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Subject: Health

  • Centre opposes petition in HC against provisions of Surrogacy Law

    surrogacy

    The Centre has opposed before the Delhi HC a petition challenging certain provisions of the surrogacy laws, including the Assisted Reproductive Technology (Regulation) Act, 2021, and the Surrogacy (Regulation) Act, 2021.

    What is the case?

    • The provisions challenged includes the exclusion of a single man and a married woman having a child from the benefit of surrogacy as a reproductive choice.
    • It challenged the ban on commercial surrogacy.
    • In their plea, the petitioners have stated that commercial surrogacy is the only option available to them.

    Invoking Article 21

    • The personal decision of a single person about the birth of a baby through surrogacy, that is, the right of reproductive autonomy is a facet of the right to privacy guaranteed under Article 21 of the Constitution.
    • Thus, the right affecting a decision to bear or beget a child through surrogacy cannot be taken away, the petition said.

    What rules say?

    • Under the Surrogacy (Regulation) Act, 2021, a married couple can opt for surrogacy only on medical grounds.
    • The law defines a couple as a married Indian “man and woman” and also prescribes an age-criteria with the woman being in the age of 23 years to 50 years and the man between 26 years to 55 years.
    • The couple should not have a child of their own.
    • Though the law allows single women to resort to surrogacy, she has to be a widow or a divorcee between the age of 35 and 45 years.
    • The law does not allow single men to go for surrogacy.

    Distinct features of the Surrogacy (Regulation) Act, 2021

    • Definition of surrogacy: It defines surrogacy as a practice where a woman gives birth to a child for an intending couple with the intention to hand over the child after the birth to the intending couple.
    • Regulation of surrogacy: It prohibits commercial surrogacy, but allows altruistic surrogacy which involves no monetary compensation to the surrogate mother other than the medical expenses and insurance.
    • Purposes for which surrogacy is permitted: Surrogacy is permitted when it is: (i) for intending couples who suffer from proven infertility; (ii) altruistic; (iii) not for commercial purposes; (iv) not for producing children for sale, prostitution or other forms of exploitation; and (v) for any condition or disease specified through regulations.
    • Eligibility criteria: The intending couple should have a ‘certificate of essentiality’ and a ‘certificate of eligibility’ issued by the appropriate authority ex. District Medical Board.

    Eligibility criteria for surrogate mother:

    • To obtain a certificate of eligibility from the appropriate authority, the surrogate mother has to be:
    1. A close relative of the intending couple;
    2. A married woman having a child of her own;
    3. 25 to 35 years old;
    4. A surrogate only once in her lifetime; and
    5. Possess a certificate of medical and psychological fitness for surrogacy.
    • Further, the surrogate mother cannot provide her own gametes for surrogacy.

     

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  • Recognizing “ASHA”: The real hope

    ASHA

    Context

    • One of the biggest issues facing rural health services is lack of information. ASHA workers are the first respondents even when there is lack of access to medical aid are threatened with violence and abused on the number of occasions while handlining the prospected patients in COVID19 pandemic.

    Evolution of “ASHA” you may want to know

    • The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
    • The ASHA was to be a local resident, looking after 200 households.
    • The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health.
    • Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.

    Who are ASHA workers?

    • ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.
    • The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
    • They act as a bridge connecting marginalized communities with facilities such as primary health centers, sub-centers and district hospitals.

    Qualifications for ASHA Workers

    • ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community.
    • They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.

    ASHA

    What role do the ASHA Workers play? 

    • Involved in Awareness programs: They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They also counsel women about contraceptives and sexually transmitted infections.
    • Ensures Mother and child health: They focus primarily on ensuring that pregnant women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children.
    • Actively involved in Immunization programs: ASHA workers are also tasked with ensuring and motivating children to get immunized.
    • Providing medicines and therapies: Other than mother and childcare, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anemia etc.
    • Tasked with Screening tests: They are also tasked with screening for infections like malaria during the season. They also get people tested and get their reports for non-communicable diseases. They were tasked to quarantine the covid 19 infected patients in the pandemic.
    • Informing the birth and death in respective areas:  The health volunteers are also tasked with informing their respective primary health center about any births or deaths in their designated areas.

    ASHA

    What are the challenges that ASHA workers face?

    • Lack of communication threating the job of ASHA Workers: One of the biggest issues facing rural health services is lack of information.
    • Lack of resources burdening the ASHA works job: Another area of concern is the lack of resources. Over the years, with the closest hospital being 9 km away and ambulances taking hours to respond, ASHA workers had to take multiple women in labour to the hospital in auto rickshaws.
    • Poor medical health facilities: Medical facilities are understaffed and lack adequate equipment for various basic procedures like deliveries. Simple tests, like for sickle cell anemia and HIV, cannot be conducted in no of respective areas of ASHA workers.
    • Low wages according to the job they do: The initial payment used to be paid was Rs 250 a month in 2009. Since ASHA’s unionized and agitated for a living wage. Thirteen years on, they earn around Rs 4,000 a month. It is simply not enough to sustain a family of four.
    • Covid 19 disruptions added to the existing problems: Low wages forcing ASHA’s to work two or more jobs. In the pandemic, no of women lost their husband or the means of earnings and had to revert to farming. Weather fluctuations disrupting the farm produce leaving no of ASHA’s the sole earner for the family. Those who don’t have land are living in miserable conditions.
    • Delayed payments reduce the morale: Payments are also delayed by months, Desperation for work leaves us unable to focus on the groundwork we do.

    ASHA

    What can be done to improve the work conditions of ASHA workers?

    • Improving the communication channels: Channels of communication between the government and the rural population need to be robust. A deadly pandemic makes the value of these channels obvious but in order to get people on board, information needs to be sent out much more effectively and in a hands-on manner. ASHA workers play a crucial role in aiding this effort. ASHA’s can’t do this alone. They need new systems to ensure the dissemination of life-saving information in remote areas.
    • ASHA’s should have fixed income: ASHA’s should have a fixed income, giving them the stability in a job where they spend between eight to twelve hours daily.
    • Role needs to be formalized ensuring the dignity: ASHA’s are recognized as “volunteers” currently. Their role needs to be formalized. Recognizing them as workers provides dignity and protection, and helps them to be taken seriously, by the state, the gram panchayat responsible for the disbursal of funds, and patients.
    • Recognizing and awarding their role will empower and motivate ASHA’s further: For people in villages, ASHA’s have become lifelines. They have led innumerable immunization drives and are everybody’s first call in a medical emergency. They have labored to build trust and serve as a bridge with the state. Examples shows recognition gives some leverage to circumvent the system and seek funds for people in my community.

    Conclusion

    • ASHA’s are lifelines of rural primary healthcare, they are playing critical role on no of fronts ensuring the basic health of India. A better, stronger India is possible if ASHA’s are enabled to serve people. Giving them due recognition would serve this end, along with making rural India’s needs medical or otherwise a priority.

    Mains Question

    Q. For the villagers, ASHA has been a lifeline in the last few years. Acknowledge the problems they face on a daily basis and suggest solutions to raise their morale for the primary health of the village community and the nation as a whole.

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  • Why the SC slammed the two-finger test on rape and sexual assault victims?

    finger

    The Supreme Court has declared that any person conducting the invasive ‘two-finger’ or ‘three-finger’ vaginal test on rape or sexual assault survivors will be found guilty of misconduct.

    What is the two-finger test?

    • The test is conducted to check whether the victim has had recent sexual intercourse.
    • It includes an inspection of the hymen.
    • The hymen is inspected as it can be torn only if the woman has had any sexual intercourse.
    • This test was performed on rape or sexual assault survivors.

    What did the Verma Committee say on the two-finger test?

    • The committee under former Chief Justice JS Verma, formed soon after the 2012 Nirbhaya Gangrape case had recommended tougher laws for such cases and ban of the two-finger test.
    • This test has no bearing on a case of sexual assault.
    • On the basis of this test observations/ conclusions such as ‘habituated to sexual intercourse’ should not be made and this is forbidden by law.
    • Yet, the test continues to be conducted in India and other countries despite rape test kits are being provided by the government to all medical institutions after the committee recommendations.

    Is the two-finger test scientifically accepted?

    • Of course NOT.
    • According to medical experts, science has proved that the hymen is not a reliable source of proving vaginal penetration.
    • The hymen, which is a thin membrane in the vagina, can rupture not just during sexual activity but also during day-to-day work or any physical activity, including playing sports.

    What has the Supreme Court said previously?

    • Violation of privacy: In May 2013, the Supreme Court banned the two-finger test on rape victims on the grounds that it violated their right to privacy.
    • Alternative procedures: The court asked the government to provide better medical procedures in order to confirm sexual assault.
    • Painful for women: The test is medically unnecessary, often times painful, humiliating and a traumatic practice that must end.

    Way ahead

    • Workshops should be held for health providers to prevent the test from being conducted on rape survivors.
    • The curriculum in medical schools should be revised.
    • The court ordered copies of the judgment to be handed over to the Health Ministry, which should be circulated to the health and home departments of the States.
    • The home departments should circulate the judgment to the Director Generals of Police in the States.

     

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  • Physical Inactivity, Neglected Burden on Economy

    physical

    Context

    • Global status report on physical activity is WHO’s first dedicated global assessment of global progress on country implementation of policy recommendations of the Global Action Plan on Physical Activity (GAPPA) 2018-2030.

    What are the findings of the report?

    • Poor physical activity standards: Over 80 per cent adolescents and 27 per cent adults do not meet the physical activity standards set by the World Health Organization (WHO), according to a new report.
    • developing non-communicable diseases: This will lead to 500 million additional people developing non-communicable diseases from 2020-2030 and cost the global economy $27 billion annually, it added.

    How physical Inactivity impacts health and Economy?

    • Changing lifestyles: Sedentary lifestyle of a large share of the global population has been linked to rising prevalence of heart diseases, obesity, diabetes or other noncommunicable diseases.
    • Increasing Hypertension and depression: Of the 500 million new cases projected, nearly half will be attributed to hypertension and 43 per cent to depression, the authors of the report said.
    • A strain on the health systems: The report quantified the economic burden of not being able to meet the GAPPA target. The sharp rise in non-communicable diseases will also put a strain on the health systems in every country.
    • Rising cost of treatment: If the current prevalence of physical inactivity doesn’t change, the world will incur treatment costs of just over $300 billion till 2030, the report mentioned.
    • 70 per cent of health-care expenditure: The largest economic cost is set to occur among high-income countries, according to the analysis. This will account for 70 per cent of health-care expenditure on treating illness resulting from physical inactivity, it showed. Around 75 per cent of the cases will occur in low- and middle-income countries, it added.

    What are the government efforts to address the physical inactivity menace?

    • National physical activity policy: Less than half the countries in the world have any national physical activity policy, showed the analysis of 194 countries by WHO published October 19, 2022.
    • National policies are in operation: Less than 40 per cent of the existing national policies are in operation, the United Nations health agency noted in the Global status report on physical activity 2022.
    • Monitor physical activity among adolescents: As many as 75 per cent of countries monitor physical activity among adolescents, and less than 30 per cent monitor physical activity in children under 5 years.
    • Addressing lack of public Infrastructure: The report highlighted that data regarding progress on certain policy actions is missing. These include provision of public open space, provision of walking and cycling infrastructure, provision of sport and physical education in schools.
    • National physical activity guidelines: only 30 per cent of countries have national physical activity guidelines for all age groups, according to the findings of the report.

    physical

    What are the Recommendations of WHO?

    • Exercise benefits mental and physical health: Light exercise and even walking has proven benefits for mental and physical health, studies have shown.
    • Infrastructural changes by governments: Citizens cannot make healthier lifestyle choices without infrastructural changes by governments such as safe walking and cycling lanes. “In policy areas that could encourage active and sustainable transport, only just over 40% of countries have road design standards that make walking and cycling safer,” the WHO analysts found.
    • Five ways to address the policy gaps: 
    1. Strengthen whole-of-government ownership and political leadership
    2. Integrate physical activity into relevant policies and support policy implementation with practical tools and guidance
    3. Strengthen partnerships, engage communities and build capacity in people
    4. Reinforce data systems, monitoring, and knowledge translation
    5. Secure sustainable funding and align with national policy commitments
    • Four areas of policy intervention:
    1. Active societies,
    2. active environments,
    3. active people and
    4. active systems.

    physical

    Government of India’s efforts to promote physical activity

    • FIT India Movement: FIT INDIA Movement was launched on 29th August 2019 by Honorable Prime Minister with a view to make fitness an integral part of our daily lives. The mission of the Movement is to bring about behavioral changes and move towards a more physically active lifestyle.
    • Objectives of Fit India: Fit India proposes to undertake various initiatives and conduct events to achieve the following objectives:
    1. To promote fitness as easy, fun and free.
    2. To spread awareness on fitness and various physical activities that promote fitness through focused campaigns.
    3. To encourage indigenous sports.
    4. To make fitness reach every school, college/university, panchayat/village, etc.
    5. To create a platform for citizens of India to share information, drive awareness and encourage sharing of personal fitness stories.

    physical

    Conclusion

    • Physical inactivity is silent poison, killing the future of the citizens. Work from home, remote working has increased the physical inactivity among the working populations. Indoor games, mobile addictions, e-learning have reduced the physical activity of children. It’s a collective responsibility of parents, society and government to promote and encourage the physical activity among citizens.

    Mains Question Q.

    What are the ill effects of physical inactivity on health and economy? What are the policies of government India to promote healthy life style?

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  • Food Security, Success Story and Challenges Ahead

    Food Security

    Context

    • The Hunger Hotspots Outlook (2022-23) a report by the Food and Agriculture Organization of the United Nations (FAO) and the World Food Programme (WFP) forebodes escalating hunger, as over 205 million people across 45 countries will need emergency food assistance to survive. 16 October is celebrated as World Food Day.

    What is the current situation of Food security worldwide?

    • Adverse impact of COVID 19 pandemic: Globally, food and nutrition security continue to be undermined by the impacts of the COVID 19 pandemic, climate change, spiralling food inflation, conflict, and inequality.
    • Challenge of Severe hunger continues: Today, around 828 million people worldwide do not have enough to eat, and over 50 million people are facing severe hunger.

    Food Security

    What are the challenges for ensuring food security?

    • The challenge of Climate change: Recent climate shocks have raised concerns about India’s wheat and rice production over the next year. Therefore, it is important to place a greater focus on climate adaptation and resilience building.
    • Rising population will need more resource: By 2030, India’s population is expected to rise to 1.5 billion. Agro food systems will need to provide for and sustainably support an increasing population.
    • The challenge of Soil degradation: Nutrition and agricultural production are not only impacted by climate change but also linked to environmental sustainability. Soil degradation by the excessive use of chemicals, non-judicious water use, and declining nutritional value of food products need urgent attention.

    How India managed its food security?

    • Constant efforts towards Self-sufficiency: India has had an inspiring journey towards better production and achieving self-sufficiency and is now one of the largest agricultural product exporters. During 2021-22,it recorded $49.6billion in total agriculture exports a 20%increase from 2020-21.
    • Efficient targeted public distribution system: One of India’s greatest contributions to equity in food is its National Food Security Act (NFSA)2013 which anchors the Targeted Public Distribution System (TPDS), the PM POSHAN scheme (earlier known as the Midday Meals scheme), and the Integrated Child Development Services (ICDS).
    • Extensive food safety net: Today, India’s food safety nets collectively reach over a billion people. The WFP works with State and national governments to strengthen these systems to reach the people who need them most.
    • Large scale digitization of programmes: The Government continues to take various measures to improve these programmes with digitisation and measures such as rice fortification, better health, and sanitation.
    • Better buffer stock policy: Food safety nets and inclusion are linked with public procurement and buffer stock policy visible during the global food crisis (2008-12)and the COVID19 pandemic fallout, whereby vulnerable and marginalised families in India continued to be buffered by the TPDS which became a lifeline.
    • Successful implementation of PMGKAY: An International Monetary Fund paper titled ‘Pandemic, Poverty, and Inequality: Evidence from India’ asserted that‘ extreme poverty was maintained below 1% in 2020 due to the Pradhan Mantri Garib KalyanAnna Yojana (PMGKAY

    Food Security

    How India and World can manage food security?

    • Avoiding conventional input intensive agriculture: There is increased recognition to move away from conventional input intensive agriculture towards more inclusive, effective and sustainable agro food systems that would facilitate better production.
    • Promoting sustainable practices: Since 1948, the FAO has continued to play a catalytic role in India’s progress in the areas of crops, livestock, fisheries, food security, and management of natural resources through the promotion of sustainable practices.
    • Focus on millets: Millets have received renewed attention as crops that are good for nutrition, health, and the planet. As climate-smart crops, they are hardier than other cereals. Since they need fewer inputs, they are less extractive for the soil and can revive soil health.
    • India’s Efforts as an example: India has led the global conversation on reviving millet production for better lives, nutrition, and the environment, including at the UN General Assembly, where it appealed to declare 2023 as the International Year of Millets. It is the world’s leading producer of millets, producing around 41% of total production in2020. The national government is also implementing a Sub-Mission on Nutrition-Cereals (Millets) as part of the National Food Security Mission.
    • G20 presidency an opportunity for India: India’s upcoming G20 presidency is an opportunity to bring food and nutrition security to the very centre of a resilient and equitable future.

    Food Security

    Conclusion

    • India can lead the global discourse on food and nutrition security by showcasing home grown solutions and best practices, and championing the principle of leaving no one behind working continuously to make its food system more equitable, empowering, and inclusive.

    Mains Question

    Q.Food security has become increasingly challenging due to unpredictable weather conditions. Illustrate. How India can contribute to the global food security issue.

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  • Mental health in India

    10th October, yesterday was observed as World Mental Health Day.

    What is the news?

    • The Lancet released a new report calling for radical action to end stigma and discrimination in mental health.
    • It stated that 90% of people living with mental health conditions feel negatively impacted by stigma and discrimination.

    Mental Illness in India

    • Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990.
    • In 2017, an estimation of the burden of mental health conditions for the states across India revealed that as many as 197.3 million people required care for mental health conditions.
    • This included around 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders.
    • The situation has been exacerbated due to the Covid-19 pandemic, making it a serious concern the world over.

    Reasons for Persistence of Mental Illness

    • Stigma to seek help: The staggering figures are void of millions of others directly, or indirectly impacted by the challenge and those who face deep-rooted stigma, many times rendering them unable to seek help.
    • Lack of awareness: This growing challenge in dealing with mental health issues is further compounded by a lack of information and awareness, self-diagnosis, and stigma.
    • Psycho-social factors: Institutions like gender, race, and ethnicity, are also responsible for mental health conditions.
    • Post-Treatment gap: There is a need for proper rehabilitation of mentally ill persons post/her treatment which is currently not present.
    • Rise in Severity: Mental health problems tend to increase during economic downturns, therefore special attention is needed during times of economic distress.

    Need for immediate intervention

    • Neglected Area: Mental health which forms the core of our personhood is often neglected which impeded the development of an individual to full potential.
    • Disproportionate impact: It is the poor, dispossessed and marginalised who bear the greatest burden of mental health problems, but historically their sufferings are dismissed as a natural extension of their social and economic conditions.
    • Vulnerability of the ills: Mentally ill patients are vulnerable to and usually suffer from drug abuse, wrongful confinement, even at homes and mental healthcare facilities which is a cause of concern and a gross human right violation.
    • Suicidal tendencies: Suicidal behavior was found to have relation with female gender, working condition, independent decision making, premarital sex, physical abuse and sexual abuse.
    • Gendered nature: Females are more predisposed to mental disorders due to rapid social change, gender discrimination, social exclusion, gender disadvantage like marrying at young age, concern about the husband’s substance misuse habits, and domestic violence.

    Policy initiatives

    • National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the NMHP since 1982.
    • Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
    • Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in the society
    • Manodarpan Initiative: An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.

    Way Forward

    • Policy boost: Mental health situation in India demands active policy interventions and resource allocation by the government.
    • Public sensitization: To reduce the stigma around mental health, we need measures to train and sensitize the community/society.
    • Awareness: People should be made aware of the significance of mental health, as much as that of physical health.
    • Destigmatising: Sharing one’s story about mental health (through media campaigns) is the most effective strategy to reduce stigma attached with mental illness
    • Community Approach: There is need to deploy community health workers who, with appropriate training and supervision, effectively deliver psychosocial interventions for the needy
    • Broadening the scope: Mental health care must embrace the diversity of experiences and strategies which work, well beyond the narrow confines of traditional biomedicine with its emphasis on “doctors, diagnoses, and drugs”.

     

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  • Free Breakfast Scheme,Healthy Children: Healthy Nation

    Free breakfast schemeContext

    • Under the free breakfast scheme of Tamil Nadu Government, children in government schools from Class I to Class V will get nutritious breakfast provided in their schools every morning. The scheme is aimed at encouraging more children to continue to come to school and help prevent dropouts in primary level.

    CM’s Breakfast Scheme

    • The scheme covers around 1.14 lakh students in 1,545 schools which include 417 municipal corporation schools, 163 municipality schools and 728 taluk and village panchayat-level schools.
    • The inauguration of the scheme marks an important milestone in the State’s history of providing free meals to school students.

    What is the approach for breakfast scheme?

    • Morning Breakfast: Under the morning breakfast scheme, every student is to be provided a cooked meal of 150-500 grams breakfast with sambar with vegetables. With a budget outlay of Rs33.5 crore in the initial phase, the new scheme caters to 1,14,095 primary school students from1,545 government schools.
    • Micronutrients deficiency: School administration will serve hot breakfasts to schoolchildren by 8:30 am before their classes begin. Students will be served upma, kichadi or Pongal from Monday to Friday, while rava kesari or semiya kesari will be added to the menu on Fridays.The local millets available in the area will also be part of the menu for at least two days a week.
    • Aim of the scheme: The scheme mainly aims to help students attend school hunger free and improve their nutritional status.

    Free breakfast schemeWhat do the Critics of the scheme argue?

    • Freebies: The scheme stands at the confluence of three socio-political developments: a fierce but murky political debate on freebies.
    • Mid-day meal scheme: There was no need to supplement the existing mid-day meal scheme. But going by the content of the scheme, it seems unlikely that it will bring any substantial or sustained improvements in the above mentioned aspects of nutrition, especially since T.N. is already doing well in this regard.
    • Populism: This is just a populist scheme by state government for vote bank politics.
    • Questionable outcomes: Though the scheme has the potential to ensure that children attend classes hunger free, reliable and representative data on what proportion of them attend school without having breakfast regularly is scarce. Though the State acknowledges that students tend to skip breakfast because of the school timing and their financial situation, it is important to identify which among these is the significant contributor. The present approach does not distinguish between the two.

    What the Defenders of the scheme argue?

    • Positive outcomes: Studies from other countries suggest that free breakfast schemes might help increase educational outcomes through a likely increase in school attendance and improved concentration on studies.
    • On freebies: The freebie debate strategically deploys fiscal burden as a potent tool to possibly constrain States from discharging this responsibility.

    Free breakfast schemeWhy feeding children in school is important?

    • Welfare state: The States have a responsibility to promote welfare and minimise inequalities in income as well as in facilities and opportunities among individuals and groups (Article38).
    • Global Food Security Index: The welfare responsibility of the States remains undiminished, especially since India is ranked 71out of 113 countries on the Global Food Security Index.
    • Global Hunger Index: India ranked 101 out of 116countries on the Global Hunger Index.
    • Human development index: 132 out of 191 countries on the Human Development Index. India’s mean years of schooling stood at just 6.7 years in 2020-21.
    • Inequality: Additionally, India has among the highest levels of inequality in education. This responds closely with the rising wealth inequality, as brought out by the recent Credit Suisse report.
    • Stunting and wasting: Malnourishment in children (stunting, wasting and underweight) under 5 years has reduced as per National family health survey-5 (2019-21) from 38.4% to 35.5%, 21.0% to 19.3% and 35.8% to 32.1% respectively as compared to NHFS-4 (2015-16). However present scenario is not good as compare to other developing nations in south Asia.

    Free breakfast schemeWhat are the different Existing Scheme?

    • The Midday Meal Scheme: The Midday meal is a school meal programme in India designed to better the nutritional standing of school-age children nationwide.
    • The programme supplies free lunches on working days for children in primary and upper primary classes in government, government aided, local body, Education Guarantee Scheme, and alternate innovative education centres, Madrasa supported under Sarva Shiksha Abhiyan, and National Child Labour Project schools run by the ministry of labour.
    • Serving 120 million children in over 1.27 million schools and Education Guarantee Scheme centres, the Midday Meal Scheme is the largest of its kind in the world.
    • PM-POSHAN: The name of the scheme has been changed to PM-POSHAN (Pradhan Mantri Poshan Shakti Nirman) Scheme, in September 2021, by MoE (Ministry of Education), which is nodal ministry for the scheme.
    • The Central Government also announced that an additional 24 lakh students receiving pre-primary education at government & government-aided schools would also be included under the scheme by 2022.

    Conclusion

    • India’s spending in human development enhancing welfare schemes has been very dismal. There is an urgent need for implementing innovative and effective welfare schemes to address the disruptions caused by the pandemic in the education and nutrition sectors and strengthen these sectors.

    Mains Question

    Q.Malnutrition, under-nutrition and micro-nutrition requires a different approach. Distinguish and suggest the existing policy gaps to address them.

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  • Ayushman Bharat scheme

    ayushman bharat

    India has completed four years of Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB-PMJAY), the world’s largest public health insurance programme.

    What is Ayushman Bharat?

    • Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
    • It was launched in September 2018 by the Ministry of Health and Family Welfare.
    • It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
    • It has subsumed the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

    Features of the scheme

    • It will have a defined benefit cover of Rs. 5 lakh per family per year.
    • Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
    • It will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
    • The beneficiaries can avail benefits in both public and empanelled private facilities.
    • To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.

    India’s health expenditure post Ayushman Bharat

    Ans. India’s public healthcare spending is still among the lowest in the world.

    • Total health expenditure declined to 3.2% of GDP in 2018-19 from 3.3% in 2017-18, while the government’s health expenditure (centre and state) as a percentage of GDP fell from 1.35% to 1.28% in the same period.
    • National health estimates showed the Centre’s share decreasing to 34.3% in 2018-19 from 40.8% in the previous year, while that of states rose from 59.2% to 65.7%.
    • Out-of-pocket spending as a percentage of total health expenditure declined to 48.2% in 2018-19, though it is significantly higher than the world average of 18.1% in 2019

    What about health insurance penetration?

    Ans. Retail health insurance covers a meagre 3.2% of the country’s population.

    • With a population of 1.36 billion, India is the world’s second most populous country, and is expected to surpass China soon.
    • Launched in 2018 to provide universal health coverage, AB-PMJAY, takes care of the bottom 50% of the population of approximately 700 million individuals.
    • The top 20% of the population is covered through social and private health insurance.
    • Therefore, about 30% of the population, or about 400 million, is “the missing middle”— they don’t have any financial protection for health emergencies.

    Why is sound healthcare important for the economy?

    • Covid-19 exposed the economic consequences of poor healthcare. Higher out-of-pocket healthcare spending hits savings and consumption.
    • In the work space, poor health impacts physical and mental abilities, increase turnover and lead to lower productivity.
    • Data shows that 7% of India’s population is pushed into poverty every year due to healthcare costs.

    Way forward

    • Healthcare management and disease prevention should be the focus, along with an all-encompassing healthcare system, including OPD.
    • The government also needs to pay attention on healthcare cover for “the missing middle” population.
    • As a pilot, states may allow the authority already implementing the AB-PMJAY scheme in the state to cover the missing middle.

     

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  • Rising number of Rabies case

    rabiesContext

    • The death of a 12-year-old girl in Pathanamthitta has sharpened the focus on the rising number of rabies cases and the growing population of stray dogs in Kerala

    What is rabies?

    • The rabies virus attacks the central nervous system of the host, and in humans, it can cause a range of debilitating symptoms including states of anxiety and confusion, partial paralysis, agitation, hallucinations, and, in its final phases, a symptom called “hydrophobia,” or a fear of water.

    What are rabies caused by?

    • Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system of mammals, ultimately causing disease in the brain and death.

    Can rabies person survive?

    • Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. Less than 20 cases of human survival from clinical rabies have been documented.

    How long can a human live with rabies?

    • Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.

    rabiesFacts on rabies

    • What animal has the most rabies?
    • Bats
    • Wild animals accounted for 92.7% of reported cases of rabies in 2018. Bats were the most frequently reported rabid wildlife species (33% of all animal cases during 2018), followed by raccoons (30.3%), skunks (20.3%), and foxes (7.2%).

    rabiesWhat is the issue?                                  

    • There is a blame game over the rising rabies cases: With the rabies deaths causing panic and reports of residents killing stray dogs through poisoning and strangulation, there is a blame game over the rising canine population and rabies cases. Some legal experts blame it on conflicts in the Prevention of Cruelty to Animals Act, 1960 and the Animal Birth Control (Dogs) Rules, 2001; others point to the flawed implementation of birth control measures.
    • Legal battle over the issue in the Supreme Court: Canine culling campaigners and advocates of animal rights are also engaged in a protracted legal battle over the issue in the Supreme Court. V.K. Biju, a lawyer of the Supreme Court, who brought the issue of the “stray dog menace” before the apex court, contends that the root cause is the enactment of the Rules, which according to him, were passed in contravention of the parent Act, the Prevention of Cruelty to Animals Act.
    • Existence of stray dogs has adversely affected the fundamental rights of citizens: Biju says that while the Act stands for the “destruction” of stray dogs, the rules are against the “destruction” of stray dogs, including the rabies affected ones, besides providing specific protection of stray dogs. In his submission before the Supreme Court, he argues that the existence of stray dogs has adversely affected the fundamental rights of citizens, i.e. the right to life and free movement.
    • The quashing of the Rules to make India free of stray dogs: In his writ petition filed before the apex court, Biju has sought orders for the strict implementation of the Act and the quashing of the Rules to make India free of stray dogs.
    • Animal rights campaigners are apprehensive: In the light of this, animal rights campaigners are apprehensive over the campaign to cull dogs to check rabies.

    rabiesHow can we prevent rabies in animals?

    1. First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.
    2. Second, maintain control of your pets by keeping cats and ferrets indoors and keeping dogs under direct supervision.
    3. Third, spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly.
    4. Finally, call animal control to remove all stray animals from your neighbourhood since these animals may be unvaccinated or ill.

    How can we prevent rabies in humans?

    • Leave all wildlife alone.
    • Know the risk: contact with infected bats is the leading cause of rabies deaths in people followed by exposure to rabid dogs while traveling internationally.
    • Wash animal bites or scratches immediately with soap and water.
    • If you are bitten, scratched, or unsure, talk to a healthcare provider about whether you need postexposure prophylaxis. Rabies in people is 100% preventable through prompt appropriate medical care.
    • Vaccinate your pets to protect them and your family.

    Initiatives by Government to curb Neglected Tropical Diseases

    National Rabies Control Programme: This programme is being restructured as Integrated National Rabies Control Programme under ‘One Health Approach’, with a aim to provide vaccination to stray dogs and free vaccines through Government hospitals.

    Way forward

    • Think globally, act locally. Study and adopt global ‘best-practices’ after customising them to local needs.
    • Apply integrated approach. Follow a holistic strategy.
    • Ensure efficient and effective collaboration across various government departments.
    • Partner with Civil Society Organisations (especially with WASH – Water, Sanitation and Hygiene – sector) for ground-level implementation and monitoring.

    Mains question

    Q. What is rabies? What ethical challenges are involved in culling of stray dogs? Explain the control measures for the same.

     

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  • Fighting anaemia

    anaemiaContext

    • The recent National Family Health Survey (NFHS-5) data shows anaemia rates increased from 53 per cent to 57 per cent in women and 58 per cent to 67 per cent in children in 2019-21.

    Definition of anaemia

    • The WHO defines anaemia as a condition where the number of red blood cells or the haemoglobin concentration within them is lower than normal. This compromises immunity and impedes cognitive development.

    Why anaemia is a concern?

    • Adverse effects of anaemia affect all age groups lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
    • Anaemia among adolescent girls (59.1 per cent) advances to maternal anaemiaand is a major cause of maternal and infant mortality and general morbidity and ill health in a community.

    What causes anaemia?

    • Imbalanced diet: Cereal-centric diets, with relatively less consumption of iron-rich food groups like meat, fish, eggs, and dark green leafy vegetables (DGLF), can be associated with higher levels of anaemia.
    • Underlying factors: High levels of anaemia are also often associated with underlying factors like poor water quality and sanitation conditions that can adversely impact iron absorption in the body.
    • Iron deficiency is major cause: A diet that does not contain enough iron, folic acid, or vitamin B12 is a common cause of anaemia.
    • Some other conditions: That may lead to anaemia include pregnancy, heavy periods, blood disorders or cancer, inherited disorders, and infectious diseases.

    anaemiaWhy is anaemia so high in the country?

    • Low vitamin intake: Iron-deficiency and vitamin B12-deficiency anaemia are the two common types of anaemia in India.
    • High population and nutrition deprivation: Among women, iron deficiency prevalence is higher than men due to menstrual iron losses and the high iron demands of a growing foetus during pregnancies.
    • Overemphasis on cereals: Lack of millets in the diet due to overdependence on rice and wheat, insufficient consumption of green and leafy vegetables could be the reasons behind the high prevalence of anaemia in India.

    What is Iron fortification?

    • Iron fortification of food is a methodology utilized worldwide to address iron deficiency. Iron fortification programs usually involve mandatory, centralized mass fortification of staple foods, such as wheat flour.

    https://www.civilsdaily.com/news/mandatory-rice-fortification-policy-should-be-re-examined/Why need iron fortification?

    • Iron deficiency anaemia is due to insufficient iron.
    • Without enough iron, the body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (haemoglobin).
    • Severe anaemia during pregnancy increases risk of premature birth, having a low birth weight baby and postpartum depression. Some studies also show an increased risk of infant death immediately before or after birth.

    anaemiaSuccess story / value addition

    • Nepal’s success story to improve maternal anaemia by national action plan .

    Anaemia Mukt Bharat

    • The scheme aims to reduce the prevalence of anaemia in India.
    • It provides bi weekly iron Folic acid supplementation to all under five children through Asha workers.
    • Also, it provides biannual Deworming for children and adolescents. The scheme also establishes institutional mechanisms for advanced research in anaemia.
    • It also focuses on non-nutritional causes of anaemia.

    We need to focus on the following interventions

    • Prophylactic Iron and Folic Acid supplementation.
    • Intensified year-round Behaviour Change Communication Campaign (Solid Body, Smart Mind).
    • Appropriate infant and young child feeding practices.
    • Increase in intake of iron-rich food through diet diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available resources.
    • Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents
    • Mandatory provision of Iron and Folic Acid fortified foods in government-funded public health programmes

    Way forward

    • India’s nutrition programmes must undergo a periodic review.
    • The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.
    • The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.

    Conclusion

    • When a person is anaemic, the capacity of his blood cells to carry oxygen decreases. This reduces the productivity of the person which in turn affects the economy of the country. Therefore, it is highly important to cover Anaemia under National Health Mission.

    Mains question

    Q. “Every second adolescent girl has anaemia. Every second woman of reproductive age is anaemic”. In this context do you think Women’s empowerment will not have any meaning without tackling anaemia? Discuss.

     

     

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