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Subject: Governance

Important aspects of Society

  • [op-ed snap] Taking a holistic approach to dengue

    Context

    The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.

    Why the holistic approach is needed

    • Apart from promoting the use of the vaccine, gaining control over dengue will also require a holistic approach that has to include within its ambit vector control and proper case management.
    • Tetravalent vaccine: The vaccine is tetravalent i.e. it provides protection against all the four types of dengue viruses.
      • The vaccine confers about 80% protection to children vaccinated between 4 and 16 years of age without any major side effects.
    • Climatic factors: It is essentially a tropical disease that occurs in the countries around the Equator; hot weather and intermittent rainfall favour the sustenance of Aedes aegypti.
      • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
    • Risk factors: Urbanisation, poor town planning, and improper sanitation are the major risk factors for the multiplication of such mosquitoes.
      • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
      • Aedes mosquitoes cannot fly beyond a hundred meters. Hence, keeping the ambiance clean can help prevent their breeding.
      • Further, these mosquitoes bite during the daytime, so keeping the windows shut in the day hours is also useful.

    What needs to be done?

    • Source reduction activities: Activities like preventing water stagnation and using chemical larvicides and adulticides.
      • These chemicals need to be applied in periodic cycles to kill the larvae that remain even after the first spray.
    • Dealing with the manpower shortage: The number of skilled workers available for such measures is low; many posts in government departments remain vacant despite there being a dire public health need.
      • Due to this deficiency of manpower, active surveillance is not being done in India, says the National Vector Borne Disease Control Program.
    • Ending the Under-reporting: Dengue cases are often under-reported due to political reasons and also to avoid spreading panic among the common people. Under-reporting needs to be dealt with.
    • Increasing coordination: There is a lack of coordination between the local bodies and health departments in the delivery of public health measures.
      • A comprehensive mechanism is required to address these issues.
    • Need for epidemiological measures: Any communicable disease needs the epidemiological approach. Singapore uses one successful model of mapping and analysing data on dengue, using Geographical Information System (GIS).
      • The use of GIS involves mapping the streets with dengue cases for vector densities.
    • Emphasis on the WHO guidelines: Fluid management in the body is the cornerstone in the management of severe diseases like dengue hemorrhagic fever and dengue shock syndrome.
      • According to the guidelines, coagulation abnormalities are not due to a reduction in the number of platelets alone.
      • This is why the WHO recommends fresh whole blood or packed cell transfusion in the event of bleeding.
    • Caution in using alternative medicine drugs: Modern medicine is not against any complementary medicine; when such a medicine is approved after rigorous testing.
      • However, in the absence of evidence, the efficacy of such medicines remains in the realm of belief instead of science.
      • So, medicines like Nilavembu kudineer and papaya leaf extract are only belief based.

    Conclusion

    The communicable nature of Dengue and its asymptomatic nature requires the holistic approach to successfully tackle the disease.

     

  • [op-ed snap] Children of lesser gods

    Context

    The deaths of nearly 200 children in Kota, from largely preventable diseases, lays bare the condition of the healthcare system in India.

    Where does India stand?

    • According to UNICEF’s ‘State of World’s Children 2019’ report, India reported the maximum number of deaths of children under five in the world in 2018.
    • 8,82,000 children under five died that year.
    • That means around 2,416 deaths per day.
    • The death of children due to largely-preventable illnesses is a matter of serious concern and calls for urgent introspection.

    Factors that govern child health

    • Most of the children who died in Gorakhpur, Muzaffarpur and Kota belong to the lowest strata of the society.
    • It won’t be wrong to conclude that they were victims of structural violence.
    • This structural violence is unleashed through a multitude of social, political and economic factors apathy of healthcare professionals, poor health services/infrastructure
    • And low rates of female literacy, economic inequality, the rigid caste system, social apartheid, lack of political will and patriarchy play role.
    • As a society, we have stopped looking at the deaths of our citizens through the prism of compassion and concern.
    • Structural violence influences the nature and distribution of extreme suffering.

    What is being done in the wrong way?

    • The government is considering the takeover of 750 district hospitals by private medical colleges through a public-private partnership (PPP) model.
    • This, despite ample evidence about the failure of the model in the country’s healthcare system.
    • Nobel laureate Kenneth Arrow demonstrated that profit and private involvement in healthcare lead to an erosion of trust.
    • An Individual’s demand for medical services is irregular and unpredictable, the involvement of a private market model for such services can be disastrous.
    • The U.S.’s experiences in the PPP model in healthcare have shone a light on the deficits in transparency and highlighted the lack of care of vulnerable groups.

    Conclusion

    • What urgently a sincere engagement by the state in matters concerning peoples’ health.
    • We need to question the government’s priorities in a country where nearly a million children die every year

  • [op-ed snap] Horror in Kota

    Context

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

    Public health as a political agenda

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

    Poor infrastructure

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

    Conclusion

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

  • [op-ed snap]Eradication of TB by 2025

    At the End TB summit, 2018 the prime minister of India made a bold commitment to end tuberculosis by 2025-five years ahead of the global target. Which is possible to achieve if the efforts are put at the level it was done in case of polio.

    The toll taken by TB

    • Despite the disease being fully curable, people still die from it.
    • TB usually affects people in their most productive years and drives families into debt.
    • It has a direct link to human suffering, discrimination and also poverty.
    • Due to its infectious spread, it directly affects our economic growth as well.
    • With resilience, sufficient investment, innovative approaches and strategies and the participation of all stakeholders, TB can be defeated.

    First Step- Awareness

    • The first step is the creation of awareness and empowering of communities.
    • TB affects millions, yet very few know enough about it.
    • Multilingual, multi-stakeholder awareness effort to ensure that all Indians knows about the challenges of TB and where to seek treatment is required.
    • With the expansion of the media and evolving technology, it is possible to reach everyone with the right information.

    Second Step- Access to diagnosis and treatment

    • Ensuring that every Indian get access to correct diagnosis and treatment for TB, regardless of their ability to pay for it is the second step.
    • To do so, working with the private sector is necessary as was done in the case of polio.
    • There are numerous innovative private-sector programmes and partnership schemes for TB.

    Role of  Private sector

    • Recently launched programmes for doctors and labs offer the private sector various incentives.
    • Even today, about half a million TB cases go unnotified, especially those seeking care in the private sector.
    • Those cases need to be tracked and ensured that everyone in the need of treatment and care gets it.
    • Organisations like Indian Medical Association and Indian Academy of Paediatrics are working with the private sector to ensure patient-centric care as per “Standards of TB Care in India” (STCI).

    Drug-resistant TB

    • A key challenge is building a forward-looking plan to address and control drug resistance.
    • Drug-resistant TB is a man-made menace that is a major roadblock in a fight against TB.
    • Every TB patient must be tested for drug resistance at the first point of care, whether in the public or private sector, to rule out any drug resistance.

    Efforts by the government

    • Nikshay Poshan Yojana -in which TB patients receive Rs 500 every month while on treatment was launched.
    • Nikshay Poshan Yojana ensure that the patients have economic support and nutrition during the required period.
    • ‘TB Harega Desh Jeetega Campaign’ was launched to accelerate the efforts to end TB by 2025.
    • The campaign aims to initiate preventive and promotive health approaches.
    • By applying “multi-sectoral and community-led” approach, the government is building a national movement to end TB by 2025.
    • Resource allocation towards the TB Elimination Programme has been increased by four-fold.
    • Sincere efforts need to be made to make our health systems more accessible and reliable.
    • It also required to ensure that those seeking care trust the healthcare system and get the appropriate care for completing treatment.
    • There is a need to create more labs, point of care tests, an assured drug pipeline, access to new drugs.
    • The government should also ensure counselling and support for those affected.
    • Every patient who is diagnosed late and does not receive timely treatment continues to infect others.
    • To break this cycle, government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual.

    Conclusion

    With all the efforts, planning and resource put in place to eradicate the menace of TB from India, it is possible to achieve the goal by 2025.

  • Restructuring of the Railways Board

    The Cabinet recently approved trimming of the Railway Board, the powerful body that governs the Indian Railways. From nine, the Board will now have only five Members.

    The move has led to protests from serving civil servants, prompting the Railway Board to reach out to them to allay their concerns.

    What is the proposed restructure?

    • The Cabinet has decided to merge all central service cadres of Railways officers into a single Indian Railways Management Service (IRMS).
    • Now, any eligible officer could occupy any post, including Board Member posts, irrespective of training and specialization since they will all belong to IRMS.
    • The five members of the Board, other than a Chairman-cum-CEO, will now be the Members Infrastructure, Finance, Rolling Stock, Track, and Operations and Business Development.
    • The Board will also have independent Members, who will be industry experts with at least 30 years of experience, but in non-executive roles, only attending Board meetings.
    • A separate exam under the Union Public Service Commission is proposed to be instituted in 2021 to induct IRMS officers.

    What is the present system like?

    • The Indian Railways is governed by a pool of officers, among whom engineers are recruited after the Indian Engineering Service Examination, and civil servants through the Civil Services Examination.
    • The civil servants are in the Indian Railway Traffic Service (IRTS), Indian Railway Accounts Service (IRAS) and Indian Railway Personnel Service (IRPS).
    • The engineers are in five technical service cadres — Indian Railway Service of Engineers (IRSE), Indian Railway Service of Mechanical Engineers (IRSME), Indian Railway Service of Electrical Engineers (IRSEE), Indian Railway Service of Signal Engineers (IRSSE) and the Indian Railway Stores Service (IRSS).
    • Until the 1950s, the Railways system was run by officers from just three main streams: Traffic, Civil Engineering, and Mechanical. The other streams emerged as separate services over time.

    Why was the reform needed?

    • The railways departments were working “in silos” and hence the government wanted to end this inter-departmental rivalries, which was been hindering growth for decades.
    • Several committees including the Bibek Debroy committee in 2015 have noted that “departmentalism” is a major problem in the system.
    • Most committees have said merger of the services in some form would be a solution.
    • The Debroy report recommended merging of all services to create two distinct services: Technical and Logistics. But it did not say how to merge the existing officers.

    Why are officers opposed to the move?

    • The questions started with a proposal to merge all 8,400 officers in the eight services — five technical and three non-technical — to prepare a common seniority list.
    • Those protesting the government’s decision say that the merger is unscientific and against established norms, because it proposes to merge two fundamentally dissimilar entities, with multiple disparities.
    • First, the civil servants come from all walks of life after clearing the Civil Services Examination.
    • The engineers usually sit for the Engineering Services Examination right after getting an engineering degree.
    • Various studies have noted that engineers join the Railways around the age of 22-23, while the civil servants join when they are around 26, barring exceptions.
    • The age difference starts to pinch at the later stages of their careers, when higher-grade posts are fewer. There are more engineers than civil servants.
    • Protesters are also saying that the merger is against the service conditions which civil servants sign up for while choosing an alternative if they cannot make it to IAS.

    What will change with the restructure?

    • In inter-departmental seniority — a complex process to fix, which has led to court cases in the past — problems arise when different services compete for posts that are open to all.
    • those of Divisional Railway Managers (DRMs), GMs, and subsequently, the Chairman Railway Board. And here lies the major criticism of the move.
    • The civil servants are saying that if all present cadres are merged and even higher departmental posts become open to all, engineers, being in larger numbers and of a certain age profile, may end up occupying most posts.
    • Another aspect is the suitability of jobs. The move, many say, emerges from the “simplistic” belief that while non-technical specialists cannot do technical jobs, technocrats can do both.
    • The counter-argument is that civil servants in government, by virtue of the screening process and subsequent training, possess acumen and skills that go beyond academic specialization.

    How did the Railways get here?

    • Departmental posts are ring-fenced; promotions happen within each department from officers of that service.
    • The problem starts when, within a department, there are too many officers eligible for a few posts.
    • A department needs a constant supply of posts in higher grades to keep promoting its seniors so that the juniors can keep getting timely promotions.
    • In the Railways, this has happened either organically when the government restructured the cadres and created new posts at intervals of several years, or through the execution of projects.
    • Across the Railways, the internal attempt by each department has always been to get a bigger share of resources to spend on projects, although the limited funds are meant for all.
    • The departments grew, promotional prospects expanded, even if Railways did not. The “temporary” posts were almost never surrendered, and were “regularised” over time.
    • This was most prevalent in the technical departments and, to an extent, in the Accounts department as well, officials say.

    What’s next?

    • The current demand is for two distinct services instead of one — a civil services, and one that encompasses all engineering specialisations.
    • The logic is that functionally, departments will continue to exist through various technical and non-technical specialisations, so merging them will not end departmentalism per se.
    • The government has on record assured all existing officers that no one’s seniority will be hampered and promotion prospects will be protected.

  • SATCOM technology

    The Rajasthan government has started using satellite communication technology in a big way to enhance the learning outcome in educational institutions and generate awareness about social welfare schemes while giving priority to the five aspirational districts selected by NITI Aayog in the State.

    SATCOM

    Rajasthan has taken an initiative to provide the facility of receive only terminals (ROT) and satellite interactive terminals (SIT) for getting the services of subject experts in the government schools and colleges and propagate various schemes in the remote areas with no Internet connectivity.

    What are ROT and SIT?

    • Satellite Interactive Terminal (SIT) is one of the six selected user networks used by CEC-UGC.
    • It is operating independently with their user terminals anywhere in the main land of India.
    • It has one main teaching end along with remote SITs and ROTs.
    • At present, there are over hundred SITs and ROTs under CEC EDUSAT network, installed at various colleges, and Universities across the country.

    Back2Basics

    EDUSAT

    • EDUSAT is the first Indian Satellite built exclusively for serving the educational sector. It was launched in September 2004 by the ISRO.
    • The satellite based distance education system enables virtual classrooms at rural and remote locations across the country.
    • Consortium for Educational Communication (CEC) has started two-way audio-video communication through EDUSAT network from 5th September 2005.
    • ISRO set up a nationwide multi-user educational network in its EDUSAT national Ku – band.

  • 2020 as the “Year of the Nurse and Midwife”

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

    Year of the Nurse and Midwife

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

  • ‘MANI’ app

    With an eye to aid the differently-abled, the Reserve Bank of India (RBI) has launched a mobile app to identify currency notes.

    MANI App

    • ‘MANI’, is an acronym for Mobile Aided Note Identifier.
    • The visually challenged can identify the denomination of a note by using the application, which can also work offline once it is installed.
    • A user will have to scan the notes using the camera and it will give the audio output to give out results in Hindi and English.
    • RBI has clarified that the app does not authenticate a note as either genuine or counterfeit.

  • [Op-ed snap]The ABCDEF of implementation

    Context

    Over the years many well-designed schemes failed to make a significant dent on the lack of access to basic services that a large proportion of our population faced. However, Swachh Bharat Mission (SBM) has thrown up six guiding principles, which can be applied to any large transformation scheme.

    What made the difference?

    • Final delivery of service was considered as the only metric of success.
    • There has been a relentless emphasis on taking all schemes to fruition on the ground.
    • The success has thrown up six important guiding principles that can be applied to any large transformation scheme — the ABCEDF of implementation.

    A-Align

    • Different people at different levels may have competing priorities. So, goal congruence has to be achieved across the administrative ecosystem i.e. aligning the goal.
    • The message must percolate down to all the levels.
    • After the announcement of SBM the Department of Drinking water and Sanitation had to ensure that the message reaches the Chief Ministers, 700 district collectors, and 2,50,000 sarpanches.
    • The three layers of the PM-CM-DM model working in cohesion is the first and most important step towards policy translating into real delivery.
    • Team SBM-Grameen ensured sanitation remained on everyone’s agenda.

    B-Believe

    • Believing in the set goal is crucial for achieving success.
    • When faced with seemingly insurmountable goals, teams that don’t genuinely believe that the goal can be achieved find themselves not motivated enough.
    • This lack of motivation results in them not trying enough and not achieving results- a self-fulfilling prophecy.
    • So, the next important step is to build a team of people who believes that the goal is achievable.
    • The SBM brought in a unique blend of young professionals and experienced but driven bureaucrats, at the center and in the states, and each person quickly became a believer.

    C-Communicate

    • At its core, SBM is a behavioral change program.
    • Communication at all levels, above and below the line, mass and inter-personal, is fundamental to the SBM.
    • Trained grassroots volunteers called Swachagrahis were created, who went from door to door to communicate the message of swachhata.
    •  SBM attempted to make sanitation glamorous.
    • Glamour was sought to achieve by engaging extensively with media, leveraging popular culture, and associating Bollywood stars, sportspersons, and other influencers.
    • A recent study estimated that each rural Indian was reached by SBM messaging about 3,000 times over the past five years.

    D-Democratise

    • Democratize means developing a feeling of belonging or being part of something.
    • SBM has become a sort of Jan Andolan.
    • It nudged people to realise that sanitation is not an individual good, but a community good, as its full benefits accrue only when it is universal.
    •  Over the years, everyone became a stakeholder and sanitation became everyone’s business.
    • Even corporates, NGOs, civil society organizations and other government ministries and departments played a role in mainstreaming sanitation.

    E-Evaluate

    • The SBM was operating at a massive scale in a largely decentralised manner
    • As progress started surpassing expectations many people questioned the veracity of official administrative progress figures.
    • So, it became important to encourage third-party monitoring.
    • The monitoring evaluates outputs, outcomes, and impacts to reinforce the credibility and keep the implementers motivated.
    • At the same time, pockets of excellence emerged which deserved to be studied and shared with others to replicate.
    • The various organization conducted an assessment with regard to various factors.
    • World Bank, UNICEF, Bill and Melinda Gates Foundation and WHO conducted various assessments of sanitation coverage and usage, successes and areas of improvement, as well as the health, economic and social impacts of the SBM.

    F-Follow-through

    • There is a strong focus on not declaring SBM a “mission accomplished”.
    • The SBM is continuing to work towards sustaining the ODF behaviour and ensuring that no one is left behind.
    • Recently released a forward-looking 10-year sanitation strategy, articulating the goal of moving from ODF to ODF Plus.
    • This post-delivery follow-through is critical to ensure that the change becomes the norm and that things don’t reset to what they used to be in the past.

    Conclusion

    The lessons learned from SBM and these guiding principles could be applied in the implementation of other such policies. And aligning with this goal, the Jal Jeevan Mission is being designed to deliver, based on the ABCDEF of implementation.

  • [pib] Political Parties Registration Tracking Management System (PPRTMS)

    In order to enable applicants to track the status of the application, the Election Commission of India has launched a “Political Parties Registration Tracking Management System (PPRTMS)”.

    About PPRTMS

    • The salient feature in the PPRTMS is that the applicant, who is applying for party registration from 1st January, 2020 will be able to track the progress of his/her application and will get status update through SMS and e-mail.
    • The status can be tracked through the Commission’s portal at link https://pprtms.eci.gov.in/.

    Back2Basics

    Registration of political parties

    • Registration of political parties is governed by the provisions of Section 29A of the Representation of the People Act, 1951.
    • An association seeking registration under the said Section has to submit an application to the ECI within a period of 30 days following the date of its formation.
    • These guidelines are in exercise by ECI of the powers conferred by Article 324 of the Constitution of India and Section 29A of the Representation of the People Act, 1951.