According to the National Institute of Nutrition (NIN), approximately 56.4% of India’s overall disease burden is linked to poor dietary habits.
Guidelines by the National Institute of Nutrition (NIN):
The NIN, operating under the Indian Council of Medical Research (ICMR), has issued comprehensive guidelines on nutrition for vulnerable groups, including pregnant and lactating women, children, and the elderly.
Preventive Measures: A healthy diet coupled with regular physical activity can prevent 80% of Type 2 diabetes cases and significantly reduce the burden of heart disease and high blood pressure.
Nutrition for Mother and Child: Proper nutrition from conception to the age of 2 years is crucial for optimal growth and development, preventing undernutrition, micronutrient deficiencies, and obesity in both mothers and children.
Suggested general dietary principles: The guidelines recommend getting required nutrients from at least eight food groups, including vegetables, leafy vegetables, roots and tubers, dairy, nuts, and oils.
Group-Specific Guidelines:
Pregnant women: Small frequent meals for those experiencing nausea and vomiting. It recommends the consumption of lots of fruit and vegetables, especially those high in iron and folate content.
Infants and children: For the first six months, infants should only be breastfed, and must not be given honey, glucose, or diluted milk. After the age of 6 months, complementary foods must be included.
Elderly: The elderly should consume foods rich in proteins, calcium, micronutrients, and fiber. Apart from pulses and cereals — with at least one-third as whole grains — at least 200-400 ml of low-fat milk or milk products, a fist full of nuts and oilseeds, and 400-500g of vegetables and fruit should be consumed.
Key concerns as per the National Institute of Nutrition (NIN):
Rising Noncommunicable Diseases (NCDs) Among Adolescents and Children: Due to poor dietary habits led to diseases like cardiovascular disease, cancers, and diabetes are increasingly affecting adolescents and even children in India.
Focus on Healthy Dietary Habits: The guidelines emphasize the importance of reducing salt intake and avoiding highly processed foods like packaged snacks, cookies, and sugary treats, which are linked to unhealthy diets and disease burden.
High Prevalence of Lifestyle Conditions: The Comprehensive National Nutrition Survey 2019 highlights a concerning prevalence of lifestyle-related conditions even among children, including overweight or obesity, diabetes, pre-diabetes, and abnormal cholesterol levels.
Cholesterol Levels: The survey indicates high levels of bad cholesterol (LDL and triglycerides) in children aged 5-9 and pre-teens and teens aged 10-19, along with low levels of good cholesterol in a significant portion of children and adolescents.
Other concerns related to the “Dual nutrition challenge”
Incidence of micronutrient (zinc, iron, vitamins) deficiencies ranged from 13% to 30% of children between ages 1 and 19. But still, the prevalence of anemia is at 40.6%, 23.5%, and 28.4% in children under age 5, ages 5-9, and 10-19 respectively.
However severe forms of undernutrition such as marasmus (a deficiency of macronutrients such as carbohydrates and proteins) and kwashiorkor (deficiency of proteins) have disappeared from the country.
Conclusion: Implementing these guidelines effectively can significantly contribute to achieving Sustainable Development Goal (SDG) targets, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 12 (Responsible Consumption and Production).
Mains PYQ:
Q How far do you agree with the view that the focus on the lack of availability of food as the main cause of hunger takes the attention away from ineffective human development policies in India? (15M) UPSC 2018
Studies show that individuals with schizophrenia are more likely to experience fatal effects from extreme heat compared to those with kidney or heart problems as per Geo Health report.
What is schizophrenia?
As per the National Institute of Mental Health, Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and their family and friends.
Effects of Extreme Heat as per the Geo Health Report:
SchizophreniaHeat-Related Deaths: GeoHealth in 2023 revealed that an extreme heat event in British Columbia in 2021 led to more fatalities among individuals with schizophrenia compared to those with kidney and heart diseases.
Mental Health Conditions: People with mental health conditions, including schizophrenia, anxiety, and bipolar disorder, were identified as being at higher risk of succumbing to heat-related deaths during extreme heat events.
Impact of Extreme Heat Event: British Columbia experienced an eight-day extreme heat event in 2021, with temperatures soaring as high as 40 degrees celsius, significantly above the average temperature of around 20 degrees celsius. The region recorded approximately 740 excess deaths during this heat wave.
Researchers analyzed the data based on various medical conditions, including heart disease, schizophrenia, chronic kidney disease, dementia, depression, Parkinson’s disease, and osteoporosis.
Higher Risk of Schizophrenia: Contrary to expectations, the study reported a 200% increase in the prevalence of schizophrenia diagnoses during the extreme heat event in 2021 compared to a summer without recorded heat waves.
Key challenges for treating Schizophrenia:
Dysfunction of the Hypothalamus: The dysfunction of the hypothalamus, a structure deep in the brain responsible for maintaining bodily homeostasis, may contribute to increased vulnerability to heat stress among individuals with schizophrenia.
Impact of Antipsychotic Medications: Certain antipsychotic medications prescribed for schizophrenia can interfere with the functioning of the hypothalamus, potentially raising body temperature. This side effect, when combined with high ambient temperatures, can lead to fatal outcomes.
Psychotic Symptoms and Anosognosia (unable to be aware of the symptoms): Individuals with schizophrenia often experience psychotic symptoms such as hallucinations, delusions, disorganized thinking, and memory loss. The anosognosia, a condition where individuals are unaware of their illness can further complicate treatment efforts.
Way Forward:
Enhanced Monitoring and Support Systems: Implement enhanced monitoring and support systems for individuals with schizophrenia during extreme heat events.
Education and Awareness Campaigns: Conduct education and awareness campaigns to inform individuals with schizophrenia and their caregivers about the risks of heat-related distress and the importance of staying cool and hydrated during extreme heat events.
Tailored Treatment Plans: Develop tailored treatment plans for individuals with schizophrenia that take into account the potential impact of antipsychotic medications on body temperature regulation.
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)
Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018) Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)
Note4Students:
Prelims: Right to life; Right to health; Right to die with dignity;
Mains: Judicial Intervention in Health Care sector;
Mentor comments:Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.
Let’s learn
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Why in the News?
Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant.
Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.
What is the difference between Life support System and Palliative Care?
Life support System
Palliative Care System
What is it?
It aims to prolong life by artificially maintaining vital bodily functions.
It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
Treatment
It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.
It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
Goals
To sustain life, even if it means prolonging the dying process.
To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
Timing
Used in critical, end-stage illness when curative treatment is no longer possible.
Can be provided at any stage of a serious illness, even alongside curative treatments.
End-of-Life Practices: West vs. India
West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
Indian Scenario:
70% of incurable patients die on life support in ICUs, alone.
The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
What is the LAMA/DAMA Practice?
Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.
Its Causes: Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.
The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.
Challenges in Indian Context:
ICU Routinisation:
Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal
In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
Lack of Legal Clarity:
Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
The term “Passive Euthanasia” isconsidered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.
Initiatives taken on Palliative Care and Living Wills:
By WHO:
WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”.
By India (through Judicial intervention):
SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health’ includes the ‘Right to palliative care’.
SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.
Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.
In March, World Inequality Lab, a Global Research Center focused on inequality and public policies, published in a paper titled, ‘Income and Wealth Inequality in India, 1922-2023: The Rise of the Billionaire Raj’.
Income and wealth inequality as per the World Inequality Lab:
Income Inequality: In 2022-23, the top 1% of Indians received 22.6% of the national income, the highest in a century. The top 0.1% earned nearly 10% of the national income. Wealth inequality was also stark, with the top 1% holding 40.1% of the wealth in 2022-23, the highest since 1961.
Wealth Inequality Trends: Wealth concentration increased significantly between 1961 and 2023. The top 10% held 65% of the wealth in 2022-23, up from 45% in 1961. The bottom 50% and middle 40% saw declines in their share of wealth.
Comparison with Other Countries: India’s wealth inequality, while not as extreme as in Brazil and South Africa, increased threefold between 1961 and 2023. India’s income inequality is among the highest globally, surpassing South Africa, Brazil, and the U.S.
Impact of 1991 Economic Reforms: Inequality increased notably after the 1991 economic reforms in India. Growth in China has been broad-based compared to India, resulting in lesser income inequality despite higher growth rates in China.
Present Dilemma in Human Development:
The Human Development Report (HDR) 2023-2024 ranked India 134 out of 193 countries.
India is now the fifth-largest economy but it still ranks lower than Sri Lanka, Bhutan, and Bangladesh in human development. Its economic growth has not translated into growth in human development.
Measures to Improve Human Development:
Investment in Education: Ensure access to quality education for all, from primary to higher levels. Focus on improving educational infrastructure, teacher training, and curriculum development.
Healthcare Access and Quality: Expand access to affordable and quality healthcare services, including preventive, primary, and specialized care. Invest in healthcare infrastructure, medical personnel, and technology.
Poverty Reduction: Implement social welfare programs to provide basic needs such as food, shelter, and clothing to the disadvantaged. Promote inclusive economic growth to create employment opportunities and increase household incomes.
Conclusion: The Indian government has taken several steps including the creation and organization of women’s self-help groups, sending civil servants to areas with poor levels of human development, and implementing land reforms. However, a major necessity of raising awareness is through an organic approach.
Mains PYQ
Q Despite the consistent experience of high growth, India still goes with the lowest indicators of human development. Examine the issues that make balanced and inclusive development elusive (UPSC IAS/2019)
In the past, we have seen that there is interdependence between humans, animals, and the environment has been made increasingly evident with the emergence of pandemics such as COVID-19.
It is not just humans who are affected by pandemics but also livestock — an example being the outbreak of lumpy skin disease that has spread across countries.
Why an integrated idea like the ‘One Health’ Mission is needed?
One Health is an interdisciplinary approach that recognizes the interconnectedness of human health, animal health, and environmental health. It emphasizes collaboration across various sectors, including medicine, veterinary science, ecology, and public health, to address health challenges comprehensively.
Key features of National One Health Mission:
Intersectoral Collaboration: The mission aims to coordinate, support, and integrate all existing One Health initiatives in the country, including the Ministries of Health and Family Welfare, Fisheries, Animal Husbandry and Dairying, Environment, and Science and Technology
Integrated Disease Surveillance: The mission implements integrated disease surveillance within and across human, animal, and environmental sectors to address communicable diseases, including zoonotic diseases, and improve overall pandemic preparedness and integrated disease control.
Consolidation of data: The mission creates an integrated, science-based environment where researchers from various disciplines can use laboratories as necessary and generate requisite inputs for One Health Science, including databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists.
Challenges in National One Health Mission
Limited Database: There have been limited efforts to develop databases and models with a consolidated approach of ecologists, field biologists, epidemiologists, and other scientists to understand and respond to the drivers that threaten health and optimize the effectiveness of public health systems in achieving these goals within each sector.
Lack of Awareness and Understanding: The lack of awareness and understanding of the One Health concept among stakeholders hinders collaborative efforts required to address complex public health issues
Funding Constraints: Funding constraints are a significant barrier to implementing One Health interventions, especially in low- and middle-income countries that may need more resources to invest in One Health initiatives
Conclusion: To address challenges in the National One Health Mission, efforts must focus on enhancing data collection, raising awareness among the stakeholders, and securing adequate funding. These measures are essential for effective implementation and holistic health management.
On the eve of World Health Day (7th April), many countries aim to implement UHC (Universal Health Coverage) in the same way as India introduced its National Health Policy, in 2017. However, there exist challenges in India too for implementing it.
Background:
On December 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
In India, the high-level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).
BACK2BASICS:
About National Health Policy, 2017:
It aims to achieve Universal Health Coverage and deliver quality healthcare services to all at an affordable cost. It focuses on improving health status through preventive, promotive, curative, palliative, and rehabilitative services with an emphasis on quality.
What are the challenges in the Implementation of UHC in India?
Federal Issue: Health is a state subject in India, but UHC policy is envisaged at the national level. This can lead to challenges in coordination between the central government and state governments.
While the Directive Principles of State Policy provide a basis for the right to health, the absence of a specific constitutional guarantee may create challenges in ensuring consistent and enforceable healthcare rights.
Migrant Population and Urban Slums: Due to issues such as overcrowding, poor sanitation, and limited infrastructure, a significant portion of the population living in urban slums face issues with the availability and accessibility of Primary Health Services is hard to provide.
Lack of Finance: Implementing UHC requires significant financial resources. Reducing out-of-pocket expenditure and strengthening primary healthcare services necessitate substantial investments, which may strain government budgets and require innovative financing mechanisms to ensure sustainability.
Lack of Healthcare Infrastructure and Human Resources: India faces shortages in both infrastructure and human resources, particularly in rural and underserved areas, which hinders efforts to improve healthcare accessibility and quality.
The vicious cycle of poverty: The vicious cycle of poverty and poor health perpetuates inequality in various spheres of life which eventually leads to the accessibility of health services.
Suggestive Measures:
Addressing Urban Migrants’ Health Needs: Establishing mobile healthcare units or clinics that can reach migrant communities in urban and peri-urban areas, providing essential primary healthcare services.
Reducing Out-of-Pocket Expenditure: Simplifying the reimbursement process by digitizing healthcare payment systems and integrating them with government identification or mobile banking platforms to facilitate easy reimbursement for medical expenses.
Creating Inclusive Health Systems: Introducing multilingual and culturally sensitive health information materials and services to bridge language barriers and ensure accessibility for diverse urban populations.
Implementing Community-Based Primary Healthcare: Establishing community health centers or clinics in urban and peri-urban areas staffed by trained community health workers who can provide basic healthcare services and referrals.
Conclusion: Building Constitutional backing, enhancing coordination, and federal with fiscal consensus with adequate infrastructure in addressing urban health needs can improve the reach of the Universal Health Program in India.
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)
Mains: 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 CSE 2015) Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022)
Prelims: With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker? (UPSC CSE 2012) 1) Accompanying women to the health facility for antenatal care checkups 2) Using pregnancy test kits for early detection of pregnancy 3) Providing information on nutrition and immunization 4) Conducting the delivery of babySelect the correct answer using the codes given below: (a) 1, 2 and 3 only (b) 2 and 4 only (c) 1 and 3 only (d) 1, 2, 3 and 4
Note4Students:
Prelims: National Health Policy; Ayushman Bharat;
Mains: Health Issues in India; Universal Health Coverage;
Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation.
Let’s learn.
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Why in the News?
The World Health Organization (WHO) has declared health to be a fundamental human right.
India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
About World Health Day 2024:
World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice.
Theme for 2024: “My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services.
There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps.
What is meant by Health Equity?
‘Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances.
WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:
Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
Significance:
Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
What does the Indian Statistics say?
1) 2011 Census:
Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound.
2)National Family Health Survey (NFHS)-5 (2019-21)
Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.
3)Public Health Foundation of India: Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas.
Limitations in India:
Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.
Initiatives Taken by Government:
Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.
Way Forward:
Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs.
Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.
It is a 14-digit id employed to uniquely identify individuals, verify their identity, and connect their health records (with their consent) across various systems and stakeholders.
Features of ABHA
Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries, reducing the financial burden during medical emergencies.
Electronic Health Records (EHR): It integrates electronic health records, facilitating storage, and retrieval of patient information for streamlined healthcare delivery.
Portability: ABHA accounts are portable across various healthcare providers under the Ayushman Bharat scheme, ensuring seamless access to services.
Real-time Monitoring: Incorporating real-time monitoring mechanisms to track fund utilization, ABHA ensures efficient allocation and prevents misuse.
Various Components
Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme, assigning a unique health identification number (UHID).
Funds Management: It manages the allocation and disbursement of funds for healthcare services, ensuring prompt and secure transfers.
Claim Settlement: ABHA processes and settles claims submitted by healthcare providers, verifying authenticity, and disbursing payments.
Audit and Oversight: Incorporating audit mechanisms to monitor fund utilization, ABHA ensures compliance with regulations and maintains system integrity.
Back2Basics: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Details
Umbrella Scheme
Ayushman Bharat
Incepted in National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC)
Launch Year
2018
Components
Health and Wellness Centres (HWCs)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Offers a sum insured of Rs. 5 lakh per family for secondary and tertiary care
Provides cashless and paperless access to services at any empanelled hospital across India
Portable scheme, allowing beneficiaries to avail treatment at any PM-JAY empanelled hospital
Coverage
3 days pre-hospitalisation and 15 days post-hospitalisation
Includes diagnostic care and expenses on medicines
No restriction on family size, age, or gender
Covers all pre-existing conditions from day one
Beneficiaries
Identified through Socio-Economic Caste Census (SECC) data
Funding
Shared funding: 60:40 for states and UTs with legislature, 90:10 in Northeast states and J&K,
Himachal Pradesh, and Uttarakhand, 100% central funding for UTs without legislature
Nodal Agency
National Health Authority (NHA)
Autonomous entity under the Society Registration Act, 1860
Responsible for effective implementation of PM-JAY in alliance with state governments
State Health Agency (SHA)
Apex body of the State Government responsible for the implementation of AB PM-JAY in the State
PYQ:
2021:
“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.
Practice MCQ:
Consider the following statements about the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):
1. 3 days pre-hospitalisation and 15 days post-hospitalisation.
2. Includes diagnostic care and expenses on medicines.
3. No restriction on family size, age, or gender.
4. Beneficiaries are identified from national family health survey.
How many of the above discussed features is/are correct?
The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.
This indicates the necessity for corrective measures to address the situation.
What is a Caesarean section?
It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.
It is often performed because vaginal delivery would put the mother or child at risk.
Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.
High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.
Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:
Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.
Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.
Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.
PYQ Mains
Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
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)
Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (2022)
Prelims:
Which of the following are the reasons for the occurrence of multi-drug resistance in microbial pathogens in India? (2019) 1. Genetic predisposition of some people 2. Taking incorrect doses of antibiotics to cure diseases 3. Using antibiotics in livestock farming 4. Multiple chronic diseases in some people
Select the correct answer using the codes given below: a) 1 and 2 only b) 2 and 3 only c) 1, 3 and 4 d) 2, 3 and 4
Note4Students:
Mains: Health Care System in India and Major Challenges;
Mentor comments: “United we stand divided we Fall”. Recently, there has a significant progress made in eradicating guinea worm disease, with a reduction from 3.5 million cases in 1986 to just 13 cases in five countries by 2023. This success underscores the importance of focusing on disease elimination as a crucial step towards eradication, aligning with the Sustainable Development Goals of ending epidemics like malaria, tuberculosis, and Neglected Tropical Diseases by 2030. There is a need for adopting effective solutions at the local level is more effective for disease elimination.
Let’s learn.
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Why in the News?
Multisectoral collaboration, encouraging innovation and adopting locally effective solutions that facilitate disease elimination, is more effective at the regional level.
Context:
The Carter Center, a leader in the global elimination and eradication of diseases, recently reported that guinea worm disease was close to eradication.
From 3.5 million cases a year in 21 countries in 1986, the number had come down to 13 in five countries in 2023, a reduction of 99.99%. This would be the second disease after smallpox to be eradicated and the first one with no known medicines or vaccines.
This has created increased attention to disease elimination, the first step in eradication. Ending the epidemics of malaria, tuberculosis, and Neglected Tropical Diseases by 2030 is one of the Sustainable Development Goals set by the United Nations.
What are the Current requirements for the Public Health System?
1) Collaborative efforts:
Rigorous Certification Requirements: International agencies impose stringent criteria for certification, necessitating thorough preparation. Preparation for certification drives improvements in primary healthcare, diagnostics, and surveillance systems.
Increased Involvement of Field Staff and Community Health Workers: The pursuit of certification encourages greater engagement from field staff and community health workers, motivated by the clearly defined goal.
Attraction of International Support: Certification efforts attract international support, bolstering resources and expertise.
Political and Bureaucratic Commitment: The pursuit of certification fosters high levels of commitment from political and bureaucratic entities.
2) Feasibility of Elimination in India:
Strategic Focus: Recommend focusing on pathogens with high population impact and low enough numbers to make elimination possible.
Gradual Approach: The initial aim should be to reduce disease numbers to a practical level through disease control before pursuing elimination.
Understanding Processes and Costs: Reduction in disease numbers enables understanding of elimination processes and associated costs.
Strengthening Health Systems: Provides an opportunity to strengthen existing health systems to effectively implement elimination strategies.
3) Need for surveillance systems
Comprehensive Data Collection: Surveillance systems are crucial for capturing every instance of the disease within a population, providing accurate and real-time data for decision-making.
Monitoring Progress: Surveillance systems allow for monitoring the progress of disease elimination efforts, assessing the effectiveness of interventions, and identifying areas that require additional support or resources.
Confirmation and Diagnosis: Strengthening laboratories for screening and confirmation ensures accurate diagnosis of cases, facilitating appropriate treatment and management.
Ensuring Availability of Resources: Surveillance helps in identifying gaps in resources such as medicines and consumables, enabling authorities to ensure their availability to support elimination efforts.
Training and Capacity Building: Surveillance systems facilitate training of healthcare workers on the requirements of elimination strategies, ensuring a skilled workforce capable of implementing surveillance protocols effectively.
What are the Challenges of the Healthcare System?
Resource Strain: Eliminating the transmission of diseases is difficult and requires significant resources. The process places a heavy burden on the healthcare system, potentially diverting attention from other essential health functions.
Potential Neglect of Health Functions: Focusing on disease elimination may divert attention and resources away from other critical health priorities, especially in weaker health systems.
High Prevalence of Diseases: Diseases with high prevalence and significant impact on populations pose greater challenges for elimination, requiring comprehensive strategies and interventions.
Cost-Benefit Analysis: Careful analysis of the costs and benefits is crucial to ensure that the resources invested in disease elimination yield optimal outcomes and minimize adverse impacts on healthcare systems and communities.
Measures that need to be taken at Regional level (Way Forward)
Regional Effectiveness: Multisectoral collaboration and innovation are more effective at the regional level for disease elimination. Smaller units allow for better resource management without neglecting essential tasks.
Ownership by Governments: While elimination efforts can proceed regionally, both national and state governments must take ownership of the process.
Phased Approach: Regional elimination efforts should be phased to culminate at the national level. Planning from a national perspective is essential to ensure coordinated progress across the country.
Technical and Material Support: Regional implementation requires technical and material support. Progress in regional elimination efforts needs to be closely monitored.
National Control: The Union government plays a crucial role in dealing with diseases spreading across states and at ports of entry to prevent reintroduction.
Conclusion: Enhancing surveillance systems, fostering multisectoral collaboration, and adopting a phased regional approach under government ownership is crucial for successful disease elimination. Scaling up efforts gradually across India is imperative for national elimination goals.
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