved the initial target of 80% triaging of patients, 80% referral, comprehensive assessment and confirmation of severe illness, and 80% admission among confirmed.
    • The State’s target is to achieve 90%-90%-90% at each district.

    Key challenges

    • The challenge is to increase the duration of admission, especially for people with very severe undernutrition, which comprises 50% of the admitted patients.

     

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    TB mukt India

     

     

  • Undernutrition: Healthy Human Capital Is The Real Wealth

    “Healthy women and children are pillars of a flourishing society”

    Central Idea

    • Undernutrition is a serious public health issue leading to adverse health consequences and affecting the economy, especially in India. Early stimulation and nutrition interventions in infants and young children lead to improved outcomes in adult life. India ranks poorly on the Human Capital Index and has high levels of stunting, anaemia, and malnutrition. Evidence suggests investing in maternal and early-life nutrition leads to high returns on investment.

    Undernutrition leads to adverse health consequences and affects the economy

    • Child deaths: Undernutrition leads to 3.1 million child deaths annually, which accounts for 45 percent of all child deaths.
    • High levels of stunting In India: India has unacceptably high levels of stunting (35.5 percent), despite marginal improvement over the years.
    • Stunting affects per capita income: Two-thirds of India’s current workforce is stunted, which has enormous economic costs in terms of a decrease in per capita income. The average reduction in per capita income for developing countries is at 7 percent, with a high of 13 percent for India due to the high rates of stunting.
    • Wasting in India: The economic losses incurred by India due to wasting are estimated at more than US $48 billion in terms of lifetime lost productivity.
    • Anaemia: Another compounding factor is anaemia among young women, at 57 percent, which has lasting effects on their future pregnancies and childbirth. The situation further worsens when infants are fed inadequate diets, and there is inadequate sanitation and hygiene.

    Investing in the well-being of women and children is an effective strategy

    • Investing in early childhood: Evidence suggests that every additional dollar invested in quality early childhood programs yields a return of between US$6 and US$17.
    • Better income in future: Early stimulation in infants is known to increase their future earnings by 25 percent. Stunting in childhood leads to impaired brain development, lower cognitive skills and education, leading to lower incomes in the future.
    • For instance: According to estimates, children who are stunted earn 20 percent less as adults than children who are not stunted.

    Increased investment in human capital brings economic growth

    • Human capital is the real wealth: The human capital is the wealth of nations and is dependent on the health, nutrition, skills, and knowledge of people.
    • Effective strategy: Evidence suggests investing in the well-being of women and children as an effective strategy for improved outcomes for children.
    • India’s ranking in Human capital Index: India ranks 116 out of 174 countries as per the Human Capital Index, with a score of 0.49 that indicates a child born in India will be 49 percent productive if provided with complete education and good health.
    • Education: Education to children plays a pivotal role in amassing human capital, improving productivity, and economic development. It has been advocated to target the 1000 days’ period from conception to two years of age for improving birth and nutrition outcomes.

    Coupling nutrition-specific interventions with nutrition-sensitive programs

    • Nutrition-sensitive interventions: Nutrition-sensitive interventions like water, sanitation, and hygiene (WASH) focus on the underlying determinants as poor sanitation can lead to stunting.
    • Integrated water and sanitation improvement program: Evidence suggests both short term and long-term reductions in diarrhoea episodes (3-50 percent) through an integrated water and sanitation improvement program in rural India. WASH can bring significant gains in tackling childhood undernutrition and are important determinants of stunting.
    • Nutrition of pregnant women and young children: Studies suggest long term benefits on adult human capital and health by improving the nutrition of pregnant women and young children.
    • For instance: The first 1000 days of life is the time for rapid growth and development, and lack of good nutrition can lead to lifelong adverse consequences. This period is a critical window of opportunity as stunting sets in during this period and aggravates by the age of two years.

    Disparities in Undernutrition Prevalence

    • Data (NFHS 5) reveals that India has more stunted children in rural areas as compared to urban areas, possibly due to socio-economic variance.
    • Stunting prevalence varies depending on mother’s education and household income,
    • There is wide variation among regions, with high rates of stunting in states of Meghalaya (46.5 percent) and Bihar (42.9 percent) while states like Sikkim and Puducherry have lowest at 22.3 percent and 20 percent respectively.
    • Notable inter-state and inter-district variation in terms of stunting prevalence.

    Way ahead

    • Investing in healthcare facilities is crucial for enhancing productivity, economic growth, and security in India.
    • Addressing undernutrition is necessary for producing and maintaining a healthy, highly skilled workforce in India.
    • Cost-effective investments in child health, nutrition, and education are necessary for improving public health and achieving economic growth in India.

    Conclusion

    • Healthy human capital is the true wealth of any nation. In India, undernutrition is a significant public health concern that not only affects the well-being of women and children but also has adverse economic implications. Therefore, addressing undernutrition is critical for creating a healthy, skilled workforce, ensuring economic growth and security in India.

    Mains Question

    Q. What is India’s ranking on the Human Capital Index, and how does investing in the well-being of women and children contribute to economic growth?

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