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Subject: Health

  • Policy paralysis, a weakened public health sector

    Why in the News?

    Primary care remains underdeveloped, while the private sector has seen significant growth in secondary and tertiary care.

    What are the major necessities in Public Health? 

    • Diseases of Poverty: This includes health issues predominantly affecting the poor and vulnerable populations, such as tuberculosis, malaria, undernutrition, maternal mortality, and illnesses caused by food and water-borne infections like typhoid and diarrheal diseases. 
      • Addressing these needs is critical not only from a health perspective but also as a matter of human rights.
    • Middle-Class Health Concerns: The second category focuses on health issues related to environmental pollution, including air and water quality, waste management, and food safety. 
      • These issues are often exacerbated by inadequate infrastructure and poor market regulations, leading to chronic illnesses and road traffic accidents.
    • Curative Care Needs: The most visible public health needs are those related to curative care, which is divided into three levels: primary, secondary, and tertiary care. 
      • The poor often rely on public primary health care for affordable services, while secondary care remains historically neglected. 
      • Tertiary care is primarily addressed through government schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat, aimed at providing coverage for serious health issues.

    How do the private hospitals become a real beneficiary in present times? 

    • Limited Coverage: India’s health insurance primarily covers only hospitalisation expenses, leaving out outpatient and primary care services. This benefits private hospitals as they can monopolise high-cost medical treatments, while the larger uninsured population faces commercialised care at market rates.
    • Weakening of Public Health Sector: The government’s shift in focus from strengthening public sector health care to outsourcing via insurance schemes like PMJAY indicates a failure to build adequate secondary and tertiary public health services.  

    Threats to Public Healthcare:

    • Neglect of Secondary and Tertiary Care: The inadequate investment in strengthening secondary- and tertiary-level health care in the public sector, leads to a reliance on private hospitals.
    • Transformation of Primary Health Centres (PHCs) and Sub-centres: The conversion of sub-centres and PHCs into Health and Wellness Centres (HWCs) has undermined their original role in preventive and promotive health care.  
    • Loss of Trust in Public Healthcare: Due to overcrowding, poor infrastructure, and inadequate funding, public health institutions are losing credibility. Coupled with the commercial interests of private providers, this creates a dual crisis of access and quality in the healthcare system.
    • Rebranding of Health Centres: The recent renaming of HWCs as “Ayushman Arogya Mandirs” raises concerns about cultural relevance and secularism in public health institutions, especially for non-Hindi-speaking populations, further undermining trust in the system.

    Way forward: 

    • Strengthen Public Healthcare Infrastructure: Invest in enhancing secondary and tertiary care facilities in the public sector to reduce dependence on private hospitals.  
    • Integrate Health Insurance and Primary Care: Expand health insurance coverage to include outpatient and primary care services, and ensure that public health centers retain their focus on preventive and promotive care.  

    Mains PYQ:

    Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

  • Crime, health-worker safety, and a self-examination 

    Why in the News?

    • The recent brutal rape and murder case in Kolkata has sparked widespread calls for the death penalty for the accused.
      • The Justice J.S. Verma Committee, formed in response to the 2012 Delhi gang rape, recommended against the death penalty for rape, even in the rarest of rare cases, arguing that it would be a regressive step.

    Deeper problem in the Health Care Sector: 

    • Healthcare Violence: The protests by resident doctors stem from a series of violent attacks against medical personnel. This violence often arises from disgruntled patients and their families who perceive poor healthcare services.
    • Corruption in Healthcare: The World Health Organization estimates that corruption claims nearly $455 billion annually, which could otherwise extend universal health coverage globally.
      • In India, this corruption manifests in various forms, including bribery and sextortion, further undermining the healthcare system’s integrity.
    • Ineffective Responses: Traditional responses to healthcare violence, such as enhancing security and legal measures, have proven inadequate. These knee-jerk reactions fail to address the root causes of the violence.

    What does the Justice K. Hema Committee report say on the Culture of Assault?

    • On Sexual Assault and Consent: Instances of sexual assault are not isolated events but are rooted in societal practices that undermine women’s autonomy and consent.
      • The National Crime Records Bureau reported 31,516 cases of rape in India in 2022, indicating a significant prevalence of sexual violence against women.
      • The Justice Hema Committee report emphasizes that rape is a manifestation of a culture that views women as objects rather than individuals with rights.
    • On Workplace Harassment: The Vishaka guidelines established in 1997 aimed to protect women from workplace harassment, leading to the Sexual Harassment of Women at Workplace Act, 2013, which mandates the formation of Internal Complaints Committees (ICC).
      • The report argues that ICCs are inadequate for the film industry due to potential biases and influence from abusers, advocating for an independent government forum to address these issues.

    Need to Rethink Violence in Healthcare:  

    • Understanding the Multi-faceted Nature of Violence: Violence in healthcare settings is not limited to patient assaults on healthcare workers, it also includes institutional and managerial violence. This encompasses horizontal violence among healthcare providers and the systemic issues that create a hostile work environment.
    • Implementing Comprehensive Safety Measures: While immediate responses such as improving security and legal protections are necessary, they must be part of a broader strategy that includes training healthcare workers on conflict resolution, mental health support, and creating a culture of safety within healthcare institutions.

    About Justice J.S. Verma Committee Recommendations

    Recommendations on

    Explanation
    Rape • It recognized rape as a Crime of Power, not just passion.
    • Expand definition to include all forms of non-consensual penetration.
    • Remove marital rape exception; marriage should not imply automatic consent. (European Commission of Human Rights in C.R. vs U.K)
    Sexual Assault • Broaden definition to include all non-consensual, non-penetrative sexual acts.
    • Penalty: Up to 5 years of imprisonment or fines.
    Verbal Sexual Assault • Criminalize unwelcome sexual threats.
    • Punishable by up to 1 year in prison or fines.
    Sexual Harassment at Workplace • Include domestic workers under protections.
    • Replace internal complaint committees with Employment Tribunals.
    • Employers to compensate victims of sexual harassment.
    Acid Attacks • Propose a 10-year minimum punishment, separate from grievous hurt.
    • Establish a compensation fund for victims.
    Women in Conflict Areas • Review AFSPA; exclude government sanction for prosecuting sexual offenses by armed forces.
    • Appoint special commissioners to monitor offenses.
    Trafficking • Comprehensive anti-trafficking laws beyond prostitution.
    • Protective homes for women and juveniles overseen by High Courts.
    Child Sexual Abuse • Define ‘harm’ and ‘health’ in the Juvenile Justice Act to include both physical and mental aspects.
    Death Penalty • Opposed chemical castration and death penalty for rape.
    • Recommend life imprisonment.
    Medical Examination of Rape Victims • Ban the two-finger test; victim’s past sexual history should not influence the case.
    Reforms in Case Management • Set up Rape Crisis Cells, increase police accountability, allow online FIR filing.
    • Encourage community policing and increase police personnel.

    Need for a Comprehensive Approach:

    • National Task Force: Improving hospital security and infrastructure alone may not be sufficient to address the problem. The national task force constituted by the Supreme Court should devise a comprehensive road map to prevent and arrest medical corruption, particularly in the public sector.
    • Need Expertise: The task force should include experts from public health, medico-legal, and other allied fields, along with the participation of the larger governing and administrative community.

    Note: Recently some states have taken steps to empower women. For example, the Himachal Pradesh Assembly passed a Bill on Tuesday to increase the minimum marriage age for women from 18 to 21 years.

    Mains PYQ: 

    Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC CSE 2018)

    Q We are witnessing increasing instances of sexual violence against women in the country. Despite existing legal provisions against it, the number of such incidences is on the rise. Suggest some innovative measures to tackle this menace. (UPSC CSE 2014)

  • How to ensure dignity for the terminally ill?  

    Why in the News?

    The Supreme Court of India denied permission to the parents of Harish Rana, a 32-year-old man in a vegetative state for 11 years, to remove his Ryles tube which is a device used for feeding.

    • A Ryles tube, also known as a nasogastric (NG) tube, is a medical device used for various purposes related to nutrition and gastric management. It is inserted through the nose, passing through the nasal cavity, down the esophagus, and into the stomach.

    Recent Supreme Court Judgment:

    • The Bench headed by CJI D.Y. Chandrachud observed that the Ryles tube is not a life support system and therefore could not be withdrawn.
    • This decision has stirred legal and ethical debates, as the Supreme Court’s 2018 judgment permits the withdrawal of life support in terminal cases under the concept of “passive euthanasia.”
    • Passive euthanasia involves the withdrawal of medical treatment with the intention of hastening the death of a terminally ill patient. 
    • The Supreme Court initially legalized this practice in 2018, allowing patients to create a “living will” to refuse life-sustaining treatment when they are unable to communicate their wishes.

    Ethical Challenges:

    • Question of whether the decision benefits the patient: The judgment raises concerns about whether the decision benefits the patient, as prolonging life in such a condition may increase suffering.
    • Prolonged suffering: The principle of not causing harm is challenged since keeping the patient in a vegetative state with artificial feeding may lead to prolonged suffering for both the patient and their caregivers.
    • Against Right to Life and Death: The patient’s rights to a dignified life and death may be compromised which is addressed in various judgments like Common Cause v. Union of India (2018). This judgment recognised the right to die with dignity as part of the right to life under Article 21.
    • Autonomy: The patient’s right to choose, which is central to the concept of dignity, has been overlooked. The judgment did not consider the wishes of the patient or their family in determining the course of action.

    Need for Legal Clarity:

    • Distinguishing Euthanasia from Withdrawal of Life Support: There is a pressing need to legally clarify the difference between euthanasia and the withdrawal of futile life-sustaining interventions.  
    • Involvement of Medical and Ethical Experts: The decision-making process in such sensitive cases should involve palliative care physicians and ethical experts to ensure that medical and ethical considerations are fully addressed.
    • Advance Care Planning: Promoting Advance Medical Directives and Advance Care Planning is crucial to empower individuals to have control over their end-of-life decisions, ensuring that their rights to a good quality of life and death are respected.
    • Systemic Reforms: The judgment highlights the need for systemic reforms to avoid forcing families into legal battles and to ensure that patients’ rights are safeguarded with appropriate legal frameworks.

    Conclusion: The recent Supreme Court judgment highlights the urgent need for legal clarity, ethical considerations, and systemic reforms to protect patient rights and ensure dignity in end-of-life decisions.

    Mains question for practice:

    Q Discuss the need for legal clarity and systemic reforms to uphold the dignity and rights of patients in end-of-life decisions. (150 words) 10M

  • Freedom from dependence, a new era in health care

    Why in the News?

    India’s healthcare since globalization has improved greatly, and is globally recognized due to skilled professionals, effective policies, and strong institutions which draw patients from over 147 countries.

    Economic implications of being a preferred Medical Destination:

    • Foreign Exchange Savings: India saves billions in foreign exchange as fewer Indians need to travel abroad for advanced medical treatments.
    • Revenue Generation: The influx of international patients generates over $9 billion annually, contributing to economic growth.
    • Job Creation: The medical tourism sector creates employment opportunities in healthcare, hospitality, transportation, and pharmaceuticals.
    • Cost-Effective Treatments: India’s affordable yet high-quality medical services attract patients globally, further boosting the economy.

    What are the challenges? 

    • Shortage of Healthcare Professionals
        • Current Shortage: India is estimated to be short of around 600,000 doctors, leading to a doctor-patient ratio of approximately 0.7 doctors per 1,000 people, which is significantly lower than the World Health Organization’s recommended ratio of 1 doctor per 1,000 people.  
        • Future Demand: By 2030, the demand for healthcare professionals in India is expected to double, driven by an ageing population and the increasing burden of non-communicable diseases.
    • Inadequate Public Healthcare Spending
        • Low Expenditure: As of 2021-22, India’s public healthcare expenditure stood at 2.1% of GDP, which is significantly lower than that of many developed countries, For instance, countries like Japan and France spend about 10% of their GDP on healthcare, while the United States spends 16.9%.
        • Comparison with Neighbors: Even neighbouring countries like Bangladesh and Pakistan allocate over 3% of their GDP to public healthcare.
    • Unequal Access to Healthcare
        • Urban-Rural Disparity: There is a stark disparity in healthcare access between urban and rural areas. Rural regions often lack basic healthcare facilities, leading to limited access to quality services for a significant portion of the population.  
        • Healthcare Infrastructure: India’s healthcare infrastructure is inadequate to meet the growing demands of its population. For instance, India has one of the lowest per capita bed counts in the world, with only about 0.5 hospital beds per 1,000 people, compared to the OECD average of 4.7 beds per 1,000 people.
    • High Out-of-Pocket Expenditure
      • Financial Burden: Approximately 75% of healthcare expenditure in India is borne out-of-pocket by individuals and families.

    Need for a Strong Vision (Way forward)

    • “Heal in India” Initiative: The Prime Minister’s vision of “Heal in India” emphasizes positioning India as a global healthcare leader. This initiative is not merely a slogan but a strategic approach to enhance India’s reputation as a preferred medical destination.
    • Youth Engagement: Inspiring the youth to pursue careers in healthcare is crucial for sustaining growth in this sector. By encouraging innovation and entrepreneurship among young Indians, the country can ensure a robust healthcare system.
    • Investment in Public Healthcare: Increase public healthcare spending to improve infrastructure, especially in rural areas, and bridge the urban-rural disparity.
    • Focus on Medical Device Manufacturing: Promote domestic production of medical devices under the “Make in India” initiative to reduce dependency on imports.

    Mains PYQ:

    Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

  • [pib] Update on Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

    Why in the News?

    • An Extended Pradhan Mantri Surakshit Matritva Abhiyan (E-PMSMA) strategy was launched to ensure quality Antenatal Care (ANC) for pregnant women.
      • The strategy focuses on individual tracking of high-risk pregnancies (HRP) and provision of additional PMSMA sessions beyond the 9th of every month.

    About High-Risk Pregnancy: 

    • A high-risk pregnancy involves greater risk of health complications for the mother, the foetus, or both, due to pre-existing medical conditions, conditions that develop during pregnancy, or foetal issues.
    • Common Factors:
      • Maternal Health Conditions: Pre-existing diabetes, hypertension, HIV, kidney disease, or conditions arising during pregnancy like gestational diabetes and preeclampsia.
      • Obstetric Factors: Previous caesarean section, history of preterm labor, multiple pregnancies, and congenital malformations.

    About Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

    Details
    About An initiative to provide quality antenatal care (ANC) to all pregnant women.
    Launch  October 2016
    Target Group All pregnant women, especially those in their second and third trimesters.
    Frequency Services provided on the 9th of every month at government health facilities.
    Objective Ensure safe motherhood by providing comprehensive and quality antenatal care universally.
    Key Functions
    • General Check-Up: Physical and clinical examinations by medical professionals.
    • Laboratory Investigations: Routine blood tests, urine tests, and other necessary laboratory investigations.
    • Ultrasound: Ultrasound examination to monitor foetal growth and development.
    • Counseling: Nutritional and lifestyle counseling to ensure a healthy pregnancy.
    • High-Risk Identification: Screening and identification of high-risk pregnancies and appropriate referrals for specialized care.
    Key Features
    • Free of Cost: All services under PMSMA are provided free of cost.
    • Fixed Day ANC Services: Antenatal care services are provided on a fixed day every month.
    • Lab Investigations: Basic investigations like Hb, urine albumin, RBS, malaria test, VDRL test, blood grouping, CBC, ESR, and USG.
    • Public-Private Partnership: Encourages participation of private sector healthcare providers in providing ANC services.
    • Incentives: Incentives for healthcare providers who participate in the program.
    Categorization of Pregnant Women 
    • Green Sticker – for women with no risk factor detected
    • Red Sticker – for women with high risk pregnancy
    • Blue Sticker – for women with Pregnancy Induced Hypertension
    • Yellow Sticker – pregnancy with co-morbid conditions such as diabetes, hypothyroidism, STIs
    Benefits
    • Improved Maternal Health: Regular and comprehensive ANC helps in early detection and management of complications, improving maternal health outcomes.
    • Reduced Mortality Rates: Timely and quality care reduces maternal and infant mortality rates.
    • Health Education: Provides health education and counseling to pregnant women, promoting better health practices.
    • High-Risk Management: Identifies and manages high-risk pregnancies effectively, ensuring specialized care for those who need it.

    PYQ:

    [2024]  With reference to the ‘Pradhan Mantri Surakshit Matritva Abhiyan’, consider the following statements:

    1. This scheme guarantees a minimum package of antenatal care services to women in their second and third trimesters of pregnancy and six months post-delivery health care service in any government health facility.

    2. Under this scheme, private sector health care providers of certain specialities can volunteer to provide services at nearby government health facilities.

    Which of the statements given above is/are correct?

    (a) 1 only

    (b) 2 only

    (c) Both 1 and 2

    (d) Neither 1 nor 2

  • [1st August 2024] The Hindu Op-ed: The global struggle for a pandemic treaty

    PYQ Relevance:

    Mains:

    Q1 COVID-19 pandemic has caused unprecedented devastation worldwide. However, technological advancements are being availed readily to win over the crisis. Give an account of how technology was sought to aid the management of the pandemic. (UPSC IAS/2020) 

    Q2 Critically examine the role of WHO in providing global health security during the Covid-19 pandemic. (UPSC IAS/2020) 

    Note4Students: 

    Mains: Reasons behind the disagreement on the Pandemic Treaty;

    Mentor comments:  Despite extensive negotiations, 194 WHO member states failed to finalize a historic Pandemic Agreement to bolster global pandemic preparedness and reduce inequities highlighted by COVID-19. At the 77th World Health Assembly (May 27-June 1, 2024), two significant developments occurred. First, amendments to the International Health Regulations (IHR) 2005 were agreed upon, drawn from 300 global reform proposals. These amendments aim to improve response to Public Health Emergencies of International Concern (PHEIC) and introduce a Pandemic Emergency (PE) category, ensuring equitable access to health products and financial support for developing countries, emphasizing solidarity and equity, and mandating a National IHR Authority.

    Let’s learn!

    __

    Why in the News? 

    The 77th World Health Assembly in May 2024 failed to finalize the treaty due to disagreements on key articles, particularly PABS, technology transfer, and the One Health approach.

    Background:

    • The COVID-19 pandemic exposed severe limitations in the International Health Regulations (IHR) and the WHO’s institutional capacities to effectively prevent, prepare for and respond to global health emergencies.
    • In light of the pandemic’s devastating global impact, many countries called for a stronger international framework to deal with future pandemics.
    • Responding to these calls, a special session of the World Health Assembly (WHA) in November 2021 agreed to establish an intergovernmental negotiating body (INB) to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response

    What is the Pandemic Treaty?

    • The Pandemic Treaty, also known as the International Treaty on Pandemic Prevention, Preparedness and Response, is a proposed international agreement currently being negotiated by the 194 member states of the World Health Organization (WHO). 

    Key Provisions

    • Pathogen Access and Benefit Sharing (PABS): The treaty aims to establish a PABS system to ensure that genetic resources and pathogen samples shared from developing countries are reciprocated with corresponding benefits, such as vaccines and diagnostics.
    • Technology Transfer and Intellectual Property: The treaty seeks to address issues related to technology transfer, local production, and intellectual property rights to enhance the manufacturing capacities of low- and middle-income countries.
    • One Health Approach: The treaty emphasizes a holistic approach that recognizes the interconnections between human, animal, and environmental health, promoting coordinated public health measures across these domains.

    Reasons behind the disagreement

    • Pathogen Access and Benefit Sharing (PABS): The PABS mechanism under Article 12  is a central point of contention, with low- and middle-income countries (LMICs) advocating for guaranteed access to at least 20% of shared pandemic products. 
      • In contrast, many high-income countries argue that this percentage should be the maximum limit, with some refusing to agree to any fixed percentage.
    • Technology Transfer and Intellectual Property: Disagreements over technology transfer provisions are significant, with LMICs pushing for mandatory technology transfer and intellectual property waivers to enable local production of vaccines and treatments.
      • High-income countries prefer voluntary agreements, fearing that mandatory requirements could undermine their intellectual property rights.
    • One Health Approach: The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, has faced resistance from LMICs. They view it as an additional burden without adequate funding, while high-income countries strongly support it.
    • Geopolitical Discord: Geopolitical tensions and competing interests between higher- and lower-income countries have hindered progress in negotiations.  
    • Misinformation and Distrust: The negotiations have been affected by misinformation, skepticism, and distrust among member states. Some countries are concerned about the implications of the agreement on their national sovereignty and public health policies.
    • Urgency vs. Comprehensive Solutions: There is a tension between the urgency to finalize an agreement and the desire to address complex issues comprehensively. Some countries are pushing for quick resolutions, while others emphasize the need for thorough discussions to ensure long-term effectiveness.

    Way forward: 

    • Promote Inclusive Dialogue and Mutual Compromise: Need to facilitate continuous, transparent dialogue among all member states to address concerns and build trust. Encourage mutual compromise by balancing the interests of both high- and low-income countries, ensuring that all parties feel their needs and perspectives are being considered. 
    • Strengthen Financial and Technical Support for LMICs: Need to enhance financial and technical assistance for low- and middle-income countries to implement the proposed treaty provisions effectively.
  • [29th July 2024] The Hindu Op-ed: Recasting care models for mental illness, homelessness

    [29th July 2024] The Hindu Op-ed: Recasting care models for mental illness, homelessness

    PYQ Relevance:
    Mains:
    Q1 Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest?(UPSC IAS/2015) 
    Q2 What do you understand by nanotechnology and how is it helping in health sector? (UPSC IAS/2020) 

    Prelims: 
    Q  Doctors Without Borders (Medecins Sans Frontieres)’, often in the news, is:
    (a) a division of World Health Organization 
    (b) a non-governmental international organization 
    (c) an inter-governmental agency sponsored by European Union 
    (d) a specialized agency of the United Nations

    Note4Students: 

    Mains: Challenges related to Homeless individuals;

    Mentor comments: Socio-normative representations of homeless persons living with mental illness (HPMI) often depict them as refuge seekers, leading to interventions focused on transferring them to mental hospitals or shelters. This perspective assumes that displacement from the streets is necessary due to associated risks, which, while valid, oversimplifies their complex realities. Such representations result in coercive measures that fail to recognise the agency of HPMI, perpetuating a cycle of institutionalization rather than fostering genuine community reintegration and support. Addressing these representations is crucial for developing more effective and respectful care strategies.

    Let’s learn!

    __

    Why in the News? 

    Homeless individuals with mental illness are often viewed as needing rescue, leading to their forced relocation to hospitals or shelters, despite the debatable risks of street living.

    Efforts at Integration

    • Collaborative Initiatives in India: The collaboration among various organizations, including the National Health Mission and local civil society groups, has facilitated access to emergency care and recovery centers (ECRCs) in district hospitals, improving support for homeless persons with mental illness (HPMI).
    • Breaking Down Asylum Models: The integration of services aims to dismantle the traditional asylum model, which often perpetuates negative stereotypes about mental illness, by providing more immediate and localized care.
    • Last-Mile Proximal Care: The establishment of ECRCs ensures that care reaches individuals in scattered geographies, addressing the immediate needs of those experiencing crises.
    • Transformative Care Models: The focus on smaller care units that are adequately staffed emphasizes personal attention and the management of comorbidities, which is essential for those facing prolonged adversities.

    Problems with institutional spaces:

    • Long-Term Custodial Care: Approximately 37% of individuals in state psychiatric facilities have long-term needs, with many having histories of homelessness. The median duration of stay is six years, indicating a reliance on institutional care rather than effective community reintegration.
      • According to the World Health Organization, mental disorders account for 10.6% of total disability among older adults.
    • Rigid Discharge Criteria: Discharge criteria for individuals in psychiatric facilities are often overly simplistic, leading to inadequate support for those transitioning back to community life.  
    • Isolation from Social Resources: Institutional settings create barriers to accessing social resources and community participation, leading to social isolation and a lower quality of life.
      • Mental Health America reports that over half (54.7%) of adults with mental illness do not receive treatment, often due to such barriers.
    • Ineffective Rehabilitation Models: Current rehabilitation models often default to custodial care, failing to promote innovative, community-based solutions.
      • Initiatives like Housing First and the ‘Home Again’ collaborative in India demonstrate the feasibility of comprehensive social and clinical care, yet traditional models continue to limit the potential for improved outcomes for individuals with mental health challenges.  

    Way forward: 

    • Shift from Paternalistic to Liberatory Strategies: The need to take social protection measures for homeless people with mental illness (HPMI) must transition from paternalistic interventions to liberatory-focused strategies that honour individual agency.
      • This includes implementing a modest monthly disability allowance of ₹1,500 to provide financial support while addressing bureaucratic barriers to accessing essential documentation like Aadhar and banking services.
    • Holistic and Imaginative Approaches: Supportive measures must be complemented by imaginative and holistic strategies that address structural issues such as discrimination, violence, and social segregation.  

  • A Budget that places health on the margins

    Why in the news?

    • With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns the virus still lingers), the Union Budget shifted focus to economic growth levers like infrastructure and employment.
    • It was also hoped that recognizing population health as crucial for economic growth would lead to continued investment in strengthening health systems.
    A budget estimate refers to the initial allocation of funds designated for various programs, departments, or projects within a fiscal year. It represents the government’s expectations regarding how much money will be required to meet planned expenditures.

    In contrast, revised estimates come into play later in the fiscal year. After assessing the actual expenditures and needs after the first six months, the government may adjust the initial budget estimates based on how much of the allocated funds have been utilised and what additional resources may be necessary.

    Comparisons with Previous Years

    • Budgetary Estimates: The comparison of the Budget Estimates (BE) for health between 2023-24 and 2025-25, reveals minimal increases:
      • Overall Health Ministry Budget: 1.98% increase
      • National Health Mission (NHM): 1.16% increase
      • PMJAY: 1.4% increase
    • Overall Health Ministry budget: The present allocation made in the current Budget is deemed to be inadequate for expanding health coverage services and enhancing the impact of flagship health programs, particularly in light of rising non-communicable diseases and the goal of universal health coverage by 2030.
    • Misleading Comparisons: When we compare the Budget estimates with the previous Revised estimates (RE) the budgetary increase of nearly 12% is misleading, as the RE reflects actual spending rather than the program’s needs.

    Missed Opportunities

    • Health Workforce Development: While the budget mentioned an increase in new medical colleges, it failed to address the critical need for a multi-layered, multi-skilled health workforce.
    • Drug Pricing Mechanisms: Although customs duties were waived on three anti-cancer drugs. However, the budget missed the chance to implement price controls and pooled procurement strategies that could have lowered drug costs across both public and private healthcare sectors. Establishing such mechanisms could enhance the affordability and accessibility of essential medications.
    • Climate-Resilient Agriculture: While the budget committed to climate-resilient agriculture, which is crucial for food security, it did not sufficiently link these efforts to health outcomes, such as nutrition and public health, which are critical in the context of rising health challenges.

    Challenges to the Inclusivity of PMJAY

    • Limited Coverage of Middle Class: PMJAY primarily targets the bottom 40% of the population based on economic status, leaving the middle class without coverage.
    • Focus on Secondary and Tertiary Care: The program emphasizes secondary and tertiary healthcare, often neglecting primary care services. This approach limits comprehensive health coverage and fails to address preventive healthcare needs, which are crucial for achieving UHC.
    • Awareness and Accessibility Issues: There is a significant disparity in awareness and accessibility of PMJAY across states.
      • For example, awareness is notably higher in Tamil Nadu (80%) compared to Bihar (20%). 

    Way forward: 

    • Targeted Funding for Flagship Programs: Need to allocate a more substantial increase in the budget for the National Health Mission (NHM) and Pradhan Mantri Jan Arogya Yojana (PMJAY) to the eradication of non-communicable diseases, tuberculosis elimination by 2025.
    • Strengthen Primary Healthcare: Govt. should ensure adequate funding for primary healthcare services, which form the foundation for preventive and community health initiatives.

    Mains PYQ:

    Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (2015)

  • Indigenous HPV vaccine, the rhetoric and the reality

    Why in the news?

    Recent discourse suggests HPV vaccination prevents cervical cancer, but evidence linking HPV to cancer is inconclusive and most infected individuals don’t develop cancer, raising doubts about vaccine necessity.

    What is Cervical Cancer?

    Cervical cancer is a type of cancer that starts in the cells lining the cervix, which is the lower part of the uterus that connects to the vagina. It is usually a slow-growing cancer that may not have symptoms in its early stages.

    Present  trends of cervical cancer prevalence in India and the Globe                

    • Global Trends: Cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths reported in 2020. 
      • Mortality rates vary widely by region, with the highest rates observed in low- and middle-income countries due to limited access to screening and treatment.
    • Trends in India: In India, cervical cancer is the second most common cancer among women aged 15-44 years. It accounts for approximately 17% of all female cancer deaths in the country, with over 97,000 new cases reported annually.

     

    Recent debate – How does vaccination against HPV prevent cervical cancer and consequent death?                                                       

    • Efficacy Against HPV Infection and Cervical Cancer: HPV vaccines target high-risk HPV types, notably types 16 and 18, which are responsible for a significant proportion of cervical cancer cases worldwide. 
      • Clinical trials and real-world data consistently demonstrate the effectiveness of HPV vaccines in reducing HPV infection rates and preventing cervical cancer.
    • Public Health Impact and Benefits: Countries with high HPV vaccination coverage have observed significant declines in HPV infection rates and cervical cancer incidence among vaccinated populations. 
      • Vaccination programs aim to achieve herd immunity, thereby reducing overall transmission of HPV and protecting unvaccinated individuals.
    • Debate and Challenges: Debate surrounds the universal versus selective vaccination strategies, with considerations on cost-effectiveness, accessibility, and cultural acceptance.
      • Challenges include vaccine hesitancy, particularly in some regions, as well as affordability and logistical barriers to widespread vaccination coverage.

    Challenges Prevalent in Vaccine Manufacturing    

    • Complex Manufacturing Processes: Vaccine manufacturing involves complex biological processes and stringent quality control measures. 
      • Developing and scaling up production requires specialized facilities and skilled personnel, which can be costly and time-consuming to establish.
    • High Regulatory Standards: Vaccines are subject to rigorous regulatory scrutiny to ensure safety, efficacy, and consistency. 
      • Meeting regulatory requirements in multiple jurisdictions adds complexity and may delay the approval and market entry of new vaccines.
    • Supply Chain and Distribution: Maintaining a reliable supply chain for vaccine components and ensuring cold chain storage and distribution are critical challenges. 
      • This becomes even more pronounced in resource-constrained settings or during global health emergencies where demand surges.

    Its Impact on India                     

    • Delayed Access to Affordable Vaccines: India’s capability to produce vaccines at scale is hindered by stringent patent laws and complex regulatory requirements. 
      • This delays the availability of affordable vaccines domestically, impacting public health initiatives and access for vulnerable populations.
    • Economic and Health Implications: High costs associated with vaccine development and production limit affordability and accessibility, exacerbating healthcare inequalities. 
      • This affects India’s ability to address preventable diseases effectively, impacting public health outcomes and economic productivity.

    Unavailability of Competing Vaccines and Future Scope

    • Lack of Market Competition: Despite the expiration of earlier patents, there is a notable absence of competing HPV vaccines from domestic manufacturers in India. 
      • This limits options for consumers and healthcare providers, potentially leading to higher prices and reduced accessibility, particularly in the private market.
    • Potential for Future Development: Several Indian biotech companies had announced plans to develop HPV vaccines, indicating a future scope for competition and potentially lower prices. 
      • However, these initiatives have not materialized into market-ready products, highlighting challenges in vaccine development and commercialization in India’s regulatory and economic environment.

    Way forward: 

    • Promote Research and Development Incentives: Encourage and support Indian biotech companies through research grants, tax incentives, and streamlined regulatory pathways for HPV vaccine development.  
    • Enhance Public-Private Partnerships: Foster collaborations between government entities, academic institutions, and private-sector vaccine manufacturers to improve vaccine accessibility and affordability. 

    Mains PYQ: 

    Q What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? (UPSC IAS/2021)

  • Tackling the Fatty Liver Disease Epidemic

    Why in the news?

    This year’s theme for International Fatty Liver Day, an awareness initiative observed annually in June, is ‘Act Now, Screen Today’. This theme holds more urgency now than ever before.

    Liver Diseases in recent times

    • Liver diseases have long been primarily linked to excessive alcohol consumption, which continues to be a major cause of advanced chronic liver disease.
    • However, in recent years, a new and quietly escalating threat to liver health has emerged: non-alcoholic fatty liver disease.

    India’s Growing Burden of Fatty Liver Disease

    Note: MASLD, or Metabolic dysfunction-associated steatotic liver disease, is a reclassification of what was previously known as non-alcoholic fatty liver disease (NAFLD). 

    • High Prevalence Rates: The global prevalence of Metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 25-30%. In India, a 2022 meta-analysis revealed that the pooled prevalence of fatty liver among adults was 38.6%. Among obese children in India, the prevalence was around 36%.
    • Progression of Disease: The continuous damage caused by fatty liver leads to more severe conditions such as steatohepatitis and cirrhosis, often requiring liver transplants.

    Causes of Growing Burden of Fatty Liver Disease

    • Lack of Early Detection: Fatty liver disease often goes undetected in early stages due to lack of symptoms. Diagnosis usually occurs at an advanced stage, when significant liver damage has already taken place.
    • Diet and Insulin Resistance: Excessive consumption of carbohydrates, especially refined carbs and sugars, leads to metabolic problems. High carbohydrate intake results in persistently high insulin levels and insulin resistance, promoting the conversion of excess glucose into fatty acids, which are then stored in the liver.

    Initiatives Taken by the Government

    • Integration with NPCDCS: The Ministry of Health & Family Welfare launched operational guidelines for integrating NAFLD with the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in February 2021.
    • Health Promotion and Prevention: The Ayushman Bharat- Health and Wellness Centres (AB-HWCs) are being used to promote healthy living and screen for hypertension, diabetes, and other common NCDs.

    Personalization is the Key

    • Tailored Screening Tests: The selection of screening tests and their frequency should be based on individual risk factors, including family history, lifestyle, and pre-existing health conditions.
    • Avoiding Generic Assumptions: Clinicians should not rely solely on age or physical markers; instead, they should consider a comprehensive risk profile. Non-communicable diseases are increasingly affecting diverse populations, including children.
    • Integrated Health Strategies: Combining dietary modifications, regular physical activity, and effective weight management to mitigate liver disease risks.
    • Frequent Screenings: Regular monitoring of liver health through non-invasive tools like vibration-controlled transient elastography. Continuous assessment of liver stiffness to detect early stages of liver fibrosis and monitor treatment responses.
    • Active Health Management: Emphasis on the importance of individuals taking control of their health by being aware of their diet and lifestyle choices.Encouragement of frequent health screenings to detect and manage liver disease early.

    Way Forward:

    • Awareness Campaigns: Government initiatives focus on raising awareness about the importance of liver health and the risks associated with MASLD.
    • Health Screenings: Programs promoting comprehensive health screenings that include physical examinations, blood tests, and abdomen ultrasounds to detect liver diseases early.

    Mains PYQ

    Q The public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)